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Li W, Bootsma G, Shultz D, Laperriere N, Millar BA, Cho YB, Jaffray DA, Chung C, Coolens C. Assessment of intra-fraction motion during frameless image guided Gamma Knife stereotactic radiosurgery. Phys Imaging Radiat Oncol 2023; 25:100415. [PMID: 36718356 PMCID: PMC9883231 DOI: 10.1016/j.phro.2023.100415] [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: 07/26/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
As frameless stereotactic radiosurgery increase in use, the aim of this study was to evaluate intra-fraction motion through cone-beam CT (CBCT) and high-definition motion management (HDMM) systems. Intra-fraction motion measured between localization, repeat localization and post-treatment CBCTs were correlated to intra-faction motion indicated by the HDMM files using the Pearson coefficient (r). A total of 302 plans were reviewed from 263 patients (114 male, 149 female); 216 pairs of localization-repeat localization, and 260 localization-post-treatment CBCTs were analyzed against HDMM logs. We found the magnitude of intra-fraction motion detected by the HDMM system were larger than the corresponding CBCT results.
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Affiliation(s)
- Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Corresponding author at: Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Level 2B, Cobalt Lounge, Toronto, ON, Canada.
| | - Gregory Bootsma
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Young Bin Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David A. Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Schasfoort J, Ruschin M, Sahgal A, MacDonald RL, Lee Y, van Pul C, Langenhuizen P, Hanssens P, Beute G, Wittkamper F, Sonke JJ. Quantifying the sensitivity of target dose on intra-fraction displacement in intra-cranial stereotactic radiosurgery. Pract Radiat Oncol 2021; 12:e221-e231. [PMID: 34929403 DOI: 10.1016/j.prro.2021.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. METHODS In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5mm, ±1.0mm or ±1.5mm. The effect on minimum dose to 99% of the target (D99) and percent target coverage by prescription dose was quantified using mixed-effect modelling with variables: displacement, target volume and location. RESULTS The effect on dose metrics is statistically larger for translational displacements compared to rotational displacements, and the effect of pitch rotations is statistically larger compared to yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6cc) and translational nose-marker displacements of 0.5mm, 1.0mm, and 1.5mm, D99 decreased by 2.2%, 7.1% and 13.0%, and coverage by 0.4%, 1.8% and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5mm, 1.0mm, and 1.5mm, D99 decreased by 1.0%, 3.6% and 6.9%, and coverage by 0.2%, 0.8% and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D99 decreased by 0.3%, 1.2% and 2.5%, and coverage by 0.1%, 0.2% and 0.5%, respectively. CONCLUSION Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.
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Affiliation(s)
- Jannie Schasfoort
- Gamma Knife Center Tilburg, Department of Medical Physics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - R Lee MacDonald
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carola van Pul
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Langenhuizen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Hanssens
- Gamma Knife Center Tilburg, Department of neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Gamma Knife Center Tilburg, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Guus Beute
- Gamma Knife Center Tilburg, Department of neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Frits Wittkamper
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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MacDonald RL, Lee Y, Schasfoort J, Soliman H, Sahgal A, Ruschin M. Personalized treatment gating thresholds in frameless stereotactic radiosurgery using predictions of dosimetric fidelity and treatment interruption. Med Phys 2021; 48:8045-8051. [PMID: 34730238 DOI: 10.1002/mp.15331] [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: 03/26/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Gamma Knife Icon (GKI) enables a user-defined gating threshold for intrafraction motion during stereotactic radiosurgery (SRS). An optimal threshold would ensure dosimetric fidelity of the planned distribution and minimize treatment time extension by gating. A prediction of motion characteristics for a patient based on a retrospective database of motion traces could be beneficial to evaluating the choice of gating threshold. A short acquisition of motion may help to define a personalized threshold that balances dosimetric accuracy and treatment length. This study aims to evaluate the performance of a prediction of motion and the resultant dosimetric consequences for a range of motion gating thresholds. METHODS A database of 2552 motion traces (776 patients) was analyzed using previously published methods to characterize patient intrafraction motion on the GKI. For a selection of six fractionated SRS patient cases (two patients with single brain metastasis, four vestibular schwannomas), a 10-min sample of motion was used to classify motion and identify traces in the database with similar metrics. The similar motion traces were used to perform a predictive reconstruction of the selected patient's delivered dose for a range of motion thresholds. The remaining fractions were reconstructed and compared to that predicted. From the six cases, 26 fractions were used to predict the number of interruptions (n = 26), change in target coverage (n = 26), and change in brainstem maximum dose (vestibular cases only, n = 20). The difference between mean predicted and reconstructed values was compared for accuracy. RESULTS The difference between mean prediction and reconstructed values was 0.32 ± 0.38% in target coverage, 2.36 ± 5.06 interruptions, and 0.15 ± 0.24 Gy for the brainstem maximum dose. Sixty-seven of the 72 predictions (26 coverage, 26 interruptions, and 20 brainstem maximum dose) were within one standard deviation of the predicted mean. CONCLUSIONS Large databases of motion traces were used to characterize patient performance and predict motion performance. Dosimetric deterioration due to motion and extension of treatment duration can be predicted in some cases using only a short acquisition of motion and the treatment plan. This reconstruction may provide benefit in generating a patient-specific motion threshold.
