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Mukwada G, Chamunyonga C, Rowshanfarzad P, Gill S, Ebert MA. Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review. PLoS One 2024; 19:e0307088. [PMID: 39121064 PMCID: PMC11315342 DOI: 10.1371/journal.pone.0307088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/30/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND GammaKnife (GK) and CyberKnife (CK) have been the mainstay stereotactic radiosurgery (SRS) solution for multiple brain metastases (MBM) for several years. Recent technological advancement has seen an increase in single-isocentre C-arm linac-based SRS. This systematic review focuses on dosimetric and geometric insights into contemporary MBM SRS and thereby establish if linac-based SRS has matured to match the mainstay SRS delivery systems. METHODS The PubMed, Web of Science and Scopus databases were interrogated which yielded 891 relevant articles that narrowed to 20 articles after removing duplicates and applying the inclusion and exclusion criteria. Primary studies which reported the use of SRS for treatment of MBM SRS and reported the technical aspects including dosimetry were included. The review was limited to English language publications from January 2015 to August 2023. Only full-length papers were included in the final analysis. Opinion papers, commentary pieces, letters to the editor, abstracts, conference proceedings and editorials were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The reporting of conformity indices (CI) and gradient indices, V12Gy, monitor units and the impact of translational and rotational shifts were extracted and analysed. RESULTS The single-isocentre technique for MBM dominated recent SRS studies and the most studied delivery platforms were Varian. The C-arm linac-based SRS plan quality and normal brain tissue sparing was comparable to GK and CK and in some cases better. The most used nominal beam energy was 6FFF, and optimised couch and collimator angles could reduce mean normal brain dose by 11.3%. Reduction in volume of the healthy brain receiving a certain dose was dependent on the number and size of the metastases and the relative geometric location. GK and CK required 4.5-8.4 times treatment time compared with linac-based SRS. Rotational shifts caused larger changes in CI in C-arm linac-based single-isocentre SRS. CONCLUSION C-arm linac-based SRS produced comparable MBM plan quality and the delivery is notably shorter compared to GK and CK SRS.
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Affiliation(s)
- Godfrey Mukwada
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Crispen Chamunyonga
- School of Clinical Sciences, Discipline of Radiation Therapy, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, Western Australia, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A. Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, Western Australia, Australia
- School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States of America
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Paddick I, Mott J, Bedford J, Filatov P, Grishchuk D, Orchin G, Houston P, Eaton DJ. Benchmarking Tests of Contemporary SRS Platforms: Have Technological Developments Resulted in Improved Treatment Plan Quality? Pract Radiat Oncol 2023; 13:e451-e459. [PMID: 37290672 DOI: 10.1016/j.prro.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Stereotactic radiosurgery treatment delivery can be performed with a range of devices, each of which have evolved over recent years. We sought to evaluate the differences in performance of contemporary stereotactic radiosurgery platforms and also to compare them with earlier platform iterations from a previous benchmarking study. METHODS AND MATERIALS The following platforms were selected as "state of the art" in 2022: Gamma Knife Icon (GK), CyberKnife S7 (CK), Brainlab Elements (Elekta VersaHD and Varian TrueBeam), Varian Edge with HyperArc (HA), and Zap-X. Six benchmarking cases were used from a 2016 study. To reflect the evolution of increasing numbers of metastases treated per patient, a 14-target case was added. The 28 targets among the 7 patients ranged from 0.02 to 7.2 cc in volume. Participating centers were sent images and contours for each patient and asked to plan them to the best of their ability. Although some variation in local practice was allowed (eg, margins), groups were asked to prescribe a specified dose to each target and tolerance doses to organs at risk were agreed upon. Parameters compared included coverage, selectivity, Paddick conformity index, gradient index (GI), R50%, efficiency index, doses to organs at risk, and planning and treatment times. RESULTS Mean coverage for all targets ranged from 98.2% (Brainlab/Elekta) to 99.7% (HA-6X). Paddick conformity index values ranged from 0.722 (Zap-X) to 0.894 (CK). GI ranged from a mean of 3.52 (GK), representing the steepest dose gradient, to 5.08 (HA-10X). The GI appeared to follow a trend with beam energy, with the lowest values from the lower energy platforms (GK, 1.25 MeV; Zap-X, 3 MV) and the highest value from the highest energy (HA-10X). Mean R50% values ranged from 4.48 (GK) to 5.98 (HA-10X). Treatment times were lowest for C-arm linear accelerators. CONCLUSIONS Compared with earlier studies, newer equipment appears to deliver higher quality treatments. CyberKnife and linear accelerator platforms appear to give higher conformity whereas lower energy platforms yield a steeper dose gradient.
