Plan quality and treatment planning technique for single isocenter cranial radiosurgery with volumetric modulated arc therapy

PurposeTo present the k‐means clustering algorithm as a tool to address treatment planning considerations characteristic of stereotactic radiosurgery using a single isocenter for multiple targets.MethodsFor 30 patients treated with stereotactic radiosurgery for multiple brain metastases, the geometric centroids and radii of each met were determined from the treatment planning system. In‐house software used this as well as weighted and unweighted versions of the k‐means clustering algorithm to group the targets to be treated with a single isocenter, and to position each isocenter. The algorithm results were evaluated using within‐cluster sum of squares as well as a minimum target coverage metric that considered the effect of target size. Both versions of the algorithm were applied to an example patient to demonstrate the prospective determination of the appropriate number and location of isocenters.ResultsBoth weighted and unweighted versions of the k‐means algorithm were applied successfully to determine the number and position of isocenters. Comparing the two, both the within‐cluster sum of squares metric and the minimum target coverage metric resulting from the unweighted version were less than those from the weighted version. The average magnitudes of the differences were small (−0.2 cm2 and 0.1% for the within cluster sum of squares and minimum target coverage, respectively) but statistically significant (Wilcoxon signed‐rank test, P < 0.01).ConclusionsThe differences between the versions of the k‐means clustering algorithm represented an advantage of the unweighted version for the within‐cluster sum of squares metric, and an advantage of the weighted version for the minimum target coverage metric. While additional treatment planning considerations have a large influence on the final treatment plan quality, both versions of the k‐means algorithm provide automatic, consistent, quantitative, and objective solutions to the tasks associated with SRS treatment planning using a single isocenter for multiple targets.

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Technical Note: Using k‐means clustering to determine the number and position of isocenters in MLC‐based multiple target intracranial radiosurgery

Yock

Kim

2017

“…1). All IMRT cases used seven to nine beams and RapidArc cases used two arcs, except for the SIMT case, which used four arcs, with dose optimization constraints that follow the technique of Clark et al (29) . Point dose measurement using an ion chamber (PTW PinPoint Chamber, Model 31014) and planar dose distribution measurement using films (Gafchromic EBT3) were performed in both the high‐dose target and a low‐dose region.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

Song

Chin-Snyder

et al. 2015

The purpose of this study is to characterize the dosimetric properties and accuracy of a novel treatment platform (Edge radiosurgery system) for localizing and treating patients with frameless, image‐guided stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Initial measurements of various components of the system, such as a comprehensive assessment of the dosimetric properties of the flattening filter‐free (FFF) beams for both high definition (HD120) MLC and conical cone‐based treatment, positioning accuracy and beam attenuation of a six degree of freedom (6DoF) couch, treatment head leakage test, and integrated end‐to‐end accuracy tests, have been performed. The end‐to‐end test of the system was performed by CT imaging a phantom and registering hidden targets on the treatment couch to determine the localization accuracy of the optical surface monitoring system (OSMS), cone‐beam CT (CBCT), and MV imaging systems, as well as the radiation isocenter targeting accuracy. The deviations between the percent depth‐dose curves acquired on the new linac‐based system (Edge), and the previously published machine with FFF beams (TrueBeam) beyond Dmax were within 1.0% for both energies. The maximum deviation of output factors between the Edge and TrueBeam was 1.6%. The optimized dosimetric leaf gap values, which were fitted using Eclipse dose calculations and measurements based on representative spine radiosurgery plans, were 0.700 mm and 1.000 mm, respectively. For the conical cones, 6X FFF has sharper penumbra ranging from 1.2−1.8 mm (80%‐20%) and 1.9−3.8 mm (90%‐10%) relative to 10X FFF, which has 1.2−2.2 mm and 2.3−5.1 mm, respectively. The relative attenuation measurements of the couch for PA, PA (rails‐in), oblique, oblique (rails‐out), oblique (rails‐in) were: −2.0%, −2.5%, −15.6%, −2.5%, −5.0% for 6X FFF and −1.4%, −1.5%, −12.2%, −2.5%, −5.0% for 10X FFF, respectively, with a slight decrease in attenuation versus field size. The systematic deviation between the OSMS and CBCT was −0.4±0.2 mm, 0.1±0.3 mm, and 0.0±0.1 mm in the vertical, longitudinal, and lateral directions. The mean values and standard deviations of the average deviation and maximum deviation of the daily Winston‐Lutz tests over three months are 0.20±0.03 mm and 0.66±0.18 mm, respectively. Initial testing of this novel system demonstrates the technology to be highly accurate and suitable for frameless, linac‐based SRS and SBRT treatment.PACS number: 87.56.J‐

The spatial accuracy of two frameless, linear accelerator‐based systems for single‐isocenter, multitarget cranial radiosurgery

Ezzell

2017

Single‐isocenter, multitarget cranial stereotactic radiosurgery (SRS) is more efficient than using an isocenter for each target, but spatial positioning uncertainties can be magnified at locations away from the isocenter. This study reports on the spatial accuracy of two frameless, linac‐based SRS systems for multitarget, single‐isocenter SRS as a function of distance from the isocenter. One system uses the ExacTrac platform for image guidance and the other localizes with cone beam computed tomography (CBCT). For each platform, a phantom with 12 target BBs distributed up to 13.8 cm from the isocenter was aligned starting from five different initial offsets and then imaged with the treatment beam at seven different gantry and couch angles. The distribution of the resulting positioning errors demonstrated the value of adding a 1‐mm PTV margin for targets up to about 7–8 cm from the isocenter. For distances 10 cm or more, the CBCT‐based alignment remained within 1.1 mm while the ExacTrac‐based alignment differed by up to 2.2 mm.