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Affiliation(s)
- R Lee MacDonald
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Li W, Cashell A, Lee I, Tamerou M, Coolens C, Bernstein M, Kongkham P, Laperriere N, Shultz D. Patient perspectives on frame versus mask immobilization for gamma knife stereotactic radiosurgery. J Med Imaging Radiat Sci 2020; 51:567-573. [PMID: 32839140 DOI: 10.1016/j.jmir.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess patient experiences and perspectives following Gamma Knife (GK) stereotactic radiosurgery (SRS) using frame versus mask immobilization. METHODS Patients who received GK-SRS using both frame and mask immobilization were included in this study. One-on-one semi-structured interviews, led by a third-party expert, were used to gain insight into the patient experience. To reduce memory bias of either immobilization device, patients underwent the interview at their follow-up appointment. Initial assessment of patient transcriptions was completed by one study staff; a second member reviewed transcripts for thematic saturation. All interviews were independently coded for themes to minimize interpretation bias. RESULTS Fifteen patients were consented; 12 were successfully interviewed (3 lost due to deteriorating health status). Interviews ranged from 30 to 60 min in duration. The most common patient concern regarding the frame was pain (9 patients), while the primary concerns with the mask system were the ability to remain still (6 patients) and claustrophobia (4 patients). Eleven patients chose the mask as their preferred choice in terms of their overall experience. Two themes emerged during the interviews that spoke to patient satisfaction with each process: unexpected pain with frame placement; and tightness experienced while wearing the mask during treatment. CONCLUSIONS From the patient perspective there was overwhelming agreement that the mask was the preferred choice for GK-SRS. The patient experience could be improved by enhanced education to better prepare patients on what to expect during the frame placement and mask treatment processes.
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Affiliation(s)
- Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto, Toronto, ON.
| | - Angela Cashell
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Ivy Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - Messeret Tamerou
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Mark Bernstein
- Division of Neurosurgery, University of Toronto/University Health Network - Toronto Western Hospital, Toronto, ON
| | - Paul Kongkham
- Division of Neurosurgery, University of Toronto/University Health Network - Toronto Western Hospital, Toronto, ON
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto, Toronto, ON
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Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys 2020; 21:63-72. [PMID: 32237274 PMCID: PMC7324699 DOI: 10.1002/acm2.12866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
To evaluate the accuracy of a commercial optical surface tracking (OST) system and to demonstrate how it can be implemented to monitor patient positioning during non‐coplanar single isocenter stereotactic treatments of brain metastases. A 3‐camera OST system was used (Catalyst HD™, C‐RAD) on a TruebeamSTx with a 6DoF couch. The setup accuracy and agreement between the OST system, and CBCT and kV‐MV imaging at couch angles 0° and 270°, respectively, were examined. Film measurements at 3 depths in the Rando‐Alderson phantom were performed using a single isocenter non‐coplanar VMAT plan containing 4 brain lesions. Setup of the phantom was performed with CBCT at couch 0° and subsequently monitored by OST at other couch angles. Setup data for 7 volunteers were collected to evaluate the accuracy and reproducibility of the OST system at couch angles 0°, 45°, 90°, 315°, and 270°. These results were also correlated to the couch rotation offsets obtained by a Winston‐Lutz (WL) test. The Rando‐Alderson phantom, as well as volunteers, were fixated using open face masks (Orfit). For repeated tests with the Rando‐Alderson phantom, deviations between rotational and translational isocenter corrections for CBCT and OST systems are always within 0.2° (pitch, roll, yaw), and 0.1mm and 0.5mm (longitudinal, lateral, vertical) for couch positions 0° and 270°, respectively. Dose deviations between the film and TPS doses in the center of the 4 lesions were −1.2%, −0.1%, −0.0%, and −1.9%. Local gamma evaluation criteria of 2%/2 mm and 3%/1 mm yielded pass rates of 99.2%, 99.2%, 98.6%, 89.9% and 98.8%, 97.5%, 81.7%, 78.1% for the 4 lesions. Regarding the volunteers, the mean translational and rotational isocenter shift values were (0.24 ± 0.09) mm and (0.15 ± 0.07) degrees. Largest isocenter shifts were found for couch angles 45˚ and 90˚, confirmed by WL couch rotation offsets. Patient monitoring during non‐coplanar VMAT treatments of brain metastases is feasible with submillimeter accuracy.
