In reply: volumetric arc therapy (RapidArc) vs Gamma Knife radiosurgery for multiple brain metastases

Finer leaf resolution and steeper beam edges using a virtual isocentre in concurrence to PTV-shaped collimators in standard distance - a planning study

Purpose

Investigation of a reduced source to target distance to improve organ at risk sparing during stereotactic irradiation (STX).

Methods

The authors present a planning study with perfectly target-volume adapted collimator compared with multi-leaf collimator (MLC) at reduced source to virtual isocentre distance (SVID) in contrast to normal source to isocentre distance (SID) for stereotactic applications. The role of MLC leaf width and 20–80% penumbra was examined concerning the healthy tissue sparing. Several prescription schemes and target diameters are considered.

Results

Paddick’s gradient index (GI) as well as comparison of the mean doses to spherical shells at several distances to the target is evaluated. Both emphasize the same results: the healthy tissue sparing in the high dose area around the planning target volume (PTV) is improved at reduced SVID ≤ 70 cm. The effect can be attributed more to steeper penumbra than to finer leaf resolution. Comparing circular collimators at different SVID just as MLC-shaped collimators, always the GI was reduced. Even MLC-shaped collimator at SVID 70 cm had better healthy tissue sparing than an optimal shaped circular collimator at SID 100 cm.

Regarding penumbra changes due to varying SVID, the results of the planning study are underlined by film dosimetry measurements with Agility™ MLC.

Conclusion

Penumbra requires more attention in comparing studies, especially studies using different planning systems. Reduced SVID probably allows usage of conventional MLC for STX-like irradiations.

Electronic supplementary material

The online version of this article (doi:10.1186/s13014-017-0826-8) contains supplementary material, which is available to authorized users.