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Lee S, Mishra S, Watanabe Y. Deep Learning-Based Heterogeneity Correction of the Homogeneous Dose Distribution for Single Brain Tumors in Gamma Knife Radiosurgery. Adv Radiat Oncol 2025; 10:101757. [PMID: 40231287 PMCID: PMC11994306 DOI: 10.1016/j.adro.2025.101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 03/03/2025] [Indexed: 04/16/2025] Open
Abstract
Purpose Heterogeneity correction is vital in radiation therapy treatment planning to ensure accurate dose delivery. Brain cancer stereotactic treatments, like Gamma Knife radiosurgery (GKRS), often rely on homogeneous water-based calculations despite the potential heterogeneity impact near bony structures. This study aims to develop a method for generating synthetic dose plans incorporating heterogeneity effects without additional computed tomography (CT) scans. Methods and Materials Magnetic resonance imaging and CT images, TMR10-based, and convolution-based dose distributions were used from 100 retrospectively collected and 22 prospectively collected GKRS patients. A conditional Generative Adversarial Network was trained to translate TMR10 into synthetic convolution (sConv) doses. Results The generated sConv dose demonstrated qualitative and quantitative similarity to the actual convolution (Conv) dose, showcasing better agreement of dose distributions and improved isodose volume similarity with the Conv dose in comparison to the TMR10 dose (γ pass rate; sConv dose, 92.43%; TMR10 dose, 74.18%. Prescription isodose dice; sConv dose, 91.7%; TMR10 dose, 89.7%). Skull-induced scatter and attenuation effects were accurately reflected in the sConv dose, indicating the usefulness of the new dose prediction model as an alternative to the time-consuming convolution dose calculations. Conclusions Our deep learning approach offers a feasible solution for heterogeneity-corrected dose planning in GKRS, circumventing additional CT scans and lengthy calculation times. This method's effectiveness in preserving dose distribution characteristics in a heterogeneous medium while only requiring a homogeneous dose plan highlights its utility for including the process in the routine treatment planning workflows. Further refinement and validation with diverse patient cohorts can enhance its applicability and impact in clinical settings.
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Affiliation(s)
- Sangyoon Lee
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Shubhendu Mishra
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Yoichi Watanabe
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
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Fager M, Gubanski M, Carlsson Tedgren Å, Benmakhlouf H. Adaptation of dose-prescription for vestibular schwannoma radiosurgery taking body contouring method and heterogeneous material into account. Acta Oncol 2025; 64:319-325. [PMID: 40008908 PMCID: PMC11884334 DOI: 10.2340/1651-226x.2025.41924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/17/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND Majority of vestibular schwannoma (VS) patients have undergone gamma-knife radiosurgery (GKRS) with favorable results. Clinical evidence is derived from doses calculated with a type-a algorithm, which in this case assumes all material to be water. A type-b algorithm (Convolution algorithm [CA]) taking tissue heterogeneity into account is available. Historically, body contour is defined using a 16-point approximation, whereas modern softwares generate the body from Magnetic Resonance Imaging (MRI). The accuracy in dose-calculation algorithms (DCA) and contouring method (CM) will have a significant influence in the relation between clinical outcome and dosimetric data. The objective was to investigate the impact of DCA and CMs on dose distribution while preserving treatment conditions. METHODS Treatment plans for 16 VS patients were recalculated in terms of DCA and CM. The difference in the dose covering 99% of the VS (DVS99%) depending on CM and DCA was estimated. The difference in DVS99% was used to adopt the prescription of new CA-based plans. CA-plans were recalculated to TMR10 to evaluate clinical treatability, as clinical evidence is derived from TMR10-doses. RESULTS Both CM and DCA had a significant impact on the dose to VS and surrounding structures. CM altered the doses homogenously by 2.1-3.3%, whereas DCA heterogeneously by 5.0-10.7%. An increase of 9.1[8.1, 10.0]% was found for DVS99% and the CA-plans recalculated into TMR10 resulted in clinically treatable plans. INTERPRETATION We conclude that transferring to more modern algorithms that take tissue heterogeneity into account heterogeneously alter dose distributions. This work establishes a safe pathway to adopt prescription dose for VS while preserving clinical treatability.