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Affiliation(s)
| | | | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, the Netherlands
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Frameless Image Guidance in Stereotactic Radiosurgery. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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MacDonald RL, Lee Y, Schasfoort J, Soliman H, Sahgal A, Ruschin M. Real-Time Infrared Motion Tracking Analysis for Patients Treated With Gated Frameless Image Guided Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2019; 106:413-421. [PMID: 31655198 DOI: 10.1016/j.ijrobp.2019.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The transition from frame-based brain stereotactic radiosurgery (SRS) to frameless delivery is supported by real-time intrafraction monitoring to ensure accurate delivery. The purpose of this study is to characterize these real-time motion traces in a large cohort of patients treated with frameless gated brain SRS and to develop patient-specific predictions of tolerance violations. METHODS AND MATERIALS SRS patients treated on the Gamma Knife Icon were immobilized using a device-specific thermoplastic head mask. A motion marker was fixed to the patient's nose, with gating and cone beam computed tomography (CBCT)-based corrections to the treatment at excursions from baseline exceeding 1.5 mm. The traces of 1446 fractions were analyzed according to magnitude (932 unique treatment plans for 462 unique individual patients), directional distribution of displacement, and stability. A neural network model was developed to predict interruptions based on a subset of trace data. RESULTS The average displacement of the marker in the first fraction of all patients was 0.62 ± 0.25 mm with beam CBCT corrections, which would otherwise be modeled at 0.96 ± 0.96 mm without intrafraction motion correction (P < .0001). Twenty-nine percent of fractions delivered were interrupted, of which the Z-axis (superoinferior) motion was the largest contributor to excursion. Baseline corrections significantly compensated for the magnitude of motion in all 3 dimensions (P < .01). The motion relative to the first acquired CBCT was on average seen to consistently increase with treatment time, with the minimum P value occurring at 61.3 minutes. The neural network prediction model was able to predict treatment interruptions with 84% sensitivity on the first 5-minute sample of the trace. CONCLUSIONS Corrections to marker position significantly decreased marker excursions in all 3 axes compared with a single CBCT alignment. Patient-specific modeling may aid in the optimization of cases selected for frameless radiosurgery to increase the accuracy of planned delivery.
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Affiliation(s)
- R Lee MacDonald
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Hashemi S, Huynh C, Sahgal A, Song WY, Nordström H, Eriksson M, Mainprize JG, Lee Y, Ruschin M. Cone-Beam CT image contrast and attenuation-map linearity improvement (CALI) for brain stereotactic radiosurgery procedures. J Appl Clin Med Phys 2018; 19:200-208. [PMID: 30338919 PMCID: PMC6236823 DOI: 10.1002/acm2.12477] [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: 06/06/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/11/2022] Open
Abstract
A Contrast and Attenuation‐map Linearity Improvement (CALI) framework is proposed for cone‐beam CT (CBCT) images used for brain stereotactic radiosurgery (SRS). The proposed framework is tailored to improve soft tissue contrast of a new point‐of‐care image‐guided SRS system that employs a challenging half cone beam geometry, but can be readily reproduced on any CBCT platform. CALI includes a pre‐ and post‐processing step. In pre‐processing we apply a shading and beam hardening artifact correction to the projections, and in post‐processing step we correct the dome/capping artifact on reconstructed images caused by the spatial variations in X‐ray energy generated by the bowtie‐filter. The shading reduction together with the beam hardening and dome artifact correction algorithms aim to improve the linearity and accuracy of the CT‐numbers (CT#). The CALI framework was evaluated using CatPhan to quantify linearity, contrast‐to‐noise (CNR), and CT# accuracy, as well as subjectively on patient images acquired on a clinical system. Linearity of the reconstructed attenuation‐map was improved from 0.80 to 0.95. The CT# mean absolute measurement error was reduced from 76.1 to 26.9 HU. The CNR of the acrylic insert in the sensitometry module was improved from 1.8 to 7.8. The resulting clinical brain images showed substantial improvements in soft tissue contrast visibility, revealing structures such as ventricles which were otherwise undetectable in the original clinical images obtained from the system. The proposed reconstruction framework also improved CT# accuracy compared to the original images acquired on the system. For frameless image‐guided SRS, improving soft tissue visibility can facilitate evaluation of MR to CBCT co‐registration. Moreover, more accurate CT# may enable the use of CBCT for daily dose delivery measurements.
