Cone Beam CT Image Guidance for Intracranial Stereotactic Treatments: Comparison With a Frame Guided Set-Up

Masi, Laura; Casamassima, F.; Polli, Caterina; Menichelli, C.; Bonucci, I.; Cavedon, Carlo

doi:10.1016/j.ijrobp.2008.03.006

Cited by 72 publications

(56 citation statements)

References 28 publications

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“…While the measured intrafractional motion (mean 3D vector = 0.76 ± 0.51 mm and 0.73 ± 0.49 mm for Uniframe and Orfit, respectively) is close to being adequate for frameless‐based SRS (for the CRW frame the mean intrafractional motion = 0.30 ± 0.21 mm), the percentage of fractions with intrafractional motion >2 mm was 3% and 4% for Uniframe and Orfit, respectively, which is suboptimal for SRS. Similar to our study, Masi et al utilized kV‐CBCT image‐guidance to quantify the initial setup error and intrafractional motion of a simple thermoplastic mask (Novastereo; Novater, Milano, Italy) used to immobilize 17 patients for 35 fractions 12. The mean 3D setup error was 3.2 ± 1.5 mm and the mean intrafractional motion was ~0.4 mm.…”

Section: Discussionsupporting

confidence: 62%

“…Compared to head frames, noninvasive immobilization systems such as thermoplastic masks have been shown to offer patient immobilization inferior to what is required for SRS, but sufficient for fully fractionated stereotactic radiotherapy (FSRT) 7, 8, 9, 10, 11, 12. These immobilization systems have been increasingly used in hypofractionated stereotactic radiotherapy (HF‐SRT), stereotactic radiation delivered in 2 to 5 fractions, but the performance has not been well studied 13…”

Section: Introductionmentioning

confidence: 99%

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To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

Babic

Lee

Ruschin

et al. 2018

J Applied Clin Med Phys

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PurposeNoninvasive frameless systems are increasingly being utilized for head immobilization in stereotactic radiosurgery (SRS). Knowing the head positioning reproducibility of frameless systems and their respective ability to limit intrafractional head motion is important in order to safely perform SRS. The purpose of this study was to evaluate and compare the intrafractional head motion of an invasive frame and a series of frameless systems for single fraction SRS and fractionated/hypofractionated stereotactic radiotherapy (FSRT/HF‐SRT).MethodsThe noninvasive PinPoint system was used on 15 HF‐SRT and 21 SRS patients. Intrafractional motion for these patients was compared to 15 SRS patients immobilized with Cosman‐Roberts‐Wells (CRW) frame, and a FSRT population that respectively included 23, 32, and 15 patients immobilized using Gill‐Thomas‐Cosman (GTC) frame, Uniframe, and Orfit. All HF‐SRT and FSRT patients were treated using intensity‐modulated radiation therapy on a linear accelerator equipped with cone‐beam CT (CBCT) and a robotic couch. SRS patients were treated using gantry‐mounted stereotactic cones. The CBCT image‐guidance protocol included initial setup, pretreatment and post‐treatment verification images. The residual error determined from the post‐treatment CBCT was used as a surrogate for intrafractional head motion during treatment.ResultsThe mean intrafractional motion over all fractions with PinPoint was 0.62 ± 0.33 mm and 0.45 ± 0.33 mm, respectively, for the HF‐SRT and SRS cohort of patients (P‐value = 0.266). For CRW, GTC, Orfit, and Uniframe, the mean intrafractional motions were 0.30 ± 0.21 mm, 0.54 ± 0.76 mm, 0.73 ± 0.49 mm, and 0.76 ± 0.51 mm, respectively. For CRW, PinPoint, GTC, Orfit, and Uniframe, intrafractional motion exceeded 1.5 mm in 0%, 0%, 5%, 6%, and 8% of all fractions treated, respectively.ConclusionsThe noninvasive PinPoint system and the invasive CRW frame stringently limit cranial intrafractional motion, while the latter provides superior immobilization. Based on the results of this study, our clinical practice for malignant tumors has evolved to apply an invasive CRW frame only for metastases in eloquent locations to minimize normal tissue exposure.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

