Precision required for dose-escalated treatment of spinal metastases and implications for image-guided radiation therapy (IGRT)

Gückenberger, Matthias; Meyer, Juergen; Wilbert, Juergen; Baier, Kurt; Bratengeier, Klaus; Vordermark, Dirk; Flentje, Michael

doi:10.1016/j.radonc.2007.05.021

Cited by 69 publications

(45 citation statements)

References 37 publications

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“…Advances in radiotherapy have led to a number of novel treatment modalities being observed such as intensity-modulated radiotherapy and stereotactic radiosurgery; [14][15][16] however, specific work 2 relating to the radiotherapy process, improving the efficiency of conventional practice and the patient pathway has not been found, although it has been recommended.…”

Section: Managementmentioning

confidence: 99%

A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service

Lacey¹,

Ockwell²,

Locke³

et al. 2015

BJR

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prospective study comparing radiographer-and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service. Br J Radiol 2015; 88: 20150586. FULL PAPERA prospective study comparing radiographer-and clinicianbased localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service Objective: To investigate whether there was parity between treatment fields localized by radiographers and clinicians, by comparing geographical variations and hence determining the feasibility of a radiographer-led service. Methods: 23 patients with metastatic spinal cord compression (MSCC) were prospectively sampled. Four radiographers not involved in the original planning performed localization on each patient. The 92 localizations that they determined were compared with the clinician-approved fields. Agreement was defined as #0.5 cm between field length, width and three isocentre co-ordinates. To be feasible, agreement was required in a minimum of 97% of the cases. The potential time saved with a radiographer-led approach was also recorded. Results: Agreement between clinicians and radiographers was 97.8%. For all field parameters, the average differences were ,0.3 cm and were significantly different from the 0.5-cm median (p , 0.0001) that would establish no agreement using Wilcoxon signed-rank test. The average (range) delay awaiting clinician approval was 54 min (4-141 min). Conclusion: Strong agreement between radiographer and clinician localizations was established. It was also highlighted that time could be saved in the patient's pathway by removing the need to wait for clinician approval. We believe this supports a radiographer-led service. Advances in knowledge: This article is novel, as it is the first known comparison between clinicians and radiographers in the localization of MSCC radiotherapy. These data show the feasibility of introducing radiographer-led practice and a methodology that could be potentially transferred to investigate the localization parity for other treatment sites.

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Section: Managementmentioning

confidence: 99%

A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service

Lacey¹,

Ockwell²,

Locke³

et al. 2015

BJR

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“…Modern systems are noninvasive, and allow near-rigid body immobilization that can be combined with IGRT to allow the safe practice of spine SBRT. 20,21 Overall, spine SBRT delivery can be classified into 2 groups according to the type of treatment unit: 1) CyberKnife 1,2 (CyberKnife; Accuray, Inc.), and 2) MLC LINAC systems. 49 As yet, application of Gamma Knife technology to the cervical spine is not advocated due to the lack of reliable immobilization with a relocatable head frame.…”

Section: Technology For Spine Sbrtmentioning

confidence: 99%

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Sahgal

Bilsky

Chang³

et al. 2011

SPI

180

103

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Stereotactic body radiotherapy (SBRT) for spinal metastases is an emerging therapeutic option aimed at delivering high biologically effective doses to metastases while sparing the adjacent normal tissues. This technique has emerged following advances in radiation delivery that include sophisticated radiation treatment planning software, body immobilization devices, and capabilities of detecting and correcting patient positional deviations with imageguided radiotherapy. There are limited clinical data specifically supporting the role of SBRT as a superior alternative to conventional radiation in the postoperative patient. The focus of this review was to examine the evidence pertaining to spine SBRT in the treatment of spinal metastases and to provide a comprehensive analysis of published patterns of failure, with emphasis on the postoperative patient.

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“…In another study of spine stereotactic radiotherapy, simulated translational errors of 2 mm increased

D_{5}

by up to 38% (28) . The dosimetric consequences of table rotational error are a function of the number of noncoplanar treatment beams used, making it especially important for the proposed highly noncoplanar methods 4 , 5 , 6 …”

Section: Discussionmentioning

confidence: 99%

Improved accuracy for noncoplanar radiotherapy: an EPID‐based method for submillimeter alignment of linear accelerator table rotation with MV isocenter

Nyflot

Cao

Meyer

et al. 2014

J Applied Clin Med Phys

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Accurate alignment of linear accelerator table rotational axis with radiation isocenter is critical for noncoplanar radiotherapy applications. The purpose of the present study is to develop a method to align the table rotation axis and the MV isocenter to submillimeter accuracy. We developed a computerized method using electronic portal imaging device (EPID) and measured alignment stability over time. Mechanical and radiation isocenter coincidence was measured by placing a steel ball bearing at radiation isocenter using existing EPID techniques. Then, EPID images were acquired over the range of table rotation. A MATLAB script was developed to calculate the center of rotation, as well as the necessary adjustment to move the table rotational axis to MV isocenter. Adjustment was applied via torque to screws at the base of the linac table. Stability of rotational alignment was measured with 49 measurements over 363 days on four linacs. Initial rotational misalignment from radiation isocenter ranged from 0.91−2.11 mm on the four tested linacs. Linac‐A had greatest error false(>2 mmfalse) and was adjusted with the described method. After adjustment, the error was significantly decreased to 0.40±0.12 mm. The adjustment was stable over the course of 15 measurements over 231 days. Linac‐B was not adjusted, but tracked from time of commissioning with 27 measurements over 363 days. No discernible shift in couch characteristics was observed (mean error 1.40±0.22 mm). The greater variability for Linac‐B may relate to the interchangeable two‐piece couch, which allows more lateral movement than the one‐piece Linac‐A couch. Submillimeter isocenter alignment was achieved by applying a precision correction to the linac table base. Table rotational characteristics were shown to be stable over the course of twelve months. The accuracy and efficiency of this method may make it suitable for acceptance testing, annual quality assurance, or commissioning of highly‐conformal noncoplanar radiotherapy programs.PACS number: 87

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Precision required for dose-escalated treatment of spinal metastases and implications for image-guided radiation therapy (IGRT)

Cited by 69 publications

References 37 publications

A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service

A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Improved accuracy for noncoplanar radiotherapy: an EPID‐based method for submillimeter alignment of linear accelerator table rotation with MV isocenter

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