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Affiliation(s)
- SayedMasoud Hashemi
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - William Y Song
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Dong P, Pérez-Andújar A, Pinnaduwage D, Braunstein S, Theodosopoulos P, McDermott M, Sneed P, Ma L. Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator-based treatments. J Neurosurg 2018; 125:97-103. [PMID: 27903198 DOI: 10.3171/2016.7.gks16881] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Noninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator-based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT). METHODS Ten patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20-30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm3 (range 1.94-24.81 cm3). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases. RESULTS The mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p < 0.002). The mean V15 was 7.5 ± 3.7 cm3 (range 1.53-13.29 cm3), 9.8 ± 5.5 cm3 (range 2.07-18.45 cm3), and 16.1 ± 10.6 cm3 (range 3.58-36.53 cm3) for GK, CK, and VMAT, respectively (p ≤ 0.03, paired 2-tailed t-tests). However, the average conformity index was 1.18, 1.12, and 1.21 for GK, CK, and VMAT, respectively (p > 0.06). The average prescription isodose values were 52% (range 47%-69%), 60% (range 46%-68%), and 88% (range 70%-94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm3 and 73.3 ± 31.8 cm3, respectively, both of which were statistically lower (p < 0.01) than the mean V5 value of 124.6 ± 67.1 cm3 for VMAT. CONCLUSIONS Significantly better near-target normal brain sparing was noted for hypofractionated GK radiosurgery versus linear accelerator-based treatments. Such a result supports the use of a large number of isocenters or confocal beams for the benefit of normal tissue sparing in hypofractionated brain radiosurgery.
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Affiliation(s)
- Peng Dong
- Departments of 1 Radiation Oncology and.,Department of Radiation Oncology, Stanford University, Stanford, California; and
| | | | - Dilini Pinnaduwage
- Department of Radiation Oncology, The University of Arizona School of Medicine and St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | | | | | - Lijun Ma
- Departments of 1 Radiation Oncology and
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Ruschin M, Sahgal A, Soliman H, Myrehaug S, Tseng CL, Bola R, Yeboah C, Sarfehnia A, Chugh B, Eriksson M, Nordström H, Lee Y. Clinical Image Coregistration Variability on a Dedicated Radiosurgery Unit. Neurosurgery 2018; 85:E101-E108. [DOI: 10.1093/neuros/nyy334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Ruschin
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ruby Bola
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Collins Yeboah
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arman Sarfehnia
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Brige Chugh
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Young Lee
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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11
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Sarfehnia A, Ruschin M, Chugh B, Yeboah C, Becker N, Cho YB, Lee Y. Performance characterization of an integrated cone-beam CT system for dedicated gamma radiosurgery. Med Phys 2018; 45:4179-4190. [PMID: 29959780 DOI: 10.1002/mp.13073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This work describes the performance characterization of a cone-beam CT-guided radiosurgery device, the Gamma Knife® Icon™. METHODS The performance tests have been categorized into: (a) image quality and mechanical integrity; (b) image coregistration fidelity; (c) adaptive treatment delivery quality; (d) high definition motion management performance characterization; (e) software communication performance testing of the integrated cone-beam CT (CBCT) system. RESULTS All image quality performance characterization satisfied or exceeded manufacturer specifications. The image quality and mechanical stability of the CBCT system over a 3-month period was within tolerance with negligible (<0.1°) detector tilt angle. The CBCT definition of the stereotactic space had a measured average discrepancy of 0.15-0.16 mm in x, y, and z directions. On average, the high definition motion management system performance was within 0.05 mm with a residual offset of 0.15 mm when large displacements in a given direction were taken. The adaptive treatment delivery component as measured with CBCT coregistration of daily setups against reference setup images was accurate to within 0.2°. Comprehensive end-to-end testing showed a total uncertainty of better than 0.2 mm in positioning and 0.4% in dosimetry for treatment of centrally located lesions. CONCLUSIONS A set of system performance characterization tests spanning all aspects of the Gamma Knife Icon are presented. Overall, the system performance was in line with manufacturer specifications.
