Achieving the Relocation Accuracy of Stereotactic Frame-based Cranial Radiotherapy in a Three-point Thermoplastic Shell

Rosenfelder, N.; Corsini, L.; McNair, Helen; Pennert, Kjell; Burke, K.; Lamb, C.; Aitken, A.; Ashley, S.; Khoo, Vincent; Brada, Michael

doi:10.1016/j.clon.2012.06.007

“…The findings of this study are consistent with similar published studies. Rosenfelder et al 14 9 reported that the Perfexion repositioning headframe system, which is most similar to the Fraxion system, had a 3D mean positioning displacement of 1.1 AE 0.8 mm.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of accuracy and reproducibility of a relocatable maxillary fixation system for fractionated intracranial stereotactic radiation therapy

Russo

¹

,

Owen

²

,

Bernard

³

et al. 2015

J of Medical Radiation Sci

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IntroductionAccurate localisation is an essential component for the delivery of intracranial stereotactic treatment. For fractionated stereotactic radiotherapy, we compared the daily localisation accuracy of a standard thermoplastic mask with a new maxillary fixation device (MFD).MethodsDaily pre‐treatment kV cone‐beam computed tomography (CBCT) scans of 23 patients (12 localised in the MFD and 11 in the mask) with benign skull‐based lesions were reviewed retrospectively. The set up accuracy was measured in 6° of freedom, to ascertain both individual and population random and systematic errors. The appropriate clinical target volume to planning target volume margin was computed from set up error data.ResultsA total of 682 CBCT scans were evaluated. Systematic (Σ) and random (σ) population errors were Σ = 0.8 mm, 0.2 mm and 0.2 mm and σ = 0.3 mm, 0.3 mm and 0.2 mm, respectively, for the standard mask in the left/right (LR), superior/inferior (SI), and anterior/posterior (AP) translational planes, and Σ = 0.2 mm, 0.1 mm and 0.2 mm and σ = 0.2 mm, 0.3 mm and 0.2 mm, respectively, for the MFD. There was a reduction in rotation errors in the MFD compared to the mask. Margin calculations suggested an isotropic margin could be safely reduced to 2 mm for the MFD.ConclusionThe two devices demonstrate similar daily positional accuracy for fractionated stereotactic treatment of intracranial lesions. Combined with daily image guidance and couch correction, either of these devices is a viable frameless option for fractionated stereotactic radiation therapy.

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“…[173] However, while both 3D-CT imaging techniques are well established for pre-and posttreatment set-up verification, the inherent process of image acquisition, reconstruction and registration necessitate long verification times (1 -3 minutes) that are impractical for tracking real-time intra-fractional motion. [174] Intra-fractional validation is a possibility using real-time kilovoltage radiographs but the resulting images provide only 2D tracking and necessitate additional radiation dose.…”

Section: Experimental Navigation System -Clinical Spine Cohortmentioning

confidence: 99%

Feasibility Of Radiation Dose Planning Guided Surgical Resection In Spinal Tumours

Jakubovic¹

2021

Preprint

0

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The objective of high dose stereotactic radiotherapy regardless of application is to treat the malignancy while minimizing the radiation dose to the surrounding healthy tissue. In the context of spinal tumours this paradigm is difficult since the rigid dose tolerance of the spinal cord precludes optimal dose coverage of the epidural disease. To achieve adequate coverage spine separation surgery is performed, increasing the distance from the spinal cord to the malignancy and facilitating adequate radiation treatment planning. This approach has been validated with delivery of maximum tolerable dose and local control rates over 90%. The objective of this dissertation is to establish the feasibility of intraoperative, dose guided, spine separation surgery. In the current clinical context, spine separation surgery is performed prior to radiation treatment planning and contours are placed based on postoperative resected tumour volumes. The extent of surgical resection is not dictated by the dosimetric constraints of the spinal cord and relies solely on the clinical expertise of the operating neurosurgeon. Further, though a skilled surgeon can perform precise tumour debulking with or without the aid of millimetre resolution neuronavigation devices, determination of surgical debulking progress with accuracy comparable to treatment delivery cannot be recognized without intraoperative imaging. To achieve this goal, we introduced pre-surgical dosimetric planning with tracked high frequency micro-ultrasound imaging into the operating theatre to inform the surgeon of the surgical progress while considering the dosimetric objectives. In this dissertation, we assessed the dosimetric advantage of spine separation surgery on a millimetre by millimetre basis in a retrospective simulation study. Feasibility of intraoperative navigation with submillimetre resolution was established by quantifying the application accuracy of surgical navigation in the context of cranial and spinal surgery. Accuracy quantification was performed, assessing our revolutionary optical topographical imaging system and benchmarked versus existing commercially available neuronavigation systems. Finally, to establish feasibility of radiation dose planning guided surgical resection we integrated a high frequency micro-ultrasound system into the operating theater during spine separation surgery. Thus, by implementing sub-millimetre high frequency micro-ultrasound imaging and neuronavigation, incremental gains towards establishing the feasibility of in traoperative dose planning by iteratively updating the extent of tumour resection were recognized.

