St. Luke’s Radiation Oncology Network: Leveraging Brainlab advanced stereotactic planning and image-guided patient positioning and monitoring to support brain and spine radiosurgery.
As Ireland’s largest public radiation oncology provider, St. Luke’s Radiation Oncology Network operates across three sites in Dublin, Ireland. Two of the centers are located on the campuses of major acute hospitals: St. James and Beaumont. The Beaumont Hospital site serves as the national referral center for craniospinal and skull base radiosurgery treatment, delivering specialized care for complex intracranial and spinal conditions.
The challenge: Achieving the seemingly unachievable. With rising demand for both intracranial and spine radiosurgery, the Beaumont RCSI Cancer Centre team needs to deliver precise, consistent treatments in both routine and high-risk scenarios while maintaining efficiency across a high-volume clinical schedule. This becomes especially critical in spine radiosurgery, where clinicians aim to deliver a sufficiently high dose to control the tumor while sparing the spinal cord just millimeters away. Achieving this balance requires a highly advanced algorithm—one that can sculpt dose in a concave target such as the vertebrae and create high-gradient plans that protect the cord without compromising tumor coverage. Once the optimal plan is created, the patient needs to be correctly positioned and monitored throughout treatment to enable intended delivery, with submillimetric accuracy from start to finish if needed. Multidisciplinary collaboration and robust high-quality technology are essential for this busy center that treats many different indications, from purely palliative to extremely complex radiosurgery.
The innovation: “Brainlab technology is deeply integrated into Beaumont RCSI Cancer Centre’s radiosurgery department.” Central to the Network’s approach are Elements Radiosurgery Solutions and ExacTrac, a configuration that supports complex radiotherapy planning, precise patient positioning and monitoring for a wide range of conditions from spinal metastases to intracranial metastases and benign intracranial conditions (including arteriovenous malformations, or AVMs, vestibular schwannomas and trigeminal neuralgia).
The intracranial radiosurgery program began using Brainlab solutions in 2013 and Beaumont RCSI Cancer Centre was the first in Europe to offer frameless radiosurgery treatments for trigeminal neuralgia. Brainlab Elements was introduced in 2018, initially used to treat multiple brain metastases, and became the primary planning platform for central nervous system cases in 2022. Single isocenter planning for multiple brain lesions enabled more consistent scheduling and workflow efficiency for a busy center treating a wide range of conditions.
The Beaumont RCSI Cancer Centre features the St. Luke’s Network’s flagship linac, Delvin, named after a river in Ireland through a patient-led naming initiative. This linac is equipped with ExacTrac which through image guidance allows for reduction in setup margins, making it very attractive to all consultants.
There is constant high demand for Delvin treatment slots and the ability to treat multiple brain metastases with a single isocenter has been practice changing for the Network. Today, nearly a third of the Network’s metastatic brain patients are treated using Elements Multiple Brain Mets SRS with a single isocenter.
Elements Radiosurgery Solutions have become a cornerstone of the Network’s rapidly expanding spine radiosurgery program. Since patients cannot be in the same position for their MR and CT scans, Elements Curvature Correction Spine—a dedicated deformable co-registration tool—enables them to use information from both modalities to better define the spinal anatomy and targets. In combination with AI-powered extra-cranial segmentation, organs at risk can be easily segmented.
In their words: “Our spine radiosurgery service has taken off over the last couple of years. We have designed a country-wide clinical trial to evaluate the safe dose escalation for patients with spinal metastases which is reaching our accrual targets much faster than expected.” — Professor Clare Faul, Consultant Radiation Oncologist at St. Luke’s Radiation Oncology Network.
Plans are generated using Elements Spine SRS, which enables accurate dose plan optimization and calculation with a Monte Carlo algorithm, which the team considers the most significant gain.
“All two-fraction patients are planned exclusively in Elements Spine SRS. Internal plan comparisons show a far better conformity to the target and sparing of organs at risk for those plans created in RT Elements. Possibly the most significant gain is the ability to optimize and calculate with a true Monte Carlo algorithm. With the newest software release, the fast Monte Carlo allows us to optimize and calculate with high accuracy in less than 20 minutes. The dedicated optimizer is extraordinary, too. We have been able to dose escalate in high-risk patients, where over 50% of the target is made of the gross target volume (GTV), without compromising proximal organs at risk. We get very excited every time we achieve the seemingly unachievable.” — Dr. Christina Skourou, Senior Physicist at St. Luke’s Radiation Oncology Network.
