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Rotational effect and dosimetric impact: HDMLC vs 5-mm MLC leaf width in single isocenter multiple metastases radiosurgery with Brainlab Elements™

Published online by Cambridge University Press:  22 April 2022

Carlos Daniel Venencia ,
José Alejandro Rojas-López Open the ORCID record for José Alejandro Rojas-López [Opens in a new window] ,
Rogelio Manuel Díaz Moreno  and
Silvia Zunino
Carlos Daniel Venencia
Affiliation:
Instituto Zunino, Obispo Oro 423, 5000, Córdoba, Argentina
José Alejandro Rojas-López*
Affiliation:
Instituto Zunino, Obispo Oro 423, 5000, Córdoba, Argentina Universidad Nacional de Córdoba, 5000, Córdoba, Argentina
Rogelio Manuel Díaz Moreno
Affiliation:
Instituto Zunino, Obispo Oro 423, 5000, Córdoba, Argentina
Silvia Zunino
Affiliation:
Instituto Zunino, Obispo Oro 423, 5000, Córdoba, Argentina
*
Author for correspondence: Instituto Zunino, Obispo Oro 423, 5000, Córdoba, Argentina. E-mail: [email protected]
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Abstract

Purpose:

To analyse the impact of multileaf collimator (MLC) leaf width in multiple metastases radiosurgery (SRS) considering the target distance to isocenter and rotational displacements.

Methods:

Ten plans were optimised. The plans were created with Elements Multiple Mets SRS v2·0 (Brainlab AG, Munchen, Germany). The mean number of metastases per plan was 5 ± 2 [min 3, max 9], and the mean volume of gross tumour volume (GTV) was 1·1 ± 1·3 cc [min 0·02, max 5·1]. Planning target volume margin criterion was based on GTV-isocenter distance and target dimensions. Plans were performed using 6 MV with high-definition MLC (HDMLC) and reoptimised using 5-mm MLC (MLC-5). Plans were compared using Paddick conformity index (PCI), gradient index, monitor units , volume receiving half of prescription isodose (PIV50), maximum dose to brainstem, optic chiasm and optic nerves, and V12Gy, V10Gy and V5Gy for healthy brain were analysed. The maximum displacement due to rotational combinations was optimised by a genetic algorithm for both plans. Plans were reoptimised and compared using optimised margin.

Results:

HDMLC plans had better conformity and higher dose falloff than MLC-5 plans. Dosimetric differences were statistically significant (p < 0·05). The smaller the lesion volume, the higher the dosimetric differences between both plans. The effect of rotational displacements produced for each target in SRS was not dependent on the MLC (p > 0·05).

Conclusions:

The finer HDMLC offers dosimetric advantages compared with the MLC-5 in terms of target conformity and dose to the surrounding organs at risk. However, only dose falloff differences due to rotations depend on MLC.

Keywords

genetic algorithmmultiple metastasesMLCradiosurgery
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e35
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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