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“…[173] However, while both 3D-CT imaging techniques are well established for pre-and posttreatment set-up verification, the inherent process of image acquisition, reconstruction and registration necessitate long verification times (1 -3 minutes) that are impractical for tracking real-time intra-fractional motion. [174] Intra-fractional validation is a possibility using real-time kilovoltage radiographs but the resulting images provide only 2D tracking and necessitate additional radiation dose.…”

Section: Experimental Navigation System -Clinical Spine Cohortmentioning

confidence: 99%

Feasibility Of Radiation Dose Planning Guided Surgical Resection In Spinal Tumours

Jakubovic¹

2021

Preprint

0

View full text Add to dashboard Cite

The objective of high dose stereotactic radiotherapy regardless of application is to treat the malignancy while minimizing the radiation dose to the surrounding healthy tissue. In the context of spinal tumours this paradigm is difficult since the rigid dose tolerance of the spinal cord precludes optimal dose coverage of the epidural disease. To achieve adequate coverage spine separation surgery is performed, increasing the distance from the spinal cord to the malignancy and facilitating adequate radiation treatment planning. This approach has been validated with delivery of maximum tolerable dose and local control rates over 90%. The objective of this dissertation is to establish the feasibility of intraoperative, dose guided, spine separation surgery. In the current clinical context, spine separation surgery is performed prior to radiation treatment planning and contours are placed based on postoperative resected tumour volumes. The extent of surgical resection is not dictated by the dosimetric constraints of the spinal cord and relies solely on the clinical expertise of the operating neurosurgeon. Further, though a skilled surgeon can perform precise tumour debulking with or without the aid of millimetre resolution neuronavigation devices, determination of surgical debulking progress with accuracy comparable to treatment delivery cannot be recognized without intraoperative imaging. To achieve this goal, we introduced pre-surgical dosimetric planning with tracked high frequency micro-ultrasound imaging into the operating theatre to inform the surgeon of the surgical progress while considering the dosimetric objectives. In this dissertation, we assessed the dosimetric advantage of spine separation surgery on a millimetre by millimetre basis in a retrospective simulation study. Feasibility of intraoperative navigation with submillimetre resolution was established by quantifying the application accuracy of surgical navigation in the context of cranial and spinal surgery. Accuracy quantification was performed, assessing our revolutionary optical topographical imaging system and benchmarked versus existing commercially available neuronavigation systems. Finally, to establish feasibility of radiation dose planning guided surgical resection we integrated a high frequency micro-ultrasound system into the operating theater during spine separation surgery. Thus, by implementing sub-millimetre high frequency micro-ultrasound imaging and neuronavigation, incremental gains towards establishing the feasibility of in traoperative dose planning by iteratively updating the extent of tumour resection were recognized.

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Achieving the Relocation Accuracy of Stereotactic Frame-based Cranial Radiotherapy in a Three-point Thermoplastic Shell

Cited by 8 publications

References 32 publications

Evaluation of accuracy and reproducibility of a relocatable maxillary fixation system for fractionated intracranial stereotactic radiation therapy

Evaluation of accuracy and reproducibility of a relocatable maxillary fixation system for fractionated intracranial stereotactic radiation therapy

Feasibility Of Radiation Dose Planning Guided Surgical Resection In Spinal Tumours

Feasibility Of Radiation Dose Planning Guided Surgical Resection In Spinal Tumours

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