Imaging-Guided Localization for Stereotactic Radiosurgery of Multiple Intracranial Lesions with a Single Isocenter Setup

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Purpose/Objective(s)

Stereotactic radiosurgery (SRS) for multiple lesions usually takes a long time to treat. New techniques such as volumetric modulated arc therapy make it possible to plan the multiple lesion case with a single isocenter setup. However, conventional frame-based localization may not be sufficient to treat multiple lesions with a single isocenter setup. In this study, we propose to use ExacTrac 6-degree couch combined with cone-beam CT (CBCT) for the localization of this type of treatment.

Materials/Methods

27 patients with multiple intracranial lesions treated with SRS were investigated in this study (14 patients with two lesions, 9 patients with three lesions, and 4 patients with four lesions). Two patients were treated with pitch (rotation along the lateral axis) and roll (rotation along the longitudinal axis) corrections. 25 patients were treated without pitch and roll corrections (treated with conventional multi-isocenter setup). For those 25 patients, the CBCT images were retrospectively

Results

Without the pitch and roll correction, the maximum differences along the lateral, vertical and longitudinal directions were 0.9 mm, 0.9 mm, and 1.3 mm respectively. The maximum magnitude of the vector was 1.6 mm. With the pitch and roll corrections, the maximum differences along the lateral, vertical and longitudinal directions were all within 0.3 mm and the maximum magnitude of the vector was 0.4 mm.

Conclusions

It is feasible to localize multiple intracranial lesions simultaneously for the single isocenter setup of SRS treatment by using CBCT combined with 6-degree couch.

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Author Disclosure: Z. Wang: B. Research Grant; Varian Medical Systems. F. Yin: None. Z. Chang: None. J. Sampson: None. J.P. Kirkpatrick: B. Research Grant; Varian Medical Systems, Genetech. D. Speakers Bureau/Honoraria; Varian Medical Systems, BrainLab.

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