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Kang CL, Huang YY, Chen YR, Tsai SH, Huang CC, Huang YJ. Patient Cranial Angle and Intrafractional Stability in CyberKnife Robotic Radiosurgery: A Retrospective Analysis. Technol Cancer Res Treat 2024; 23:15330338241235058. [PMID: 38460959 PMCID: PMC10924736 DOI: 10.1177/15330338241235058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/11/2024] Open
Abstract
Purpose: The aim of this study was to investigate whether variations in cranial angles and treatment accuracy during CyberKnife robotic radiosurgery necessitate adjustment of the margins of the planning target volume. Patients and Methods: Data from 66 patients receiving CyberKnife treatment for brain tumors were retrospectively analyzed. Patients were immobilized using a thermoplastic mask and headrest. The cranial angle was measured on planning CT and patients were divided into 2 groups: ≤10° (Group A) and >10° (Group B). Intrafractional motion was recorded using the CyberKnife tracking system over 50 min. Translational and rotational errors were compared between groups, and planning target volume margins were calculated. Results: In Group A, significant translational error differences were found along with the X-axis over time (P < .02). In Group B, significant differences occurred along with the Z-axis (P < .03). No significant rotational or 3-dimensional vector differences were found in either group. Group A had significantly lower Y-axis (P < .045) and roll axis (P < .005) errors compared to Group B. Estimated planning target volume margins in Group A were 0.56 mm (X), 0.46 mm (Y), and 0.47 mm (Z). In Group B, margins were 0.62 mm (X), 0.48 mm (Y), and 0.46 mm (Z). Margins covering 95% of intrafraction motion were 0.49 to 0.50 mm (X, Y, Z) and 0.69 mm (3-dimensional vector) for Group A, and 0.48 to 0.60 mm and 0.79 mm for Group B. With a 1-mm margin, complete coverage was achieved in Group A while 2.1% of vectors in Group B exceeded 1 mm. Conclusion: Adjusting cranial angle to ≤10° during thermoplastic mask molding provided better or similar intrafractional stability compared to >10°.
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Affiliation(s)
- Chen-Lin Kang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Ya-Yu Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ren Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Huei Tsai
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Kon M, Okamoto H, Nakamura S, Iijima K, Chiba T, Takemori M, Nakayama H, Nakaichi T, Mikasa S, Fujii K, Urago Y, Ishikawa M, Sofue T, Katsuta S, Inaba K, Igaki H, Aso T. Planning study: prone versus supine position for stereotactic body radiotherapy in prostate by CyberKnife. JOURNAL OF RADIATION RESEARCH 2023; 64:186-194. [PMID: 36316958 PMCID: PMC9855311 DOI: 10.1093/jrr/rrac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/30/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to clarify the differences in radiotherapy dose characteristics and delivery efficiency between the supine and prone positions in patients with prostate cancer using the CyberKnife. The planning computed tomography (CT) and delineations of the prone position were obtained by rotating the supine CT images with delineations of 180° using image processing software. The optimization parameters for planning target volume (PTV) and organs at risk (OARs) were based on the prone position. The optimization parameters determined for the prone position were applied to the supine position for optimization and dose calculation. The dosimetric characteristics of the PTV and OARs, and delivery efficiency were compared between the two different patient positions. The plans in the prone position resulted in better PTV conformity index (nCI), rectum V90%, V80%, V75%, V50% and bladder V50%. A significant difference was observed in treatment time and depth along the central axis (dCAX) between the two plans. The mean treatment time per fraction and dCAX for the supine and prone positions were 20.9 ± 1.7 min versus 19.8 ± 1.3 min (P = 0.019) and 151.1 ± 33.6 mm versus 233.2 ± 8.8 mm (P < 0.001), respectively. In this study the prone position was found to improve dosimetric characteristics and delivery efficiency compared with the supine position during prostate cancer treatment with the CyberKnife.