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Affiliation(s)
- Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Judith Mott
- Northern Centre for Cancer Care, Department of Radiotherapy Physics, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Petr Filatov
- Department of Medical Physics, GenesisCare, Oxford, United Kingdom
| | - Diana Grishchuk
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gavin Orchin
- Beatson West of Scotland Cancer Centre, Department of Radiotherapy Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Peter Houston
- Beatson West of Scotland Cancer Centre, Department of Medical Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - David J Eaton
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
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Srivastava SP, Sorensen SP, Jani SS, Yan X, Pinnaduwage DS. Machine performance and stability of the first clinical self-shielded stereotactic radiosurgery system: Initial 2-year experience. J Appl Clin Med Phys 2023; 24:e13857. [PMID: 36519493 PMCID: PMC10018673 DOI: 10.1002/acm2.13857] [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: 07/08/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
This study provides insight into the overall system performance, stability, and delivery accuracy of the first clinical self-shielded stereotactic radiosurgery (SRS) system. Quality assurance procedures specifically developed for this unit are discussed, and trends and variations over the course of 2-years for beam constancy, targeting and dose delivery are presented. Absolute dose calibration for this 2.7 MV unit is performed to deliver 1 cGy/MU at dmax = 7 mm at a source-to-axis-distance (SAD) of 450 mm for a 25 mm collimator. Output measurements were made with 2-setups: a device that attaches to a fixed position on the couch (daily) and a spherical phantom that attaches to the collimating wheel (monthly). Beam energy was measured using a cylindrical acrylic phantom at depths of 100 (D10 ) and 200 (D20 ) mm. Beam profiles were evaluated using Gafchromic film and compared with TPS beam data. Accuracy in beam targeting was quantified with the Winston-Lutz (WL) and end-to-end (E2E) tests. Delivery quality assurance (DQA) was performed prior to clinical treatments using Gafchromic EBT3/XD film. Net cumulative output adjustments of 15% (pre-clinical), 9% (1st year) and 3% (2nd year) were made. The mean output was 0.997 ± 0.010 cGy/MU (range: 0.960-1.046 cGy/MU) and 0.993 ± 0.029 cGy/MU (range: 0.884-1.065 cGy/MU) for measurements with the daily and monthly setups, respectively. The mean relative beam energy (D10 /D20 ) was 0.998 ± 0.004 (range: 0.991-1.006). The mean total targeting error was 0.46 ± 0.17 mm (range: 0.06-0.98 mm) for the WL and 0.52 ± 0.28 mm (range: 0.11-1.27 mm) for the E2E tests. The average gamma pass rates for DQA measurements were 99.0% and 90.5% for 2%/2 mm and 2%/1 mm gamma criteria, respectively. This SRS unit meets tolerance limits recommended by TG-135, MPPG 9a., and TG-142 with a treatment delivery accuracy similar to what is achieved by other SRS systems.