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Affiliation(s)
- Arman Sarfehnia
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N-3M5, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N-3M5, Canada
| | - Brige Chugh
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N-3M5, Canada
| | - Collins Yeboah
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N-3M5, Canada
| | - Nathan Becker
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Princess Margaret Cancer Centre, 610 University Ave., Toronto, ON, M5G-2M9, Canada
| | - Young-Bin Cho
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Princess Margaret Cancer Centre, 610 University Ave., Toronto, ON, M5G-2M9, Canada
| | - Young Lee
- Department of Radiation Oncology, University of Toronto, 150 College St., Toronto, ON, M5S-3E2, Canada
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N-3M5, Canada
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Chen KK, Guo WY, Yang HC, Lin CJ, Wu CHF, Gehrisch S, Kowarschik M, Wu YT, Chung WY. Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery. AJNR Am J Neuroradiol 2017; 38:740-746. [PMID: 28126751 DOI: 10.3174/ajnr.a5074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery. MATERIALS AND METHODS Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA. RESULTS Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging (P = .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula (P = .042 and 0.039, respectively, for measurements conducted by 2 authors). CONCLUSIONS Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
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Affiliation(s)
- K-K Chen
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - C-J Lin
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-H F Wu
- Siemens Healthcare Ltd, Advanced Therapies (C.-H.F.W.), Taipei, Taiwan
| | - S Gehrisch
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - Y-T Wu
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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Hessen ED, van Buuren LD, Nijkamp JA, de Vries KC, Kong Mok W, Dewit L, van Mourik AM, Berlin A, van der Heide UA, Borst GR. Significant tumor shift in patients treated with stereotactic radiosurgery for brain metastasis. Clin Transl Radiat Oncol 2017; 2:23-28. [PMID: 29657996 PMCID: PMC5893526 DOI: 10.1016/j.ctro.2016.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Linac-based stereotactic radiosurgery (SRS) for brain metastases may be influenced by the time interval between treatment preparation and delivery, related to risk of anatomical changes. We studied tumor position shifts and its relations to peritumoral volume edema changes over time, as seen on MRI. Methods Twenty-six patients who underwent SRS for brain metastases in our institution were included. We evaluated the occurrence of a tumor shift between the diagnostic MRI and radiotherapy planning MRI. For 42 brain metastases the tumor and peritumoral edema were delineated on the contrast enhanced T1weighted and FLAIR images of both the diagnostic MRI and planning MRI examinations. Centre of Mass (CoM) shifts and tumor borders were evaluated. We evaluated the influence of steroids on peritumoral edema and tumor volume and the correlation with CoM and tumor border changes. Results The median values of the CoM shifts and of the maximum distances between the tumor borders obtained from the diagnostic MRI and radiotherapy planning MRI were 1.3 mm (maximum shift of 5.0 mm) and 1.9 mm (maximum distance of 7.4 mm), respectively. We found significant correlations between the absolute change in edema volume and the tumor shift of the CoM (p < 0.001) and tumor border (p = 0.040). Patients who received steroids did not only had a decrease in peritumoral edema, but also had a median decrease in tumor volume of 0.02 cc while patients who did not receive steroids had a median increase of 0.06 cc in tumor volume (p = 0.035). Conclusion Our results show that large tumor shifts of brain metastases can occur over time. Because shifts may have a significant impact on the local dose coverage, we recommend minimizing the time between treatment preparation and delivery for Linac based SRS.
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Affiliation(s)
- Eline D Hessen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laurens D van Buuren
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper A Nijkamp
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kim C de Vries
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wai Kong Mok
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anke M van Mourik
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerben R Borst
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Rojas-Villabona A, Miszkiel K, Kitchen N, Jäger R, Paddick I. Evaluation of the stability of the stereotactic Leksell Frame G in Gamma Knife radiosurgery. J Appl Clin Med Phys 2016; 17:75-89. [PMID: 27167264 PMCID: PMC5690935 DOI: 10.1120/jacmp.v17i3.5944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/04/2016] [Accepted: 01/27/2016] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the stability of the Leksell Frame G in Gamma Knife radiosurgery (GKR). Forty patients undergoing GKR underwent pretreatment stereotactic MRI for GKR planning and stereotactic CT immediately after GKR. The stereotactic coordinates of four anatomical landmarks (cochlear apertures and the summits of the anterior post of the superior semicircular canals, bilaterally) were measured by two evaluators on two separate occasions in the pretreatment MRI and post‐treatment