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Volumetric modulated arc therapy: a dosimetric comparison with dynamic IMRT and step-and-shoot IMRT. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:The aim of this study was to compare volumetric modulated arc therapy (VMAT) with dynamic intensity-modulated radiation therapy (dIMRT) and step-and-shoot IMRT (ssIMRT) for different treatment sites.Materials and methods:Twelve patients were selected for the planning comparison study. This included three head and neck, three brain, three rectal and three cervical cancer patients. Total dose of 50 Gy was given for all the plans. Plans were done for Elekta synergy with Monaco treatment planning system. All plans were generated with 6 MV photons beam. Plan evaluation was based on the ability to meet the dose volume histogram, dose homogeneity index, conformity index and radiation delivery time, and monitor unit needs to deliver the prescribed dose.Results:The VMAT and dIMRT plans achieved the better conformity (CI98% = 0·965 ± 0·023) and (CI98% = 0·939 ± 0·01), respectively, while ssIMRT plans were slightly inferior (CI98% = 0·901 ± 0·038). The inhomogeneity in the planning target volume (PTV) was highest with ssIMRT with HI equal to 0·097 ± 0·015 when compared to VMAT with HI equal to 0·092 ± 0·0369 and 0·095 ± 0·023 with dIMRT. The integral dose is found to be inferior with VMAT 105·31 ± 53·6 (Gy L) when compared with dIMRT 110·75 ± 52·9 (Gy L) and ssIMRT 115 38 ± 55·1(Gy L). All the techniques respected the planning objective for all organs at risk. The delivery time per fraction for VMAT was much lower than dIMRT and ssIMRT.Findings:Our results indicate that dIMRT and VMAT provide better sparing of normal tissue, homogeneity and conformity than ssIMRT with reduced treatment delivery time.
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Rossi E, Fiorino C, Fodor A, Deantoni C, Mangili P, Di Muzio NG, Del Vecchio A, Broggi S. Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices. Phys Imaging Radiat Oncol 2020; 16:20-25. [PMID: 33458339 PMCID: PMC7807594 DOI: 10.1016/j.phro.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Spinal stereotactic body radiotherapy (SBRT) involves large dose gradients and high geometrical accuracy is therefore required. The aim of this work was to assess residual intra-fraction error with a tracking robotic system for non-immobilized patients. Shifts from the first alignment (i.e. mimicking the unavailability of tracking) were also quantified. MATERIALS AND METHODS Forty-two patients treated for spinal metastasis (128 fractions, 4220 images) were analyzed. Residual error was quantified as the difference between translations/rotations referring to consecutive x-ray images during delivery (tracking) and to the initial set-up (no-tracking). The error distribution for each fraction/patient and the entire population was assessed for each axis/rotation angle. The impact of lesion sites, fractionation and patient's pain (VAS score) were investigated. Finally, the dosimetric impact of residual motion was quantified in the four most affected fractions. RESULTS Mean overall errors (OE) were near 0 (SD < 0.1 mm). Residual translations/rotations >1 mm/1° were found in less than 1.5%/1% of measurements. Lesion site and fractionation showed no impact. The dosimetric impact in the most affected fractions was negligible. For "no-tracking", mean OE was <1 mm/0.5°; less than 2% of displacements were >2 mm/1° within 10 min from the start of treatment with an increasing probability of shifts >2 mm over time. A significantly higher fraction of OE ≥ 2 mm was found for patients with pain in case of no-tracking. CONCLUSIONS Spine tracking with a latest-generation robotic system is highly efficient for non-immobilized patients: residual error is time independent and close to 0. For delivery times >7-8 min, tracking should be considered as mandatory for non-immobilized patients.
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Affiliation(s)
- Eleonora Rossi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Suzuki T, Saito M, Onishi H, Mochizuki K, Satani K, Yamazaki A, Miura K, Taka S, Sano N, Komiyama T, Takahashi H. Comparison of CT artifacts and image recognition of various fiducial markers including two types of thinner fiducial markers for CyberKnife treatment. Rep Pract Oncol Radiother 2020; 25:117-124. [DOI: 10.1016/j.rpor.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/04/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022] Open
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Hanna SA, Mancini A, Dal Col AH, Asso RN, Neves-Junior WFP. Frameless Image-Guided Radiosurgery for Multiple Brain Metastasis Using VMAT: A Review and an Institutional Experience. Front Oncol 2019; 9:703. [PMID: 31440464 PMCID: PMC6693418 DOI: 10.3389/fonc.2019.00703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
We undertook a structured review of stereotactic radiosurgery (SRS) using linear particle accelerator (linac) equipment, focusing on volumetric modulated arc therapy (VMAT) technology, and frameless image-guided radiotherapy (IGRT), for the treatment of brain metastases. We analyzed the role of linac SRS and its clinical applications, exploring stereotactic localization. Historically, there was a shift from fixed frames to frameless approaches, moving toward less invasive treatments. Thus, we reviewed the concepts of VMAT for multiple-target applications, comparing its dosimetric and technical features to those of other available techniques. We evaluated relevant technical issues and discussed the planning parameters that have gained worldwide acceptance to date. Thus, we reviewed the current literature on the clinical aspects of SRS, especially its main indications and how the advantages of VMAT may achieve clinical benefits in such scenarios. Finally, we reported our institutional results on IGRT-VMAT for SRS treatments for patients with multiple brain metastases.
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Affiliation(s)
| | - Anselmo Mancini
- Radiation Oncology Department, Sírio-Libanês Hospital, São Paulo, Brazil
| | | | - Rie Nadia Asso
- Radiation Oncology Department, Sírio-Libanês Hospital, São Paulo, Brazil
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Rehman JU, Zahra, Ahmad N, Khalid M, Noor ul Huda Khan Asghar H, Gilani ZA, Ullah I, Nasar G, Akhtar MM, Usmani MN. Intensity modulated radiation therapy: A review of current practice and future outlooks. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1016/j.jrras.2018.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jalil ur Rehman
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Zahra
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Nisar Ahmad
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Muhammad Khalid
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - H.M. Noor ul Huda Khan Asghar
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Zaheer Abbas Gilani
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Irfan Ullah
- Centre for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - Gulfam Nasar
- Department of Chemistry, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, Pakistan
| | - Malik Muhammad Akhtar
- Department of Environmental Science, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, Pakistan
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Yang B, Chiu TL, Law WK, Geng H, Lam WW, Leung TM, Yiu LH, Cheung KY, Yu SK. Performance evaluation of the CyberKnife system in real-time target tracking during beam delivery using a moving phantom coupled with two-dimensional detector array. Radiol Phys Technol 2019; 12:86-95. [PMID: 30604357 DOI: 10.1007/s12194-018-00495-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
The aim of the current study was to evaluate the tracking error of the Synchrony Respiratory Tracking system by conducting beam-by-beam analyses to determine the variation in the tracking beams measured during target motion. A moving phantom of in-house design coupled with a two-dimensional (2D) detector array was used to simulate respiratory motion in the superoinferior (SI) and anteroposterior (AP) direction. A styrofoam block with four implanted fiducial markers was placed on top of the detector to enable the fiducial-based respiratory tracking. Measurements were performed with the phantom under either stationary mode or sinusoidal motion of 6-s cycle and 15/20-mm amplitude at SI and AP direction. The measurement data were saved as movie files that were used to calculate the center shift of the beam with 100-ms sampling time. The tracking accuracy of the system was defined as the targeting error, which could be tracked with probability of > 95% (Ep95). The mean ± standard deviation of Ep95 was 0.28 ± 0.08 mm under stationary condition; 0.66 ± 0.23 mm (range: 0.28-1.22 mm) under sinusoidal respiratory motion. The maximum drift of the beam center for all beam paths was 2.7 mm. The tracking accuracy of CyberKnife Synchrony system was successfully evaluated using a moving phantom and 2D detector array; the maximum tracking error was < 1.5 mm for sinusoidal motion of amplitude ≤ 20 mm.