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Affiliation(s)
- Mitsuhiro Kon
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Hiroyuki Okamoto
- Corresponding author. Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan 104-0045, Tokyo, Japan. Tel: +81(3)3542-2511; Fax: +81(3)3545-3567;
| | - Satoshi Nakamura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Kotaro Iijima
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Takahito Chiba
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Mihiro Takemori
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Hiroki Nakayama
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Tetsu Nakaichi
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Shohei Mikasa
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Kyohei Fujii
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Yuka Urago
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Masayori Ishikawa
- Faculty of Health Sciences, Hokkaido University, North12, West5, Kita-ku, Sapporo, Hokkaido 060-0812, Japan
| | - Toshimitsu Sofue
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Shoichi Katsuta
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Tomohiko Aso
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
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Goc B, Roch-Zniszczoł A, Larysz D, Zarudzki Ł, Stąpór-Fudzińska M, Rożek A, Woźniak G, Boczarska-Jedynak M, Miszczyk L, Napieralska A. The Effectiveness and Toxicity of Frameless CyberKnife Based Radiosurgery for Parkinson's Disease-Phase II Study. Biomedicines 2023; 11:biomedicines11020288. [PMID: 36830825 PMCID: PMC9952894 DOI: 10.3390/biomedicines11020288] [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: 12/15/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Frame-based stereotactic radiosurgery (SRS) has an established role in the treatment of tremor in patients with Parkinson's disease (PD). The low numbers of studies of frameless approaches led to our prospective phase 2 open-label single-arm clinical trial (NCT02406105), which aimed to evaluate the safety and efficacy of CyberKnife frameless SRS. Twenty-three PD patients were irradiated on the area of the thalamic ventral nuclei complex with gradually increasing doses of 70 to 105 Gy delivered in a single fraction. After SRS, patients were monitored for tremor severity and the toxicity of the treatment. Both subjective improvement and dose-dependent efficacy were analysed using standard statistical tests. The median follow-up was 23 months, and one patient died after COVID-19 infection. Another two patients were lost from follow-up. Hyper-response resulting in vascular toxicity and neurologic complications was observed in two patients irradiated with doses of 95 and 100 Gy, respectively. A reduction in tremor severity was observed in fifteen patients, and six experienced stagnation. A constant response during the whole follow-up was observed in 67% patients. A longer median response time was achieved in patients irradiated with doses equal to or less than 85 Gy. Only two patients declared no improvement after SRS. The efficacy of frameless SRS is high and could improve tremor control in a majority of patients. The complication rate is low, especially when doses below 90 Gy are applied. Frameless SRS could be offered as an alternative for patients ineligible for deep brain stimulation; however, studies regarding optimal dose are required.
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Affiliation(s)
- Bartłomiej Goc
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Agata Roch-Zniszczoł
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Dawid Larysz
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland
| | - Łukasz Zarudzki
- Department of Radiology and Diagnostic Imaging, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Małgorzata Stąpór-Fudzińska
- Department of Radiotherapy Planning, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Agnieszka Rożek
- “Kangur” Centre for Treatment of CNS Disorders and Child Development Support in Katowice, 40-594 Katowice, Poland
| | - Grzegorz Woźniak
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Magdalena Boczarska-Jedynak
- Neurology and Restorative Medicine Department, Health Institute dr Boczarska-Jedynak, 32-600 Oświęcim, Poland
| | - Leszek Miszczyk
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Napieralska
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
- Correspondence:
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Nakano H, Takizawa T, Kawahara D, Tanabe S, Utsunomiya S, Kaidu M, Maruyama K, Takeuchi S, Onda K, Koizumi M, Nishio T, Ishikawa H. Radiobiological evaluation considering the treatment time with stereotactic radiosurgery for brain metastases. BJR Open 2022; 4:20220013. [PMID: 38525167 PMCID: PMC10958663 DOI: 10.1259/bjro.20220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We evaluated the radiobiological effect of the irradiation time with the interruption time of stereotactic radiosurgery (SRS) using CyberKnife® (CK) systemfor brain metastases. Methods We used the DICOM data and irradiation log file of the 10 patients with brain metastases from non-small-cell lung cancer (NSCLC) who underwent brain SRS. We defined the treatment time as the sum of the dose-delivery time and the interruption time during irradiations, and we used a microdosimetric kinetic model (MKM) to evaluate the radiobiological effects of the treatment time. The biological parameters, i.e. α0, β0, and the DNA repair constant rate (a + c), were acquired from NCI-H460 cell for the MKM. We calculated the radiobiological dose for the gross tumor volume (GTVbio) to evaluate the treatment time's effect compared with no treatment time as a reference. The D95 (%) and the Radiation Therapy Oncology Group conformity index (RCI) and Paddick conformity index (PCI) were calculated as dosimetric indices. We used several DNA repair constant rates (a + c) (0.46, 1.0, and 2.0) to assess the radiobiological effect by varying the DNA repair date (a + c) values. Results The mean values of D95 (%), RCI, and PCI for GTVbio were 98.8%, 0.90, and 0.80, respectively, and decreased with increasing treatment time. The mean values of D95 (%), RCI, and PCI of GTVbio at 2.0 (a+c) value were 94.9%, 0.71, and 0.49, respectively. Conclusion The radiobiological effect of the treatment time on tumors was accurately evaluated with brain SRS using CK. Advances in knowledge There has been no published investigation of the radiobiological impact of the longer treatment time with multiple interruptions of SRS using a CK on the target dose distribution in a comparison with the use of a linac. Radiobiological dose assessment that takes into account treatment time in the physical dose in this study may allow more accurate dose assessment in SRS for metastatic brain tumors using CK.