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Affiliation(s)
- Marcus Fager
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden; Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital, Solna, Sweden.
| | - Michael Gubanski
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden; Department of Radiotherapy, Karolinska University Hospital, Solna, Sweden; Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
| | - Åsa Carlsson Tedgren
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden; Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital, Solna, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Hamza Benmakhlouf
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden; Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital, Solna, Sweden; Department of Radiotherapy, Karolinska University Hospital, Solna, Sweden
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Grishchuk D, Dimitriadis A, Sahgal A, De Salles A, Fariselli L, Kotecha R, Levivier M, Ma L, Pollock BE, Regis J, Sheehan J, Suh J, Yomo S, Paddick I. ISRS Technical Guidelines for Stereotactic Radiosurgery: Treatment of Small Brain Metastases (≤1 cm in Diameter). Pract Radiat Oncol 2022; 13:183-194. [PMID: 36435388 DOI: 10.1016/j.prro.2022.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this literature review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus technical guidelines for the treatment of small, ≤1 cm in maximal diameter, intracranial metastases with stereotactic radiosurgery. Although different stereotactic radiosurgery technologies are available, most of them have similar treatment workflows and common technical challenges that are described. METHODS AND MATERIALS A systematic review of the literature published between 2009 and 2020 was performed in Pubmed using the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) methodology. The search terms were limited to those related to radiosurgery of brain metastases and to publications in the English language. RESULTS From 484 collected abstract 37 articles were included into the detailed review and bibliographic analysis. An additional 44 papers were identified as relevant from a search of the references. The 81 papers, including additional 7 international guidelines, were deemed relevant to at least one of five areas that were considered paramount for this report. These areas of technical focus have been employed to structure these guidelines: imaging specifications, target volume delineation and localization practices, use of margins, treatment planning techniques, and patient positioning. CONCLUSION This systematic review has demonstrated that Stereotactic Radiosurgery (SRS) for small (1 cm) brain metastases can be safely performed on both Gamma Knife (GK) and CyberKnife (CK) as well as on modern LINACs, specifically tailored for radiosurgical procedures, However, considerable expertise and resources are required for a program based on the latest evidence for best practice.
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Affiliation(s)
- Diana Grishchuk
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Alexis Dimitriadis
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Antonio De Salles
- Department of Neurosurgery, University of California, Los Angeles, California
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta Milano, Unita di Radiotherapia, Milan, Italy
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Bruce E Pollock
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jean Regis
- Department of Functional Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia, Charlottesville, Virginia
| | - John Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Ian Paddick
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Abstract
There have been advances in both the hardware and software used in GKNS. The first major change in hardware had been Gamma Knife PERFEXION which introduced in 2006 had given more space for treatment, and removed the need for helmets, facilitating the treatment of complex conditions. Gamma Knife ICON was commissioned first in 2017. This has two important changes. It is based on the PERFEXION model, but it is constructed to permit frameless treatments. It also has an attached CBCT apparatus which may be used to define the stereotactic space. The Gamma Knife software has also improved in two important respects. The speedy calculations available to modern computer power has enabled improvements in the accuracy of the determination of intracranial radiation absorption between source and target. The other improvement has been the introduction of inverse treatment planning which continues to be under development.