Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T20:33:56.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Estimation of technical treatment accuracy in fractionated stereotactic radiosurgery

Published online by Cambridge University Press:  29 April 2019

Raj Kishor Bisht ,
Gopishankar Natanasabapathi  and
Shashank Sharad Kale
Raj Kishor Bisht*
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
Gopishankar Natanasabapathi
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
Shashank Sharad Kale
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
*
Author for correspondence: Raj Kishor Bisht, Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India. Tel: +91 11 26594588. Fax: +91 11 26588927. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

The purpose of this study was to estimate technical treatment accuracy in fractionated stereotactic radiosurgery (fSRS) using the Extend™ system (ES) of Gamma Knife (GK).

Methods and materials:

The fSRS with GK relies on a re-locatable ES where the reference treatment position is estimated using repositioning check tool (RCT). A patient surveillance unit (PSU) monitors the head and neck movement of the patient during treatment and imaging. The quality assurance test of RCT was performed to evaluate a standard error (SE) associated with a measurement tool called digital probe. A ‘4-mm collimator shot’ dose plan for a head–neck phantom was investigated using EBT3 films. CT and MR distortion measurement studies were combined to evaluate SEimaging. The combined uncertainty from all measurements was evaluated using statistical methods, and the resultant treatment accuracy was investigated for the ES.

Results:

Four sets of RCT measurements and 20 observations of associated digital probe showed SERCT of ±0·0186 mm and SEdigital probe of ±0·0002 mm. The mean positional shift of 0·2752 mm (σ = 0·0696 mm) was observed for 20 treatment settings of the phantom. The differences between radiological and predefined isocentres were 0·4650 and 0·4270 mm for two independent experiments. SEimaging and SEdiode  tool were evaluated as ±0·1055 and ±0·0096 mm, respectively. An expanded uncertainty of ±0·2371 mm (at 95% confidence level) was observed with our system.

Conclusions:

The combined result of the positional shift and expanded uncertainty showed close agreement with film investigations.

