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Régis J, Merly L, Balossier A, Baumstarck K, Hamdi H, Mariani S, Delsanti C, Vincent M, Nigoul JM, Beltaifa Y, Muracciole X. Mask-Based versus Frame-Based Gamma Knife ICON Radiosurgery in Brain Metastases: A Prospective Randomized Trial. Stereotact Funct Neurosurg 2021; 100:86-94. [PMID: 34933308 DOI: 10.1159/000519280] [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: 05/11/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiosurgery is performed with a diversity of instruments relying usually either on a stereotactic frame or a mask for patient head fixation. Comfort and safety efficacy of the 2 systems have never been rigorously evaluated and compared. MATERIAL AND METHOD Between February 2016 and January 2017, 58 patients presenting with nonsmall cell lung cancer brain metastases have been treated by Gamma Knife radiosurgery (GKS) with random use of a frame or a mask for fixation were included patients older than 18, with <5 brain metastases (at the exclusion of brainstem and optic pathway's locations) and no earlier history of radiotherapy. The primary outcome measure was the pain scale assessment (PSA) at the beginning of the GKS procedure. RESULTS The PSA at the beginning of the GKS procedure was not different between the 2 groups. The PSA at the day before GKS, before magnetic resonance imaging, just after frame application, and the day after radiosurgery (departure) has shown no difference between the 2 groups. At the end of the radiosurgery itself (just after frame or mask removal) and 1 h after, the mean pain scale was higher in patients treated with the frame (p < 0.05 and p < 0.001, respectively) but 2 patients were not able to tolerate the mask discomfort and had to be treated with frame. Tumor control and morbidity probability were demonstrated to be no difference between the 2 groups in this population of patients with BM not in highly functional area. The median of the extra dose to the body due to the cone-beam computed tomography was 7.5 mGy with a maximum of 35 mGy in patients treated with a mask fixation (null in the others treated with frame). Mask fixation was associated to longer treatment time although the beam on time was not different between the 2 groups. CONCLUSION In selected patients, with brain oligo-metastases out of critical location, single-dose mask-based GKS can be done with a comfort and a safety efficacy comparable to frame-based GKS. There seems to be no clear patient data that confirm the value of the mask system with regards to comfort.
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Affiliation(s)
- Jean Régis
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Louise Merly
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Anne Balossier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Karine Baumstarck
- Department of Biostatistic, Aix Marseille University, Marseille, France
| | - Hussein Hamdi
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Sarah Mariani
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Christine Delsanti
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Marion Vincent
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Jean Marc Nigoul
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Yassin Beltaifa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Xavier Muracciole
- Department of Radiotherapy, Aix Marseille University, Marseille, France
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Bossart E, Mellon EA, Monterroso I, Elsayyad N, Diwanji T, Samuels S, Dogan N. Assessment of single isocenter linear accelerator radiosurgery for metastases and base of skull lesions. Phys Med 2020; 81:1-8. [PMID: 33278764 DOI: 10.1016/j.ejmp.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/22/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Newer technology for stereotactic radiosurgery (SRS) should be assessed for different multi-leaf collimators (MLC). OBJECTIVE Assess plan quality of an automated, frameless, linear accelerator based (linac) planning and delivery system (HyperArc) for SRS using both standard MLC (SMLC) and high definition MLC (HDMLC) compared to a cobalt-60 based SRS system (Gamma Knife, GK). METHODS We re-planned twenty GK Perfexion-treated SRS patients (27 lesions) for HyperArc using SMLC and HDMLC. We assessed plan quality using the following metrics: gradient index (GI), Paddick and RTOG conformity indices (CIPaddick, CIRTOG), volume receiving half of prescription isodose (PIVhalf) and maximum dose to 0.03 cc for brainstem, optic chiasm and optic nerves, and V12Gy for brain-GTV. RESULTS Linac plans had better conformity with HDMLC being most conformal. GK exhibited better GI. PIVhalf demonstrated no statistically significant difference between HDMLC and GK, and SMLC was nominally worse than GK. Mean PIVhalf was generally 0.85 cc larger for SMLC than HDMLC. For TV > 1.0 cc, the relative differences in CIRTOG, GI, and PIVhalf for SMLC vs. HDMLC were less than 21%. For TV less than < 1.0 cc, there were more obvious relative differences for SMLC vs. HDMLC in CIRTOG (mean 146%, max 700%), GI (mean 49%, max 162%), and PIVhalf (mean 77%, max 522%). Organ at risk doses were met in all plans. CONCLUSIONS New linac-based plans positively compare to GK plans overall. HDMLC should be strongly considered for treatment of lesions < 1.0 cc given the significant improvements in conformity and PIVhalf over SMLC.
