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Lee YC, Wieczorek DJ, Chaswal V, Kotecha R, Hall MD, Tom MC, Mehta MP, McDermott MW, Gutierrez AN, Tolakanahalli R. A study on inter-planner plan quality variability using a manual planning- or Lightning dose optimizer-approach for single brain lesions treated with the Gamma Knife ® Icon™. J Appl Clin Med Phys 2023; 24:e14088. [PMID: 37415385 PMCID: PMC10647977 DOI: 10.1002/acm2.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/11/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The purpose of this study is to investigate inter-planner plan quality variability using a manual forward planning (MFP)- or fast inverse planning (FIP, Lightning)-approach for single brain lesions treated with the Gamma Knife® (GK) Icon™. METHODS Thirty patients who were previously treated with GK stereotactic radiosurgery or radiotherapy were selected and divided into three groups (post-operative resection cavity, intact brain metastasis, and vestibular schwannoma [10 patients per group]). Clinical plans for the 30 patients were generated by multiple planners using FIP only (1), a combination of FIP and MFP (12), and MFP only (17). Three planners (Senior, Junior, and Novice) with varying experience levels re-planned the 30 patients using MFP and FIP (two plans per patient) with planning time limit of 60 min. Statistical analysis was performed to compare plan quality metrics (Paddick conformity index, gradient index, number of shots, prescription isodose line, target coverage, beam-on-time (BOT), and organs-at-risk doses) of MFP or FIP plans among three planners and to compare plan quality metrics between each planner's MFP/FIP plans and clinical plans. Variability in FIP parameter settings (BOT, low dose, and target max dose) and in planning time among the planners was also evaluated. RESULTS Variations in plan quality metrics of FIP plans among three planners were smaller than those of MFP plans for all three groups. Junior's MFP plans were the most comparable to the clinical plans, whereas Senior's and Novice's MFP plans were superior and inferior, respectively. All three planners' FIP plans were comparable or superior to the clinical plans. Differences in FIP parameter settings among the planners were observed. Planning time was shorter and variations in planning time among the planners were smaller for FIP plans in all three groups. CONCLUSIONS The FIP approach is less planner dependent and more time-honored than the MFP approach.
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Affiliation(s)
- Yongsook C. Lee
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - D Jay Wieczorek
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Vibha Chaswal
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Rupesh Kotecha
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
- Department of Translational MedicineHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Matthew D. Hall
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Martin C. Tom
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Minesh P. Mehta
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Michael W. McDermott
- Department of Translational MedicineHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
- Department of NeurosurgeryMiami Neuroscience InstituteBaptist Health South FloridaMiamiUSA
| | - Alonso N. Gutierrez
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Ranjini Tolakanahalli
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
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Faraj MK, Al-Musawi MS, Ali Abdulameer T. Design and manufacturing of a head mask for fixation in stereotactic radiosurgery by the Gamma Knife ® Icon™. Surg Neurol Int 2023; 14:188. [PMID: 37404506 PMCID: PMC10316152 DOI: 10.25259/sni_1053_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/08/2023] [Indexed: 07/06/2023] Open
Abstract
Background This study evaluates an alternative to the classical method of head fixation during Gamma Knife radiosurgery using a Leksell head frame. In the Gamma Knife® Icon™ model, a new method of head fixation is used by utilizing a thermal molded polymer mask that takes the shape of the patient's head before fixing the head to the table. However, this mask is for single use and quite expensive. Methods We describe a new, very economical method to fix the head of the patient during radiosurgery. We used commercial, quite cheap material [polylactic acid (PLA)] plastic and made a 3D printing model for the patient's face, taking special measurements to put this mask and fix it on the Gamma Knife. The actual material cost is only $4 (100 times less than the original mask cost). Results The new mask efficiency was tested using the movement checker software, the same one used to measure the efficiency of the original mask. Conclusion The newly designed and manufactured mask is quite effective for use with the Gamma Knife® Icon™, with a much lower cost, and it can be manufactured locally.