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Ganz JC. Dosimetry. PROGRESS IN BRAIN RESEARCH 2022; 268:9-22. [PMID: 35074097 DOI: 10.1016/bs.pbr.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The dosimeters used to measure radiation dose produce a value which has to be calibrated to be in keeping with the values in an approved laboratory, which will be one of an international network of such laboratories at the center of which is the Bureau International des Poids et Mesures in France (BIPM). Dosimeters work by producing a quantitatively proportional change in status to the intensity of the radiation being measure. Amongst the techniques in use are thermoluminescent devices, radiographic film, radiochromic film, semiconductors, ionization chambers, silicon diodes and gel dosimeters. The Gamma Knife radiation has been difficult to measure directly because the beams have been to fine for accurate measurement by commonly available dosimeters. For more modern dosimeters this is less of a problem. During the treatment of a patient, a variety of indices are recorded to assist in the standardization and accuracy of treatment. Having determined the dose in the beams, it is necessary to calculate how much energy is lost during the passage of radiation from the source to the target. There has been a steady evolution of these calculations to make them more accurate.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Petti PL, Rivard MJ, Alvarez PE, Bednarz G, Daniel Bourland J, DeWerd LA, Drzymala RE, Johansson J, Kunugi K, Ma L, Meltsner SG, Neyman G, Seuntjens JP, Shiu AS, Goetsch SJ. Recommendations on the practice of calibration, dosimetry, and quality assurance for gamma stereotactic radiosurgery: Report of AAPM Task Group 178. Med Phys 2021; 48:e733-e770. [DOI: 10.1002/mp.14831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Paula L. Petti
- Gamma Knife Center Washington Hospital Fremont CA 94538 USA
| | - Mark J. Rivard
- Department of Radiation Oncology Alpert Medical School of Brown University Providence RI 02903 USA
| | - Paola E. Alvarez
- Radiological Physics Center University of Texas MD Anderson Cancer Center Houston TX 77054 USA
| | - Greg Bednarz
- Department of Radiation Oncology University of Pittsburgh Medical Center Pittsburgh PA 15232 USA
| | - J. Daniel Bourland
- Department of Radiation Oncology Wake Forest University Winston‐Salem NC 27157 USA
| | - Larry A. DeWerd
- Accredited Dosimetry and Calibration Laboratory University of Wisconsin Madison WI 53705 USA
| | - Robert E. Drzymala
- Department of Radiation Oncology Washington University Saint Louis MO 63119 USA
| | | | - Keith Kunugi
- Accredited Dosimetry and Calibration Laboratory University of Wisconsin Madison WI 53705 USA
| | - Lijun Ma
- Department of Radiation Oncology University California–San Francisco San Francisco CA 94143 USA
| | - Sheridan G. Meltsner
- Department of Radiation Oncology Duke University Medical Center Durham NC 27713 USA
| | - Gennady Neyman
- Department of Radiation Oncology The Cleveland Clinic Cleveland OH 44195 USA
| | - Jan P. Seuntjens
- Department of Medical Physics McGill University Montreal QC H4A3J1 Canada
| | - Almon S. Shiu
- Department of Radiation Oncology University of Southern California Los Angeles CA 90033 USA
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Antończyk-Szewczyk K, Kozłowska B. Analysis of treatment planning parameters in the Gamma Knife® technique for different prescription isodoses and volumes of meningiomas. Appl Radiat Isot 2021; 172:109653. [PMID: 33735825 DOI: 10.1016/j.apradiso.2021.109653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
The following Indexes: Homogeneity, Gradient, Conformity, Paddick Conformity and New Conformity of the dose distribution were compared. The parameters to assess a high dose to the organs at risk: V10/TV, V90%/TV and the Integral Dose were discussed. The higher the prescription isodose, the more uniform the dose distribution in the target, which is highly beneficial in the case of larger tumor sizes due to the lower risk of complications. For smaller tumors, higher dose heterogeneity is desirable. This can be obtained with a 40% prescription isodose.
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Affiliation(s)
- K Antończyk-Szewczyk
- University of Silesia in Katowice, August Chełkowski Institute of Physics, 75 Pułku Piechoty 1, 41-500, Chorzów, Poland; University Clinical Center prof. K. Gibińskiego Medical University of Silesia in Katowice, Exira Gamma Knife, Ceglana 35, 40-514, Katowice, Poland.
| | - B Kozłowska
- University of Silesia in Katowice, August Chełkowski Institute of Physics, 75 Pułku Piechoty 1, 41-500, Chorzów, Poland.