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Affiliation(s)
- Bin Yang
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China.
| | - Tin Lok Chiu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Wai Kong Law
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Hui Geng
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Wai Wang Lam
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Tat Ming Leung
- Biomedical Engineering Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Lok Hang Yiu
- Biomedical Engineering Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
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Choi HS, Kang KM, Jeong BK, Song JH, Lee YH, Ha IB, Kam SC, Hwa JS, Hyun JS, Do J, Jeong DH, Jeong H. Analysis of Motion-dependent Clinical Outcome of Tumor Tracking Stereotactic Body Radiotherapy for Prostate Cancer. J Korean Med Sci 2018; 33:e107. [PMID: 29607633 PMCID: PMC5879038 DOI: 10.3346/jkms.2018.33.e107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To analyze clinical outcome of CyberKnife (CK) tumor-tracking stereotactic body radiotherapy (SBRT) for prostate cancer (Pca) according to the magnitude of intra-fractional prostate motion. METHODS Medical records and daily treatment logs for 71 patients who received CK tumor-tracking SBRT were retrospectively analyzed. Statistical relationships between prostate motion and various outcome results, including local recurrence (LR), biochemical failure (BF), and treatment-related toxicity, were investigated in order to evaluate motion-dependent efficacy of tumor-tracking SBRT for Pca. RESULTS In a total 71 patients, 3 (4.2%) patients with LR, 12 (16.9%) patients with BF, and 22 (31%) patients with grade-II or worse toxicities to rectal or bladder (22 to rectal, 22 to bladder and 8 patients to both) were observed in a median follow-up of 47 months. Magnitudes of intra-fractional tumor motion along superior-inferior, right-left, and anterior-posterior (AP) axes were 0.15 ± 0.31, 0.12 ± 0.19, and 0.73 ± 0.32 mm, respectively. Radial magnitude was estimated to be 1.0 ± 0.35 mm. Intra-fractional movement was not significantly correlated with tumor control. However, it was significant correlated with the incidence of grade-II or worse toxicity to rectum or bladder particularly when tumor motion was in the AP axis. CONCLUSION Our quantitative results revealed that toxicity related to SBRT treatment was highly sensitive to intra-fractional prostate movements, although local-tumor control was not affected by such movements. Our results demonstrate that precise motion correction is essential in prostate SBRT, even if it seems to be small.
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Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Bae Kwon Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Yun Hee Lee
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - In Bong Ha
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sung Chul Kam
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Seok Hwa
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Seog Hyun
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jungmo Do
- Department of Urology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Hyeok Jeong
- Research Center, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Hojin Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
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Fürweger C, Prins P, Coskan H, Heijmen BJM. Characteristics and performance of the first commercial multileaf collimator for a robotic radiosurgery system. Med Phys 2017; 43:2063. [PMID: 27147318 DOI: 10.1118/1.4944740] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The "InCise™ multileaf-collimator (MLC)" is the first commercial MLC to be mounted on a robotic SRS/SBRT platform (CyberKnife). The authors assessed characteristics and performance of this novel device in a preclinical five months test period. METHODS Commissioning beam data were acquired with unshielded diodes. EBT3 radiochromic films were employed for measurement of transmission, leaf/bank position accuracy (garden fence) before and after exercising the MLC, for end-to-end testing and further characterization of the beam. The robot workspace with MLC was assessed analytically by transformation to an Euler geometry ("plane," "gantry," and "collimator" angles) and by measuring pointing accuracy at each node. Stability over time was evaluated in picket fence and adapted Winston-Lutz tests (AQA). RESULTS Beam penumbrae (80%-20%, with 100% = 2 × dose at inflection point for field sizes ≥ 50 × 50 mm(2)) were 2.2-3.7 mm for square fields in reference condition (source-axis-distance 800 mm, depth 15 mm) and depended on field size and off-axis position. Transmission and leakage did not exceed 0.5%. Accessible clinical workspace with MLC covered non-coplanar gantry angles of [-113°; +112°] and collimator angles of [-100°; +107°], with an average robot pointing accuracy of 0.12 ± 0.09 mm. For vertical beams, garden fence tests exhibited an average leaf positioning error of ≤0.2 mm, which increased by 0.25 and 0.30 mm (banks X1 and X2) with leaves traveling parallel to gravity. After execution of a leaf motion stress routine, garden fence tests showed slightly increased jaggedness and allowed to identify one malfunctioning leaf motor. Total system accuracy with MLC was 0.38 ± 0.05 mm in nine end-to-end tests. Picket fence and AQA tests displayed stable results over the test period. CONCLUSIONS The InCise™ MLC for CyberKnife showed high accuracy and adequate characteristics for SRS/SBRT applications. MLC performance after exercise demands specific quality assurance measures.
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Affiliation(s)
- Christoph Fürweger
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 EA, The Netherlands and European CyberKnife Center Munich, Munich 81377, Germany
| | - Paulette Prins
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 EA, The Netherlands
| | - Harun Coskan
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 EA, The Netherlands
| | - Ben J M Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 EA, The Netherlands
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Wen N, Snyder KC, Scheib SG, Schmelzer P, Qin Y, Li H, Siddiqui MS, Chetty IJ. Technical Note: Evaluation of the systematic accuracy of a frameless, multiple image modality guided, linear accelerator based stereotactic radiosurgery system. Med Phys 2017; 43:2527. [PMID: 27147363 DOI: 10.1118/1.4947199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the total systematic accuracy of a frameless, image guided stereotactic radiosurgery system. METHODS The localization accuracy and intermodality difference was determined by delivering radiation to an end-to-end prototype phantom, in which the targets were localized using optical surface monitoring system (OSMS), electromagnetic beacon-based tracking (Calypso®), cone-beam CT, "snap-shot" planar x-ray imaging, and a robotic couch. Six IMRT plans with jaw tracking and a flattening filter free beam were used to study the dosimetric accuracy for intracranial and spinal stereotactic radiosurgery treatment. RESULTS End-to-end localization accuracy of the system evaluated with the end-to-end phantom was 0.5 ± 0.2 mm with a maximum deviation of 0.9 mm over 90 measurements (including jaw, MLC, and cone measurements for both auto and manual fusion) for single isocenter, single target treatment, 0.6 ± 0.4 mm for multitarget treatment with shared isocenter. Residual setup errors were within 0.1 mm for OSMS, and 0.3 mm for Calypso. Dosimetric evaluation based on absolute film dosimetry showed greater than 90% pass rate for all cases using a gamma criteria of 3%/1 mm. CONCLUSIONS The authors' experience demonstrates that the localization accuracy of the frameless image-guided system is comparable to robotic or invasive frame based radiosurgery systems.