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Affiliation(s)
- Moneer K. Faraj
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Mustafa Salih Al-Musawi
- Department of Medical Physics, College of Medicine, Al-Mustansyria University, Baghdad, Iraq
| | - Tabarek Ali Abdulameer
- Department of Medical Physics, College of Medicine, Al-Mustansyria University, Baghdad, Iraq
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Maraghechi B, Kim T, Mitchell TJ, Goddu SM, Dise J, Kavanaugh JA, Zoberi JE, Mutic S, Knutson NC. Filmless quality assurance of a Leksell Gamma Knife® Icon™. J Appl Clin Med Phys 2020; 22:59-67. [PMID: 33300664 PMCID: PMC7856498 DOI: 10.1002/acm2.13070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The annual quality assurance (QA) of Leksell Gamma Knife® (LGK) systems are typically performed using films. Film is a good candidate for small field dosimetry due to its high spatial resolution and availability. However, there are multiple challenges with using film; film does not provide real-time measurement and requires batch-specific calibration. Our findings show that active detector-based QA can simplify the procedure and save time without loss of accuracy. METHODS Annual QA tests for a LGK Icon™ system were performed using both film-based and filmless techniques. Output calibration, relative output factors (ROF), radiation profiles, sector uniformity/source counting, and verification of the unit center point (UCP) and radiation focal point (RFP) coincidence tests were performed. Radiochromic films, two ionization chambers, and a synthetic diamond detector were used for the measurements. Results were compared and verified with the treatment planning system (TPS). RESULTS The measured dose rate of the LGK Icon was within 0.4% of the TPS value set at the time of commissioning using an ionization chamber. ROF for the 8 and 4-mm collimators were found to be 0.3% and 1.8% different from TPS values using the MicroDiamond detector and 2.6% and 1.9% different for film, respectively. Excellent agreement was found between TPS and measured dose profiles using the MicroDiamond detector which was within 1%/1 mm vs 2%/1 mm for film. Sector uniformity was found to be within 1% for all eight sectors measured using an ionization chamber. Verification of UCP and RFP coincidence using the MicroDiamond detector and pinprick film test was within 0.3 mm at isocenter for both. CONCLUSION The annual QA of a LGK Icon was successfully performed by employing filmless techniques. Comparable results were obtained using radiochromic films. Utilizing active detectors instead of films simplifies the QA process and saves time without loss of accuracy.
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Affiliation(s)
- Borna Maraghechi
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Taeho Kim
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Timothy J Mitchell
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - S Murty Goddu
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Joe Dise
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - James A Kavanaugh
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacqueline E Zoberi
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Sasa Mutic
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nels C Knutson
- Departments of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
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Leroy HA, Tuleasca C, Zeverino M, Drumez E, Reyns N, Levivier M. Impact of the skull contour definition on Leksell Gamma Knife ® Icon™ radiosurgery treatment planning. Acta Neurochir (Wien) 2020; 162:2203-2210. [PMID: 32556528 DOI: 10.1007/s00701-020-04458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Gamma Knife® planning software (TMR 10, Elekta Instruments, AB, Sweden) affords two ways of defining the skull volume, the "historical" one using manual measurements (still perform in some centers) and the new one using image-based skull contours. Our objective was to assess the potential variation of the dose delivery calculation using consecutively in the same patients the two above-mentioned techniques. MATERIALS AND METHODS We included in this self-case-control study, 50 patients, treated with GKRS between July 2016 and January 2017 in Lausanne University Hospital, Switzerland, distributed among four groups: convexity targets (n = 18), deep-seated targets (n = 13), vestibular schwannomas (n = 11), and trigeminal neuralgias (n = 8). Each planning was performed consecutively with the 2 skull definition techniques. For each treatment, we recorded the beam-on time (min), target volume coverage (%), prescription isodose volume (cm3), and maximal dose (Gy) to the nearest organ at risk if relevant, according to each of the 2 skull definition techniques. The image-based contours were performed using CT scan segmentation, based upon a standardized windowing for all patients. RESULTS The median difference in beam-on time between manual measures and image-based contouring was + 0.45 min (IQR; 0.2-0.6) and was statistically significant (p < 0.0001), corresponding to an increase of 1.28% beam-on time per treatment, when using image-based contouring. The target location was not associated with beam-on time variation (p = 0.15). Regarding target volume coverage (p = 0.13), prescription isodose volume (p = 0.2), and maximal dose to organs at risk (p = 0.85), no statistical difference was reported between the two skull contour definition techniques. CONCLUSION The beam-on time significantly increased using image-based contouring, resulting in an increase of the total dose delivery per treatment with the new TMR 10 algorithm. Other dosimetric parameters did not differ significantly. This raises the question of other potential impacts. One is potential dose modulation that should be performed as an adjustment to new techniques developments. The second is how this changes the biologically equivalent dose per case, as related to an increased beam on time, delivered dose, etc., and how this potentially changes the radiobiological effects of GKRS in an individual patient.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France.
- U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Univ. Lille, Inserm, CHU Lille, F-59000, Lille, France.
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Faculté de Médecine, Sorbonne Université, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Paris, France
| | - Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Elodie Drumez
- Univ. Lille, Department of Neurosurgery, CHU Lille, F-59000, Lille, France
| | - Nicolas Reyns
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France
- U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Univ. Lille, Inserm, CHU Lille, F-59000, Lille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland
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