We present a preliminary report on the intra-operative use of a head-mounted microscope ("Varioscope" Leica HM500) in spinal neurosurgery. The Varioscope is a dynamic microscope mounted on a head-set. It weights 297 g and measures 73 x 120 x 63 mm (length x width x height). It offers an infinitely variable range of magnification from 3.6x to 7.2x. The working distance ranges from 300 to 600 mm. The field of view varies between 30-144 mm, depending on the selected enlargement factor and the working distance. In addition to the zoom function, the device offers a focus function (automatic or on demand). The optical elements for focus and zoom are located in two separate tubes which are mounted on a middle section containing the mechanical components as well as the receiver unit for the focussing elements. The lenses are adjusted by means of motor-driven push/pull cables. The autofocus works well in larger operative fields and a working distance between 30 and 60 cm. Nevertheless, when used in today's "keyhole" approaches, the autofocus is not helpful when operating in deep structures. Based on the satisfactory results achieved in our series, we can recommend the Varioscope, especially when no stationary microscope is available. The portable device can be packed in a suitcase and can travel with the consultant microsurgeon to different hospitals and distant units. The built-in video camera is ideal for patients, staff, assistant surgeons, and student education with real-time video monitoring of procedures from the microsurgeon's perspective. For daily microsurgery, we felt more comfortable with fixed, stationary operating microscopes.
PurposeAdvanced radiotherapy delivery systems designed for high‐dose, high‐precision treatments often come equipped with high‐definition multi‐leaf collimators (HD‐MLC) aimed at more finely shaping radiation dose to the target. In this work, we study the effect of a high definition MLC on spine stereotactic body radiation therapy (SBRT) treatment plan quality and plan deliverability.Methods and MaterialsSeventeen spine SBRT cases were planned with VMAT using a standard definition MLC (M120), HD‐MLC, and HD‐MLC with an added objective to reduce monitor units (MU). M120 plans were converted into plans deliverable on an HD‐MLC using in‐house software. Plan quality and plan deliverability as measured by portal dosimetry were compared among the three types of plans.ResultsOnly minor differences were noted in plan quality between the M120 and HD‐MLC plans. Plans generated with the HD‐MLC tended to have better spinal cord sparing (3% reduction in maximum cord dose). HD‐MLC plans on average had 12% more MU and 55% greater modulation complexity as defined by an in‐house metric. HD‐MLC plans also had significantly degraded deliverability. Of the VMAT arcs measured, 94% had lower gamma passing metrics when using the HD‐MLC.ConclusionModest improvements in plan quality were noted when switching from M120 to HD‐MLC at the expense of significantly less accurate deliverability in some cases.
The Rexon UL-320 FDR is a novel resistive-heating thermoluminescent dosimeter reader with a unique temperature measurement system and an automated dosimeter processing mechanism. The removable contact heating planchets have black-body adhesives on the back for capturing temperature information with infrared sensors. A heating cycle feedback loop ensures accurate, precise, and reproducible heating sequences. Heating rates between 0.8 and 40°C s−1 for up to 1,000 s are possible. Photomultiplier tube sensitivity and drift, dark current counts, and planchet glow were measured experimentally. Additionally, 25 LiF:Mg,Ti dosimeters were calibrated to demonstrate reader performance. Sensitivity was optimized at 1,200 V, which produced the highest reference light count to dark current count ratio while extending photomultiplier tube life. Dark current counts measured with typical time-temperature profiles for LiF:Mg,Ti were below 10 counts per channel but increased by up to 2.5% for more extreme heating cycles. Reader sensitivity drifts of up to 10% were observed during extended automated operations with typical time-temperature profiles. Total counts resulting from planchet glow decreased with faster heating rates. Calibrations performed with LiF:Mg,Ti dosimeters yielded results comparable to more established reader designs. Spikes were observed in ~3% of the glow curves from planchet dust and oil burning off at elevated temperatures. The use of N2 gas and sensitivity drift corrections are recommended to improve dosimetry performance for the UL-320 FDR reader.
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