scholarly journals Integration of functional neuroimaging in CyberKnife radiosurgery: feasibility and dosimetric results

2013 ◽  
Vol 34 (4) ◽  
pp. E5 ◽  
Author(s):  
Alfredo Conti ◽  
Antonio Pontoriero ◽  
Giuseppe K. Ricciardi ◽  
Francesca Granata ◽  
Sergio Vinci ◽  
...  

Object The integration of state-of-the-art neuroimaging into treatment planning may increase the therapeutic potential of stereotactic radiosurgery. Functional neuroimaging, including functional MRI, navigated brain stimulation, and diffusion tensor imaging–based tractography, may guide the orientation of radiation beams to decrease the dose to critical cortical and subcortical areas. The authors describe their method of integrating functional neuroimaging technology into radiosurgical treatment planning using the CyberKnife radiosurgery system. Methods The records of all patients who had undergone radiosurgery for brain lesions at the CyberKnife Center of the University of Messina, Italy, between July 2010 and July 2012 were analyzed. Among patients with brain lesions in critical areas, treatment planning with the integration of functional neuroimaging was performed in 25 patients. Morphological and functional imaging data sets were coregistered using the Multiplan dedicated treatment planning system. Treatment planning was initially based on morphological data; radiation dose distribution was then corrected in relation to the functionally relevant cortical and subcortical areas. The change in radiation dose distribution was then calculated. Results The data sets could be easily and reliably integrated into the Cyberknife treatment planning. Using an inverse planning algorithm, the authors achieved an average 17% reduction in the radiation dose to functional areas. Further gain in terms of dose sparing compromised other important treatment parameters, including target coverage, conformality index, and number of monitor units. No neurological deficit due to radiation was recorded at the short-term follow-up. Conclusions Radiosurgery treatments rely on the quality of neuroimaging. The integration of functional data allows a reduction in radiation doses to functional organs at risk, including critical cortical areas, subcortical tracts, and vascular structures. The relative simplicity of integrating functional neuroimaging into radiosurgery warrants further research to implement, standardize, and identify the limits of this procedure.

2013 ◽  
Vol 4 (1) ◽  
pp. 43-49
Author(s):  
M Jahangir Alam ◽  
Syed Md Akram Hussain ◽  
Kamila Afroj ◽  
Shyam Kishore Shrivastava

A three dimensional treatment planning system has been installed in the Oncology Center, Bangladesh. This system is based on the Anisotropic Analytical Algorithm (AAA). The aim of this study is to verify the validity of photon dose distribution which is calculated by this treatment planning system by comparing it with measured photon beam data in real water phantom. To do this verification, a quality assurance program, consisting of six tests, was performed. In this program, both the calculated output factors and dose at different conditions were compared with the measurement. As a result of that comparison, we found that the calculated output factor was in excellent agreement with the measured factors. Doses at depths beyond the depth of maximum dose calculated on-axis or off-axis in both the fields or penumbra region were found in good agreement with the measured dose under all conditions of energy, SSD and field size, for open and wedged fields. In the build up region, calculated and measured doses only agree (with a difference 2.0%) for field sizes > 5 × 5 cm2 up to 25 × 25 cm2. For smaller fields, the difference was higher than 2.0% because of the difficulty in dosimetry in that region. Dose calculation using treatment planning system based on the Anisotropic Analytical Algorithm (AAA) is accurate enough for clinical use except when calculating dose at depths above maximum dose for small field size.DOI: http://dx.doi.org/10.3329/bjmp.v4i1.14686 Bangladesh Journal of Medical Physics Vol.4 No.1 2011 43-49


Author(s):  
Muhammad Masud Rana ◽  
S.M. Azharul Islam ◽  
M. Moinul Islam ◽  
Md. Shakilur Rahman ◽  
Sarwar Alam ◽  
...  

The Pencil Beam Convolution (PBC) algorithm in radiation treatment planning system is widely used to calculate the radiation dose distribution in radiotherapy planning. A new photon dose calculation algorithm known as Anisotropic Analytical Algorithm (AAA) by Varian Medical Systems is applied to investigate the difference of dose distribution by using AAA and PBC algorithms for the lung cancer with an inhomogeneity of its low density. In the present work, radiotherapy treatment planning of 10 lung cancer patients are designed with 6 MV photon beam using three-dimensional conformal radiation therapy (3DCRT) and dose distribution was calculated by the AAA and the PBC Algorithms. The dose distribution performance is evaluated by dose profile curve along transversal slice of PTV and Dose Volume Histogram (DVH) covered by the 95% isodose of PTV. The mean dose of organ at risks did not changed significantly but the volume of the PTV covered by the 95% isodose curve was decreased by 6% with inhomogeneity due to the algorithms. The dose distribution and the accuracy in calculating the absorbed dose of the AAA algorithm of the Varian Eclipse treatment planning system is analyzed and discussed.


2021 ◽  
Vol 11 (21) ◽  
pp. 9906
Author(s):  
Joseph R. Newton ◽  
Maxwell Recht ◽  
Joseph A. Hauger ◽  
Gabriel Segarra ◽  
Chase Inglett ◽  
...  