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Affiliation(s)
- Shiv P Srivastava
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen P Sorensen
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Shyam S Jani
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dilini S Pinnaduwage
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Sorensen SP, Jani SS, Pinnaduwage DS, Yan X, Srivastava SP. Technical note: Absolute dose measurements of a vault-free radiosurgery system. Med Phys 2022; 49:7733-7741. [PMID: 35964159 DOI: 10.1002/mp.15912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/12/2022] [Accepted: 07/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Methods for accurate absolute dose (AD) calibration are essential for the proper functioning of radiotherapy treatment machines. Many systems do not conform to TG-51 calibration standards, and modifications are required. TG-21 calibration is also a viable methodology for these situations with the appropriate setup, equipment, and factors. It has been shown that both these methods result in minimal errors. A similar approach has been taken in calibrating the dose for a recent vault-free radiosurgery system. PURPOSE To evaluate modified TG-21 and TG-51 protocols for AD calibrations of the ZAP-X radiosurgery system using ion chambers, film, and thermoluminescent dosimeters (TLDs). METHODS The current treatment planning system for ZAP-X requires AD calibration at dmax (7 mm) and 450 mm source-to-axis distance. Both N D , w 60 C o [ G y / C ] $N_{D,w}^{{60}Co}[ {Gy/C} ]$ and Nx [R/C] calibration coefficients were provided by an accredited dosimetry calibration laboratory for a physikalisch technische werkstatten (PTW) 31010 chamber (0.125 cc). The vendor provides an f-bracket that can be mounted on the collimator. Various phantoms can then be attached to the f-bracket. A custom acrylic phantom was designed based on recommendations from TG-21 and technical report series-398 that places the chamber at 500 mm from the source with a depth of 44-mm acrylic and 456-mm SSD. Nx along with other TG-21 parameters was used to calculate the AD. Measurements using a PTW MP3-XS water tank and the same chamber were used to calculate AD using N D , w 60 C o $N_{D,w}^{{60}Co}$ and TG-51 factors. Dose verification was performed using Gafchromic film and 3rd party TLDs. RESULTS Measurements from TG-51, TG-21 (utilizing the custom acrylic phantom), film, and TLDs agreed to within ± 2%. CONCLUSIONS A modified TG-51 AD calculation in water is preferred but may not be practical due to the difficulty in tank setup. The TG-21 modified protocol using a custom acrylic phantom is an accurate alternative option for dose calibration. Both of these methods are within acceptable agreement and provide confidence in the system's AD calibration.
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Affiliation(s)
- Stephen P Sorensen
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shyam S Jani
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dilini S Pinnaduwage
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shiv P Srivastava
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Muacevic A, Eder MM, Hofmann T, Fürweger C, Ehret F. Self-Shielding Gyroscopic Radiosurgery - A First Clinical Experience, Case Series, and Dosimetric Comparison. World Neurosurg 2022; 164:e420-e426. [PMID: 35568128 DOI: 10.1016/j.wneu.2022.04.120] [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: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Self-shielding gyroscopic radiosurgery (GRS) represents a technical innovation in the field of stereotactic radiosurgery (SRS). GRS does not require a radiation vault and is optimized for radiosurgical treatments. Reports on its usage are limited. We describe the first clinical experience of GRS at our institution to assess the application of GRS in the treatment of cranial tumors. Moreover, we perform a dosimetric comparison to robotic radiosurgery (RRS) with vestibular schwannoma (VS) GRS patients. METHODS Patients who were treated with GRS between July and November 2021 were included. Patient, tumor, and dosimetric characteristics were retrospectively summarized and analyzed. RESULTS Forty-one patients with 48 intracranial tumors were included. Tumor entities mostly comprised VS, brain metastases, and meningiomas. The median prescription dose and isodose line were 13.5 Gy and 50.0% for benign neoplasia vs. 20 Gy and 60.0% for malignant tumors, respectively. The mean planning target volume was 1.5 cubic centimeters. All patients received a single-fraction treatment without encountering any technical setup difficulties. Treatment plan comparisons with RRS revealed comparable plan characteristics, dose gradients, and organs at risk doses. Significant differences were detected concerning the new conformity index and number of monitor units per treatment (both p < 0.001). CONCLUSION This case series provides more evidence on the usage of self-shielding GRS in the management of cranial tumors. Dosimetric comparisons for VS cases revealed mostly equivalent dosimetric characteristics to RRS. Further clinical and physical analyses for GRS are on their way.
