Assessment of image co-registration accuracy for frameless gamma knife surgery

Chung, Hyun‐Tai; Kim, Jeong Hun; Kim, Jin Wook; Paek, Sun Ha; Kim, Dong Gyu; Chun, Kook Jin; Kim, Tae Hoon; Kim, Yong Kyun

doi:10.1371/journal.pone.0193809

Cited by 27 publications

(30 citation statements)

References 10 publications

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“…Additionally, CBCT can be used to verify patient position during setup prior to irradiation. 1 In this study, we utilized CBCT to compare motion uncertainties between frame-based fixation and mask-based fixation while using the GK Icon.…”

Section: Discussionmentioning

confidence: 99%

Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system

Carminucci

Nie

Weiner

et al. 2018

Journal of Neurosurgery

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T he high dose of radiation delivered via stereotactic radiosurgery (SRS) requires accurate and reproducible immobilization of the head. 7 Accuracy within a range of 1-2 mm is essential to limit irradiation of surrounding anatomical structures. A rigid stereotactic head frame has traditionally been used for fixation in Gamma Knife (GK) radiosurgery. 20 Frame-based fixation allows for precise delivery of a single high-dose fraction of radiation treatment. Motion error associated with frame-based fixation is estimated to be ≤ 1-1.5 mm. 12 New SRS strategies for the treatment of large intracranial lesions have trended toward the use of multifractionation stereotactic radiotherapy (SRT) treatments. But head frame placement is invasive, involving 4-point fixation us-ABBREVIATIONS CBCT = cone-beam computed tomography; GK = Gamma Knife; IR = infrared; LINAC = linear accelerator; SRS = stereotactic radiosurgery; SRT = stereotactic radiotherapy. OBJECTIVE The Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system. METHODS A retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded. RESULTS Data were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre-and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation-i.e., the number of treatment stoppages due to re...

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Section: Discussionmentioning

confidence: 99%

Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system

Carminucci

Nie

Weiner

et al. 2018

Journal of Neurosurgery

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“…Because a mask is not as rigid as a frame, this method relies on radiographic confirmation of accurate patient positioning. One such technique is cone-beam computed tomography, used to check the alignment of the patient and real-time monitoring of patient head movement [6,7].…”

Section: Introductionmentioning

confidence: 99%

Frame-Based and Mask-Based Stereotactic Radiosurgery: The Patient Experience, Compared

Pavlica

Dawley

Goenka

et al. 2021

Stereotact Funct Neurosurg

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Introduction: Noninvasive frameless modalities have become increasingly utilized for stereotactic radiosurgery (SRS) for benign and malignant pathologies. There is minimal comparison in the literature of frame-based (FB) and mask-based (MB) SRS. With the dual capabilities of the Elekta Gamma Knife® Icon™, we sought to compare patient perceptions of FB and MB SRS with respect to comfort and pain and to examine effects of lesion type on the patient experience of SRS. Methods: Over a 1-year period, patients who underwent single fraction, fractionated or hypofractionated FB or MB Gamma Knife SRS at our institution were given an 8-question survey about their experience with the procedure immediately after treatment was completed. Descriptive statistics were applied. Results: A total of 117 patients completed the survey with 65 FB and 52 MB SRS treatments. Mean pain for FB SRS (5.64 ± 2.55) was significantly greater than mean pain for MB SRS (0.92 ± 2.24; t114 = 10.46, p < 0.001). Patient comfort during the procedure was also higher for those having MB SRS (p < 0.001). Mixed results were obtained when investigating if benign versus malignant diagnosis affected patient experience of SRS. For the purposes of this study, malignant diagnoses were almost entirely metastatic lesions. Diagnosis played no role on pain levels when all patients were analyzed together. The treatment technique had no effect on patient comfort in patients with benign diagnoses, while patients with malignant diagnoses treated with MB SRS were more likely to be comfortable (p < 0.001). Among patient’s receiving FB treatments, diagnosis played no role on patient comfort. When only MB treatments were analyzed, patients were more likely to be comfortable if they had a malignant lesion (p < 0.01). Conclusions: Patients treated with MB SRS experience the procedure as more comfortable and less painful compared to those treated using a FB modality. Overall, this difference was not affected by a benign versus a malignant diagnosis and the treatment type is more indicative of the patient experience during SRS. A more homogenous sample between modalities and diagnoses and further follow-up with the patient’s input on their experience would be beneficial.

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“…1 The combination of CBCT positioning and HDMM has been demonstrated to provide sufficient localization and motion management for Gamma Knife SRS treatments. [2][3][4] The patient-specific mask and headrest used for immobilization Three-dimensional printing has been previously demonstrated in patient immobilization applications for radiotherapy. Pham et al used 3D-printed head models from patients' CT scans to fabricate thermoplastic masks before a patient's simulation.…”

Section: Introductionmentioning

confidence: 99%

3D‐printed headrest for frameless Gamma Knife radiosurgery: Design and validation

Baltz

Briere

Luo

et al. 2020

J Applied Clin Med Phys

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Purpose Frameless Gamma Knife stereotactic radiosurgery (SRS) uses a moldable headrest with a thermoplastic mask for patient immobilization. An efficacious headrest is time consuming and difficult to fabricate due to the expertise required to mold the headrest within machine geometrical limitations. The purpose of this study was to design and validate a three‐dimensional (3D)‐printed headrest for frameless Gamma Knife SRS that can overcome these difficulties. Materials and methods A headrest 3D model designed to fit within the frameless adapter was 3D printed. Dosimetric properties of the 3D‐printed headrest and a standard‐of‐care moldable headrest were compared by delivering a Gamma Knife treatment to an anthropomorphic head phantom fitted with an ionization chamber and radiochromic film. Ionization measurements were compared to assess headrest attenuation and a gamma index was calculated to compare the film dose distributions. A volunteer study was conducted to assess the immobilization efficacy of the 3D‐printed headrest compared to the moldable headrest. Five volunteers had their head motion tracked by a surface tracking system while immobilized in each headrest for 20 min. The recorded motion data were used to calculate the average volunteer movement and a paired t‐test was performed. Results The ionization chamber readings were within 0.55% for the 3D‐printed and moldable headrests, and the calculated gamma index showed 98.6% of points within dose difference of 2% and 2 mm distance to agreement for the film measurement. These results demonstrate that the headrests were dosimetrically equivalent within the experimental uncertainties. Average motion (±standard deviation) of the volunteers while immobilized was 1.41 ± 0.43 mm and 1.36 ± 0.51 mm for the 3D‐printed and moldable headrests, respectively. The average observed volunteer motion between headrests was not statistically different, based on a P‐value of 0.466. Conclusions We designed and validated a 3D‐printed headrest for immobilizing patients undergoing frameless Gamma Knife SRS.

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Assessment of image co-registration accuracy for frameless gamma knife surgery

Cited by 27 publications

References 10 publications

Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system

Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system

Frame-Based and Mask-Based Stereotactic Radiosurgery: The Patient Experience, Compared

3D‐printed headrest for frameless Gamma Knife radiosurgery: Design and validation

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