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Affiliation(s)
| | | | - Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, Japan
| | - Katsuya Maruyama
- Department of Radiation Oncology, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-ku, Niigata-shi, Niigata, Japan
| | - Shigekazu Takeuchi
- Department of Neurosurgery, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-ku, Niigata-shi, Niigata, Japan
| | - Kiyoshi Onda
- Department of Neurosurgery, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-ku, Niigata-shi, Niigata, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-shi, Osaka, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-shi, Osaka, Japan
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, Japan
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Zhang J, Wang L, Xu B, Huang M, Chen Y, Li X. Influence of Using a Contrast-Enhanced CT Image as the Primary Image on CyberKnife Brain Radiosurgery Treatment Plans. Front Oncol 2021; 11:705905. [PMID: 34604041 PMCID: PMC8483719 DOI: 10.3389/fonc.2021.705905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study aimed to quantify the differences between pre- and post-contrast agent (CA) CT for CyberKnife brain SRS plans. Materials and Methods Twenty-five patients were retrospectively analyzed. They were divided into two categories, inhomogeneous cases (13 patients) and homogeneous cases (12 patients), according to whether the tumor was close to the cavity and inhomogeneous tissues or not. The pre-CA and post-CA plans were designed and calculated using the same monitor unit and paths as those in the ray-tracing algorithm, respectively. Results The CT number difference of tumor between pre- and post-CA was significant (on average, 24.78 ± 18.56 HU, P-value < 0.01). The deviation value of the target was the largest at approximately 37 HU (inhomo-) and 13 HU (homo-) (P < 0.01), and the values of the organs at risk (OARs) were not statistically significant (P-value > 0.05). However, it was not statistically significant for the dose difference between the two groups with the injection of CA (P-value > 0.05). The absolute effective depth difference generally remained at a level of 1 mm, but the dose difference was quitely fluctuated sometimes more than 20%. The absolute effective depth difference of the inhomo-case (0.62 mm) was larger than that of the homo-case (0.37 mm) on median, as well as the variation amplitude (P-value < 0.05). Moreover, the relative dose differences between the two cases were 0.38% (inhomo-) and 0.2% (homo-), respectively (P-value < 0.05). At the criterion of 1 mm/1%, the gamma pass rate of the homo-case (95.89%) was larger than that of the inhomo-case (93.79%). For the OARs, except for the cochlea, the two cases were almost the same (>98.85%). The tumor control probability of the target was over 99.99% before and after injection of a CA, as well as the results for the homo-case and inhomo-case. Conclusions Considering the difference of evaluation indexes between pre- and post-CA images, we recommended plain CT to be employed as the primary image for improving the CK treatment accuracy of brain SRS, especially when the target was close to CA-sensitive OARs and cavity.
