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Treatment efficiency, high gamma passing rate, strong conformity and satisfaction metrics, and common acute side effects such as fatigue and headache are reported.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/zap-x-stereotactic-radiosurgery-the-initial-experience-involving-200-patients/413339/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/zap-x-stereotactic-radiosurgery-the-initial-experience-involving-200-patients/413339.png","ImageObject",300,407,{"name":42,"@type":43},"mieayamfan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is ZAP-X and what was the study designed to evaluate?","Question",{"text":63,"@type":64},"ZAP-X is a dedicated cranial stereotactic radiosurgery platform. The study evaluated workflow feasibility, safety, clinical and dosimetric performance, and patient satisfaction.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How many patients and targets were included in the initial experience?",{"text":68,"@type":64},"The prospective cohort included 200 patients and 374 intracranial targets treated between October 2023 and January 2025.",{"name":70,"@type":61,"acceptedAnswer":71},"Which types of CNS pathologies were treated in the patient cohort?",{"text":72,"@type":64},"The cohort included brain metastases, meningiomas, trigeminal neuralgias, acoustic neuromas, recurrent glioblastomas, pituitary adenomas, spinal tumors, arteriovenous malformations, and a cavernous hemangioma of the pons.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},413339,1790716019,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Review began 10/12/2025  \nReview ended 11/24/2025  \nPublished 12/02/2025  \n© Copyright 2025  \nChen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98320  \nOpen Access Original Article  \nZAP-X Stereotactic Radiosurgery: The Initial Experience Involving 200 Patients  \nTimothy Chen 1 , Patrick Pema 2 , Michael Chaga 1, Wenzheng Feng 1 , Tingyu Wang 1, Darra Conti 1 , Jing Feng 1, Akil Anthony 3 , Ma Rhudelyn Rodrigo 1, Harshal Shah 2, Daniel Monahan 2, Elizabeth Luick  \n1  \n,  \nDaniel Thompson 1, Joy Baldwin 1, Brielle Latif 1 , Georgia Montone 1, Joseph Hanley 1 , Nitesh V. Patel 4, Shabbar Danish 4  \n1. Radiation Oncology, Jersey Shore University Medical Center, Neptune, USA 2. Neurosurgery, Hackensack Meridian School of Medicine, Hackensack, USA 3. Genetics and Statistics, Rutgers University, New Brunswick, USA 4. Neurosurgery, Jersey Shore University Medical Center, Neptune, USA  \nCorresponding author: Michael Chaga, [michael.chaga@hmhn.org](michael.chaga@hmhn.org)  \nAbstract  \nThe ZAP-X (ZAP Surgical Systems, Inc., San Carlos, CA) is the newest dedicated cranial stereotactic radiosurgery (SRS) platform. A prospective study was conducted between October 2023 and January 2025 involving 200 patients with 374 intracranial targets treated using ZAP-X. The study aimed to assess the feasibility of the ZAP-X workflow, as well as its safety, clinical and dosimetric performance, and patient satisfaction. The study cohort included various central nervous system pathologies, including 106 brain metastases (BM), 42 meningiomas (MA), 18 trigeminal neuralgias (TN), 11 acoustic neuromas (AN), nine recurrent glioblastomas (RGBM), seven pituitary adenomas (PA), three spinal tumors (ST), three arteriovenous malformations (AVM), and one cavernous hemangioma of the pons (HM) .  \nThe average number of patients treated per month was 13 ± 2, and the average number of treatments per month was 35 ± 9. The maximum number of patients treated in a day was five. The average gamma passing rate was 98.5 ± 1. 7%(91 .2-100%) at a 10% low-dose threshold, 2% dose difference, and 1 mm distance-toagreement. The average conformity index (CI), Paddick conformity index (PCI), gradient index (GI), homogeneity Index (HI), and gradient measure across all patients were 1.3 ± 0.3, 0.77 ± 0.11, 3.3 ± 0.8, 1.5 ± 0.3, and 0 .38 ± 0.16 cm, respectively. The largest tumor volume treated was 29.29 cm3, and the highest number of targets treated in a single course was 10. Average treatment time was 50 ± 20 minutes, with setup time being the most significant predictor (adjusted r² = 0 .972) . The Efficast head and shoulder mask significantly improved patient comfort and reduced alignment errors compared to head-only masks. Patient satisfaction was high across all measured domains, with average scores ranging from 4.7 to 5.0 on a 5-point scale. The most common treatment side effects were fatigue and headache.  \nThis initial experience represents the largest single institution series to date and supports the ZAP-X as a promising alternative to conventional SRS platforms such as Gamma Knife (GK) and CyberKnife (CK) . Continued research and multi-institutional studies are warranted to further validate these findings and assess long-term outcomes.  \nCategories: Medical Physics, Radiation Oncology, Neurosurgery  \nKeywords: gyroscopic, radiosurgery, srs, stereotactic radiosurgery, zap-x  \nIntroduction  \nThe ZAP-X (ZAP Surgical Systems, Inc., San Carlos, CA) is the newest dedicated cranial stereotactic radiosurgery (SRS) platform. The radiation source for the ZAP-X is a 3 MV S-band linear accelerator (Linac) mounted on axial and oblique gimbals, which allows for isocentric, non-coplanar, dual-axis radiation delivery over a solid angle of greater than 2π stera","cbCaieTdjYA0lVRE","https://ap.wps.com/l/cbCaieTdjYA0lVRE","pdf",4731474,17,"English","# Abstract\n## Introduction\n## Materials and Methods","[{\"question\":\"What is ZAP-X and what was the study designed to evaluate?\",\"answer\":\"ZAP-X is a dedicated cranial stereotactic radiosurgery platform. The study evaluated workflow feasibility, safety, clinical and dosimetric performance, and patient satisfaction.\"},{\"question\":\"How many patients and targets were included in the initial experience?\",\"answer\":\"The prospective cohort included 200 patients and 374 intracranial targets treated between October 2023 and January 2025.\"},{\"question\":\"Which types of CNS pathologies were treated in the patient cohort?\",\"answer\":\"The cohort included brain metastases, meningiomas, trigeminal neuralgias, acoustic neuromas, recurrent glioblastomas, pituitary adenomas, spinal tumors, arteriovenous malformations, and a cavernous hemangioma of the pons.\"}]","ZAP-X Stereotactic Radiosurgery - The Initial Experience Involving 200 Patients | PDF",1790594499,43]