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Affiliation(s)
- Elizabeth Bossart
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irene Monterroso
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stuart Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nesrin Dogan
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Buatti JS, Buatti JM, Yaddanapudi S, Pennington EC, Wang D, Gross B, St‐Aubin JJ, Hyer DE, Smith MC, Flynn RT. Stereotactic radiotherapy of appropriately selected meningiomas and metastatic brain tumor beds with gamma knife icon versus volumetric modulated arc therapy. J Appl Clin Med Phys 2020; 21:246-252. [PMID: 33207030 PMCID: PMC7769414 DOI: 10.1002/acm2.13100] [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: 03/30/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine if the gamma knife icon (GKI) can provide superior stereotactic radiotherapy (SRT) dose distributions for appropriately selected meningioma and post-resection brain tumor bed treatments to volumetric modulated arc therapy (VMAT). MATERIALS AND METHODS Appropriately selected targets were not proximal to great vessels, did not have sensitive soft tissue including organs-at-risk (OARs) within the planning target volume (PTV), and did not have concave tumors containing excessive normal brain tissue. Four of fourteen candidate meningioma patients and six of six candidate patients with brain tumor cavities were considered for this treatment planning comparison study. PTVs were generated for GKI and VMAT by adding 1 mm and 3 mm margins, respectively, to the GTVs. Identical PTV V100% -values were obtained for the GKI and VMAT plans for each patient. Meningioma and tumor bed prescription doses were 52.7-54.0 in 1.7-1.8 Gy fractions and 25 Gy in 5 Gy fractions, respectively. GKI dose rate was 3.735 Gy/min for 16 mm collimators. RESULTS PTV radical dose homogeneity index was 3.03 ± 0.35 for GKI and 1.27 ± 0.19 for VMAT. Normal brain D1% , D5% , and D10% were lower for GKI than VMAT by 45.8 ± 10.9%, 38.9 ± 11.5%, and 35.4 ± 16.5% respectively. All OARs considered received lower maximum doses for GKI than VMAT. GKI and VMAT treatment times for meningioma plans were 12.1 ± 4.13 min and 6.2 ± 0.32 min, respectively, and, for tumor cavities, were 18.1 ± 5.1 min and 11.0 ± 0.56 min, respectively. CONCLUSIONS Appropriately selected meningioma and brain tumor bed patients may benefit from GKI-based SRT due to the decreased normal brain and OAR doses relative to VMAT enabled by smaller margins. Care must be taken in meningioma patient selection for SRT with the GKI, even if they are clinically appropriate for VMAT.
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Affiliation(s)
- Jacob S. Buatti
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - John M. Buatti
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Sridhar Yaddanapudi
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Edward C. Pennington
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Dongxu Wang
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Brandie Gross
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Joël J. St‐Aubin
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Daniel E. Hyer
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Mark C. Smith
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
| | - Ryan T. Flynn
- Department of Radiation OncologyUniversity of Iowa Hospital and Clinics200 Hawkins DriveIowa CityIA52242USA
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Buitrago Rojas SM, Castellanos Dominguez YZ, Contreras Vargas JA, Solano Diaz YT, Gutierrez Argote EF. Reproducibilidad en el diagnóstico imagenológico de periodontitis apical a partir de CBCT. ACTA ODONTOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/aoc.v10n1.81133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: esta investigación evaluó la reproducibilidad en el diagnóstico imagenológico de PA en dientes del maxilar superior a partir de 60 CBCT tomadas en una institución clínica en una ciudad intermedia en Colombia. Métodos: el estudio fue realizado por dos observadores previamente calibrados de CBCT del maxilar superior que contenían dientes permanentes con ápice cerrado, correspondientes a adultos mayores de 18 años de edad. La presencia o ausencia de periodontitis apical se analizó utilizando el índice CBCT PAI. La información registrada fue relacionada con variables de interés. Resultados: la reproducibilidad entre los evaluadores fue sustancial o perfecta. La prevalencia de periodontitis apical encontrada fue del 21,6%, en los dientes con tratamiento de endodoncia 12,4% y en los dientes sin tratamiento endodóntico 9,2%. Conclusiones: la tomografía CBCT proporciona al clínico información que permite una mayor claridad en la fase de diagnóstico. Los dientes con la mayor prevalencia de PA fueron el primer molar y el primer premolar superior izquierdo respectivamente.