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Affiliation(s)
- N Wen
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
| | - K C Snyder
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
| | - S G Scheib
- Varian Medical System, Täfernstrasse 7, Dättwil AG 5405, Switzerland
| | - P Schmelzer
- Varian Medical System, Täfernstrasse 7, Dättwil AG 5405, Switzerland
| | - Y Qin
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
| | - H Li
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
| | - M S Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
| | - I J Chetty
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202
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Voynov G, Heron DE, Burton S, Grandis J, Quinn A, Ferris R, Ozhasoglu C, Vogel W, Johnson J. Frameless Stereotactic Radiosurgery for Recurrent Head and Neck Carcinoma. Technol Cancer Res Treat 2016; 5:529-35. [PMID: 16981796 DOI: 10.1177/153303460600500510] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the feasibility and toxicity of stereotactic radiosurgery (CK-SRS) using the CyberKnife® Frameless Radiosurgery System (Accuray Inc., Sunnyvale, CA) in the management of recurrent squamous cell carcinoma of the head and neck region (SCCHN). Between November 2001 and February 2004, 22 patients with recurrent, previously irradiated SCCHN were treated with CK-SRS. The following endpoints were assessed post-CK-SRS: local control (LC), cause-specific survival (CSS), overall survival (OS), symptom relief, and acute and late toxicity. Kaplan-Meier survival analyses were used to estimate the LC, CSS, and OS rates. Clinical symptoms were graded as “improved,” “stable,” or “progressed” after CK-SRS. Acute and late toxicity were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) scale, version 2.0. Seventeen patients were followed until their death. The median follow-up in the remaining five patients was 19 months (range 11–40 months). The median survival time for the entire cohort was 12 months from the time of CK-SRS. The 2-year LC, CSS, and OS rates were 26%, 26%, and 22%, respectively. After CK-SRS, symptoms were improved or stable in all but one patient who reported increasing pain. The treatment was well tolerated, with one case each of Grade 2 and 3 mucositis. There were no acute Grade 4 or 5 CTC toxicities. There were no late toxicities in this cohort. Frameless stereotactic radiosurgery for recurrent SCCHN is feasible and safe in the setting of high doses of prior irradiation. The majority of patients experienced palliation of disease without excess toxicity.
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Affiliation(s)
- George Voynov
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
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Okamoto H, Hamada M, Sakamoto E, Wakita A, Nakamura S, Kato T, Abe Y, Takahashi K, Igaki H, Itami J. Log-file analysis of accuracy of beam localization for brain tumor treatment by CyberKnife. Pract Radiat Oncol 2016; 6:e361-e367. [PMID: 27053497 DOI: 10.1016/j.prro.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/20/2015] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The CyberKnife system generates log-files including actual treatment parameters for each procedure. In this study, log-files were analyzed to evaluate the mechanical uncertainty in beam localization over the long term (approximately 1 year), as were patterns of patient movements during brain tumor treatments using CyberKnife. METHODS AND MATERIALS The clinical to planning target volume (CTV-PTV) margin in clinical use was examined based on this analysis. Log-file analysis was performed using data from 140 brain tumor patients (267 treatment plans; 27,166 beams; approximately 66 beams/fraction), who underwent CyberKnife stereotactic radiosurgery and radiation therapy. We calculated a mean error and 2 standard deviations (2σ) for this population. Additionally, we calculated the radius R95% spatially covering 95% of all error vectors. RESULTS The mean mechanical uncertainties of CyberKnife brain tumor treatment were found to be 0.07, 0.01, and -0.09 mm in the +inferior/-superior, +left/-right, and +anterior/-posterior directions, respectively. The mean (2σ) of R95% was 1.02 (0.42) mm. A smaller degree of correlation between patient movement and R95% was observed. CONCLUSION The CyberKnife is robust in tracking accuracy, regardless of patient movement. The effectiveness of log-file analysis was demonstrated regarding quality control for monitoring beam localization in the CyberKnife system. The CTV-PTV margin of 2.0 mm was found to be adequate in brain tumor treatments using the CyberKnife.
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Affiliation(s)
- Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan.
| | - Minoru Hamada
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Emi Sakamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Akihisa Wakita
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Satoshi Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Toru Kato
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Yoshihisa Abe
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo Japan
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Sumida I, Shiomi H, Higashinaka N, Murashima Y, Miyamoto Y, Yamazaki H, Mabuchi N, Tsuda E, Ogawa K. Evaluation of tracking accuracy of the CyberKnife system using a webcam and printed calibrated grid. J Appl Clin Med Phys 2016; 17:74-84. [PMID: 27074474 PMCID: PMC5875552 DOI: 10.1120/jacmp.v17i2.5914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/04/2015] [Accepted: 10/28/2015] [Indexed: 11/23/2022] Open
Abstract
Tracking accuracy for the CyberKnife's Synchrony system is commonly evaluated using a film‐based verification method. We have evaluated a verification system that uses a webcam and a printed calibrated grid to verify tracking accuracy over three different motion patterns. A box with an attached printed calibrated grid and four fiducial markers was attached to the motion phantom. A target marker was positioned at the grid's center. The box was set up using the other three markers. Target tracking accuracy was evaluated under three conditions: 1) stationary; 2) sinusoidal motion with different amplitudes of 5, 10, 15, and 20 mm for the same cycle of 4 s and different cycles of 2, 4, 6, and 8 s with the same amplitude of 15 mm; and 3) irregular breathing patterns in six human volunteers breathing normally. Infrared markers were placed on the volunteers’ abdomens, and their trajectories were used to simulate the target motion. All tests were performed with one‐dimensional motion in craniocaudal direction. The webcam captured the grid's motion and a laser beam was used to simulate the CyberKnife's beam. Tracking error was defined as the difference between the grid's center and the laser beam. With a stationary target, mean tracking error was measured at 0.4 mm. For sinusoidal motion, tracking error was less than 2 mm for any amplitude and breathing cycle. For the volunteers’ breathing patterns, the mean tracking error range was 0.78‐1.67 mm. Therefore, accurate lesion targeting requires individual quality assurance for each patient. PACS number(s): 87.55.D‐, 87.55.km, 87.55.Qr, 87.56.Fc
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Affiliation(s)
- Iori Sumida
- Osaka University Graduate School of Medicine; CyberKnife Center.
