Kate Hazelwood, Shane McCarthy, Josh Misa, David Castelvetere, William St Clair, Damodar Pokhrel
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Plan quality metrics including conformity index (CI), gradient index (GI), gradient distance (GD), PTV coverage, gross tumor volume (GTV) dose, heterogeneity index (HI), and doses to organs-at-risk (OAR) including normal brain dose were evaluated. Patient-specific quality assurance (PSQA) and independent dose verification via in-house Monte Carlo (MC) 2nd checks were performed.</p><p><strong>Results: </strong>The Halcyon was able to provide highly conformal brain SRS plans. When compared to TrueBeam, CI, planning target volume (PTV) coverage, GTV dose (mean and minimum), HI, and doses to brainstem, optic pathway, and cochlea were statistically insignificant. Statistically significant increases in GI (3.76 vs. 3.25, p < 0.001), GD (0.56 cm vs. 0.48 cm, p = 0.001), and V<sub>12Gy</sub> (5.5 cc vs. 4.6 cc, p = 0.014), on average using Halcyon versus TrueBeam was found, albeit clinically acceptable values for the majority of brain SRS cases. Halcyon plans provided statistically insignificant maximum dose to most adjacent OARs, though there was a statistically significant decrease in the maximum dose to the spinal cord (0.1 Gy vs. 0.4 Gy, p = 0.009). Halcyon beam-on time increases by a factor of ∼2 (p < 0.001). However, the faster patient setup on Halcyon results in a comparable estimated overall treatment time for both platforms. Plan deliverability and accuracy was ensured with PSQA (> 95% pass rate for 2%/2 mm clinical gamma criteria) results and MC 2nd check agreement within ± 5.0%.</p><p><strong>Conclusions: </strong>Halcyon brain SRS plans provided a similar plan quality compared to HyperArc plans, although it demonstrated an inferior intermediate dose fall off thus slightly higher V<sub>12Gy</sub>. This study suggests that Halcyon provides acceptable treatment for solitary relatively small brain lesions of 1-3 cm in diameter. Treatment of select patients on Halcyon will be started at our clinic and it is recommended that other clinics complete an end-to-end test, validate, and implement Halcyon SRS treatments at their practices, especially community cancer centers to provide high-quality service to an underserved patient cohort.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70105"},"PeriodicalIF":2.0000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An investigation into the feasibility and efficacy of stereotactic radiosurgery for 1-3 cm single brain lesions on the ring-mounted Halcyon LINAC.\",\"authors\":\"Kate Hazelwood, Shane McCarthy, Josh Misa, David Castelvetere, William St Clair, Damodar Pokhrel\",\"doi\":\"10.1002/acm2.70105\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>An evaluation of the accuracy, safety, and efficiency of the Halcyon ring delivery system (RDS) for stereotactic radiosurgery (SRS) treatment to relatively small (1-3 cm) brain lesions.</p><p><strong>Methods: </strong>After completing the extensive in-house quality assurance checks including Winston-Lutz test and independent dose verification via MD Anderson IROC SRS head phantom irradiation on Halcyon, fifteen brain SRS patients previously treated with a single dose of 20 Gy on TrueBeam (6MV-FFF) with HyperArc geometry were retrospectively replanned on Halcyon (6MV-FFF). Plan quality metrics including conformity index (CI), gradient index (GI), gradient distance (GD), PTV coverage, gross tumor volume (GTV) dose, heterogeneity index (HI), and doses to organs-at-risk (OAR) including normal brain dose were evaluated. Patient-specific quality assurance (PSQA) and independent dose verification via in-house Monte Carlo (MC) 2nd checks were performed.</p><p><strong>Results: </strong>The Halcyon was able to provide highly conformal brain SRS plans. When compared to TrueBeam, CI, planning target volume (PTV) coverage, GTV dose (mean and minimum), HI, and doses to brainstem, optic pathway, and cochlea were statistically insignificant. Statistically significant increases in GI (3.76 vs. 3.25, p < 0.001), GD (0.56 cm vs. 0.48 cm, p = 0.001), and V<sub>12Gy</sub> (5.5 cc vs. 4.6 cc, p = 0.014), on average using Halcyon versus TrueBeam was found, albeit clinically acceptable values for the majority of brain SRS cases. 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引用次数: 0