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Peters GW, Tien CJ, Chiang V, Yu J, Hansen JE, Aneja S. Impact of tissue heterogeneity correction on Gamma Knife stereotactic radiosurgery of acoustic neuromas. JOURNAL OF RADIOSURGERY AND SBRT 2021; 7:207-212. [PMID: 33898084 PMCID: PMC8055239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE/OBJECTIVES Treatment planning systems (TPS) for Gamma Knife stereotactic radiosurgery (GK-SRS) include TMR10 algorithms, which assumes tissue homogeneity equivalent to water, and collapsed-cone convolutional (CCC) algorithms, which accounts for tissue inhomogeneity. This study investigated dosimetric differences between TMR10 and CCC TPS for acoustic neuromas (ANs) treated with GK-SRS. MATERIALS/METHODS A retrospective review of 56 AN treated with GK-SRS was performed. All patients underwent MRI and CT imaging during their initial treatment and were planned using TMR10. Each plan was recalculated with CCC using electron density extracted from CT. Parameters of interest included Dmax, Dmin, D50%, cochlea Dmax, mean cochlea dose, target size, and laterality (>20 mm from central axis). RESULTS Median target volume of patients was 1.5 cc (0.3 cc-2.8 cc) with median dose of 12 Gy prescribed to the 50% isodose line. Compared to CCC algorithms, the TMR10 calculated dose was higher: Dmax was higher by an average 6.2% (p < 0.001), Dmin was higher by an average 3.1% (p < 0.032), D50% was higher by an average of 11.3%. For lateralized targets, calculated Dmax and D50% were higher by 7.1% (p < 0.001) and 10.6% (p < 0.001), respectively. For targets <1 cc, Dmax and D50% were higher by 8.9% (p ≤ 0.009) and 12.1% (p ≤ 0.001), respectively. Cochlea Dmax was higher, by an average of 20.1% (p < 0.001). CONCLUSION There was a statistically significant dosimetric differences observed between TMR10 and CCC algorithms for AN GK-SRS, particularly in small and lateralized ANs. It may be important to note these differences when relating GK-SRS with standard heterogeneity-corrected SRS regimens.
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Affiliation(s)
- Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Christopher J Tien
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Veronica Chiang
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - James Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - James E. Hansen
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Sanjay Aneja
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA
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Leroy HA, Tuleasca C, Zeverino M, Drumez E, Reyns N, Levivier M. Impact of the skull contour definition on Leksell Gamma Knife ® Icon™ radiosurgery treatment planning. Acta Neurochir (Wien) 2020; 162:2203-2210. [PMID: 32556528 DOI: 10.1007/s00701-020-04458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Gamma Knife® planning software (TMR 10, Elekta Instruments, AB, Sweden) affords two ways of defining the skull volume, the "historical" one using manual measurements (still perform in some centers) and the new one using image-based skull contours. Our objective was to assess the potential variation of the dose delivery calculation using consecutively in the same patients the two above-mentioned techniques. MATERIALS AND METHODS We included in this self-case-control study, 50 patients, treated with GKRS between July 2016 and January 2017 in Lausanne University Hospital, Switzerland, distributed among four groups: convexity targets (n = 18), deep-seated targets (n = 13), vestibular schwannomas (n = 11), and trigeminal neuralgias (n = 8). Each planning was performed consecutively with the 2 skull definition techniques. For each treatment, we recorded the beam-on time (min), target volume coverage (%), prescription isodose volume (cm3), and maximal dose (Gy) to the nearest organ at risk if relevant, according to each of the 2 skull definition techniques. The image-based contours were performed using CT scan segmentation, based upon a standardized windowing for all patients. RESULTS The median difference in beam-on time between manual measures and image-based contouring was + 0.45 min (IQR; 0.2-0.6) and was statistically significant (p < 0.0001), corresponding to an increase of 1.28% beam-on time per treatment, when using image-based contouring. The target location was not associated with beam-on time variation (p = 0.15). Regarding target volume coverage (p = 0.13), prescription isodose volume (p = 0.2), and maximal dose to organs at risk (p = 0.85), no statistical difference was reported between the two skull contour definition techniques. CONCLUSION The beam-on time significantly increased using image-based contouring, resulting in an increase of the total dose delivery per treatment with the new TMR 10 algorithm. Other dosimetric parameters did not differ significantly. This raises the question of other potential impacts. One is potential dose modulation that should be performed as an adjustment to new techniques developments. The second is how this changes the biologically equivalent dose per case, as related to an increased beam on time, delivered dose, etc., and how this potentially changes the radiobiological effects of GKRS in an individual patient.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France.
- U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Univ. Lille, Inserm, CHU Lille, F-59000, Lille, France.