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Subedi G, Karasick T, Grimm J, Jain S, Xue J, Xu Q, Chen Y, Asbell S, Pahlajani N, LaCouture T. Factors that may determine the targeting accuracy of image-guided radiosurgery. Med Phys 2015; 42:6004-10. [DOI: 10.1118/1.4930961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Inoue M, Shiomi H, Iwata H, Taguchi J, Okawa K, Kikuchi C, Inada K, Iwabuchi M, Murai T, Koike I, Tatewaki K, Ohta S, Inoue T. Development of system using beam's eye view images to measure respiratory motion tracking errors in image-guided robotic radiosurgery system. J Appl Clin Med Phys 2015; 16:5049. [PMID: 25679160 PMCID: PMC5689998 DOI: 10.1120/jacmp.v16i1.5049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 09/01/2014] [Accepted: 08/26/2014] [Indexed: 11/23/2022] Open
Abstract
The accuracy of the CyberKnife Synchrony Respiratory Tracking System (SRTS) is considered to be patient-dependent because the SRTS relies on an individual correlation between the internal tumor position (ITP) and the external marker position (EMP), as well as a prediction method to compensate for the delay incurred to adjust the position of the linear accelerator (linac). We aimed to develop a system for obtaining pretreatment statistical measurements of the SRTS tracking error by using beam's eye view (BEV) images, to enable the prediction of the patient-specific accuracy. The respiratory motion data for the ITP and the EMP were derived from cine MR images obtained from 23 patients. The dynamic motion phantom was used to reproduce both the ITP and EMP motions. The CyberKnife was subsequently operated with the SRTS, with a CCD camera mounted on the head of the linac. BEV images from the CCD camera were recorded during the tracking of a ball target by the linac. The tracking error was measured at 15 Hz using in-house software. To assess the precision of the position detection using an MR image, the positions of test tubes (determined from MR images) were compared with their actual positions. To assess the precision of the position detection of the ball, ball positions measured from BEV images were compared with values measured using a Vernier caliper. The SRTS accuracy was evaluated by determining the tracking error that could be identified with a probability of more than 95% (Ep95). The detection precision of the tumor position (determined from cine MR images) was < 0.2 mm. The detection precision of the tracking error when using the BEV images was < 0.2mm. These two detection precisions were derived from our measurement system and were not obtained from the SRTS. The median of Ep95 was found to be 1.5 (range, 1.0-3.5) mm. The difference between the minimum and maximum Ep95 was 2.5mm, indicating that this provides a better means of evaluating patient-specific SRTS accuracy. A suitable margin, based on the predicted patient-specific SRTS accuracy, can be added to the clinical target volume.
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Schätti A, Meer D, Lomax AJ. First experimental results of motion mitigation by continuous line scanning of protons. Phys Med Biol 2014; 59:5707-23. [DOI: 10.1088/0031-9155/59/19/5707] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ma L, Sahgal A, Larson DA, Pinnaduwage D, Fogh S, Barani I, Nakamura J, McDermott M, Sneed P. Impact of millimeter-level margins on peripheral normal brain sparing for gamma knife radiosurgery. Int J Radiat Oncol Biol Phys 2014; 89:206-13. [PMID: 24725703 DOI: 10.1016/j.ijrobp.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. METHODS AND MATERIALS A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. RESULTS Confirmatory correlation between the nominal target radius (ie, RT) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/RT, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R(2) >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/RT values for the target. CONCLUSIONS Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.
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Affiliation(s)
- Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Larson
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Dilini Pinnaduwage
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Shannon Fogh
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Igor Barani
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Jean Nakamura
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Michael McDermott
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Penny Sneed
- Department of Radiation Oncology, University of California, San Francisco, California
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Effect of residual patient motion on dose distribution during image-guided robotic radiosurgery for skull tracking based on log file analysis. Jpn J Radiol 2014; 32:461-6. [PMID: 24841323 DOI: 10.1007/s11604-014-0330-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The present study aimed to assess the effect of residual patient motion on dose distribution during intracranial image-guided robotic radiosurgery by analyzing the system log files. MATERIALS AND METHODS The dosimetric effect was analyzed according to the difference between the original and estimated dose distributions, including targeting error, caused by residual patient motion between two successive image acquisitions. One hundred twenty-eight treatments were analyzed. Forty-two patients were treated using the isocentric plan, and 86 patients were treated using the conformal (non-isocentric) plan. RESULTS The median distance from the imaging center to the target was 55 mm, and the median interval between the acquisitions of sequential images was 79 s. The median translational residual patient motion was 0.1 mm for each axis, and the rotational residual patient motion was 0.1° for Δpitch and Δroll and 0.2° for Δyaw. The dose error for D 95 was within 1 % in more than 95 % of cases. The maximum dose error for D 10 to D 90 was within 2 %. None of the studied parameters, including the interval between the acquisitions of sequential images, was significantly related to the dosimetric effect. CONCLUSION The effect of residual patient motion on dose distribution was minimal.
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Nguyen T, Hsu W, Lim M, Naff N. Delivery of stereotactic radiosurgery: a cross-platform comparison. Neurol Res 2013; 33:787-91. [DOI: 10.1179/016164111x13123658647409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 2013; 40:48-59. [PMID: 23810288 DOI: 10.1016/j.ctrv.2013.05.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/22/2022]
Abstract
Chemotherapy has made substantial progress in the therapy of systemic cancer, but the pharmacological efficacy is insufficient in the treatment of brain metastases. Fractionated whole brain radiotherapy (WBRT) has been a standard treatment of brain metastases, but provides limited local tumor control and often unsatisfactory clinical results. Stereotactic radiosurgery using Gamma Knife, Linac or Cyberknife has overcome several of these limitations, which has influenced recent treatment recommendations. This present review summarizes the current literature of single session radiosurgery concerning survival and quality of life, specific responses, tumor volumes and numbers, about potential treatment combinations and radioresistant metastases. Gamma Knife and Linac based radiosurgery provide consistent results with a reproducible local tumor control in both single and multiple brain metastases. Ideally minimum doses of ≥18Gy are applied. Reported local control rates were 90-94% for breast cancer metastases and 81-98% for brain metastases of lung cancer. Local tumor control rates after radiosurgery of otherwise radioresistant brain metastases were 73-90% for melanoma and 83-96% for renal cell cancer. Currently, there is a tendency to treat a larger number of brain metastases in a single radiosurgical session, since numerous studies document high local tumor control after radiosurgical treatment of >3 brain metastases. New remote brain metastases are reported in 33-42% after WBRT and in 39-52% after radiosurgery, but while WBRT is generally applied only once, radiosurgery can be used repeatedly for remote recurrences or new metastases after WBRT. Larger metastases (>8-10cc) should be removed surgically, but for smaller metastases Gamma Knife radiosurgery appears to be equally effective as surgical tumor resection (level I evidence). Radiosurgery avoids the impairments in cognition and quality of life that can be a consequence of WBRT (level I evidence). High local efficacy, preservation of cerebral functions, short hospitalization and the option to continue a systemic chemotherapy are factors in favor of a minimally invasive approach with stereotactic radiosurgery.
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Fiducial-free CyberKnife radiosurgery for residual metastatic spinal tumor after decompression and instrumentation. J Clin Neurosci 2012; 19:1573-5. [PMID: 22939778 DOI: 10.1016/j.jocn.2011.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 11/22/2022]
Abstract
Stereotactic spinal radiotherapy is a promising technology for use in the multidisciplinary management of benign and malignant spinal tumors. We present two patients with residual metastatic spinal tumors and their treatment with CyberKnife (Accuray, Sunnyvale, CA, USA) after decompression and instrumentation, one of which was successful and the other not. A 73-year-old male patient was admitted with bilateral extremity weakness (Grade IV) and voiding difficulty that had developed 2 days previously. CyberKnife treatment for the residual tumor after surgery with decompression and instrumentation was attempted, but could not be performed due to imaging interference caused by the instrumentation. A second patient, a 49-year-old male, was admitted with right extremity weakness and voiding difficulty that had developed 5 months previously. In this patient, we were able to perform CyberKnife treatment on the residual tumor after decompression and instrumentation. Based on these two patients, we believe that fiducial-free CyberKnife treatment is not suitable for treatment of residual metastatic spinal tumors at the upper thoracic levels, after decompression with instrumentation. This is due to the difficulties in matching digitally reconstructed radiographs with live radiographic images, as a result of the larger inclination and smaller vertebral body surface at the upper thoracic level.