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Affiliation(s)
| | | | | | - Christoph Fürweger
- European Radiosurgery Center Munich, Munich, Germany; Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Felix Ehret
- European Radiosurgery Center Munich, Munich, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.
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Das IJ, Dawes SL, Dominello MM, Kavanagh B, Miyamoto CT, Pawlicki T, Santanam L, Vinogradskiy Y, Yeung AR. Quality and Safety Considerations in Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy: An ASTRO Safety White Paper Update. Pract Radiat Oncol 2022; 12:e253-e268. [DOI: 10.1016/j.prro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
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Pinnaduwage DS, Srivastava SP, Yan X, Jani SS, Jenkins C, Barani IJ, Sorensen S. Small-field beam data acquisition, detector dependency, and film-based validation for a novel self-shielded stereotactic radiosurgery system. Med Phys 2021; 48:6121-6136. [PMID: 34260069 DOI: 10.1002/mp.15091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This study reports a single-institution experience with beam data acquisition and film-based validation for a novel self-shielded sterotactic radiosurgery unit and investigates detector dependency on field output factors (OFs), off-axis ratios (OARs), and percent depth dose (PDD) measurements within the context of small-field dosimetry. METHODS The delivery platform for this unit consists of a 2.7-MV S-band linear accelerator mounted on coupled gimbals that rotate around a common isocenter (source-to-axis distance [SAD] = 450 mm), allowing for more than 260 noncoplanar beam angles. Beam collimation is achieved via a tungsten collimator wheel with eight circular apertures ranging from 4 mm to 25 mm in diameter. Three diodes (PTW 60012 Diode E, PTW 60018 SRS Diode, and Sun Nuclear EDGE) and a synthetic diamond detector (PTW 60019 micro Diamond [µD] detector) were used for OAR, PDD, and OF measurements. OFs were also acquired with a PTW 31022 PinPoint ionization chamber. Beam scanning was performed using a 3D water tank at depths of 7, 50, 100, 200, and 250 mm with a source-to-surface distance of 450 mm. OFs were measured at the depth of maximum dose (dmax = 7 mm) with the SAD at 450 mm. Gafchromic EBT3 film was used to validate OF and profile measurements and as a reference detector for estimating correction factors for active detector OFs. Deviations in field size, penumbra, and PDDs across the different detectors were quantified. RESULTS Relative OFs (ROFs) for the diodes were within 1.4% for all collimators except for 5 and 7.5 mm, for which SRS Diode measurements were higher by 1.6% and 2.6% versus Diode E. The µD ROFs were within 1.4% of the diode measurements. PinPoint ROFs were lower by >10% for the 4-mm and 5-mm collimators versus the Diode E and µD. Corrections to OFs using EBT3 film as a reference were within 1.2% for all diodes and the µD detector for collimators 10 mm and greater and within 2.0%, 2.8%, and 1.1% for the 7.5-, 5-, and 4-mm collimators, respectively. The maximum difference in full width at half maximum (FWHM) between the Diode E and the other active detectors was for the 25-mm collimator and was 0.09 mm (µD), 0.16 mm (SRS Diode), and 0.65 mm (EDGE). Differences seen in PDDs beyond the depth of dmax were <1% across the three diodes and the µD. FWHM and penumbra measurements made using EBT3 film were within 1.34% and 3.26%, respectively, of the processed profile data entered into the treatment planning system. CONCLUSIONS Minimal differences were seen in OAR and PDD measurements acquired with the diodes and the µD. ROFs measured with the three diodes were within 2.6% and within 1.4% versus the µD. Gafchromic Film measurements provided independent verification of the OAR and OF measurements. Estimated corrections to OFs using film as a reference were <1.6% for the Diode E, EDGE, and µD detector.
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Affiliation(s)
- Dilini S Pinnaduwage
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shiv P Srivastava
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shyam S Jani
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Igor J Barani
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Stephen Sorensen
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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