The current practice for patient-specific quality assurance (QA) uses ion chambers or diode arrays primarily because of their ease of use and reliability. A standard routine compares the dose distribution measured in a phantom with the dose distribution calculated by the treatment planning system for the same experimental conditions. For the particular problems encountered in the treatment planning of complex radiotherapy techniques, such as small fields/segments and dynamic delivery systems, additional tests are required to verify the accuracy of dose calculations. The dose distribution verification should be throughout the total 3D dose distribution for a high dose gradient in a small, irradiated volume, instead of the standard practice of one to several planes with 2D radiochromic (GAFChromic) film. To address this issue, we have developed a 3D radiochromic dosimeter that improves the rigor of current QA techniques by providing high-resolution, complete 3D verification for a wide range of clinical applications. The dosimeter is composed of polyurethane, a radical initiator, and a leuco dye, which is radiolytically oxidized to a dye absorbing at 633 nm. Since this chemical dosimeter is single-use, it represents a significant expense. The purpose of this research is to develop a cost-effective reusable dosimeter formulation. Based on prior reusability studies, three promising dosimeter formulations were studied using small volume optical cuvettes and irradiated to known clinically relevant doses of 0.5–10 Gy. After irradiation, the change in optical density was measured in a spectrophotometer. All three formulations retained linearity of optical density response to radiation upon re-irradiations. However, only one formulation retained dose sensitivity upon at least five re-irradiations, making it ideal for further evaluation as a 3D dosimeter.


Author(s):  
F Falahati ◽  
A Nickfarjam ◽  
M Shabani

Background: Intensity modulated radiation therapy (IMRT) is an advanced method for delivery of three dimensional therapies, which provides optimal dose distribution with giving multiple nonuniform fluency to the patient. The complex dose distribution of IMRT should be checked to ensure that the accurate dose is delivered. Today, film dosimetry is a powerful tool for radiotherapy treatment Quality Assurance (QA) and a good method to verify dose distribution in phantoms. Objective: This study aimed to evaluate the accuracy of IMRT treatment planning system, Prowess Panther® software, with Gafchromic EBT3 films in a inhomogeneity phantomMethod: The IMRT plan was generated by Prowess Panther® treatment planning system (TPS) version 5.2 on a inhomogeneity phantom, then it was irradiated by ONCOR linear accelerator (Linac) with 6 (MV) photon beam energy. The Gafchromic EBT3 film located between the phantom has measured the dose distribution.­ To compare between TPS calculated doses and film measured doses, Gamma criteria 3%/3 mm, 4%/4 mm, 5%/5 mm, 6%/6 mm and 7%/7 mm Dose Difference (DD) and Distance to Agreement (DTA), respectively were used.Results: Gammas passing rates for PTV are obtained 67.5% for 3%/3mm, 78.8% for 4%/4mm, 86.3% for 5%/5mm, 91.2% for 6%/6mm and 94.3% for 7%/7mm and for organs at risk is 72.4% for 3%/3mm, 82.8% for 4%/4mm, 89.8% for 5%/5mm, 93.3% for 6%/6mm and 95.4% for 7%/7mm (respectively DD/DTA). By increasing the range of criteria the capability increased.Conclusion: The results show that the use of EBT3 film in a inhomogeneity phantoms allows us to evaluate the dose differences between the EBT3 measured dose distribution and TPS calculated dose distribution .Hence, a result Prowess Panther® TPS can be used for IMRT technique treatment.


2009 ◽  
Vol 111 (4) ◽  
pp. 807-819 ◽  
Author(s):  
Federico Colombo ◽  
Carlo Cavedon ◽  
Leopoldo Casentini ◽  
Paolo Francescon ◽  
Francesco Causin ◽  
...  

Object The authors describe a method that utilizes an image-guided robotic radiosurgical apparatus (the CyberKnife) for treatment of cerebral arteriovenous malformations (AVMs). This procedure required the development of an original technique that allows a high degree of automation. Methods Angiographic images were imported into the treatment planning software by coregistering CT and 3D rotational angiography. The nidus contour was delineated using the contouring tools of the treatment planning system. Functional MR imaging was employed for contouring critical cortical regions, such as the motor cortex and language areas. Once the radiation dose to be delivered to the target volume and dose constraints to critical structures were prescribed, the inverse treatment planning function determined the optimal treatment plan. Results A series of 279 patients with cerebral AVMs underwent CyberKnife radiosurgery. One transitory adverse effect of the radiation procedure was observed. Eight bleeding occurrences were noted before complete AVM obliteration. Of the 102 patients with follow-up > 36 months, 80 underwent angiographic evaluation. In this group, 65 patients (81.2%) showed complete angiographic obliteration of their AVM. In 8 more patients, complete angiographic obliteration was demonstrated by MR angiography only. Conclusions This is the first report describing a technique developed for CyberKnife radiosurgery of cerebral AVMs. The use of different imaging modalities for automatic delineation of the target and critical structures combined with the employment of the inverse treatment planning capability is the crucial point of the procedure. The procedure proved to be safe and efficient.


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