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Title: SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity

Abstract

Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment planmore » revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained.« less

Authors:
 [1];  [2]
  1. Associates In Medical Physics, Louisville, KY (United States)
  2. Norton Cancer Institute, Louisville, Kentucky (United States)
Publication Date:
OSTI Identifier:
22538177
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; COMPUTERIZED TOMOGRAPHY; IMAGES; NERVOUS SYSTEM DISEASES; NMR IMAGING; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

Howe, J, and Spalding, A. SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity. United States: N. p., 2015. Web. doi:10.1118/1.4925032.
Howe, J, & Spalding, A. SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity. United States. doi:10.1118/1.4925032.
Howe, J, and Spalding, A. Mon . "SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity". United States. doi:10.1118/1.4925032.
@article{osti_22538177,
title = {SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity},
author = {Howe, J and Spalding, A},
abstractNote = {Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment plan revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained.},
doi = {10.1118/1.4925032},
journal = {Medical Physics},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}