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Title: SU-F-T-638: Is There A Need For Immobilization in SRS?

Abstract

Purpose: Frameless Stereotactic radiosurgery (SRS) is increasingly used in the clinic. Cone-Beam CT (CBCT) to simulation-CT match has replaced the 3-dimensional coordinate based set up using a stereotactic localizing frame. The SRS frame however served as both a localizing and immobilizing device. We seek to measure the quality of frameless (mask based) and frame based immobilization and evaluate its impact on target dose. Methods: Each SRS patient was set up by kV on-board imaging (OBI) and then fine-tuned with CBCT. A second CBCT was done at treatment-end to ascertain intrafraction motion. We compared pre- vs post-treatment CBCT shifts for both frameless and frame based SRS patients. CBCT to sim-CT fusion was repeated for each patient off-line to assess systematic residual image registration error. Each patient was re-planned with measured shifts to assess effects on target dose. Results: We analyzed 11 patients (12 lesions) treated with frameless SRS and 6 patients (11 lesions) with a fixed frame system. Average intra-fraction iso-center positioning errors for frameless and frame-based treatments were 1.24 ± 0.57 mm and 0.28 ± 0.08 mm (mean ± s.d.) respectively. Residual error in CBCT registration was 0.24 mm. The frameless positioning uncertainties led to target dose errors in Dminmore » and D95 of 15.5 ± 18.4% and 6.6 ± 9.1% respectively. The corresponding errors in fixed frame SRS were much lower with Dmin and D95 reduced by 4.2 ± 6.5% and D95 2.5 ± 3.8% respectively. Conclusion: Frameless mask provides good immobilization with average patient motion of 1.2 mm during treatment. This exceeds MRI voxel dimensions (∼0.43mm) used for target delineation. Frame-based SRS provides superior patient immobilization with measureable movement no greater than the background noise of the CBCT registration. Small lesions requiring submm precision are better served with a frame based SRS.« less

Authors:
; ; ; ; ; ;  [1]
  1. Loyola University Medical Center, Maywood, IL (United States)
Publication Date:
OSTI Identifier:
22649198
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BACKGROUND NOISE; BIOMEDICAL RADIOGRAPHY; COMPUTERIZED TOMOGRAPHY; DOSES; ERRORS; NMR IMAGING; PATIENTS; THREE-DIMENSIONAL CALCULATIONS

Citation Formats

Masterova, K, Sethi, A, Anderson, D, Prabhu, V, Rusu, I, Gros, S, and Melian, E. SU-F-T-638: Is There A Need For Immobilization in SRS?. United States: N. p., 2016. Web. doi:10.1118/1.4956823.
Masterova, K, Sethi, A, Anderson, D, Prabhu, V, Rusu, I, Gros, S, & Melian, E. SU-F-T-638: Is There A Need For Immobilization in SRS?. United States. doi:10.1118/1.4956823.
Masterova, K, Sethi, A, Anderson, D, Prabhu, V, Rusu, I, Gros, S, and Melian, E. 2016. "SU-F-T-638: Is There A Need For Immobilization in SRS?". United States. doi:10.1118/1.4956823.
@article{osti_22649198,
title = {SU-F-T-638: Is There A Need For Immobilization in SRS?},
author = {Masterova, K and Sethi, A and Anderson, D and Prabhu, V and Rusu, I and Gros, S and Melian, E},
abstractNote = {Purpose: Frameless Stereotactic radiosurgery (SRS) is increasingly used in the clinic. Cone-Beam CT (CBCT) to simulation-CT match has replaced the 3-dimensional coordinate based set up using a stereotactic localizing frame. The SRS frame however served as both a localizing and immobilizing device. We seek to measure the quality of frameless (mask based) and frame based immobilization and evaluate its impact on target dose. Methods: Each SRS patient was set up by kV on-board imaging (OBI) and then fine-tuned with CBCT. A second CBCT was done at treatment-end to ascertain intrafraction motion. We compared pre- vs post-treatment CBCT shifts for both frameless and frame based SRS patients. CBCT to sim-CT fusion was repeated for each patient off-line to assess systematic residual image registration error. Each patient was re-planned with measured shifts to assess effects on target dose. Results: We analyzed 11 patients (12 lesions) treated with frameless SRS and 6 patients (11 lesions) with a fixed frame system. Average intra-fraction iso-center positioning errors for frameless and frame-based treatments were 1.24 ± 0.57 mm and 0.28 ± 0.08 mm (mean ± s.d.) respectively. Residual error in CBCT registration was 0.24 mm. The frameless positioning uncertainties led to target dose errors in Dmin and D95 of 15.5 ± 18.4% and 6.6 ± 9.1% respectively. The corresponding errors in fixed frame SRS were much lower with Dmin and D95 reduced by 4.2 ± 6.5% and D95 2.5 ± 3.8% respectively. Conclusion: Frameless mask provides good immobilization with average patient motion of 1.2 mm during treatment. This exceeds MRI voxel dimensions (∼0.43mm) used for target delineation. Frame-based SRS provides superior patient immobilization with measureable movement no greater than the background noise of the CBCT registration. Small lesions requiring submm precision are better served with a frame based SRS.},
doi = {10.1118/1.4956823},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: Estimates of the need for radiotherapy (RT) using different methods (criterion based benchmarking [CBB]and the Canadian [C-EBEST]and Australian [A-EBEST]epidemiologically based estimates) exist for various cancer sites. We compared these model estimates to actual RT rates for lung, breast, and prostate cancers in British Columbia (BC). Methods and Materials: All cases of lung, breast, and prostate cancers in BC from 1997 to 2004 and all patients receiving RT within 1 year (RT{sub 1Y}) and within 5 years (RT{sub 5Y}) of diagnosis were identified. The RT{sub 1Y} and RT{sub 5Y} proportions in health regions with a cancer center for the mostmore » recent year were then calculated. RT rates were compared with CBB and EBEST estimates of RT needs. Variation was assessed by time and region. Results: The RT{sub 1Y} in regions with a cancer center for lung, breast, and prostate cancers were 51%, 58%, and 33% compared with 45%, 57%, and 32% for C-EBEST and 41%, 61%, and 37% for CBB models. The RT{sub 5Y} rates in regions with a cancer center for lung, breast, and prostate cancers were 59%, 61%, and 40% compared with 61%, 66%, and 61% for C-EBEST and 75%, 83%, and 60% for A-EBEST models. The RT{sub 1Y} rates increased for breast and prostate cancers. Conclusions: C-EBEST and CBB model estimates are closer to the actual RT rates than the A-EBEST estimates. Application of these model estimates by health care decision makers should be undertaken with an understanding of the methods used and the assumptions on which they were based.« less
  • Glucoamylase and glucose oxidase have been immobilized on carbodiimide-treated activated carbon particles of various sizes. Loading data indicate nonuniform distribution of immobilized enzyme within the porous support particles. Catalysts with different enzyme loading and overall activities have been prepared by varying enzyme concentration in the immobilizing solution. Analysis of these results by a new method based entirely upon experimentally observable catalyst properties indicates that intrinsic catalytic activity is reduced by immobilization of (both enzymes. Immobilized glucoamylase intrinsic activity decreases with increasing) enzyme loading, and similar behavior is suggested by immobilized glucose oxidase data analysis. The overall activity data interpretation methodmore » should prove useful in other immobilized enzyme characterization research, especially in situations where the intraparticle distribution of immobilized enzyme is nonuniform and unknown.« less