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Duggar WN, Morris B, Fatemi A, Bonds J, He R, Kanakamedala M, Rey-Dios R, Vijayakumar S, Yang C. Gamma Knife ® icon CBCT offers improved localization workflow for frame-based treatment. J Appl Clin Med Phys 2019; 20:95-103. [PMID: 31587520 PMCID: PMC6839378 DOI: 10.1002/acm2.12745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 11/26/2022] Open
Abstract
Object The purpose of this study was to compare two methods of stereotactic localization in Gamma Knife treatment planning: cone beam computed tomography (CBCT) or fiducial. While the fiducial method is the traditional method of localization, CBCT is now available for use with the Gamma Knife Icon. This study seeks to determine whether a difference exists between the two methods and then whether one is better than the other regarding accuracy and workflow optimization. Methods Cone beam computed tomography was used to define stereotactic space around the Elekta Film Pinprick phantom and then treated with film in place. The same phantom was offset known amounts from center and then imaged with CBCT and registered with the reference CBCT image to determine if measured offsets matched those known. Ten frameless and 10 frame‐based magnetic resonance imaging (MRI) to CBCT patient fusions were retrospectively evaluated using the TG‐132 TRE method. The stereotactic coordinates defined by CBCT and traditional fiducials were compared on the Elekta 8 cm Ball phantom, an anthropomorphic phantom, and actual patient data. Offsets were introduced to the anthropomorphic phantom in the stereotactic frame and CBCT's ability to detect those offsets was determined. Results Cone beam computed tomography defines stereotactic space well within the established limits of the mechanical alignment system. The CBCT to CBCT registration can detect offsets accurately to within 0.1 mm and 0.5°. In all cases, some disagreement existed between fiducial localization and that of CBCT which in some cases was small, but also was as high as 0.43 mm in the phantom domain and as much as 1.54 mm in actual patients. Conclusion Cone beam computed tomography demonstrates consistent accuracy in defining stereotactic space. Since both localization methods do not agree with each other consistently, the more reliable method must be identified. Cone beam computed tomography can accurately determine offsets occurring within stereotactic space that would be nondiscernible utilizing the fiducial method and seems to be more reliable. Using CBCT localization offers the opportunity to streamline workflow both from a patient and clinic perspective and also shows patient position immediately prior to treatment.
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Affiliation(s)
- William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bart Morris
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ali Fatemi
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA.,Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jemeria Bonds
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rui He
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Roberto Rey-Dios
- Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Claus Yang
- Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
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Xu AY, Wang YF, Wang TJC, Cheng SK, Elliston CD, Savacool MK, Dona Lemus O, Sisti MB, Wuu CS. Performance of the cone beam computed tomography-based patient positioning system on the Gamma Knife Icon™. Med Phys 2019; 46:4333-4339. [PMID: 31359438 DOI: 10.1002/mp.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/17/2019] [Accepted: 07/20/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Cone beam computed tomography (CBCT) imaging has been implemented on the Leksell Gamma Knife® Icon™ for assessing patient positioning in mask-based Gamma Knife radiosurgery. The purpose of this study was to evaluate the performance of the CBCT-based patient positioning system as a tool for frameless Gamma Knife radiosurgery. METHODS Daily quality assurance (QA) CBCT precision test results from a 12-month period were analyzed for the geometric accuracy and the stability of the imager. The performance of the image acquisition module and the image registration algorithm was evaluated using an anthropomorphic head phantom (CIRS Inc., Norfolk, VA) and a XYZR axis manual positioning stage (TOAUTO Inc., Guangdong, China). The head phantom was fixed on a mask adaptor and manually translated in the X, Y, Z directions or rotated around the X, Y, Z axes in the range of ±10 mm or ±10º. A CBCT scan was performed after each manual position setup followed by an image registration to the reference scan. To assess the overall setup uncertainties in fractionated treatment, two cylindrical Presage phantoms (Heuris Inc., Skillman, NJ) of 15 cm diameter and 10 cm height were irradiated with identical prescription dose and shot placement following standard mask-based treatment workflow according to two different fraction schedules: a single fraction treatment of 7.5 Gy and a 5-fraction treatment with 1.5 Gy per fraction. RESULTS The averaged vector deviations of the four marks from their preset values are 0.087, 0.085, 0.095, and 0.079 mm from the 212 daily QA tests. The averaged displacements in the X, Y, Z coordinates and the pitch, yaw, roll angles from the image registration tests are 0.23, 0.27, 0.14, 0.32º, 0.19º, 0.31º from the manual setup. The corresponding maximum differences are 0.41, 0.33, 0.29 mm, 0.45º, 0.31º, and 0.43º, respectively. Compared to the treatment plan using the 2% & 1 mm criteria, the averaged 2D Gamma passing rate is 98.25% for the measured dose distribution from the Presage phantom with 1-fraction irradiation and 95.12% for the 5-fraction irradiation. The averaged Gamma passing rates are 99.53% and 98.16% for the 1-fraction and 5-fraction irradiations using the 2% & 2 mm criteria. CONCLUSIONS The CBCT imager and the image registration algorithm can reproduce phantom position with <0.5 mm/0.5º uncertainty. A systematic contribution from the interfraction phantom repositioning procedure was observed in the Gamma analysis over the irradiated volumes of two end-to-end test phantoms.
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Affiliation(s)
- Andy Y Xu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl D Elliston
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michelle K Savacool
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Olga Dona Lemus
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B Sisti
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheng-Shie Wuu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
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