Relocatable fixation systems in intracranial stereotactic radiotherapy

Theelen, A.; Martens, Jonathan; Bosmans, Geert; Houben, Ruud; Jager, J.J.; Rutten, Isabelle; Lambin, Philippe; Minken, A.; Baumert, Brigitta G.

doi:10.1007/s00066-011-0018-7

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…Theelen et al . recently provided a comprehensive tabular summary of previously published studies involving thermoplastic masks with an additional dental tray: most series found an accuracy of <2 mm [12]. …”

Section: Discussionmentioning

confidence: 99%

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Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy

Amelio

Winter

Habermehl

et al. 2013

Journal of Radiation Research

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The present paper reports and discusses the results concerning both the inter- and intrafraction accuracy achievable combining the immobilization system employed in patients with head-and-neck, brain and skull base tumors with image guidance at our particle therapy center. Moreover, we investigated the influence of intrafraction time on positioning displacements. A total of 41 patients treated between January and July 2011 represented the study population. All the patients were immobilized with a tailored commercial thermoplastic head mask with standard head-neck rest (HeadSTEP®, IT-V). Patient treatment position was verified by two orthogonal kilovoltage images acquired through a ceiling imaging robot (Siemens, Erlangen, Germany). The analysis of the applied daily corrections during the first treatment week before and after treatment delivery allowed the evaluation of the interfraction and intrafraction reproducibility of the thermoplastic mask, respectively. Concerning interfraction reproducibility, translational and rotational systematic errors (Σs) were ≤2.2 mm and 0.9º, respectively; translational and rotational random errors (σs) were ≤1.6 mm and 0.6º, respectively. Regarding the intrafraction accuracy translational and rotational Σs were ≤0.4 mm and 0.4º, respectively; translational and rotational σs were ≤ 0.5 mm and 0.3º, respectively. Concerning the time-intrafraction displacements correlation Pearson coefficient was 0.5 for treatment fractions with time between position checks less than or equal to median value, and 0.2 for those with time between position controls longer than the median figure. These results suggest that intrafractional patient motion is smaller than interfractional patient motion. Moreover, we can state that application of different imaging verification protocols translate into a relevant difference of accuracy for the same immobilization device. The magnitude of intrafraction displacements correlates with the time for short treatment sessions or during the early phase of long treatment delivery.

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Section: Discussionmentioning

confidence: 99%

“…Such studies are difficult to compare due to the employment of different methods and measurement of deviations. Despite the advantages advocated by the authors most of them seem equally effective, with reported daily setup errors ranging between 0.5–1 mm in the best series [12]. …”

Section: Introductionmentioning

confidence: 99%

Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy

Amelio

Winter

Habermehl

et al. 2013

Journal of Radiation Research

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“…While there exist a number of studies that have assessed the positional accuracy and stability of different invasive and noninvasive immobilization systems for cranial stereotactic radiotherapy,6, 9, 16, 17, 18, 19, 20 to our knowledge, no study has directly compared the performance of various systems used in the same institution.…”

Section: Introductionmentioning

confidence: 99%

To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

Babic

Lee

Ruschin

et al. 2018

J Applied Clin Med Phys

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PurposeNoninvasive frameless systems are increasingly being utilized for head immobilization in stereotactic radiosurgery (SRS). Knowing the head positioning reproducibility of frameless systems and their respective ability to limit intrafractional head motion is important in order to safely perform SRS. The purpose of this study was to evaluate and compare the intrafractional head motion of an invasive frame and a series of frameless systems for single fraction SRS and fractionated/hypofractionated stereotactic radiotherapy (FSRT/HF‐SRT).MethodsThe noninvasive PinPoint system was used on 15 HF‐SRT and 21 SRS patients. Intrafractional motion for these patients was compared to 15 SRS patients immobilized with Cosman‐Roberts‐Wells (CRW) frame, and a FSRT population that respectively included 23, 32, and 15 patients immobilized using Gill‐Thomas‐Cosman (GTC) frame, Uniframe, and Orfit. All HF‐SRT and FSRT patients were treated using intensity‐modulated radiation therapy on a linear accelerator equipped with cone‐beam CT (CBCT) and a robotic couch. SRS patients were treated using gantry‐mounted stereotactic cones. The CBCT image‐guidance protocol included initial setup, pretreatment and post‐treatment verification images. The residual error determined from the post‐treatment CBCT was used as a surrogate for intrafractional head motion during treatment.ResultsThe mean intrafractional motion over all fractions with PinPoint was 0.62 ± 0.33 mm and 0.45 ± 0.33 mm, respectively, for the HF‐SRT and SRS cohort of patients (P‐value = 0.266). For CRW, GTC, Orfit, and Uniframe, the mean intrafractional motions were 0.30 ± 0.21 mm, 0.54 ± 0.76 mm, 0.73 ± 0.49 mm, and 0.76 ± 0.51 mm, respectively. For CRW, PinPoint, GTC, Orfit, and Uniframe, intrafractional motion exceeded 1.5 mm in 0%, 0%, 5%, 6%, and 8% of all fractions treated, respectively.ConclusionsThe noninvasive PinPoint system and the invasive CRW frame stringently limit cranial intrafractional motion, while the latter provides superior immobilization. Based on the results of this study, our clinical practice for malignant tumors has evolved to apply an invasive CRW frame only for metastases in eloquent locations to minimize normal tissue exposure.

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“…Alternatively, stereotactically guided treatments using linear accelerator (LINAC)-based stereotactically based or frameless radiosurgery treatments are available. From the clinical perspective in the case of skull base meningiomas, all approaches have the potential to create comparable dose distributions with respect to dose conformity and sparing of normal tissue, therefore leading to comparable short-term clinical outcomes [11-13]. It is important to remember however that physicians do not all use these techniques similarly.…”

Section: Radiosurgery and Fractionated Radiation Therapymentioning

confidence: 99%

State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques

et al. 2012

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For skull base meningiomas, several treatment paradigms are available: Observation with serial imaging, surgical resection, stereotactic radiosurgery, radiation therapy or some combination of both. The choice depends on several factors. In this review we evaluate different treatment options, the outcome of modern irradiation techniques as well as the clinical results available, and establish recommendations for the treatment of patients with skull-base meningiomas.

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Relocatable fixation systems in intracranial stereotactic radiotherapy

Cited by 16 publications

References 30 publications

Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy

Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy

To frame or not to frame? Cone‐beam CT‐based analysis of head immobilization devices specific to linac‐based stereotactic radiosurgery and radiotherapy

State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques

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