Spatial Shifts in Frame-based Gamma Knife Radiosurgery: A Case for Cone Beam CT Imaging As Quality Assurance Using the Gamma Knife® Icon™

Overview

Journal J Radiosurg SBRT

Date 2018 Dec 13

PMID 30538892

Citations 6

Authors

M Sean Peach

Daniel M Trifiletti

Sunil W Dutta

James M Larner

David J Schlesinger

Jason P Sheehan

Affiliations

Soon will be listed here.

Abstract

Background: Cone beam CT (CBCT) imaging has been integrated into the most recent version of the Leksell Gamma Knife for the primary purpose to facilitate fractionated therapy.

Case Description: This case study presents three patients where the CBCT system of the Gamma Knife Icon discovered potentially clinically significant frame shifts. In each case, patients were imaged with volumetric MR prior to stereotactic frame placement. Immediately following frame placement, diagnostic stereotactic CT imaging was acquired with a stereotactic indicator box attached to the frame. Following treatment planning and immediately before radiosurgery, a CBCT was acquired using the on-board imaging functionality of the Gamma Knife Icon, which provides a registration of the patient's anatomy to stereotactic space independent of that provided by the stereotactic frame/fiducials. Co-registration of the CT and CBCT provides an estimate of the difference between these two estimates of stereotactic coordinates. The vector magnitudes of the differences measured at the center of stereotactic space were 0.93mm, 2.64mm and 2.18 mm for Case 1, Case 2 and Case 3 respectively.

Conclusions: Use of the CBCT functionality of the Gamma Knife Icon to verify the consistency of frame placement can prevent clinically significant targeting errors due to frame slippage or frame adapter mounting errors, and allows any required adjustments to be made without interrupting the overall treatment workflow.

Citing Articles

Discrepancies between frame- and CBCT-based stereotactic space definition on the Gamma Knife Icon.

Bannikova I, Dalechina A, Kostjuchenko V, ZHuravleva A, Golanov A, Banov S J Appl Clin Med Phys. 2022; 23(7):e13637.

PMID: 35635549 PMC: 9278688. DOI: 10.1002/acm2.13637.

Single Fraction Frameless Stereotactic Radiosurgery on the Gamma Knife Icon for Patients With Brain Metastases: Time to Abandon the Frame?.

Wegner R, Horne Z, Liang Y, Goss M, Yu A, Pace J Adv Radiat Oncol. 2021; 6(5):100736.

PMID: 34646964 PMC: 8498737. DOI: 10.1016/j.adro.2021.100736.

Utilization of CBCT to improve the delivery accuracy of Gamma Knife radiosurgery with G-frame.

Claps L, Mathew D, Dusenbery K, Reynolds M, Watanabe Y J Appl Clin Med Phys. 2021; 22(8):120-128.

PMID: 34196098 PMC: 8364265. DOI: 10.1002/acm2.13332.

Predictors of Treatment Interruption During Frameless Gamma Knife Icon Stereotactic Radiosurgery.

Wegner R, Xu L, Horne Z, Yu A, Goss M, Liang Y Adv Radiat Oncol. 2020; 5(6):1152-1157.

PMID: 33305076 PMC: 7718496. DOI: 10.1016/j.adro.2020.06.025.

Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy.

Schmitt D, Blanck O, Gauer T, Fix M, Brunner T, Fleckenstein J Strahlenther Onkol. 2020; 196(5):421-443.

PMID: 32211939 PMC: 7182540. DOI: 10.1007/s00066-020-01583-2.

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