CT scans and the absolute distance between the observations is reported. The measurement method was validated with an independent group of patients who underwent both stereotactic MRI and CT imaging before treatment (negative controls; n: 5). Patients undergoing GKR for arteriovenous malformations (AVM) also underwent digital subtraction angiography (DSA), which could result in extra stresses on the frame. The distance between landmark localization in the scans for the negative control group (0.63 mm; 95% CI: 0.57–0.70; SD: 0.29) represents the overall consistency of the evaluation method and provides an estimate of the minimum displacement that could be detected by the study. Two patients in the study group had the fiducial indicator box accidentally misplaced at post‐treatment CT scanning. This simulated the scenario of a frame displacement, and these cases were used as positive controls to demonstrate that the evaluation method is capable of detecting a discrepancy between the MRI and CT scans, if there was one. The mean distance between the location of the landmarks in the pretreatment MRI and post‐treatment CT scans for the study group was 0.71 mm (95% CI: 0.68–0.74; SD:0.32), which was not statistically different from the overall uncertainty of the evaluation method observed in the negative control group (p=0.06). The subgroup of patients with AVM (n: 9), who also underwent DSA, showed a statistically significant difference between the location of the landmarks compared to subjects with no additional imaging: 0.78 mm (95% CI: 0.72–0.84) vs. 0.69 mm (95% CI: 0.66–0.72), p=0.016. This is however a minimal difference (0.1 mm) and the mean difference in landmark location for each AVM patient remained submillimeter. This study demonstrates submillimeter stability of the Leksell Frame G in GKR throughout the treatment procedure. PACS number(s): 87.53.‐j, 87.53.Ly, 87.56.Fc
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Li W, Cho YB, Ansell S, Laperriere N, Ménard C, Millar BA, Zadeh G, Kongkham P, Bernstein M, Jaffray DA, Chung C. The Use of Cone Beam Computed Tomography for Image Guided Gamma Knife Stereotactic Radiosurgery: Initial Clinical Evaluation. Int J Radiat Oncol Biol Phys 2016; 96:214-20. [PMID: 27511857 DOI: 10.1016/j.ijrobp.2016.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/26/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study used cone beam computed tomography (CBCT) to measure the inter- and intrafraction uncertainties for intracranial stereotactic radiosurgery (SRS) using the Leksell Gamma Knife (GK). METHODS AND MATERIALS Using a novel CBCT system adapted to the GK radiosurgery treatment unit, CBCT images were acquired immediately before and after treatment for each treatment session within the context of a research ethics board-approved prospective clinical trial. Patients were immobilized in the Leksell coordinate frame (LCF) for both volumetric CBCT imaging and GK-SRS delivery. The relative displacement of the patient's skull to the stereotactic reference (interfraction motion) was measured for each CBCT scan. Differences between the pre- and post-treatment CBCT scans were used to determine the intrafraction motion. RESULTS We analyzed 20 pre- and 17 post-treatment CBCT scans in 20 LCF patients treated with SRS. The mean translational pretreatment setup error ± standard deviation in the left-right, anteroposterior, and craniocaudal directions was -0.19 ± 0.32, 0.06 ± 0.27, and -0.23 ± 0.2 mm, with a maximum of -0.74, -0.53, and -0.68 mm, respectively. After an average time between the pre- and post-treatment CBCT scans of 82 minutes (range 27-170), the mean intrafraction error ± standard deviation for the LCF was -0.03 ± 0.05, -0.03 ± 0.18, and -0.03 ± 0.12 mm in the left-right, anteroposterior, and craniocaudual direction, respectively. CONCLUSIONS Using CBCT on a prototype image guided GK Perfexion unit, we were able to measure the inter- and intrafraction positional changes for GK-SRS using the invasive frame. In the era of image guided radiation therapy, the use of CBCT image guidance for both frame- and non-frame-based immobilization systems could serve as a useful quality assurance tool. Our preliminary measurements can guide the application of achievable thresholds for inter- and intrafraction discrepancy when moving to a frameless approach.
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Affiliation(s)
- Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Young-Bin Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Steve Ansell
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Ménard
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; Macfeeters-Hamilton Centre for Neuro-oncology, Ontario Cancer Institute, Toronto, Ontario, Canada
| | - Paul Kongkham
- Division of Neurosurgery, University of Toronto University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mark Bernstein
- Division of Neurosurgery, University of Toronto University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Li W, Bootsma G, Von Schultz O, Carlsson P, Laperriere N, Millar BA, Jaffray D, Chung C. Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife. Cureus 2016; 8:e531. [PMID: 27081592 PMCID: PMC4829406 DOI: 10.7759/cureus.531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator. Materials & methods This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient’s nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared. Results Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm. Conclusions: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.