Keywords

expanded uncertaintyfractionated stereotactic radiosurgeryGamma Knifephantom
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 1 , March 2020 , pp. 30 - 37
Check for updates
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, E 3rd, Moriarty, T M, Davis, R B et al. Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 1995; 87 (1): 34–40.CrossRefGoogle ScholarPubMed
Mehta, M, Noyes, W, Craig, B et al. A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases. Int J Radiat Oncol Biol Phys 1997; 39: 445–454.Google ScholarPubMed
Niranjan, A, Gobbel, G T, Kondziolka, D, Flickinger, J C, Lunsford, L D. Experimental radiobiological investigations into radiosurgery: present understanding and future directions. Neurosurgery 2004; 55: 495–504.CrossRefGoogle ScholarPubMed
Aoki, M, Abe, Y, Hatayama, Y, Kondo, H, Basaki, K. Clinical outcome of hypofractionated conventional confirmation radiotherapy for patients with single and no more than three metastatic brain tumors, with non invasive fixation of the skull without whole brain irradiation. Int J Radiat Oncol Biol Phys 2006; 64: 414–418.CrossRefGoogle Scholar
Kim, J W, Im, Y S, Nam, D H, Park, K, Kim, J H, Lee, J I. Preliminary report of multisession Gamma Knife radiosurgery for benign perioptic lesions: visual outcome in 22 patients. J Korean Neurosurg Soc 2008; 44: 67–71. doi: 10.3340/jkns.2008.44.2.67.CrossRefGoogle ScholarPubMed
Adler, J R Jr, Gibbs, I C, Puataweepong, P, Chang, S D. Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 2008; 62 (suppl 2): 733–743. doi: 10.1227/01.neu.0000316277.14748.63.CrossRefGoogle ScholarPubMed
Tuniz, F, Soltys, S G, Choi, C Y et al. Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 2009; 65: 898–907. doi: 10.1227/01.NEU.0000359316.34041.A8.CrossRefGoogle ScholarPubMed
Depotter, B, De Meerleer, G, De Neve, W, Boterberg, T, Speleers, B, Ost, P. Hypofractionated frameless stereotactic intensity-modulated radiotherapy with whole brain radiotherapy for the treatment of 1-3 brain metastasis. Neurol Sci 2013; 34 (5): 647–653. doi: 10.1007/s10072-012-1091-0.CrossRefGoogle Scholar
Olsson, L E, Arndt, J, Fransson, A, Nordell, B. Three-dimensional dose mapping from Gamma Knife treatment using a dosimeter gel and MR-imaging. Radiother Oncol 1992; 24 (2): 82–86 CrossRefGoogle ScholarPubMed
Guo, W Y, Chu, W C, Wu, M C et al. An evaluation of the accuracy of magnetic-resonance-guided Gamma Knife surgery. Stereotact Funct Neurosurg 1996; 66 (suppl 1): 85–92.CrossRefGoogle ScholarPubMed
Ibbott, G S, Maryanski, M J, Eastman, P et al. Three-dimensional visualization and measurement of conformal dose distributions using magnetic resonance imaging of BANG polymer gel dosimeters. Int J Radiat Oncol Biol Phys 1997; 38 (5): 1097–1103.Google ScholarPubMed
Ertl, A, Saringer, W, Heimberger, K, Kindl, P. Quality assurance for the Leksell gamma unit: considering magnetic resonance image-distortion and delineation failure in the targeting of the internal auditory canal. Med Phys 1999; 26 (2): 166–170.CrossRefGoogle ScholarPubMed
Ertl, A, Berg, A, Zehetmayer, M, Frigo, P. High-resolution dose profile studies based on MR imaging with polymer BANG(TM) gels in stereotactic radiation techniques. Magn Reson Imag 2000; 18 (3): 343–349.CrossRefGoogle ScholarPubMed
Novotny, J, Dvorak, P, Spevacek, V et al. Quality control of the stereotactic radiosurgery procedure with the polymer-gel dosimetry. Radiother Oncol 2002; 63(2): 223–230.CrossRefGoogle ScholarPubMed
Novotny, J Jr, Bhatnagar, J P, Chung, H T et al. Assessment of variation in Elekta plastic spherical-calibration phantom and its impact on the Leksell Gamma Knife calibration. Med Phys 2010; 37 (9): 5066–5071.CrossRefGoogle ScholarPubMed
Watanabe, Y, Perera, G M, Mooij, R B. Image distortion in MRI-based polymer gel dosimetry of Gamma Knife stereotactic radiosurgery systems. Med Phys 2002; 29: 797–802.CrossRefGoogle ScholarPubMed
Scheib, S G, Gianolini, S. Three-dimensional dose verification using BANG gel: a clinical example. J Neurosurg 2002; 97: 582–587.Google ScholarPubMed
Cheung, J Y, Yu, K N, Yu, C P, Ho, R T. Monte Carlo calculation of single-beam dose profiles used in a Gamma Knife treatment planning system. Med Phys 1998; 25 (9): 1673–1675.Google Scholar
Cheung, Y C, Yu, K N, Ho, R T, Yu, C P. Stereotactic dose planning system used in Leksell Gamma Knife model-B: EGS4 Monte Carlo versus GafChromic films MD-55. Appl Radiat Isot 2000; 53 (3): 427–430.CrossRefGoogle ScholarPubMed
Moskvin, V, Papiez, L, Timmerman, R, Randall, M, DesRosiers, P. Monte Carlo simulation of the Leksell Gamma Knife: I. Source modelling and calculations in homogeneous media. Phys Med Biol 2002; 47 (12): 1995–2011.CrossRefGoogle ScholarPubMed
Maryanski, M J, Ibbott, G S, Eastman, P, Schulz, R J, Gore, J C. Radiation therapy dosimetry using magnetic resonance imaging of polymer gels. Med Phys 1996; 23 (5): 699–705.CrossRefGoogle ScholarPubMed
Stereotactic radiosurgery. AAPM report no. 54. Retrived on 2 October 2018, from https://www.aapm.org/pubs/reports/RPT_54.pdf. Accessed on June 1995.Google Scholar
Ma, L, Pinnaduwage, D, McDermotte, M, Sneed, P K. Whole procedural radiological accuracy for delivering multisession Gamma Knife radiosurgery with relocatable frame system. Echnol Cancer Res Treat 2014; 13 (5): 403–408. doi: 10.7785/tcrtexpress.2013.600259.Google Scholar
Lindquist, C, Paddick, I. The Leksell Gamma Knife Perfexion and comparisons with its predecessors. Neurosurgery 2007; 61 (3 Suppl): 130–140 Google ScholarPubMed
Sahgal, A, Ma, L, Chang, E et al. Advances in technology for intracranial stereotactic radiosurgery. Technol Cancer Res Treat 2009; 8 (4): 271–280 CrossRefGoogle ScholarPubMed
Ruschin, M, Nayebi, N, Carlsson, P et al. Performance of a novel repositioning head frame for Gamma Knife Perfexion and image- guided LINAC-based intracranial stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78 (1): 306–313. doi: 10.1016/j.ijrobp.2009.11.001.CrossRefGoogle ScholarPubMed
Sayer, F T, Sherman, J H, Yen, C P, Schlesinger, D J, Kersh, R, Sheehan, J P. Initial experience with the eXtend System: a relocatable frame system for multiple session Gamma Knife radiosurgery. World Neurosurgery 2011; 75 (5/6): 665–672, doi: 10.1016/j.wneu.2010.12.051.Google ScholarPubMed
Devic, S, Seuntjens, J, Sham, E et al. Precise radiochromic film dosimetry using a flat-bed document scanner. Med Phys 2005; 32 (7): 2245–2253.CrossRefGoogle ScholarPubMed
Richley, L, John, A C, Coomber, H, Fletcher, S. Evaluation and optimization of the new EBT2 radiochromic film dosimetry system for patient dose verification in radiotherapy. Phys Med Biol 2010; 55 (9): 2601–2617. doi: 10.1088/0031-9155/55/9/012.CrossRefGoogle ScholarPubMed
Hartmann, B B, Martisiková, M M, Jäkel, O O. Homogeneity of Gafchromic EBT2 film. Med Phys 2010; 37(4): 1753–1756.CrossRefGoogle ScholarPubMed
Kim, T, Sheehan, J, Schlesinger, D. Inter- and intrafractional dose uncertainty in hypofractionated Gamma Knife radiosurgery. J Appl Clin Med Phys 2016; 17 (2): 5851.CrossRefGoogle ScholarPubMed
Devriendt, D, De Smedt, F, Glineur, R, Massager, N. Five-fraction Gamma Knife radiosurgery using the extend relocatable system for benign neoplasms close to optic pathways. Pract Rad Oncol 2015; 5 (3): 119–125,Google ScholarPubMed
Schlesinger, D, Xu, Z, Taylor, F, Yen, C P, Sheehan, J. Interfraction and intrafraction performance of the Gamma Knife extend system for patient positioning and immobilization, J Neurosurg 2012; 117 suppl: 217–224.CrossRefGoogle ScholarPubMed
Bisht, R K, Kale, S S, Natanasabapathi, G et al. Verification of Gamma Knife based fractionated radiosurgery with newly developed head-thorax phantom. Rad Measur 2016; 91: 65–74. doi: 10.1016/j.radmeas.2016.06.001.CrossRefGoogle Scholar