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Faculté de Médecine, Sorbonne Université, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Paris, France
| | - Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Elodie Drumez
- Univ. Lille, Department of Neurosurgery, CHU Lille, F-59000, Lille, France
| | - Nicolas Reyns
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France
- U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Univ. Lille, Inserm, CHU Lille, F-59000, Lille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland
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Han EY, Diagaradjane P, Luo D, Ding Y, Kalaitzakis G, Zoros E, Zourari K, Boursianis T, Pappas E, Wen Z, Wang J, Briere TM. Validation of PTV margin for Gamma Knife Icon frameless treatment using a PseudoPatient® Prime anthropomorphic phantom. J Appl Clin Med Phys 2020; 21:278-285. [PMID: 32786141 PMCID: PMC7497928 DOI: 10.1002/acm2.12997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
The Gamma Knife Icon allows the treatment of brain tumors mask-based single-fraction or fractionated treatment schemes. In clinic, uniform axial expansion of 1 mm around the gross tumor volume (GTV) and a 1.5 mm expansion in the superior and inferior directions are used to generate the planning target volume (PTV). The purpose of the study was to validate this margin scheme with two clinical scenarios: (a) the patient's head remaining right below the high-definition motion management (HDMM) threshold, and (b) frequent treatment interruptions followed by plan adaptation induced by large pitch head motion. A remote-controlled head assembly was used to control the motion of a PseudoPatient® Prime head phantom; for dosimetric evaluations, an ionization chamber, EBT3 films, and polymer gels were used. These measurements were compared with those from the Gamma Knife plan. For the absolute dose measurements using an ionization chamber, the percentage differences for both targets were less than 3.0% for all scenarios, which was within the expected tolerance. For the film measurements, the two-dimensional (2D) gamma index with a 2%/2 mm criterion showed the passing rates of ≥87% in all scenarios except the scenario 1. The results of Gel measurements showed that GTV (D100 ) was covered by the prescription dose and PTV (D95 ) was well above the planned dose by up to 5.6% and the largest geometric PTV offset was 0.8 mm for all scenarios. In conclusion, the current margin scheme with HDMM setting is adequate for a typical patient's intrafractional motion.
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Affiliation(s)
- Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parmeswaran Diagaradjane
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Emmanouil Zoros
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Zourari
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Pappas
- Department of Biomedical Sciences, Radiology & Radiotherapy Sector, University of West Attica, Athens, Greece
| | - Zhifei Wen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Marie Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Multi-institutional dosimetric delivery assessment of intracranial stereotactic radiosurgery on different treatment platforms. Radiother Oncol 2020; 147:153-161. [DOI: 10.1016/j.radonc.2020.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022]
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Logothetis A, Pantelis E, Zoros E, Pappas EP, Dimitriadis A, Paddick I, Garding J, Johansson J, Kollias G, Karaiskos P. Dosimetric evaluation of the Leksell GammaPlan ™ Convolution dose calculation algorithm. Phys Med Biol 2020; 65:045011. [PMID: 31860889 DOI: 10.1088/1361-6560/ab64b7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The dosimetric accuracy of the Leksell GammaPlan Convolution calculation algorithm was evaluated through comparison with corresponding Monte Carlo (MC) dosimetric results. MC simulations were based on generated sector phase space files for the 4 mm, 8 mm and 16 mm collimator sizes, using a previous comprehensive Gamma Knife Perfexion™ source model and validated using film dosimetry. Test cases were designed for the evaluation of the Convolution algorithm involving irradiation of homogeneous and inhomogeneous phantom geometries mimicking clinical cases, with radiation fields created using one sector (single sector), all sectors with the same (single shot) or different (composite shot) collimator sizes. Dose calculations using the Convolution algorithm were found to be in excellent agreement (gamma pass rate greater than 98%, applying 1%/1 mm local dose difference and distance agreement criteria), with corresponding MC calculations, indicating the accuracy of the Convolution algorithm in homogeneous and heterogeneous model geometries. While of minor clinical importance, large deviations were observed for the voxels laying inside air media. The calculated beam on times using the Convolution algorithm were found to increase (up to 7%) relative to the TMR 10 algorithm currently used in clinical practice, especially in a test case mimicking a brain metastasis close to the skull, in excellent agreement with corresponding MC calculations.
