Characterization and validation of an intra‐fraction motion management system for masked‐based radiosurgery

Knutson, Nels C.; Hawkins, Brad J.; Bollinger, Douglas; Goddu, S; Kavanaugh, James; Santanam, Lakshmi; Mitchell, Timothy J.; Zoberi, Jacqueline E.; Tsien, Christina; Huang, Jiayi; Robinson, Clifford G.; Perkins, Stephanie M.; Dowling, Joshua L.; Chicoine, Michael R.; Rich, Keith M.; Dunn, Gavin P.; Mutic, Sasa

doi:10.1002/acm2.12573

Cited by 10 publications

(14 citation statements)

References 12 publications

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“…The GK Icon™ (Elekta, Stockholm, Sweden) is the sixth-generation and most recent commercial model. This latest upgrade includes a cone-beam computed tomography (CBCT) module, permitting non-invasive immobilization utilizing frameless treatments without compromising sub-millimeter accuracy [ 2 , 3 ]. Frameless stereotactic radiotherapy (SRT) allows for custom-tailored utilization and opens many new indications for treatment on the GK system.…”

Section: Introductionmentioning

confidence: 99%

Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™

Mendel¹,

Schroeder²,

Plitt³

et al. 2021

Cureus

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The indications and techniques for the treatment of intracranial lesions continue to evolve with the advent of novel technologies. The Gamma Knife Icon™ (GK Icon™) is the most recent model available from Elekta, providing a frameless solution for stereotactic radiosurgery. At our institution, 382 patients with 3,213 separate intracranial lesions have been treated with frameless stereotactic radiotherapy using the GK Icon. The wide range of diagnoses include brain metastases, meningiomas, arteriovenous malformations, acoustic neuromas, pituitary adenomas, and several other histologies. The ability to perform both frame and frameless treatments on the GK Icon has significantly increased our daily volume by almost 50% on a single machine. Although the frameless approach allows one to take advantage of the precision in radiosurgery, the intricacies regarding treatment with this frameless system are not well established. Our initial experience will help to serve as a guide to those wishing to implement this novel technology in their practice.

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Section: Introductionmentioning

confidence: 99%

Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™

Mendel¹,

Schroeder²,

Plitt³

et al. 2021

Cureus

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“…The Icon is unique in that it utilizes on‐board cone beam computed tomography (CBCT) imaging system to enable fractionated and frameless treatments . The specifics on commissioning and QA for the Icon system can be found in the literature . Dose is calculated for Icon patients using the TMR10 algorithm .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a new secondary dose calculation software for Gamma Knife radiosurgery

Prusator

Zhao

Kavanaugh

et al. 2020

J Applied Clin Med Phys

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Current available secondary dose calculation software for Gamma Knife radiosurgery falls short in situations where the target is shallow in depth or when the patient is positioned with a gamma angle other than 90°. In this work, we evaluate a new secondary calculation software which utilizes an innovative method to handle nonstandard gamma angles and image thresholding to render the skull for dose calculation. 800 treatment targets previously treated with our GammaKnife Icon system were imported from our treatment planning system (GammaPlan 11.0.3) and a secondary dose calculation was conducted. The agreement between the new calculations and the TPS were recorded and compared to the original secondary dose calculation agreement with the TPS using a Wilcoxon Signed Rank Test. Further comparisons using a Mann-Whitney test were made for targets treated at a 90°gamma angle against those treated with either a 70 or 110 gamma angle for both the new and commercial secondary dose calculation systems. Correlations between dose deviations from the treatment planning system against average target depth were evaluated using a Kendall's Tau correlation test for both programs. The Wilcoxon Signed Rank Test indicated a significant difference in the agreement between the two secondary calculations and the TPS, with a P-value < 0.0001. With respect to patients treated at nonstandard gamma angles, the new software was largely independent of patient setup, while the commercial software showed a significant dependence (Pvalue < 0.0001). The new secondary dose calculation software showed a moderate correlation with calculation depth, while the commercial software showed a weak correlation (Tau = −.322 and Tau = −.217 respectively). Overall, the new secondary software has better agreement with the TPS than the commercially available secondary calculation software over a range of diverse treatment geometries. K E Y W O R D SGamma Knife, icon, secondary dose calculation, SRS

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“…Several studies have presented quality assurance (QA) procedures of the LGK Icon™ 4–9 . Zeverino et al .…”

Section: Introductionmentioning

confidence: 99%

“…discussed commissioning procedures of the LGK Icon™ 5 . Knutson et al described QA techniques for the IFMM system of the LGK Icon™ 6 . AlDahlawi et al reported the QA procedure for the GK Icon™’s CBCT system 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Filmless quality assurance of a Leksell Gamma Knife® Icon™

Maraghechi

Kim

Mitchell

et al. 2020

J Applied Clin Med Phys

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Purpose: The annual quality assurance (QA) of Leksell Gamma Knife ® (LGK) systems are typically performed using films. Film is a good candidate for small field dosimetry due to its high spatial resolution and availability. However, there are multiple challenges with using film; film does not provide real-time measurement and requires batch-specific calibration. Our findings show that active detector-based QA can simplify the procedure and save time without loss of accuracy.Methods: Annual QA tests for a LGK Icon™ system were performed using both film-based and filmless techniques. Output calibration, relative output factors (ROF), radiation profiles, sector uniformity/source counting, and verification of the unit center point (UCP) and radiation focal point (RFP) coincidence tests were performed.Radiochromic films, two ionization chambers, and a synthetic diamond detector were used for the measurements. Results were compared and verified with the treatment planning system (TPS). Results:The measured dose rate of the LGK Icon was within 0.4% of the TPS value set at the time of commissioning using an ionization chamber. ROF for the 8 and 4mm collimators were found to be 0.3% and 1.8% different from TPS values using the MicroDiamond detector and 2.6% and 1.9% different for film, respectively. Excellent agreement was found between TPS and measured dose profiles using the MicroDiamond detector which was within 1%/1 mm vs 2%/1 mm for film. Sector uniformity was found to be within 1% for all eight sectors measured using an ionization chamber. Verification of UCP and RFP coincidence using the MicroDiamond detector and pinprick film test was within 0.3 mm at isocenter for both. Conclusion:The annual QA of a LGK Icon was successfully performed by employing filmless techniques. Comparable results were obtained using radiochromic films.Utilizing active detectors instead of films simplifies the QA process and saves time without loss of accuracy.

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Characterization and validation of an intra‐fraction motion management system for masked‐based radiosurgery

Cited by 10 publications

References 12 publications

Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™

Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™

Evaluation of a new secondary dose calculation software for Gamma Knife radiosurgery

Filmless quality assurance of a Leksell Gamma Knife® Icon™

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