Isocenter accuracy in frameless stereotactic radiotherapy using implanted fiducials

Kim, K.i-Hwan; Cho, Moon-June; Kim, Jun-Sang; Kim, Jae-Sung; Song, Chang; Song, Shi-Hun; Kim, Seon‐Hwan; Myers, L.; Kim, Yong-Eun

doi:10.1016/s0360-3016(03)00088-9

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…Recent investigations for image-guided stereotactic systems found errors of 0.65 AE 0.17 mm with active infrared light-emitting diodes (10, 11) and 0.82 mm for passive infrared reflectors (12,13). The accuracy of X-ray systems using implanted fiducial markers was found to be equivalent to that of ringbased radiosurgery (14). Errors in X-ray systems using bony anatomy have ranged from 0.7 to 1.2 mm in one study (15) and was 0.42 mm in another (16).…”

Section: Discussionmentioning

confidence: 95%

Evaluation of Image-Guided Positioning for Frameless Intracranial Radiosurgery

Lamba

Breneman

Warnick

2009

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 95%

Evaluation of Image-Guided Positioning for Frameless Intracranial Radiosurgery

Lamba

Breneman

Warnick

2009

International Journal of Radiation Oncology*Biology*Physics

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“…In the past two decades, diverse frameless devices have been developed, such as infrared camera guidance, dental and implanted fiducial markers. [11][12][13][14][15][16] For frameless SRS, an important prerequisite is a high degree of accuracy to deliver safe radiation similar to that of invasive frame-based radiosurgery. In our study, we have evaluated the accuracy in terms of both translational and rotational uncertainties for both frame-based and frameless radiosurgery using pretreatment CBCT.…”

Section: Discussionmentioning

confidence: 99%

Frame-based radiosurgery: Is it relevant in the era of IGRT?

et al. 2013

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Purpose: To assess the setup errors and intrafraction motion in patients treated with frame-based and frameless stereotactic radiosurgery (SRS). Materials and Methods: Ten patients treated with frame-based and six patients treated with frameless radiosurgery were prospectively enrolled in the study. Leksell frame was used for frame-based and a customized uniframe orfit cast for frameless techniques. Cone beam computed tomography (CBCT) scans were taken immediately before and after each treatment to evaluate the positional accuracy and corrections applied with the use of hexapod couch for both groups. Results: The mean translational shifts with frame-based SRS were 1.00 ± 0.30 mm in the lateral direction (X), 0.20 ± 1.20 mm in craniocaudal direction (Y) and -0.10 ± 0.31 mm in the anteroposterior direction (Z). The rotational shifts for frame-based treatments were as follows: roll 0.32 ± 0.70, pitch 0.44 ± 0.66 and yaw 0.20 ± 0.4. For frameless SRS, translational shifts were -0.40 ± 0.90, 1.10 ± 1.10, and 0.50 ± 1.30 mm in X, Y, and Z directions, respectively, and rotational shifts were -0.11 ± 0.78, 0.20 ± 0.44, and 0.29 ± 0.35 in roll, pitch, and yaw, respectively. Intrafraction shifts with frame-based SRS were: X = 0.60 ± 1.80 mm, Y = 0.20 ± 0.60 mm, and Z = 0.00 ± 0.05 mm; and rotational shifts were: roll 0.01 ± 0.27, pitch 0.06 ± 0.15, and yaw 0.01 ± 0.09. For frameless SRS, these were: X = 0.11 ± 0.20 mm, Y = 0.20 ± 0.40 mm, and Z = 0.20 ± 0.20 mm and rotational shifts were: roll 0.09 ± 0.23, pitch 0.00 ± 0.12, and yaw 0.00 ± 0.09. Conclusions: In our experience, set up accuracy of frameless SRS is as good as frame-based SRS. With availability of verification methods such as CBCT and hexapod couch, an accurate and precise treatment delivery is feasible with frameless techniques.

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“…Different frameless stereotactic systems, including infrared camera guidance [17], dental [18-20], implanted fiducial markers [21,22], and mask fixation system [6-12] have been developed in the last two decades. In our study using a mask-based stereotactic system we have evaluated the accuracy of isocenter relocation by repeat CT scans.…”

Section: Discussionmentioning

confidence: 99%

Frameless linac-based stereotactic radiosurgery (SRS) for brain metastases: analysis of patient repositioning using a mask fixation system and clinical outcomes

et al. 2011

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PurposeTo assess the accuracy of patient repositioning and clinical outcomes of frameless stereotactic radiosurgery (SRS) for brain metastases using a stereotactic mask fixation system.Patients and MethodsOne hundred two patients treated consecutively with frameless SRS as primary treatment at University of Rome Sapienza Sant'Andrea Hospital between October 2008 and April 2010 and followed prospectively were involved in the study. A commercial stereotactic mask fixation system (BrainLab) was used for patient immobilization. A computerized tomography (CT) scan obtained immediately before SRS was used to evaluate the accuracy of patient repositioning in the mask by comparing the isocenter position to the isocenter position established in the planning CT. Deviations of isocenter coordinates in each direction and 3D displacement were calculated. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS.ResultsThe mean measured isocenter displacements were 0.12 mm (SD 0.35 mm) in the lateral direction, 0.2 mm (SD 0.4 mm) in the anteroposterior, and 0.4 mm (SD 0.6 mm) in craniocaudal direction. The maximum displacement of 2.1 mm was seen in craniocaudal direction. The mean 3D displacement was 0.5 mm (SD 0.7 mm), being maximum 2.9 mm. The median survival was 15.5 months, and 1-year and 2-year survival rates were 58% and 24%, respectively. Nine patients recurred locally after SRS, with 1-year and 2-year local control rates of 91% and 82%, respectively. Stable extracranial disease (P = 0.001) and KPS > 70 (P = 0.01) were independent predictors of survival.ConclusionsFrameless SRS is an effective treatment in the management of patients with brain metastases. The presented non-invasive mask-based fixation stereotactic system is associated with a high degree of patient repositioning accuracy; however, a careful evaluation is essential since occasional errors up to 3 mm may occur.

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Isocenter accuracy in frameless stereotactic radiotherapy using implanted fiducials

Cited by 19 publications

References 16 publications

Evaluation of Image-Guided Positioning for Frameless Intracranial Radiosurgery

Evaluation of Image-Guided Positioning for Frameless Intracranial Radiosurgery

Frame-based radiosurgery: Is it relevant in the era of IGRT?

Frameless linac-based stereotactic radiosurgery (SRS) for brain metastases: analysis of patient repositioning using a mask fixation system and clinical outcomes

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