摘要
目的:评价Halcyon环传送系统(RDS)用于立体定向放射外科(SRS)治疗相对较小(1- 3cm)脑病变的准确性、安全性和有效性。方法:在完成广泛的内部质量保证检查,包括Winston-Lutz试验和通过MD Anderson IROC SRS头部幻影照射在Halcyon上进行的独立剂量验证后,回顾性地重新计划在Halcyon (6MV-FFF)上治疗15例先前使用HyperArc几何结构的TrueBeam (6MV-FFF)单剂量20 Gy的脑SRS患者。评估计划质量指标,包括一致性指数(CI)、梯度指数(GI)、梯度距离(GD)、PTV覆盖率、总肿瘤体积(GTV)剂量、异质性指数(HI)和危险器官剂量(OAR),包括正常脑剂量。患者特异性质量保证(PSQA)和通过内部蒙特卡洛(MC)第二次检查进行的独立剂量验证。结果:Halcyon能够提供高度适形的脑SRS图。与TrueBeam相比,CI、计划靶体积(PTV)覆盖率、GTV剂量(平均和最小)、HI、脑干、视神经通路和耳蜗剂量均无统计学意义。Halcyon与TrueBeam的GI平均升高(3.76 vs. 3.25, p = 12Gy (5.5 cc vs. 4.6 cc, p = 0.014),尽管大多数脑SRS病例的GI值在临床上是可接受的。Halcyon计划对大多数相邻的OARs提供的最大剂量在统计学上不显著,尽管对脊髓的最大剂量在统计学上有显著降低(0.1 Gy对0.4 Gy, p = 0.009)。Halcyon光束照射时间增加了2倍(2%/ 2mm临床伽马标准95%合格率),MC第二次检查一致性在±5.0%以内。结论:Halcyon脑SRS计划与HyperArc计划相比提供了相似的计划质量,尽管它表现出较差的中间剂量下降,因此V12Gy略高。本研究表明,Halcyon对直径1-3厘米的孤立性相对较小的脑病变提供了可接受的治疗。选定的Halcyon患者的治疗将在我们的诊所开始,建议其他诊所完成端到端测试,验证并在他们的实践中实施Halcyon SRS治疗,特别是社区癌症中心,为服务不足的患者群体提供高质量的服务。
An investigation into the feasibility and efficacy of stereotactic radiosurgery for 1-3 cm single brain lesions on the ring-mounted Halcyon LINAC.
Purpose: An evaluation of the accuracy, safety, and efficiency of the Halcyon ring delivery system (RDS) for stereotactic radiosurgery (SRS) treatment to relatively small (1-3 cm) brain lesions.
Methods: After completing the extensive in-house quality assurance checks including Winston-Lutz test and independent dose verification via MD Anderson IROC SRS head phantom irradiation on Halcyon, fifteen brain SRS patients previously treated with a single dose of 20 Gy on TrueBeam (6MV-FFF) with HyperArc geometry were retrospectively replanned on Halcyon (6MV-FFF). Plan quality metrics including conformity index (CI), gradient index (GI), gradient distance (GD), PTV coverage, gross tumor volume (GTV) dose, heterogeneity index (HI), and doses to organs-at-risk (OAR) including normal brain dose were evaluated. Patient-specific quality assurance (PSQA) and independent dose verification via in-house Monte Carlo (MC) 2nd checks were performed.
Results: The Halcyon was able to provide highly conformal brain SRS plans. When compared to TrueBeam, CI, planning target volume (PTV) coverage, GTV dose (mean and minimum), HI, and doses to brainstem, optic pathway, and cochlea were statistically insignificant. Statistically significant increases in GI (3.76 vs. 3.25, p < 0.001), GD (0.56 cm vs. 0.48 cm, p = 0.001), and V12Gy (5.5 cc vs. 4.6 cc, p = 0.014), on average using Halcyon versus TrueBeam was found, albeit clinically acceptable values for the majority of brain SRS cases. Halcyon plans provided statistically insignificant maximum dose to most adjacent OARs, though there was a statistically significant decrease in the maximum dose to the spinal cord (0.1 Gy vs. 0.4 Gy, p = 0.009). Halcyon beam-on time increases by a factor of ∼2 (p < 0.001). However, the faster patient setup on Halcyon results in a comparable estimated overall treatment time for both platforms. Plan deliverability and accuracy was ensured with PSQA (> 95% pass rate for 2%/2 mm clinical gamma criteria) results and MC 2nd check agreement within ± 5.0%.
Conclusions: Halcyon brain SRS plans provided a similar plan quality compared to HyperArc plans, although it demonstrated an inferior intermediate dose fall off thus slightly higher V12Gy. This study suggests that Halcyon provides acceptable treatment for solitary relatively small brain lesions of 1-3 cm in diameter. Treatment of select patients on Halcyon will be started at our clinic and it is recommended that other clinics complete an end-to-end test, validate, and implement Halcyon SRS treatments at their practices, especially community cancer centers to provide high-quality service to an underserved patient cohort.
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