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• W2057271505 abstract "The high precision necessary for single fraction high dose brain treatments is usually attained by the employment of invasive stereotactic frames. However, standard mask fixation used for fractionated brain and head-and-neck treatments does have the potential to provide very good short-term stability. The overall geometrical accuracy will then be limited by the ability to localize the patient on the Linac. We developed a procedure that applies on-line set-up corrections based on bony anatomy registration of cone-beam computed tomography (CBCT) data acquired on the treatment machine, which enables a non-invasive treatment for this patient group. The aim of this study is to determine the accuracy of this approach. Twenty patients were included in the protocol thus far. Standard PETG masks with 3-point fixation were used. Prior to treatment a CBCT scan (Elekta Synergy 3.5) was acquired and matched to the planning CT scan. Deviations larger than 1 mm were corrected by a manual couch shift. Corrections were validated with a second CBCT scan. To assess intra-fraction errors a third scan was acquired after treatment. All scans were registered with in-house developed software that uses a 6-D rigid body transform (3 translations and 3 rotations). The rotation center of the registration was placed in the middle of the PTV to minimize the effect of rotations. The pre-and post-treatment setup errors were computed in terms of a group standard deviation (SD) and overall mean. Matching accuracy was estimated by comparing the registrations of any pair of scans in a “full circle”. Finally, intra-fraction motion was quantified by the difference between the pre- and post-treatment measurements. Sixteen patients were corrected in either one or more directions. The mean and standard deviation of the corrected set-up errors were smaller than 0.1 mm and 1 mm respectively. Intra-fraction motion was smaller than 0.5 mm (SD) in any direction with no significant mean differences (Table). The matching accuracy, as derived from the “full circle” analysis was slightly smaller than the intra-fraction movement. The proposed method is accurate and comparable to methods utilizing an invasive stereotactic frame. The intra-fraction movement was very small, which shows that the rigidity of the PETG mask is sufficient for this type of treatment. Furthermore, registration accuracy is not limiting the total precision of the procedure. In conclusion, the use of CBCT on a linear accelerator to determine and correct set-up errors in combination with standard mask fixation does provide the accuracy needed for frameless stereotactic treatments.Tabled 1Left-right (mm)Cranial-caudal (mm)Anterior-posterior (mm)MeanSDMeanSDMeanSDBefore corr.−0.51.10.82.2−0.41.5After corr.−0.10.50.10.80.10.5Intra frac.0.10.60.20.4−0.10.5 Open table in a new tab" @default.
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• W2057271505 date "2007-11-01" @default.
• W2057271505 modified "2023-10-01" @default.
• W2057271505 title "Frameless Stereotactic Treatment of Brain Metastases Using Cone-Beam CT Based Image Guidance" @default.
• W2057271505 doi "https://doi.org/10.1016/j.ijrobp.2007.07.2054" @default.
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