Dynamic Radiosurgery at the Toronto - Bayview Regional Cancer Centre, 1988-2007

Davey, Phillip; Schwartz, Michael L.; O’Brien, P.; Gillies, B. A.

doi:10.1017/s031716710001341x

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…18 The concept of dynamic radiotherapy was developed in the 1980s. 19,20 Podgorsak et al first studied the properties of this treatment type in 10 patient plans where dynamic rotation of the couch and gantry were delivered. 20 Dosimetric validation at the time was limited by experimental comparison with empirical calculations using several correction factors (for transmission through the frame and disagreement of doses measured between deliveries with or without dynamic rotation).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of plan quality and treatment efficiency in cranial stereotactic radiosurgery treatment plans with a variable source‐to‐axis distance

et al. 2023

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Introduction: Radiotherapy deliveries with dynamic couch motions that shorten the source-to-axis distance (SAD) on a C-arm linac have the potential to increase treatment efficiency through the increase of the effective dose rate. In this investigation, we convert clinically deliverable volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) plans for cranial radiosurgery into virtual isocenter plans through implementation of couch trajectories that maintain the target at a shortened but variable SAD throughout treatment. Materials and Methods: A randomly sampled population of patients treated with cranial radiosurgery from within the last three years were separated into groups with one, two, and three lesions. All plans had a single isocenter (regardless of number of targets), and a single prescription dose. Patient treatment plans were converted from their original delivery at a standard isocenter to a dynamic virtual isocenter in MATLAB. The virtual isocenter plan featured a variable isocenter position based upon the closest achievable source-to-target distance (referred to herein as a virtual source-to-axis distance [vSAD]) which avoided collision zones on a TrueBeam STx platform. Apertures were magnified according to the vSAD and monitor units at a given control point were scaled based on the inverse square law. Doses were calculated for the plans with a virtual isocenter in the Eclipse (v13.6.23) treatment planning system (TPS) and were compared with the clinical plans. Plan metrics (MU, Paddick conformity index, gradient index, and the volume receiving 12 Gy or more), normal brain dose-volume differences, as well as maximum doses received by organs at risk (OARs) were assessed. The values were compared between standard and virtual isocenter plans with Wilcoxon Sign Ranked tests to determine significance. A subset of the plans were mapped to the MAX-HD anthropomorphic phantom which contained an insert housing EBT3 GafChromic film and a PTW 31010 microion chamber for dose verification on a linac. Results: Delivering plans at a virtual isocenter resulted in an average reduction of 20.9% (p = 3×10 −6 ) and 20.6% (p = 3.0×10 −6 ) of MUs across all VMAT and all DCA plans, respectively. There was no significant change in OAR max doses received by plans delivered at a virtual isocenter.The low dose wash (1.0-2.0 Gy or 5-11% of the prescription dose) was increased (by approximately 20 cc) for plans with three lesions. This was equivalent to a 2.7%-3.8% volumetric increase in normal tissue receiving the respective dose level when comparing the plan with a virtual isocenter to a plan with a standard isocenter. Gamma pass rates with a 5%/1mm analysis criteria were 96.40% ± 2.90% and 95.07% ± 3.10% for deliveries at standard and virtual isocenter, respectively. Absolute point dose agreements were within −0.36% ± 3.45% and −0.55% ± 3.39% for

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