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Affiliation(s)
- Winnie Li
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Gregory Bootsma
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON
| | - Oscar Von Schultz
- Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden
| | - Per Carlsson
- Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Barbara-Ann Millar
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - David Jaffray
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON
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Sager O, Dincoglan F, Beyzadeoglu M. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives. CNS Oncol 2015; 4:105-14. [PMID: 25768334 DOI: 10.2217/cns.14.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad. 06018, Etlik, Kecioren, Ankara, Turkey
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Nakazawa H, Uchiyama Y. [Effect of source positional discrepancy on dose and dose distributions in cobalt-60 stereotactic radiosurgery units]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2015; 71:177-85. [PMID: 25797659 DOI: 10.6009/jjrt.2015_jsrt_71.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We assessed the impact of source positional discrepancy on dose and dose distributions in Gamma Knife (GK) Perfexion (PFX) stereotactic radiosurgery. A spherical phantom dedicated in GK machine was used and irradiated by 2 Gy in each position moved at an interval of 0.1 mm from its original position using three types of collimators (4, 8, 16 mm) to evaluate the changes of dose. In addition, to obtain the dose distributions, radiochromic film was inserted in the phantom and irradiated by 6 Gy in each position moved at an interval of 1 mm from its original position using three types of collimators. A distance-to-agreement analysis (DTA) was performed to compare isodose lines from 10% to 90% of dose distributions between the original and deviated position. As a result, when the source moved toward the discrepancy from the center of the collimator, the dose and dose distributions discrepancies increased according to the degree of discrepancy. Especially in 4-mm collimator, 0.5 mm discrepancy caused dose reduction of 5%. On the other hand, 0.5 mm discrepancy showed merely dose differences less than 0.5% in 8 mm and 16 mm collimators. Regarding dose distributions, 1 mm discrepancy in all collimators showed little changes in DTA within 1 mm on average.
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Ruschin M, Lee Y, Beachey D, Yeboah C, Wronski M, Babic S, Lochray F, Nico A, Khan L, Soliman H, Sahgal A. Investigation of Dose Falloff for Intact Brain Metastases and Surgical Cavities Using Hypofractionated Volumetric Modulated Arc Radiotherapy. Technol Cancer Res Treat 2015; 15:130-8. [PMID: 25627201 DOI: 10.1177/1533034614567277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/05/2014] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Intact brain metastases tend to be small and spherical compared to postsurgery brain cavities, which tend to be large and irregular shaped and, as a result, a challenge with respect to treatment planning. The purpose of the present study is to develop guidelines for normal brain tissue dose and to investigate whether there is a dependence on target type for patients treated with hypofractionated volumetric modulated arc radiotherapy (HF-VMAT). METHODS Treatment plans from a total of 100 patients and 136 targets (55 cavity and 81 intact) were retrospectively reviewed. All targets were treated with HF-VMAT with total doses ranging between 20 and 30 gray (Gy) in 5 fractions. All plans met institutional objectives for organ-at-risk constraints and were clinically delivered. Dose falloff was quantified using gradient index (GI) and distance between the 100% and 50% isodose lines (R50). Additionally, the dose to normal brain tissue (brain contour excluding all gross tumor or clinical target volumes) was assessed using volume receiving specific doses (Vx) where x ranged from 5 to 30 Gy. Best-fit curves using power law relationships of the form y = ax(b) were generated for GI, R50, and Vx (normal brain tissue) versus target volume. RESULTS There was a statistically significant difference in planning target volume (PTV) for cavities versus intact metastases with mean volumes of 37.8 cm(3) and 9.5 cm(3), respectively (P < .0001). The GI and R50 were statistically different: 3.4 and 9.8 mm for cavities versus 4.6 and 8.3 mm for intact metastases (P < .0001). The R50 increased with PTV with power law coefficients (a, b) = (6.3, 0.12) and (5.9, 0.15) for cavities and intact, respectively. GI decreased with PTV with coefficients (a, b) = (5.9, -0.18) and (5.7, -0.14) for cavities and intact, respectively. The normal brain tissue Vx also exhibited power law relationships with PTV for x = 20 to 28.8 Gy. In conclusion, target volume is the main predictor of dose falloff. The results of the present study can be used for determining target volume-based thresholds for dose falloff and normal brain tissue dose-volume constraints.