Babic

Lee

Ruschin

et al. 2018

J Applied Clin Med Phys

View full text Add to dashboard Cite

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“…Jin et al listed positional uncertainties of various mask system and different localization methods published in the literature (5). Recently, Masi et al also concluded that daily image guidance is essential for the efficacy of SRT treatment when mask immobilization is used (9).…”

Section: Discussionmentioning

confidence: 99%

“…For these systems, MV portal images are not useful to visualize identifiable anatomy when the patient was set up on the treatment couch because of field size restriction with the tertiary collimation system (2,4). The addition of an onboard imager (OBI) kV images and kV cone beam computed tomography (CBCT) on LINACs has made image-guided stereotactic radiotherapy of cranial treatment possible in recent years (5)(6)(7)(8)(9). For cranial treatments with an mMLC attached to the linear accelerator and with special bulky stereotactic couch mount, it is not feasible to do CBCT routinely because there would be no clearance for the gantry to rotate freely around the couch-especially for those patients with relatively inferior lesions.…”

Section: Introductionmentioning

confidence: 99%

Clinical Experiences With Onboard Imager KV Images for Linear Accelerator–Based Stereotactic Radiosurgery and Radiotherapy Setup

Hong

Chen

Garg

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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“…3,10,22,30 Reports have been presented regarding the accuracy of Novalis frameless IGRS with ExacTrac (BrainLAB) in particular. 18,38 Ultimately, however, the usability of frameless methods in comparison with traditional frame-based methods must be determined on the basis of clinical outcomes.…”

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confidence: 99%

Control of brain metastases using frameless image-guided radiosurgery

Chen

Bugoci

Girvigian

et al. 2009

FOC

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Object Radiosurgery is an important and well-accepted method in the management of brain metastases. Using conventional frame-based techniques, high lesional control rates are expected. The introduction of image-guided techniques allows for improved patient comfort and workflow. Some controversy exists as to the accuracy of imageguided techniques and consequently the impact they might have on control of brain metastases (as opposed to the level of control achieved with frame-based methods). The authors describe their initial 15-month experience with image-guided radiosurgery (IGRS) using Novalis with ExacTrac for management of brain metastases. Methods The authors reviewed the cases of brain metastasis treated by means of IGRS in their tertiary regional radiation oncology service over a 15-month period. During the study period 54 patients (median age 57.9 years) harboring 108 metastases were treated with IGRS. The median time from cancer diagnosis to development of brain metastasis was 12 months (range 0–144 months). The median tumor volume was 0.98 cm3 (range 0.03–19.07 cm3). The median prescribed dose was 18 Gy to the 80% isodose line (range 14–20 Gy). Lesions were followed with postradiosurgery MR imaging every 2–3 months following treatment. Results The median follow-up period was 9 months (range 0–20 months). Median actuarial survival was 8.6 months following IGRS. Eight patients with 18 lesions died within the first 2 months after the procedure, before scheduled follow-up imaging. Thus 90 lesions (in 46 patients) were followed up with imaging studies. Lesions that were unchanged or reduced in size were considered to be under control. The 6-month actuarial lesion control rate was 88%. Smaller lesions (< 1 cm3) had a statistically improved likelihood of complete imaging response (loss of all contrast-enhancement p = 0.01). Conclusions Image-guided radiosurgical treatment of brain metastases resulted in high rates of tumor control comparable to control rates reported for frame-based methods. High control rates were seen for small lesions in which spatial precision in dose delivery is critical. These data suggests that in regard to lesion control, IGRS using Novalis with ExacTrac is equivalent to frame-based radiosurgery methods.

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Cone Beam CT Image Guidance for Intracranial Stereotactic Treatments: Comparison With a Frame Guided Set-Up

Cited by 72 publications

References 28 publications

To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

Clinical Experiences With Onboard Imager KV Images for Linear Accelerator–Based Stereotactic Radiosurgery and Radiotherapy Setup

Control of brain metastases using frameless image-guided radiosurgery

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