Radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: Rationale and technique

Saunders, William; Winston, K.; Siddon, Robert L.; Svensson, G; Kijewski, Peter K.; Rice, R.; Hansen, Jorgen L.; Barth, Norman H.

doi:10.1016/s0360-3016(98)90028-1

Cited by 69 publications

(9 citation statements)

References 19 publications

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“…The accuracy of linear accelerators (linacs) has been improved significantly since the 1980s 5 , 6 , 7 and linac‐based radiosurgery has been widely adopted over the subsequent decades. Since the 1990s, various technological advances have taken place to allow very precise treatments.…”

Section: Introductionmentioning

confidence: 99%

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

Song

Chin-Snyder

et al. 2015

J Applied Clin Med Phys

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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‐

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Section: Introductionmentioning

confidence: 99%

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

Song

Chin-Snyder

et al. 2015

J Applied Clin Med Phys

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“…Investigators started exploring the clinical use of radiosurgery for a variety of indications. While proton beam radiosurgery for arteriovenous malformation [3][4][5] was being used by some pioneers, others started using modified LINAC-based radiosurgery [6][7][8][9] . The first report of LINAC-based radiosurgery was published in 1983 by Betti and Derechinsky [8] .…”

Section: Methodsmentioning

confidence: 99%

Intracranial Radiosurgery: An Effective and Disruptive Innovation in Neurosurgery

Niranjan

Madhavan²,

Pc³

et al. 2011

Stereotact Funct Neurosurg

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Physicians are guided by the teachings of their chosen field, standards of accepted practice, peer pressure, prior training, and other sources of bias. When potential bias begins to impact recommendations for care in the field of tumor management, physicians may fail to realize the importance of emerging medical innovations. Some of these ultimately turn out to be ‘disruptive innovations.’ These innovations are more often than not both low risk and cost effective. But the leaders in the field often initially ignore these newer technologies in favor of more mature existing technologies. However, over time these technologies gradually improve and become mainstream management practices. Intracranial radiosurgery is one such innovation which was not embraced by the neurosurgical community in the beginning. Nowadays, a wide variety of brain and body disorders are treated with radiosurgery. Acoustic neuromas and brain metastases are examples of rapidly growing indications of radiosurgery. In this report, the authors describe the emergence of stereotactic radiosurgery as a disruptive innovation in the field of medicine.

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“…The group at the German Cancer Center (DKFZ) in Heidelberg used a commercial Reichert-Mundinger stereotactic frame modified to mount on the couch of a Siemens linac (Hartmann et al 1985). Concurrently, a large group at the Joint Center for Radiation Therapy and Harvard Medical School on Boston, led by Dr. William Saunders, and later, Dr. Jay Loeffler, was developing a system that would profoundly impact the adoption of linac radiosurgery (Saunders et al 1988;Loeffler et al 1989). At the time, mechanical characteristics of the many moving components continued to be the major impediment to a more routine of linacs for radiosurgery.…”

Section: Initial Experience With Linacmentioning

confidence: 99%

“…Intrinsic to the system was a patient-specific QA process in which a radio-opaque ball mounted to a BRW ring was attached to the floor stand. After establishing the patient's target coordinates on the floor stand, a series of films at eight representative gantry and couch positions were obtained (Saunders et al 1988;Lutz et al 1988). In this manner patients could be accurately localized without depending on external marks or room lasers.…”

Section: Initial Experience With Linacmentioning

confidence: 99%

Historical Development of Stereotactic Ablative Radiotherapy

Solberg

Siddon

Kavanagh

2012

Stereotactic Body Radiation Therapy

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Radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: Rationale and technique

Cited by 69 publications

References 19 publications

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

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

Intracranial Radiosurgery: An Effective and Disruptive Innovation in Neurosurgery

Historical Development of Stereotactic Ablative Radiotherapy

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