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Estimation of technical treatment accuracy in fractionated stereotactic radiosurgery

Published online by Cambridge University Press:  29 April 2019

Raj Kishor Bisht ,
Gopishankar Natanasabapathi  and
Shashank Sharad Kale
Raj Kishor Bisht*
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
Gopishankar Natanasabapathi
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
Shashank Sharad Kale
Affiliation:
Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
*
Author for correspondence: Raj Kishor Bisht, Gamma Knife Unit, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India. Tel: +91 11 26594588. Fax: +91 11 26588927. E-mail: raaj_bisht@rediffmail.com
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Abstract

Aim:

The purpose of this study was to estimate technical treatment accuracy in fractionated stereotactic radiosurgery (fSRS) using the Extend™ system (ES) of Gamma Knife (GK).

Methods and materials:

The fSRS with GK relies on a re-locatable ES where the reference treatment position is estimated using repositioning check tool (RCT). A patient surveillance unit (PSU) monitors the head and neck movement of the patient during treatment and imaging. The quality assurance test of RCT was performed to evaluate a standard error (SE) associated with a measurement tool called digital probe. A ‘4-mm collimator shot’ dose plan for a head–neck phantom was investigated using EBT3 films. CT and MR distortion measurement studies were combined to evaluate SEimaging. The combined uncertainty from all measurements was evaluated using statistical methods, and the resultant treatment accuracy was investigated for the ES.

Results:

Four sets of RCT measurements and 20 observations of associated digital probe showed SERCT of ±0·0186 mm and SEdigital probe of ±0·0002 mm. The mean positional shift of 0·2752 mm (σ = 0·0696 mm) was observed for 20 treatment settings of the phantom. The differences between radiological and predefined isocentres were 0·4650 and 0·4270 mm for two independent experiments. SEimaging and SEdiode  tool were evaluated as ±0·1055 and ±0·0096 mm, respectively. An expanded uncertainty of ±0·2371 mm (at 95% confidence level) was observed with our system.

Conclusions:

The combined result of the positional shift and expanded uncertainty showed close agreement with film investigations.

Keywords

expanded uncertaintyfractionated stereotactic radiosurgeryGamma Knifephantom
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 1 , March 2020 , pp. 30 - 37
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Copyright
© Cambridge University Press 2019 

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