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Affiliation(s)
- A Logothetis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Duggar WN, He R, Bhandari R, Kanakamedala M, Morris B, Rey-Dios R, Vijayakumar S, Yang CC. Considering inhomogeneities in Gamma Knife treatment planning: Factors affecting the loss of prescription dose coverage †. JOURNAL OF RADIOSURGERY AND SBRT 2020; 6:303-310. [PMID: 32185090 PMCID: PMC7065893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECT To compare the consistency of the agreement between the Convolution and TMR10 algorithms using a homogeneous phantom and to identify target characteristics that lead to large changes in target isodose coverage when the Convolution algorithm is used in GammaPlan as opposed to the TMR10 algorithm. METHODS The IROC phantom end-to-end test was performed and RTDose for both the TMR10 and Convolution algorithm were submitted for comparison to the measurement. Treatment plans for 16 patients and 26 different targets were retrospectively re-calculated with the Convolution algorithm when originally planned with the TMR10 algorithm. Multivariate regression was used to find statistically significant predictors of loss in target prescription isodose coverage. RESULTS Both algorithms agreed well with the IROC TLD measurement (within 1 %) and slightly better agreement was seen in the film analysis for the Convolution algorithm. After multivariate regression, small target volumes, < 1cm from air cavity, and minimum dose to target were potential predictors of large percentage loss of prescription isodose coverage (p = 0.049, 0.026, and 0.002, respectively). CONCLUSION Convolution and TMR10 appear to be equivalent in homogeneous situations. Some target characteristics have been identified that might be indications for use of the Convolution algorithm in clinical practice.
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Affiliation(s)
- William N Duggar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rui He
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rahul Bhandari
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Madhava Kanakamedala
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bart Morris
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Claus Chunli Yang
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
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O'Connor KP, Algan O, Vesely SK, Palejwala AH, Briggs RG, Conner AK, Cornwell BO, Andrews B, Sughrue ME, Glenn CA. Factors Associated with Treatment Failure and Radiosurgery-Related Edema in WHO Grade 1 and 2 Meningioma Patients Receiving Gamma Knife Radiosurgery. World Neurosurg 2019; 130:e558-e565. [PMID: 31299310 DOI: 10.1016/j.wneu.2019.06.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Before the advent of radiosurgery, neurosurgical treatment of meningiomas typically involved gross total resection of the mass whenever surgery was deemed possible. Over the past 4 decades, though, Gamma Knife radiosurgery (GKRS) has proved to be an effective, minimally invasive means to control the growth of these tumors. However, the variables associated with treatment failure (regrowth or clinical progression) after GKRS and GKRS-related complications, such as cerebral edema, are less well understood. METHODS We retrospectively collected data between 2009 and 2018 for patients who underwent GKRS for meningiomas. After data collection, we performed univariate and multivariable modeling of the factors that predict treatment failure and cerebral edema after GKRS. Hazard ratios (HR) and P values were determined for these variables. RESULTS Fifty-two patients were included our analysis. The majority of patients were female (38/52,73%), and nearly all patients presented with a suspected or confirmed World Health Organization grade 1 meningioma (48/52, 92%). The median tumor volume was 3.49 cc (range, 0.22-20.11 cc). Evidence of meningioma progression after treatment developed in 5 patients (10%), with a median time to continued tumor growth of 5.9 months (range, 2.7-18.3 months). In multivariable analysis, patients in whom treatment failed were more likely to be male (HR = 8.42, P = 0.045) and to present with larger tumor volumes (HR = 1.27, P = 0.011). In addition, 5 patients (10%) experienced treatment-related cerebral edema. On univariate analysis, patients who experienced cerebral edema were more likely present with larger tumors (HR = 1.16, P = 0.028). CONCLUSIONS Increasing meningioma size and male gender predispose to meningioma progression after treatment with GKRS. Increasing tumor size also predicts the development of postradiosurgery cerebral edema.
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Affiliation(s)
- Kyle P O'Connor
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ozer Algan
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew K Conner
- University of California San Francisco, San Francisco, California, USA
| | - Benjamin O Cornwell
- Department of Neuroradiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bethany Andrews
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael E Sughrue
- Department of Neurosurgery, Prince of Wales Private Hospital, New South Wales, Australia
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Dosimetric comparison of TMR10 and convolution dose calculation algorithms in GammaPlan treatment planning system. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAims:In this article, our goal is to compare the TMR10 and convolution dose calculation algorithm in GammaPlan used in stereotactic radiosurgery (SRS) treatments with Gamma Knife and to assess if the algorithms produce clinically significant differences.Materials and methods:Treatment plans were analysed from ten patients who have undergone Gamma Knife SRS treatments. Patient plans were retrospectively recalculated using Lesksell GammaPlan 10 treatment software utilising the TMR10 and convolution dose calculation algorithms in order to create a paired dataset for comparison. Evaluation was based on the dose volume histogram (parameters of minimum, mean, maximum and integral doses.Results:The ratios of average integral doses calculated by the convolution dose calculation algorithm to the average integral doses calculated by the TMR10 algorithm are 0·997 for the target (p=0·028), 1·048 (p=0·48) for the skull and 1·005 (p=0·68) for the brainstem.Conclusions:Although doses calculated with the convolution algorithm resulted in slightly higher mean integral doses for the brainstem and skull critical structures when compared to that of TMR10 doses, these results were not statistically or clinically significant. Thus we continue to use the TMR10 algorithm at our clinic.
