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Can Radiosurgery Follow Standard Workflow in a Clinic?

C Saw

C Saw1*, C Gillette2 , C Peters1 , L Koutcher2 , (1) Northeast Radiation Oncology Centers, Dunmore, PA, (2) Hudson Valley Radiation Oncology Associates, Cortland Manor, NY


SU-I-GPD-T-616 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: Examine whether radiosurgery can follow standard workflow in a clinic.

Methods: Recently, ASTRO has advocated the use of radiosurgery in the management of brain metastases. In January 2016, we embarked on studying whether radiosurgery can be implemented in a community center setting and be streamlined. This entails following the IMRT procedures: CT-simulation, treatment planning, patient QA, and dose delivery for TomoTherapy Unit. We adopted a frameless immobilization system consisting of a thermoplastic mask and an “SRS/SRT” device. In addition to immobilization, CT simulation consists of scanning from the top of the head to the cervical spine in 1 mm slice thickness which is then followed by an MRI scan in the same treatment position. Image fusion was performed and the TomoHD treatment planning system was used to generate treatment plans. Patient quality assurance was performed using the Delta4 phantom as done for IMRT patients. The IGRT system consisting of the MVCT was used to verify patient setup. Additional hardware is not needed for this system.

Results: The workflow for IMRT was implemented for radiosurgery and examined from January 2016 to January 2017. During this time period, five patients underwent radiosurgery receiving 21 Gy in a single fraction. The same treatment planning system was used to generate the treatment plans. The planning process took similar planning time for IMRT patients. Patient quality assurance showed near 100% passing rate at 3 mm/2% criteria. No adjustment or alignment was needed for IGRT using the MVCT imaging system. Treatment times were about 10 min which is within the delivery times for IMRT patients.

Conclusion: Unlike in the past when radiosurgery was a whole day event for patients, radiosurgery using a TomoTherapy unit can be implemented as a standard workflow in a community center similar to IMRT treatment procedures.

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