Treating so close to the spinal cord, nerve roots and esophagus are inherently challenging. For this reason, early on, the team performed extensive setup validation to establish safe and realistic planning target volume (PTV) margins. They would also acquire multiple CBCTs during each treatment fraction, but as they gained confidence in ExacTrac, they realized they could safely reduce patient imaging dose and shorten treatment time by relying on the device alone for intrafraction monitoring and correction. Today, spine stereotactic ablative radiotherapy (SABR) patients receive one posterior kV image to confirm the correct vertebral level, a CBCT to verify internal anatomy against plan and multiple ExacTrac kV images throughout treatment. Overall, treatment time per fraction is only slightly longer than for conventionally fractionated treatments.
The impact: Expanding access to radiosurgery for patients with complex brain and spine conditions. Together, Elements Radiosurgery Solutions and ExacTrac offer the Beaumont team greater confidence to deliver radiosurgery in high-risk scenarios. Consistent target definition and high-quality dose planning, together with precise patient positioning and continuous monitoring, enable submillimetric accuracy throughout treatment. The high level of accuracy supports evolving treatment pathways and allows radiosurgery to be integrated into clinical decision-making across a wider array of conditions.
St Luke’s Radiation Oncology Network was the first center in Ireland to achieve Novalis Certification, underscoring its leadership in advanced stereotactic radiotherapy. “The Novalis Certified program has played an important role in quality assurance and patient safety at the Network by independently validating that stereotactic radiotherapy is delivered to the highest international standards” — Paul Davenport, Principal Physicist at St. Luke’s Radiation Oncology Network.
Pictures: © St. Luke’s Radiation Oncology Network, Dublin, Ireland
Disclaimer: The statements made by the clinicians represent their personal opinion and experience. These statements may not be supported by scientific evidence or peer-reviewed research. For verified information about the device, please refer to the manufacturer's official documentation.
For more than a decade, Instituto Zunino in Córdoba, Argentina has been recognized as a regional reference center for high-precision radiotherapy. Built on long-standing clinical expertise and a strong culture of quality, the center has developed a mature SRS and SBRT program that continues to evolve through structured processes, external validation and a commitment to shared learning.
The team’s journey with Brainlab technology began in 2009 with iPlan RT and expanded in 2011 with ExacTrac X-Ray. Today, RT Elements is clinically adopted across the department of four treatment machines, supported by ExacTrac Dynamic—forming the technical backbone of daily practice.
A benchmark for quality: Novalis Certification
At Instituto Zunino, maintaining excellence means welcoming independent evaluation. First Novalis Certified in 2016, and successfully re-certified in 2020 and 2025, the team has consistently demonstrated its commitment to quality, safety and transparency. The most recent re-certification reinforces the center’s alignment with international standards and its place within the Novalis Certified community.
Why certification matters—in their own words
Silvia Zunino, MD, PhD, Director and Founder of Instituto Zunino and Fundación Marie Curie, explains: “Novalis Certification confirms that we work according to the same standards as leading centers in the United States and Europe. It gives us confidence in our methods and supports continuous improvement.”
Daniel Venencia, PhD, Head of Medical Physics, adds: “Even as an experienced institution, having our work audited helps us identify opportunities to improve. Clearly defined protocols and external review ensure our patients receive the best possible treatment.” Motivated by his commitment to excellence in SRS and SBRT and to support his colleagues, Daniel Venencia has now joined the Novalis Certification Program team as an auditor.
Beyond the clinic: sharing expertise to advance the region
Instituto Zunino’s impact extends beyond its own walls. Through Fundación Marie Curie, the team actively supports regional development by sharing protocols, workflows and clinical experience with the wider medical community. Every two years, the foundation hosts an internationally recognized SRS & SBRT congress (Congreso sobre Avances Integrados en Oncología, Radiocirugía y Física Médica: Innovación y Precisión en el tratamiento del cancer), bringing together physicians, physicists and researchers for high-level exchange. A dedicated hands-on workshop focused on Brainlab technology offers open insight into clinical workflows, physics considerations and decision-making processes—earning a strong reputation across the region. As Daniel Venencia notes: “Advancing treatment techniques, software, automation and artificial intelligence—and helping others do the same—is how we move the field forward together.”
Stories from the Circle: leadership through openness
Instituto Zunino shows that leadership in radiosurgery and radiotherapy is not defined by outcomes alone. By combining long-standing expertise with education, openness and a sustained commitment to Novalis Certification, the team actively contributes to raising standards across the region.
We’re proud to share Instituto Zunino’s story and to recognize the team’s ongoing commitment to collaboration, clinical rigor and patient-centered care.
The statements made by the clinician represent their personal opinion and experience. These statements may not be supported by scientific evidence or peer-reviewed research. For verified information about the device, please refer to the manufacturer's official documentation.
