Inverse planning in Gamma Knife radiosurgery: A comparative planning study

Spaniol, M.; Mai, Sabine; Zakrzewski, Tonja; Ehmann, Michael; Stieler, Florian

doi:10.1016/j.ejmp.2021.02.019

Cited by 9 publications

(21 citation statements)

References 25 publications

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“…Wieczorek et al ( 11) compared inverse plans optimized by GK Lightning with manual forward plans on 115 lesions and demonstrated that the inverse plans were comparable or superior to forward plans with regard to plan quality metrics. Spaniol et al (12) performed similar analyses on 38 patients' plans, as well as evaluated inter-operator variability on one plan for every pathology type. They also showed improved plan quality with GK Lightning, with minimal variability on the operator's experience.…”

Section: Discussionmentioning

confidence: 99%

“…Spaniol et al. ( 12 ) performed similar analyses on 38 patients’ plans, as well as evaluated inter-operator variability on one plan for every pathology type. They also showed improved plan quality with GK Lightning, with minimal variability on the operator’s experience.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, a new inverse planning technology has become clinically available in the latest GK Lightning TPS which enables an automatic workflow for GK treatment planning with minimum manual inputs ( 10 ). While the initial study performed by the vendor has demonstrated encouraging results, only two independent studies on GK Lightning have been recently published ( 11 , 12 ), and independent evaluations of the inverse planning technology with broader clinical relevance are still in need. In the current manuscript, we aim to evaluate this new inverse planning technology by comparing the inversely optimized plan generated with this technology to clinically approved forward-based plans for a variety of disease types.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

et al. 2022

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ObjectivesThe purpose of this study is to independently compare the performance of the inverse planning algorithm utilized in Gamma Knife (GK) Lightning Treatment Planning System (TPS) to manual forward planning, between experienced and inexperienced users, for different types of targets.Materials and MethodsForty patients treated with GK stereotactic radiosurgery (SRS) for pituitary adenoma (PA), vestibular schwannoma (VS), post-operative brain metastases (pBM), and intact brain metastases (iBM) were randomly selected, ten for each site. Three inversely optimized plans were generated for each case by two experienced planners (OptExp1 and OptExp2) and a novice planner (OptNov) using GK Lightning TPS. For each treatment site, the Gradient Index (GI), the Paddick Conformity Index (PCI), the prescription percentage, the scaled beam-on time (sBOT), the number of shots used, and dosimetric metrics to OARs were compared first between the inversely optimized plans and the manually generated clinical plans, and then among the inversely optimized plans. Statistical analyses were performed using the Student’s t-test and the ANOVA followed by the post-hoc Tukey tests.ResultsThe GI for the inversely optimized plans significantly outperformed the clinical plans for all sites. PCIs were similar between the inversely optimized and clinical plans for PA and VS, but were significantly improved in the inversely optimized plans for iBM and pBM. There were no significant differences in the sBOT between the inversely optimized and clinical plans, except for the PA cases. No significant differences were observed in dosimetric metrics, except for lower brain V12Gy and PTV D98% in the inversely optimized plans for iBM. There were no noticeable differences in plan qualities among the inversely optimized plans created by the novice and experienced planners.ConclusionInverse planning in GK Lightning TPS produces GK SRS plans at least equivalent in plan quality and similar in sBOT compared to manual forward planning in this independent validation study. The automatic workflow of inversed planning ensures a consistent plan quality regardless of a planner’s experience.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

et al. 2022

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“…The GammaPlan Lightning optimization system was used to create treatment plans using the same margin dose (20 Gy) to the target as in the actual clinical plan. 16 Parameters for Lightning optimization were identical for all plans (low-dose weight = 0.50; beam-on-time weight = 0.50; max dose = 40 Gy, coverage = 100%, max dose to risk structure = 14 Gy). A baseline treatment plan without considering any connectome networks was created and compared with subsequent plans considering a single network as an avoidance structure.…”

Section: Clinical Presentationmentioning

confidence: 99%

Incorporation of Brain Connectomics for Stereotactic Radiosurgery Treatment Planning

