Improving dose delivery in non-coplanar cranial SRS: Stereoscopic x-ray-guided mitigation of table walkout errors.

IF 2 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Yohan A Walter, Philip F Durham, Anne N Hubbard, William E Burrell, Hsinshun T Wu
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引用次数: 0

Abstract

Purpose: Linear accelerator (LINAC)-based single-isocenter multi-target (SIMT) treatment has streamlined the cranial stereotactic radiosurgery (SRS) workflow. Though efficient, SIMT delivery adds additional challenges that should be considered, including increased sensitivity to rotational errors for off-isocenter targets. Room-mounted imaging systems carry the advantage of allowing fast, low-dose imaging at nonzero couch angles, which may combat the effects of table walkout and residual rotational errors. Here, we performed a series of end-to-end tests to determine if these corrections correlate with a measurable difference in delivered dose and to assess the overall accuracy of SIMT delivery on our LINAC-based SRS platform.

Methods: Ten treatment plans of increasing complexity were created in the Elements 4.0 treatment planning system (TPS, Brainlab AG). Plans were delivered on an Elekta Versa HD LINAC (Elekta AB) with the ExacTrac (ETX) imaging system (Brainlab AG). A CT scan of a StereoPHAN with SRS MapCHECK (Sun Nuclear) was imported into the TPS. Measured targets were contoured on the detector plane. Plans used 4-15 treatment arcs and 4-6 couch angles. ETX was used for initial phantom positioning. Dose measurements were performed for each plan with and without ETX-guided corrections at all table angles.

Results: Translational and rotational residual shifts were all submillimeter and ≤1.0 degrees, respectively, across all table angles. Using 3.0%/1.0 mm gamma criteria, all gamma pass rates (GPR) were either equal or improved when ETX shifts were executed, though the difference was not statistically significant (p = 0.076). However, using 2.0%/0.5 mm criteria, GPR improved significantly (p = 0.016) with ETX repositioning. The average GPR improvement was 4.5% ± 4.8%.

Conclusions: Results demonstrate that repositioning corrections at each table angle improve agreement between planned and delivered dose at the submillimeter level. The test treatment plans in this study may be used for assessment of end-to-end treatment delivery accuracy for complex LINAC-based stereotactic radiotherapy procedures.

改善非共面颅骨SRS的剂量传递:立体x线引导下减轻手术台行走误差。
目的:基于直线加速器(LINAC)的单等中心多靶点(SIMT)治疗简化了颅立体定向放射外科(SRS)的工作流程。虽然SIMT传输效率高,但也增加了需要考虑的额外挑战,包括对偏离等心目标旋转误差的灵敏度增加。室内安装成像系统的优点是允许在非零沙发角度进行快速,低剂量成像,这可能会对抗工作台行走和残余旋转误差的影响。在这里,我们进行了一系列端到端测试,以确定这些校正是否与递送剂量的可测量差异相关,并评估基于linac的SRS平台上SIMT递送的总体准确性。方法:在Elements 4.0治疗计划系统(TPS, Brainlab AG)中创建10个逐渐复杂的治疗计划。设计方案采用Elekta Versa HD LINAC (Elekta AB)和ExacTrac (ETX)成像系统(Brainlab AG)。使用SRS MapCHECK (Sun Nuclear)将StereoPHAN的CT扫描导入TPS。被测目标在探测平面上进行轮廓化处理。计划使用4-15个治疗弧和4-6个沙发角。ETX用于初始幻体定位。在所有工作台角度上,在有或没有etx引导校正的情况下,对每个计划进行剂量测量。结果:在所有表角上,平移和旋转残余位移分别为亚毫米和≤1.0度。使用3.0%/1.0 mm伽马标准,当执行ETX移位时,所有伽马通过率(GPR)相等或提高,尽管差异无统计学意义(p = 0.076)。然而,使用2.0%/0.5 mm标准时,使用ETX重新定位,GPR显著提高(p = 0.016)。GPR平均提高4.5%±4.8%。结论:结果表明,每个表角的重新定位修正提高了亚毫米水平上计划剂量和交付剂量之间的一致性。本研究中的试验治疗方案可用于评估基于linac的复杂立体定向放疗程序的端到端治疗递送准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.60
自引率
19.00%
发文量
331
审稿时长
3 months
期刊介绍: Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission. JACMP will publish: -Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500. -Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed. -Technical Notes: These should be no longer than 3000 words, including key references. -Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents. -Book Reviews: The editorial office solicits Book Reviews. -Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics. -Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic
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