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Independent dose validation system for Gamma Knife radiosurgery, using a DICOM-RT interface and Geant4. Phys Med 2018; 51:117-124. [PMID: 29914795 DOI: 10.1016/j.ejmp.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/21/2022] Open
Abstract
Leksell GammaPlan was specifically designed for Gamma Knife (GK) radiosurgery planning, but it has limited accuracy for estimating the dose distribution in inhomogeneous areas, such as the embolization of arteriovenous malformations. We aimed to develop an independent patient dose validation system based on a patient-specific model, constructed using a DICOM-RT interface and the Geant4 toolkit. Leksell Gamma Knife Perfexion was designed in Geant4.10.00 and includes a DICOM-RT interface. Output factors for each collimator in a sector and dose distributions in a spherical water phantom calculated using a Monte Carlo (MC) algorithm were compared with the output factors calculated by the tissue maximum ratio (TMR) 10 algorithm and dose distributions measured using film, respectively. Studies using two types of water phantom and two patient simulation cases were evaluated by comparing the dose distributions calculated by the MC, the TMR and the convolution algorithms. The water phantom studies showed that if the beam size is small and the target is located in heterogeneous media, the dose difference could be up to 11%. In the two patient simulations, the TMR algorithm overestimated the dose by about 4% of the maximum dose if a complex and large bony structure was located on the beam path, whereas the convolution algorithm showed similar results to those of the MC algorithm. This study demonstrated that the in-house system could accurately verify the patient dose based on full MC simulation and so would be useful for patient cases where the dose differences are suspected.
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Fallows P, Wright G, Harrold N, Bownes P. A comparison of the convolution and TMR10 treatment planning algorithms for Gamma Knife ® radiosurgery. JOURNAL OF RADIOSURGERY AND SBRT 2018; 5:157-167. [PMID: 29657896 PMCID: PMC5893456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/25/2017] [Indexed: 06/08/2023]
Abstract
AIMS To compare the accuracies of the convolution and TMR10 Gamma Knife treatment planning algorithms, and assess the impact upon clinical practice of implementing convolution-based treatment planning. METHODS Doses calculated by both algorithms were compared against ionisation chamber measurements in homogeneous and heterogeneous phantoms. Relative dose distributions calculated by both algorithms were compared against film-derived 2D isodose plots in a heterogeneous phantom, with distance-to-agreement (DTA) measured at the 80%, 50% and 20% isodose levels. A retrospective planning study compared 19 clinically acceptable metastasis convolution plans against TMR10 plans with matched shot times, allowing novel comparison of true dosimetric parameters rather than total beam-on-time. Gamma analysis and dose-difference analysis were performed on each pair of dose distributions. RESULTS Both algorithms matched point dose measurement within ±1.1% in homogeneous conditions. Convolution provided superior point-dose accuracy in the heterogeneous phantom (-1.1% v 4.0%), with no discernible differences in relative dose distribution accuracy. In our study convolution-calculated plans yielded D99% 6.4% (95% CI:5.5%-7.3%,p<0.001) less than shot matched TMR10 plans. For gamma passing criteria 1%/1mm, 16% of targets had passing rates >95%. The range of dose differences in the targets was 0.2-4.6Gy. CONCLUSIONS Convolution provides superior accuracy versus TMR10 in heterogeneous conditions. Implementing convolution would result in increased target doses therefore its implementation may require a revaluation of prescription doses.
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Affiliation(s)
- Peter Fallows
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Gavin Wright
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Natalie Harrold
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Peter Bownes
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, United Kingdom
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Choi HJ, Sohn JW, Chung HT, Kim TH, Min CH. Abstract ID: 157 Development of Geant4-based patient-specific QA system of gamma knife treatment plans using automated DICOM-RT interface. Phys Med 2017. [DOI: 10.1016/j.ejmp.2017.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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