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Kang HJ, Grelewicz Z, Wiersma RD. Development of an automated region of interest selection method for 3D surface monitoring of head motion. Med Phys 2012; 39:3270-82. [PMID: 22755710 DOI: 10.1118/1.4711805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To simplify the often complex and user-dependent manual region of interest (ROI) selection process for head motion monitoring, an automatic ROI selection method was developed. METHODS The automatic ROI selection algorithm calculated the displacements and velocities of 3D surface points between a temporally correlated 3D image series and a reference image. Only facial surfaces satisfying certain spatial and temporal criteria were selected. The algorithm was tested on five healthy volunteers instructed to perform different types of facial movements for a total of 27 real-time image sets (40-120 images for each image set). RESULTS The algorithm detected and excluded surface areas affected by different types of local facial movements that were independent of actual net head motion. Eye, eyebrow, and mandible motion were most commonly detected as being independent of head motion and were excluded from the final ROI. For 3D images taken with substantial facial or whole head motion, either most of the facial area was excluded or only small areas with random patterns were included in the final ROI. Surface image registration using iterative closest point (ICP) methods showed more stable real-time head tracking using the automatically selected ROI than manual user defined ROIs. CONCLUSIONS The automatic selection method successfully found ROIs stable over time for tracking head motion by excluding locally varying facial motions. By automating the ROI selection process, it is feasible that the time and complexity of current ROI definition can be reduced, together with user-dependent registration errors.
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Affiliation(s)
- H J Kang
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA.
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Abstract
Radiotherapy technology has improved rapidly over the past two decades. New imaging modalities, such as positron emission (computed) tomography (PET, PET-CT) and high-resolution morphological and functional magnetic resonance imaging (MRI) have been introduced into the treatment planning process. Image-guided radiation therapy (IGRT) with 3D soft tissue depiction directly imaging target and normal structures, is currently replacing patient positioning based on patient surface markers, frame-based intracranial and extracranial stereotactic treatment and partially also 2D field verification methods. On-line 3D soft tissue-based position correction unlocked the full potential of new delivery techniques, such as intensity-modulated radiotherapy, by safely delivering highly conformal dose distributions that facilitate dose escalation and hypofractionation. These strategies have already resulted in better clinical outcomes, e.g. in prostate and lung cancer and are expected to further improve radiotherapy results.
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Initial clinical experience with a frameless and maskless stereotactic radiosurgery treatment. Pract Radiat Oncol 2012; 2:54-62. [DOI: 10.1016/j.prro.2011.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/18/2011] [Accepted: 04/21/2011] [Indexed: 11/23/2022]
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Li G, Ballangrud A, Kuo LC, Kang H, Kirov A, Lovelock M, Yamada Y, Mechalakos J, Amols H. Motion monitoring for cranial frameless stereotactic radiosurgery using video-based three-dimensional optical surface imaging. Med Phys 2011; 38:3981-94. [PMID: 21858995 DOI: 10.1118/1.3596526] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To establish a new clinical procedure in frameless stereotactic radiosurgery (SRS) for patient setup verification at treatment couch angles as well as for head-motion monitoring during treatment using video-based optical surface imaging (OSI). METHODS A video-based three-dimensional (3D) OSI system with three ceiling-mounted camera pods was employed to verify setup at treatment couch angles as well as to monitor head motion during treatment. A noninvasive head immobilization device was utilized, which includes an alpha head mold and a dental mouthpiece with vacuum suction; both were locked to the treatment couch. Cone beam computed tomography (CBCT) was used as the standard for image-guided setup. Orthogonal 2D-kV imaging was applied for setup verification before treatment, between couch rotations, and after treatment at zero couch angle. At various treatment couch angles, OSI setup verification was performed, relative to initial OSI setup verification at zero couch angle after CBCT setup through a coordinate transformation. For motion monitoring, the setup uncertainty was decoupled by taking an on-site surface image as new reference to detect motion-induced misalignment in near real-time (1-2 frames per second). Initial thermal instability baseline of the real-time monitoring was corrected. An anthropomorphous head phantom and a 1D positioning platform were used to assess the OSI accuracy in motion detection in longitudinal and lateral directions. Two hypofractionated (9 Gy x 3 and 6 Gy x 5) frameless stereotactic radiotherapy (SRT) patients as well as two single-fraction (21 and 18 Gy) frameless SRS patients were treated using this frameless procedure. For comparison, 11 conventional frame-based SRS patients were monitored using the OSI to serve as clinical standards. Multiple noncoplanar conformal beams were used for planning both frameless and frame-based SRS with a micromultileaf collimator. RESULTS The accuracy of the OSI in 1D motion detection was found to be 0.1 mm with uncertainty of +/- 0.1 mm using the head phantom. The OSI registration against simulation computed tomography (CT) external contour was found to be dependent on the CT skin definition with -0.4 mm variation. For frame-based SRS patients, head-motion magnitude was detected to be <1.0 mm (0.3 +/- 0.2 mm) and <1.0 degree (0.2 degrees +/- 0.2 degrees) for 98% of treatment time, with exception of one patient with head rotation <1.5 degrees for 98% of the time. For frameless SRT/SRS patients, similar motion magnitudes were observed with an average of 0.3 +/- 0.2 mm and 0.2 degrees +/- 0.1 degree in ten treatments. For 98% of the time, the motion magnitude was <1.1 mm and 1.0 degree. Complex head-motion patterns within 1.0 mm were observed for frameless SRT/SRS patients. The OSI setup verification at treatment couch angles was found to be within 1.0 mm. CONCLUSIONS The OSI system is capable of detecting 0.1 +/- 0.1 mm 1D spatial displacement of a phantom in near real time and useful in head-motion monitoring. This new frameless SRS procedure using the mask-less head-fixation system provides immobilization similar to that of conventional frame-based SRS. Head-motion monitoring using near-real-time surface imaging provides adequate accuracy and is necessary for frameless SRS in case of unexpected head motion that exceeds a set tolerance.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.
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The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy. Am J Clin Oncol 2011; 34:372-9. [PMID: 20859194 DOI: 10.1097/coc.0b013e3181e84dc0] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the effect of stereotactic body radiotherapy (SBRT) dose and tumor volume on outcomes in patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck. MATERIALS AND METHODS A total of 96 patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck were treated with SBRT using Cyberknife and Trilogy-intensity-modulated radiosurgery. Kaplan-Meier survival analyses were used to estimate locoregional control (LRC) and overall survival rates. Response was evaluated using positron emission tomography/computed tomography or computed tomography and detailed physical examination. RESULTS The median follow-up for all patients was 14 months (2-39 months). The median dose of prior radiation was 68.4 Gy (32-170 Gy). Patients were divided into 4 SBRT dose groups: I (15-28 Gy/n = 29), II (30-36 Gy/n = 22), III (40 Gy/n = 18), and IV (44-50 Gy/n = 27). The median gross tumor volume (GTV) was 24.3(3) cm (2.5-162 cm). For GTV ≤25 cm(3) (n = 50), complete response rates were 27.8%/30%/45.5%/45.5%, and for GTV >25 cm(3) (n = 46), complete response rates were 20%/25%/42.8%/50% for SBRT groups I-IV, respectively. The 1-/2-/3-year LRC rates for doses 40 to 50 Gy were 69.4%/57.8%/41.1%, respectively, whereas for 15 to 36 Gy, they were 51.9%/31.7%/15.9%, respectively (P = 0.02). The overall 1- and 2-year overall survival rates were 58.9% and 28.4%, respectively. Treatment was well tolerated with no grade 4/5 toxicities. CONCLUSIONS Dose escalation up to 50 Gy in 5 fractions is feasible with SBRT for recurrent head and neck squamous cell carcinoma. Higher SBRT doses were associated with significantly higher LRC rates. Large tumor volume required higher SBRT doses to achieve optimal response rates compared with smaller tumor volume.