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Affiliation(s)
- Jianping Zhang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Lin Wang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Miaoyun Huang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Yuangui Chen
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaobo Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
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Inata H, Tominaga M, Sasaki M, Kuribayashi Y, Sodeoka N, Katakami A, Nishizaki O. Estimation of imaging intervals and intra-fraction displacement in CyberKnife image-guided radiotherapy for intracranial lesions. Med Phys 2021; 48:7580-7589. [PMID: 34388854 DOI: 10.1002/mp.15169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/20/2021] [Accepted: 08/29/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE A recent report by the American Association of Physicists in Medicine Task Group 75 and 180 provided imaging dose estimates for image-guided CyberKnife radiotherapy. However, to our knowledge, there have been no concrete demonstrations of imaging intervals that are directly linked to exposure dose. We hypothesized that setting a rational standard may be clearer through a balance of treatment accuracy and reducing imaging doses if the margin of the planned treatment volume is controlled through the imaging interval. This study was conducted to simulate the association between the imaging interval and intra-fraction displacement and to estimate a reasonable internal margin (IM). METHODS We retrospectively analyzed data from 21 shell-fixed heads of patients treated with CyberKnife G3 using our dedicated monitoring system. This system comprises pressure sensors that can monitor head displacement every 0.2 s in the absence of any imaging dose. First, the root sum square of head displacements was calculated in 76 treatment fractions with an imaging interval of 10-1440 s. The cumulative frequency of a root sum square displacement (that was less than the IM) was evaluated in image verifications that were undertaken 546,274 times for every imaging interval. RESULTS We found that the mean values and standard deviations (SD) of the displacement were larger in proportion to the imaging interval (p<0.002) and that the maximum displacements did not correlate in any combination within 720 s (p>0.056). The cumulative frequencies of displacement of 0.6 and 1.4 mm (i.e., less than an IM) were 99.2% and 99.1% for imaging intervals of 10 and 360 s, respectively. CONCLUSIONS In the current study, we found that imaging intervals were directly proportional to intra-fraction displacement and that there was no correlation in any combination within 720 s. Imaging intervals for an IM of 0.6 mm and 1.4 mm were 10 s and 360 s, respectively, with a 99% confidence interval of intra-fraction displacement. With CyberKnife M6 or a previous version of this system, the imaging dose could be reduced by 0.4760 mSv per 24-minute treatment as the imaging dose ranged from 0.4896 to 0.0136 mSv for imaging intervals of 10 and 360 s with an IM of 0.6 and 1.4 mm, respectively. A rational method that includes X-ray imaging guidance may be achieved with modulation of the imaging interval via the CyberKnife system. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hiroki Inata
- Department of Radiology, Saiseikai Imabari Hospital, Ehime, Japan
| | | | | | - Yuta Kuribayashi
- Department of Radiology, Saiseikai Imabari Hospital, Ehime, Japan
| | - Noritaka Sodeoka
- Department of Radiology, Saiseikai Imabari Hospital, Ehime, Japan
| | - Azusa Katakami
- Department of Radiology, Saiseikai Imabari Hospital, Ehime, Japan
| | - Osamu Nishizaki
- Department of Neurosurgery, Saiseikai Imabari Hospital, Ehime, Japan
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Sagawa T, Ohira S, Ueda Y, Akino Y, Mizuno H, Matsumoto M, Miyazaki M, Koizumi M, Teshima T. Dosimetric effect of rotational setup errors in stereotactic radiosurgery with HyperArc for single and multiple brain metastases. J Appl Clin Med Phys 2019; 20:84-91. [PMID: 31507075 PMCID: PMC6806481 DOI: 10.1002/acm2.12716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose In stereotactic radiosurgery (SRS) with single‐isocentric treatments for brain metastases, rotational setup errors may cause considerable dosimetric effects. We assessed the dosimetric effects on HyperArc plans for single and multiple metastases. Methods For 29 patients (1–8 brain metastases), HyperArc plans with a prescription dose of 20–24 Gy for a dose that covers 95% (D95%) of the planning target volume (PTV) were retrospectively generated (Ref‐plan). Subsequently, the computed tomography (CT) used for the Ref‐plan and cone‐beam CT acquired during treatments (Rot‐CT) were registered. The HyperArc plans involving rotational setup errors (Rot‐plan) were generated by re‐calculating doses based on the Rot‐CT. The dosimetric parameters between the two plans were compared. Results The dosimetric parameters [D99%, D95%, D1%, homogeneity index, and conformity index (CI)] for the single‐metastasis cases were comparable (P > 0.05), whereas the D95% for each PTV of the Rot‐plan decreased 10.8% on average, and the CI of the Rot‐plan was also significantly lower than that of the Ref‐plan (Ref‐plan vs Rot‐plan, 0.93 ± 0.02 vs 0.75 ± 0.14, P < 0.01) for the multiple‐metastases cases. In addition, for the multiple‐metastases cases, the Rot‐plan resulted in significantly higher V10Gy (P = 0.01), V12Gy (P = 0.02), V14Gy (P = 0.02), and V16Gy (P < 0.01) than those in the Ref‐plan. Conclusion The rotational setup errors for multiple brain metastases cases caused non‐negligible underdosage for PTV and significant increases of V10Gy to V16Gy in SRS with HyperArc.
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Affiliation(s)
- Tomohiro Sagawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuichi Akino
- Division of Medical Physics, Oncology Center, Osaka University Hospital, Suita, Japan
| | - Hirokazu Mizuno
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masao Matsumoto
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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