Skip to main content Accessibility help
×
Home

Estimation of technical treatment accuracy in fractionated stereotactic radiosurgery

  • Raj Kishor Bisht (a1), Gopishankar Natanasabapathi (a1) and Shashank Sharad Kale (a1)

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.

Copyright

Corresponding author

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: raaj_bisht@rediffmail.com

References

Hide All
1. 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): 3440.
2. 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: 445454.
3. 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: 495504.
4. 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: 414418.
5. 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: 6771. doi: 10.3340/jkns.2008.44.2.67.
6. 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): 733743. doi: 10.1227/01.neu.0000316277.14748.63.
7. 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: 898907. doi: 10.1227/01.NEU.0000359316.34041.A8.
8. 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): 647653. doi: 10.1007/s10072-012-1091-0.
9. 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): 8286
10. 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): 8592.
11. 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): 10971103.
12. 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): 166170.
13. 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): 343349.
14. 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): 223230.
15. 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): 50665071.
16. 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: 797802.
17. Scheib, S G, Gianolini, S. Three-dimensional dose verification using BANG gel: a clinical example. J Neurosurg 2002; 97: 582587.
18. 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): 16731675.
19. 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): 427430.
20. 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): 19952011.
21. 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): 699705.
22. 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.
23. 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): 403408. doi: 10.7785/tcrtexpress.2013.600259.
24. Lindquist, C, Paddick, I. The Leksell Gamma Knife Perfexion and comparisons with its predecessors. Neurosurgery 2007; 61 (3 Suppl): 130140
25. Sahgal, A, Ma, L, Chang, E et al. Advances in technology for intracranial stereotactic radiosurgery. Technol Cancer Res Treat 2009; 8 (4): 271280
26. 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): 306313. doi: 10.1016/j.ijrobp.2009.11.001.
27. 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): 665672, doi: 10.1016/j.wneu.2010.12.051.
28. Devic, S, Seuntjens, J, Sham, E et al. Precise radiochromic film dosimetry using a flat-bed document scanner. Med Phys 2005; 32 (7): 22452253.
29. 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): 26012617. doi: 10.1088/0031-9155/55/9/012.
30. Hartmann, B B, Martisiková, M M, Jäkel, O O. Homogeneity of Gafchromic EBT2 film. Med Phys 2010; 37(4): 17531756.
31. 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.
32. 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): 119125,
33. 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: 217224.
34. 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: 6574. doi: 10.1016/j.radmeas.2016.06.001.

Keywords

Estimation of technical treatment accuracy in fractionated stereotactic radiosurgery

  • Raj Kishor Bisht (a1), Gopishankar Natanasabapathi (a1) and Shashank Sharad Kale (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed