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Frameless Cranial Stereotactic Radiosurgery Immobilization Effectiveness Evaluation

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T Tseng

T Tseng*, S Green , R Sheu , Y Lo , Mount Sinai Medical Center, New York, NY


SU-E-T-438 (Sunday, July 12, 2015) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose:To evaluate immobilization effectiveness of Brainlab frameless mask in cranial stereotactic radiosurgery (SRS).

Methods:Two sets of setup images were collected pre-and post-treatment for 24 frameless SRS cases. The pre-treatment images were obtained after applying 2D-2D kV image-guided shifts with patients in treatment position and approved by physicians; the post-treatment images were taken immediately after treatment completion. All cases were treated on a Novalis linac with ExacTrac positioning system and Exact Couch. The two image sets were compared with the correctional shifts measured by ExacTrac 6D auto-fusion. The shift differences were considered patient motion within the frameless mask and were used to evaluate its effectiveness for immobilization. Two-tailed paired t-test was applied for significance comparison.

Results:The correctional shifts (mean±STD, median) of pre-and post-treatment images were 0.33±0.27mm, 0.26mm and 0.34±0.27mm, 0.23mm (p=0.740) in lateral direction; 0.32±0.29mm, 0.22mm and 0.48±0.30mm, 0.50mm (p=0.012) in longitudinal direction; 0.31±0.22mm, 0.24mm and 0.33±0.21mm, 0.36mm (p=0.623) in vertical direction. The radial correctional shifts (mean±STD, median) of pre-and post-treatment images were 0.60±0.38mm, 0.45mm and 0.75±0.31mm, 0.66mm (p=0.033). The shift differences (mean±STD, median, maximum) were 0.35±0.28mm, 0.3mm, 1.05mm, 0.34±0.28mm, 0.3mm, 1.00mm, 0.24±0.15mm, 0.21mm, 0.60mm and 0.61±0.32mm, 0.57mm, 1.40mm in lateral, longitudinal, vertical and radial direction, respectively. Two shifts greater than 1 mm (1.06mm and 1.02mm) were acquired from post-treatment images. However, the shift differences were only 0.09 and 0.19mm for these two shifts. Two patients with shift differences greater than 1mm (1.05 and 1.04mm) were observed and didn't coincide with those two who had post-correctional shifts greater than 1mm.

Conclusion:Image-guided SRS allowed us to set up patients with sub-millimeter accuracy relative to simulation position. However, patient motion during treatment could affect treatment accuracy. Our result shows that Brainlab frameless mask provides reasonable patient immobilization and maintains the mean post-treatment position within sub-millimeter accuracy with some borderline results observed.

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