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Affiliation(s)
- Mark Ruschin
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Young Lee
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - David Beachey
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Collins Yeboah
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Matt Wronski
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Steven Babic
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Fiona Lochray
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Anula Nico
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Luluel Khan
- Department of Radiation Oncology, University of Toronto, Toronto, Canada Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, Canada Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Canada Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
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Multisession Gamma Knife Radiosurgery: A Preliminary Experience with a Noninvasive, Relocatable Frame. World Neurosurg 2014; 82:1256-63. [DOI: 10.1016/j.wneu.2014.07.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/02/2014] [Accepted: 07/29/2014] [Indexed: 11/20/2022]
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Nakazawa H, Mori Y, Komori M, Tsugawa T, Shibamoto Y, Kobayashi T, Hashizume C, Uchiyama Y, Hagiwara M. Simulational study of a dosimetric comparison between a Gamma Knife treatment plan and an intensity-modulated radiotherapy plan for skull base tumors. JOURNAL OF RADIATION RESEARCH 2014; 55:518-526. [PMID: 24351459 PMCID: PMC4014159 DOI: 10.1093/jrr/rrt136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 06/03/2023]
Abstract
Fractionated stereotactic radiotherapy (SRT) is performed with a linear accelerator-based system such as Novalis. Recently, Gamma Knife Perfexion (PFX) featured the Extend system with relocatable fixation devices available for SRT. In this study, the dosimetric results of these two modalities were compared from the viewpoint of conformity, heterogeneity and gradient in target covering. A total of 14 patients with skull base tumors were treated with Novalis intensity-modulated (IM)-SRT. Treatment was planned on an iPlan workstation. Five- to seven-beam IM-SRT was performed in 14-18 fractions with a fraction dose of 2.5 or 3 Gy. With these patients' data, additional treatment planning was simulated using a GammaPlan workstation for PFX-SRT. Reference CT images with planning structure contour sets on iPlan, including the planning target volume (PTV, 1.1-102.2 ml) and organs at risk, were exported to GammaPlan in DICOM-RT format. Dosimetric results for Novalis IM-SRT and PFX-SRT were evaluated in the same prescription doses. The isocenter number of PFX was between 12 and 50 at the isodose contour of 50-60%. The PTV coverage was 95-99% for Novalis and 94-98% for PFX. The conformity index (CI) was 1.11-1.61 and 1.04-1.15, the homogeneity index (HI) was 1.1-3.62 and 2.3-3.25, and the gradient index (GI) was 3.72-7.97 and 2.54-3.39 for Novalis and PFX, respectively. PTV coverage by Novalis and PFX was almost equivalent. PFX was superior in CI and GI, and Novalis was better in HI. Better conformality would be achieved by PFX, when the homogeneity inside tumors is less important.
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Affiliation(s)
- Hisato Nakazawa
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yoshimasa Mori
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masataka Komori
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahiko Tsugawa
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tatsuya Kobayashi
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yukio Uchiyama
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Masahiro Hagiwara
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
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Schmidhalter D, Malthaner M, Born EJ, Pica A, Schmuecking M, Aebersold DM, Fix MK, Manser P. Assessment of patient setup errors in IGRT in combination with a six degrees of freedom couch. Z Med Phys 2014; 24:112-22. [DOI: 10.1016/j.zemedi.2013.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 09/20/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
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23
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Kobayashi Y, Inose H, Nagasu R, Nakagawa T, Kubota Y, Gonda K, Ohuchi N. X-ray imaging technique using colloid solution of Au/silica/poly(ethylene glycol) nanoparticles. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1433075x13y.0000000100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Y. Kobayashi
- Department of Biomolecular Functional EngineeringCollege of Engineering, Ibaraki University, 4-12-1 Naka-narusawa-cho, Hitachi, Ibaraki 316-8511, Japan
| | - H. Inose
- Department of Biomolecular Functional EngineeringCollege of Engineering, Ibaraki University, 4-12-1 Naka-narusawa-cho, Hitachi, Ibaraki 316-8511, Japan
| | - R. Nagasu
- Department of Biomolecular Functional EngineeringCollege of Engineering, Ibaraki University, 4-12-1 Naka-narusawa-cho, Hitachi, Ibaraki 316-8511, Japan
| | - T. Nakagawa
- Division of Surgical OncologyGraduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Y. Kubota
- Division of Surgical OncologyGraduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - K. Gonda
- Division of Surgical OncologyGraduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - N. Ohuchi
- Division of Surgical OncologyGraduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
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Bichay T, Dieterich S, Orton CG. Point/Counterpoint. Submillimeter accuracy in radiosurgery is not possible. Med Phys 2013; 40:050601. [PMID: 23635246 DOI: 10.1118/1.4790690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Tewfik Bichay
- Saint Mary's Health Care, Grand Rapids, Michigan 49503, USA.
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Ghobadi K, Ghaffari HR, Aleman DM, Jaffray DA, Ruschin M. Automated treatment planning for a dedicated multi-source intra-cranial radiosurgery treatment unit accounting for overlapping structures and dose homogeneity. Med Phys 2013; 40:091715. [DOI: 10.1118/1.4817555] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Ruschin M, Komljenovic PT, Ansell S, Ménard C, Bootsma G, Cho YB, Chung C, Jaffray D. In reply to Cheung. Int J Radiat Oncol Biol Phys 2013; 85:291-2. [PMID: 23312270 DOI: 10.1016/j.ijrobp.2012.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/15/2012] [Indexed: 11/16/2022]
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27
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Cheung R. In regard to Ruschin et al. Int J Radiat Oncol Biol Phys 2013; 85:291. [PMID: 23312269 DOI: 10.1016/j.ijrobp.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Indexed: 11/15/2022]
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