Dayawansa

Schlesinger

Mantziaris

et al. 2023

Operative Neurosurgery

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BACKGROUND AND IMPORTANCE: Neurosurgeons have integrated neuroanatomy-based tractography to avoid critical structures during dose planning. However, they have yet to integrate more comprehensive connectome networks for radiosurgical planning. CLINICAL PRESENTATION: A young man presented with a Spetzler-Martin Grade 3 right temporal arteriovenous malformation. DISCUSSION: As proof of concept, we incorporated connectomic networks including default mode network, optic radiation and central executive network into the Gamma Knife radiosurgical treatment planning workflow. Connectome networks were created from T1 anatomic and diffusion-weighted images magnetic resonance images using Quicktome software. The resulting networks were voxel-encoded in the magnetic resonance images, imported into GammaPlan, and segmented by image thresholding. The GammaPlan Lightning optimizer was used to create radiosurgical plans with a dose of 20 Gy to the 50% isodose line delivered to the arteriovenous malformation nidus both with and without treating these networks as risk structures. When taking into account the connectome networks, a maximum dose restriction of 14 Gy was placed on each network during lightning dose planning. With default mode network, optic radiation, and central executive network as risk structures, the maximum dose and V12Gy were reduced by 23.4% and 88.3%, 20% and 34.3%, and 29.8% and 63.2%, respectively. CONCLUSION: We were able to incorporate connectomes into radiosurgical dose planning approaches. This allowed for dose reductions to the networks while still achieving delivery of a therapeutic dose to the target volume.

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“…4 With the advent of the Icon platform, stereotactic radiotherapy (SRT) with treatment in three or more fractions has now become feasible on the GK unit. 5,6 Like the Per-fexion™, the Icon houses 192 sealed cobalt-60 sources arranged in eight motorized sectors, each containing 24 sources. 4,7 Each sector is controlled independently and can be in one of four collimator states: 4, 8, 16 mm, or beam-off (block) state.…”

Section: Introductionmentioning

confidence: 99%

A study on inter‐planner plan quality variability using a manual planning‐ or Lightning dose optimizer‐approach for single brain lesions treated with the Gamma Knife^® Icon™

Lee

Wieczorek

Chaswal

et al. 2023

J Applied Clin Med Phys

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PurposeThe purpose of this study is to investigate inter‐planner plan quality variability using a manual forward planning (MFP)‐ or fast inverse planning (FIP, Lightning)‐approach for single brain lesions treated with the Gamma Knife® (GK) Icon™.MethodsThirty patients who were previously treated with GK stereotactic radiosurgery or radiotherapy were selected and divided into three groups (post‐operative resection cavity, intact brain metastasis, and vestibular schwannoma [10 patients per group]). Clinical plans for the 30 patients were generated by multiple planners using FIP only (1), a combination of FIP and MFP (12), and MFP only (17). Three planners (Senior, Junior, and Novice) with varying experience levels re‐planned the 30 patients using MFP and FIP (two plans per patient) with planning time limit of 60 min. Statistical analysis was performed to compare plan quality metrics (Paddick conformity index, gradient index, number of shots, prescription isodose line, target coverage, beam‐on‐time (BOT), and organs‐at‐risk doses) of MFP or FIP plans among three planners and to compare plan quality metrics between each planner's MFP/FIP plans and clinical plans. Variability in FIP parameter settings (BOT, low dose, and target max dose) and in planning time among the planners was also evaluated.ResultsVariations in plan quality metrics of FIP plans among three planners were smaller than those of MFP plans for all three groups. Junior's MFP plans were the most comparable to the clinical plans, whereas Senior's and Novice's MFP plans were superior and inferior, respectively. All three planners’ FIP plans were comparable or superior to the clinical plans. Differences in FIP parameter settings among the planners were observed. Planning time was shorter and variations in planning time among the planners were smaller for FIP plans in all three groups.ConclusionsThe FIP approach is less planner dependent and more time‐honored than the MFP approach.

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Inverse planning in Gamma Knife radiosurgery: A comparative planning study

Cited by 9 publications

References 25 publications

Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

Incorporation of Brain Connectomics for Stereotactic Radiosurgery Treatment Planning

A study on inter‐planner plan quality variability using a manual planning‐ or Lightning dose optimizer‐approach for single brain lesions treated with the Gamma Knife^® Icon™

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Inverse planning in Gamma Knife radiosurgery: A comparative planning study

Cited by 9 publications

References 25 publications

Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

Clinical Evaluation of the Inverse Planning System Utilized in Gamma Knife Lightning

Incorporation of Brain Connectomics for Stereotactic Radiosurgery Treatment Planning

A study on inter‐planner plan quality variability using a manual planning‐ or Lightning dose optimizer‐approach for single brain lesions treated with the Gamma Knife® Icon™

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A study on inter‐planner plan quality variability using a manual planning‐ or Lightning dose optimizer‐approach for single brain lesions treated with the Gamma Knife^® Icon™