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Fürweger C, Drexler C, Kufeld M, Muacevic A, Wowra B. Advances in fiducial-free image-guidance for spinal radiosurgery with CyberKnife--a phantom study. J Appl Clin Med Phys 2010; 12:3446. [PMID: 21587167 PMCID: PMC5718658 DOI: 10.1120/jacmp.v12i2.3446] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/22/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
The image‐guided CyberKnife radiosurgery system is capable of tracking spinal targets without fiducial implants. Recently, a new version of this fiducial‐free image guidance modality (“enhanced Xsight spine tracking”) has been introduced. We assessed the accuracy of this novel technique versus its precursor in a comparative phantom study. The CyberKnife consists of a 6 MV linac on a six‐axis robot and a stereoscopic kV image guidance system. An anthropomorphic head‐and‐neck phantom with a cervical spine section was mounted on the linac nozzle. The robotic manipulator was used to precisely move the phantom to defined positions in the CyberKnife workspace. Multiple stereoscopic images were acquired at different translational and rotational positions. The enhanced Xsight spine tracking readouts were recorded and compared to the nominal phantom position. These tests were repeated with the original Xsight spine tracking version to analyze potential differences. Enhanced Xsight spine tracking correctly reported translational offsets with an RMS error of less than 0.4 mm. Yaw and roll rotations were detected with an accuracy of 0.2°, 0.25°. Pitch offsets were slightly underestimated, with up to 0.3° for an offset of ± 2°. Nominal X (left‐right) translational offsets were partially misinterpreted as roll (0.2° at a 10 mm offset). Apart from this, no correlation between rotational and translational directions was found. In comparison, the original Xsight spine tracking showed identical results for translations, but larger systematic and statistical errors for rotations. Enhanced Xsight spine tracking measurably improves precision in fiducial‐free spinal radiosurgery with the CyberKnife. PACS number: 87.53.Ly
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Kilby W, Dooley JR, Kuduvalli G, Sayeh S, Maurer CR. The CyberKnife® Robotic Radiosurgery System in 2010. Technol Cancer Res Treat 2010; 9:433-52. [DOI: 10.1177/153303461000900502] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This review provides a complete technical description of the CyberKnife® VSI™ System, the latest addition to the CyberKnife product family, which was released in September 2009. This review updates the previous technical reviews of the original system version published in the late 1990s. Technical developments over the last decade have impacted virtually every aspect of the CyberKnife System. These developments have increased the geometric accuracy of the system and have enhanced the dosimetric accuracy and quality of treatment, with advanced inverse treatment planning algorithms, rapid Monte Carlo dose calculation, and post-processing tools that allow trade-offs between treatment efficiency and dosimetric quality to be explored. This review provides a system overview with detailed descriptions of key subsystems. A detailed review of studies of geometric accuracy is also included, reporting a wide range of experiments involving phantom tests and patient data. Finally, the relationship between technical developments and the greatly increased range of clinical applications they have allowed is reviewed briefly.
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Affiliation(s)
- W. Kilby
- Accuray Incorporated, 1310 Chesapeake Terrace, Sunnyvale, CA 94089, USA
| | - J. R. Dooley
- Accuray Incorporated, 1310 Chesapeake Terrace, Sunnyvale, CA 94089, USA
| | - G. Kuduvalli
- Accuray Incorporated, 1310 Chesapeake Terrace, Sunnyvale, CA 94089, USA
| | - S. Sayeh
- Accuray Incorporated, 1310 Chesapeake Terrace, Sunnyvale, CA 94089, USA
| | - C. R. Maurer
- Accuray Incorporated, 1310 Chesapeake Terrace, Sunnyvale, CA 94089, USA
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Fractionated stereotactic body radiation therapy in the treatment of previously-irradiated recurrent head and neck carcinoma: updated report of the University of Pittsburgh experience. Am J Clin Oncol 2010; 33:286-93. [PMID: 19875950 DOI: 10.1097/coc.0b013e3181aacba5] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and outcome of stereotactic body radiotherapy (SBRT) in patients with recurrent previously irradiated squamous cell carcinoma of the head and neck (rSCCHN). METHODS We reviewed our experience with 85 patients who received SBRT for rSCCHN between January 2003 and May 2008. The mean dose of SBRT was 35 Gy (range: 15-44 Gy). The following end points were evaluated: tumor response, time-to-progression, acute and late toxicities, local control (LC) rates and impact of tumor dose and tumor size on LC, and overall survival. RESULTS The median follow-up of all patients was 6 months (range: 1.3-39 months). For those patients who were alive at last follow-up (40%) the median follow-up was 17.6 months. The mean total dose of prior radiation to the primary site was 74 Gy (range: 32-170 Gy). Those patients who received SBRT <35 Gy had significantly lower LC than those with > or =35 Gy at 6 months the median follow-up time (P = 0.014). Tumor responses were 34% complete response, 34% partial response, 20% stable disease, and 12% progressive disease. Among those with an initial tumor response followed by progression (58 patients), there was a median interval of 5.5 months for time-to-progression. The 1-year and 2-year LC and overall survival rates for all patients were 51.2% and 30.7%, and 48.5% and 16.1%, respectively. Overall, the median survival for all patients was 11.5 months (range: 3-51). Treatment was well-tolerated with no grade 4 or 5 treatment-related toxicities. CONCLUSIONS SBRT is feasible and safe with minimal toxicities for treatment of rSCCHN patients with prior radiation therapy deemed to be poor candidates for re-irradiation by conventional means.