Picture: ©Instituto Zunino, Córdoba, Argentina
From a clinical workflow and technology standpoint, I was wondering—given the geometric limitations in ring gantry systems, is the likely direction toward surface imaging with AI-based prediction, or are there ongoing developments for internal tracking within closed-bore architectures?
First of all thank you for this platform.
May i know Sir from your experience, what are the most effective strategies for managing intrafraction motion during SBRT, particularly in spine and lung cases?
Join us in Philadelphia for our Mid-Atlantic Regional Symposium with insightful clinical talks by renowned clinical experts and inspirational discussions on SRS and SBRT.
Experience cutting edge of radiotherapy and radiosurgery at our exciting two days symposium focused on precision, personalization, and standardization in Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT).
This event will bring together medical physicists, dosimetrists, radiation oncologists and radiation therapists to share valuable clinical techniques and innovative management strategies, as well as to gain insights into how complex data is reshaping the field of radiosurgery.
Brainlab Mid-Atlantic Regional Symposium
May 8 and 9, 2026
Click here to have the program.
We look forward to welcoming you to Philadelphia for this inspiring event!
To register click here
Thank you for this motivational webinar. What is the typical time period to accomplish the certification process? How many rounds of iteration does it take typically? Are there any quantitative quality indicators?
Join our upcoming Brainlab Novalis Circle Webinar: Achieving Excellence in SRS & SBRT – The Novalis Certification Journey
Every center striving for world-class radiosurgery faces the same challenge: How do we know we’re delivering the safest, most consistent care possible?
That question is at the heart of the Novalis Certification Program—and the focus of our upcoming Brainlab Novalis Circle webinar.
Our experts will share what certification looks like in practice, why peer review matters, and how centers around the world are raising the bar for SRS and SBRT. Join Timothy Solberg, Global Radiosurgery and Foretell Medical, Seattle, USA, andLinda Carruthers, Edinburgh Cancer Centre, Edinburgh, UK, to discover how the Novalis Certification Program helps centers deliver world-class SRS & SBRT care.
Date: December 11, 2025
Time: 5:00 PM CET / 8:00 AM PST
They will discuss:
- Why independent peer review strengthens SRS & SBRT quality
- The most common clinical and workflow challenges in advanced radiosurgery
- How the Novalis Certification Program defines global benchmarks for safety
- A real-world case study from a certified center
- Live Q&A with the experts
Participation is only possible for Novalis Circle Members. If you are not yet a member, please click here.
Big News! 🎉 We are excited to announce that the Brainlab Novalis Circle 10th International Conference is happening on September 17-19, 2026, in the vibrant city of Munich, Germany!
Mark your calendars and get ready for two full days of cutting-edge scientific talks and thought-provoking discussions, featuring some of the most brilliant minds in the world of stereotactic radiosurgery and stereotactic body radiation therapy.
It’s going to be an unforgettable event, and we can’t wait to see you there!
You can find more information here: Novalis Circle Conference 2026 | Brainlab
Exciting News!
Join us in Nashville, Tennessee for the Brainlab Regional Symposium happening November 14 and 15, 2025!
This 2 day symposium will bring together clinicians, physicists, and innovators from across the region to explore the latest breakthroughs in radiation oncology, featuring Brainlab’s cutting-edge SRS and SBRT solutions. From cranial SRS to extracranial treatments like DIBH breast, prostate, and lung applications — there's something for every aspect of clinical practice.
Agenda is coming soon
Click here to register
Looking forward to seeing you there!
Join us in Warsaw on June 24th, 2025, for the Brainlab Central Europe SRS & SBRT Symposium 2025. Experience an inspiring lineup of expert talks and engaging discussions on cutting-edge developments in radiotherapy and radiosurgery.
Highlights of the symposium:
- Discover advancements: Attend scientific talks and explore the latest techniques in precision, personalization, and standardization of SRS & SBRT.
- Join interactive sessions: Take part in live demonstrations and dynamic discussions that will shape the future of patient care.
- Network with experts: Engage with leading professionals in the field and connect with peers from across Central Europe.
We look forward to welcoming you to Warsaw this June! Click here to learn more: Welcome | Brainlab
Wir laden Sie herzlich ein zu unserem DACH Radiotherapie Symposium zum Thema Präzision, Personalisierung und Standardisierung in der stereotaktischen Radiochirurgie und Radiotherapie am 24. Januar 2025 im Brainlab Headquarter in München.
Klinische Anwender:innen und Fachkolleg:innen werden Erfahrungen und Fallstudien aus dem klinischen Alltag präsentieren und freuen sich auf spannende Diskussionen sowie den Austausch mit Ihnen.
Mehr information hier