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Potters L, Kavanagh B, Galvin JM, Hevezi JM, Janjan NA, Larson DA, Mehta MP, Ryu S, Steinberg M, Timmerman R, Welsh JS, Rosenthal SA. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2010; 76:326-32. [PMID: 20117285 DOI: 10.1016/j.ijrobp.2009.09.042] [Citation(s) in RCA: 316] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 09/24/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Louis Potters
- Department of Radiation Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Kai J, Shiomi H, Sasama T, Sato Y, Inoue T, Tamura S, Inoue T. Optical High-Precision Three-Dimensional Position Measurement System Suitable for Head Motion Tracking in Frameless Stereotactic Radiosurgery. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929089809149847] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Murphy MJ, Adler JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J. Image-Guided Radiosurgery for the Spine and Pancreas. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080009148895] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lasak JM, Gorecki JP. The History of Stereotactic Radiosurgery and Radiotherapy. Otolaryngol Clin North Am 2009; 42:593-9. [DOI: 10.1016/j.otc.2009.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Intrafraction Geometric Uncertainties in Frameless Image-Guided Radiosurgery. Int J Radiat Oncol Biol Phys 2009; 73:1364-8. [DOI: 10.1016/j.ijrobp.2008.06.1921] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/16/2008] [Accepted: 06/17/2008] [Indexed: 11/24/2022]
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Sohn MJ, Lee DJ, Yoon SW, Lee HR, Hwang YJ. The effective application of segmental image fusion in spinal radiosurgery for improved targeting of spinal tumours. Acta Neurochir (Wien) 2009; 151:231-8; discussion 238. [PMID: 19240972 DOI: 10.1007/s00701-009-0210-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 02/05/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE As a result of experiences of failed image fusion, an improved protocol for effective CT and MRI image fusion was developed. Image fusion is a critical part of image-guided stereotactic radiosurgery (IG-SRS) and greatly influences the accurate measurement of gross tumour volume (GTV) and optimal dosimetry. Avoidance of any positional discrepancy is vital for optimal image fusion and results in improved targeting, which improves clinical results. This paper describes a protocol for effective image fusion and how it impacted on the clinical outcome of stereotactic radiosurgery for spinal tumours. METHODS Fused MRI/CT images from 20 patients were examined and compared. A protocol for fusing images from thin slice MR images and CTs was developed for improved identification and measurement of tumour volume. Differences in individual GTV values both before and after image fusion were evaluated. The effectiveness of tumour targeting was also assessed by comparing discrepancies in individual and overall GTV values. RESULTS Differences in mean GTVs using either CT or MRI alone compared with the mean found through combined CT/MR image fusion showed a difference of 30.5 +/- 4.8% and 14.5 +/- 3.3% respectively. Additionally, the median GTV values from CT- and MR-based imaging were 11.64 +/- 7.8 cm(3) and 11.72 +/- 6.6 cm(3) vs 14.06 +/- 8.0 cm(3). Median GTV from CT-MR fusion was 14.06 +/- 8.0 cm(3). Improved information provided by the fused images enabled us to prescribe more effective dosages, as the fused images gave more accurate information about tumour se due to better delineation of tumour perimeters. CONCLUSIONS This protocol provides improved visualisation of spinal tumours and enables better treatment planning. Segmented image fusion was shown to provide significant advantages for planning stereotactic radiosurgery. Fused images provided more precise and accurate data and allowed better targeting of tumours, with improved tumour coverage that resulted in better clinical outcomes.
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Matinfar M, Ford E, Iordachita I, Wong J, Kazanzides P. Image-guided small animal radiation research platform: calibration of treatment beam alignment. Phys Med Biol 2009; 54:891-905. [PMID: 19141881 DOI: 10.1088/0031-9155/54/4/005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Small animal research allows detailed study of biological processes, disease progression and response to therapy with the potential to provide a natural bridge to the clinical environment. The small animal radiation research platform (SARRP) is a portable system for precision irradiation with beam sizes down to approximately 0.5 mm and optimally planned radiation with on-board cone-beam CT (CBCT) guidance. This paper focuses on the geometric calibration of the system for high-precision irradiation. A novel technique for the calibration of the treatment beam is presented, which employs an x-ray camera whose precise positioning need not be known. Using the camera system we acquired a digitally reconstructed 3D 'star shot' for gantry calibration and then developed a technique to align each beam to a common isocenter with the robotic animal positioning stages. The calibration incorporates localization by cone-beam CT guidance. Uncorrected offsets of the beams with respect to the calibration origin ranged from 0.4 mm to 5.2 mm. With corrections, these alignment errors can be reduced to the sub-millimeter range. The calibration technique was used to deliver a stereotactic-like arc treatment to a phantom constructed with EBT Gafchromic films. All beams were shown to intersect at a common isocenter with a measured beam (FWHM) of approximately 1.07 mm using the 0.5 mm collimated beam. The desired positioning accuracy of the SARRP is 0.25 mm and the results indicate an accuracy of 0.2 mm. To fully realize the radiation localization capabilities of the SARRP, precise geometric calibration is required, as with any such system. The x-ray camera-based technique presented here provides a straightforward and semi-automatic method for system calibration.
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Affiliation(s)
- Mohammad Matinfar
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
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Wurm RE, Erbel S, Schwenkert I, Gum F, Agaoglu D, Schild R, Schlenger L, Scheffler D, Brock M, Budach V. Novalis frameless image-guided noninvasive radiosurgery: initial experience. Neurosurgery 2008; 62:A11-7; discussion A17-8. [PMID: 18580775 DOI: 10.1227/01.neu.0000325932.34154.82] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate our initial experience with Novalis (BrainLAB, Heimstetten, Germany) frameless image-guided noninvasive radiosurgery. METHODS The system combines the dedicated Novalis linear accelerator with ExacTrac X-Ray 6D, an infrared camera and a kilovolt stereoscopic x-ray imaging system, a noninvasive mask system, and ExacTrac robotics for patient positioning in six degrees of freedom. Reference cranial skeletal structures are radiographically imaged and automatically fused to digital reconstructed radiographs calculated from the treatment planning computed tomographic scan to find the target position and accomplish automatic real-time tracking before and during radiosurgery. We present the acceptance testing and initial experience in 15 patients with 19 intracranial lesions treated between December 2005 and June 2006 at the Charité by frameless image-guided radiosurgery with doses between 12 and 20 Gy prescribed to the target-encompassing isodose. RESULTS Phantom tests showed an overall system accuracy of 1.04 +/- 0.47 mm, with an average in-plane deviation of 0.02 +/- 0.96 mm for the x-axis and 0.02 +/- 0.70 mm for the y-axis. After infrared-guided patient setup of all patients, the overall average translational deviation determined by stereoscopic x-ray verification was 1.5 +/- 1.3 mm, and the overall average rotational deviation was 1.0 +/- 0.8 degree. The data used for radiosurgery, after stereoscopic x-ray verification and correction, demonstrated an overall average setup error of 0.31 +/- 0.26 mm for translation and 0.26 +/- 0.23 degree for rotation. CONCLUSION This initial evaluation demonstrates the system accuracy and feasibility of Novalis image-guided noninvasive radiosurgery for intracranial benign and malignant lesions.
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Affiliation(s)
- Reinhard E Wurm
- Department of Radiation Oncology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Rah J, Shin D, Jang J, Kim M, Yoon S, Suh T. Application of a glass rod detector for the output factor measurement in the CyberKnife. Appl Radiat Isot 2008; 66:1980-5. [DOI: 10.1016/j.apradiso.2008.06.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 06/05/2008] [Accepted: 06/29/2008] [Indexed: 11/15/2022]
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Ma L, Chuang C, Descovich M, Petti P, Smith V, Verhey L. Whole-procedure clinical accuracy of Gamma Knife treatments of large lesionsa). Med Phys 2008; 35:5110-4. [DOI: 10.1118/1.2987669] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Avanzo M, Romanelli P. Spinal radiosurgery: technology and clinical outcomes. Neurosurg Rev 2008; 32:1-12; discussion 12-3. [DOI: 10.1007/s10143-008-0167-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 05/23/2008] [Accepted: 07/26/2008] [Indexed: 12/25/2022]
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Benedict SH, Bova FJ, Clark B, Goetsch SJ, Hinson WH, Leavitt DD, Schlesinger DJ, Yenice KM. The role of medical physicists in developing stereotactic radiosurgery. Med Phys 2008; 35:4262-77. [DOI: 10.1118/1.2969268] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Antypas C, Pantelis E. Performance evaluation of a CyberKnife® G4 image-guided robotic stereotactic radiosurgery system. Phys Med Biol 2008; 53:4697-718. [DOI: 10.1088/0031-9155/53/17/016] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gerszten PC, Burton SA. Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery. Med Dosim 2008; 33:107-16. [PMID: 18456162 DOI: 10.1016/j.meddos.2008.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 02/29/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. gersztenpc@upm .edu
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Saw CB, Chen H, Wagner H. Implementation of Fiducial-Based Image Registration in the Cyberknife Robotic System. Med Dosim 2008; 33:156-60. [DOI: 10.1016/j.meddos.2008.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
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Ozhasoglu C, Saw CB, Chen H, Burton S, Komanduri K, Yue NJ, Huq SM, Heron DE. Synchrony--cyberknife respiratory compensation technology. Med Dosim 2008; 33:117-23. [PMID: 18456163 DOI: 10.1016/j.meddos.2008.02.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 02/29/2008] [Indexed: 12/16/2022]
Abstract
Studies of organs in the thorax and abdomen have shown that these organs can move as much as 40 mm due to respiratory motion. Without compensation for this motion during the course of external beam radiation therapy, the dose coverage to target may be compromised. On the other hand, if compensation of this motion is by expansion of the margin around the target, a significant volume of normal tissue may be unnecessarily irradiated. In hypofractionated regimens, the issue of respiratory compensation becomes an important factor and is critical in single-fraction extracranial radiosurgery applications. CyberKnife is an image-guided radiosurgery system that consists of a 6-MV LINAC mounted to a robotic arm coupled through a control loop to a digital diagnostic x-ray imaging system. The robotic arm can point the beam anywhere in space with 6 degrees of freedom, without being constrained to a conventional isocenter. The CyberKnife has been recently upgraded with a real-time respiratory tracking and compensation system called Synchrony. Using external markers in conjunction with diagnostic x-ray images, Synchrony helps guide the robotic arm to move the radiation beam in real time such that the beam always remains aligned with the target. With the aid of Synchrony, the tumor motion can be tracked in three-dimensional space, and the motion-induced dosimetric change to target can be minimized with a limited margin. The working principles, advantages, limitations, and our clinical experience with this new technology will be discussed.
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Affiliation(s)
- Cihat Ozhasoglu
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
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Sohn MJ, Lee DJ. Radiosurgery for Spinal Lesions. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Moon-Jun Sohn
- Department of Neurosurgery, Inje University College of Medicine, Korea.
| | - Dong Joon Lee
- Department of Neurosurgery, Inje University College of Medicine, Korea.
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Precision Radiotherapy for Small Animal Research. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2008 2008; 11:619-26. [DOI: 10.1007/978-3-540-85990-1_74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
The introduction of image-guided radiotherapy systems (IGS) allows improved management of geometric variations in patient setup and internal organ motion. Commercially available technologies, based on ultrasound, projection radiography, or cone-beam CT, have been widely adopted in radiation therapy. All rely on the comparison of daily images with reference images of the patient anatomy to ensure coincidence of the treatment and planned isocenters. This article reviews how IGS hardware and software are commissioned for clinical release and what quality control checks are required to ensure consistent and reproducible geometric accuracy. As image guidance significantly modifies conventional radiotherapy processes, recommendations and potential issues are discussed to facilitate the introduction of image guidance into the clinical environment.
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Affiliation(s)
- Jean-Pierre Bissonnette
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto University Health Network, Toronto, Ontario, Canada.
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Hoh DJ, Liu CY, Chen JCT, Pagnini PG, Yu C, Wang MY, Apuzzo MLJ. CHAINED LIGHTNING, PART II. Neurosurgery 2007; 61:433-46; discussion 446. [PMID: 17881954 DOI: 10.1227/01.neu.0000290888.54578.f5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
THE FUNDAMENTAL PRINCIPLE in the radiosurgical treatment of neurological conditions is the delivery of energy to a lesion with minimal injury to surrounding structures. The development of radiosurgical techniques from Leksell's original design has focused on the refinement of various methodologies to achieve energy containment within a target. This article is the second in a series reviewing the evolution of radiosurgical instruments with respect to issues of energy beam generation and delivery for improved conformal therapy.
Continuing with concepts introduced in an earlier article, this article examines specific aspects of beam delivery and the emergence of stereotactic radiosurgery as a measure for focusing energy beams within a target volume. The application of stereotactic principles and devices to gamma ray and linear accelerator-based energy sources provides the methodology by which energy beams are generated and targeted precisely in a focal lesion. Advanced technological systems are reviewed, including fixed beams, dynamic radiosurgery, multileaf collimation, beam shaping, and robotics as various approaches for manipulating beam delivery. Radiosurgical instruments are also compared with regard to mechanics, geometry, and dosimetry. Finally, new radiosurgical designs currently on the horizon are introduced. In exploring the complex history of radiosurgery, it is evident that the discovery and rediscovery of ideas invariably leads to the development of innovative technology for the next generation.
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Affiliation(s)
- Daniel J Hoh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Wurm RE, Gum F, Erbel S, Schlenger L, Scheffler D, Agaoglu D, Schild R, Gebauer B, Rogalla P, Plotkin M, Ocran K, Budach V. Image guided respiratory gated hypofractionated Stereotactic Body Radiation Therapy (H-SBRT) for liver and lung tumors: Initial experience. Acta Oncol 2007; 45:881-9. [PMID: 16982554 DOI: 10.1080/02841860600919233] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To evaluate our initial experience with image guided respiratory gated H-SBRT for liver and lung tumors. The system combines a stereoscopic x-ray imaging system (ExacTrac X-Ray 6D) with a dedicated conformal stereotactic radiosurgery and radiotherapy linear accelerator (Novalis) and ExacTrac Adaptive Gating for dynamic adaptive treatment. Moving targets are located and tracked by x-ray imaging of implanted fiducial markers defined in the treatment planning computed tomography (CT). The marker position is compared with the position in verification stereoscopic x-ray images, using fully automated marker detection software. The required shift for a correct, gated set-up is calculated and automatically applied. We present our acceptance testing and initial experience in patients with liver and lung tumors. For treatment planning CT and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) as well as magnetic resonance imaging (MRI) taken at free breathing and expiration breath hold with internal and external fiducials present were used. Patients were treated with 8-11 consecutive fractions to a dose of 74.8-79.2 Gy. Phantom tests demonstrated targeting accuracy with a moving target to within +/-1 mm. Inter- and intrafractional patient set-up displacements, as corrected by the gated set-up and not detectable by a conventional set-up, were up to 30 mm. Verification imaging to determine target location during treatment showed an average marker position deviation from the expected position of up to 4 mm on real patients. This initial evaluation shows the accuracy of the system and feasibility of image guided real-time respiratory gated H-SBRT for liver and lung tumors.
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Affiliation(s)
- R E Wurm
- Department of Radiation Oncology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany.
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