Download - Alexis Dimitriadis Prof Karen Kirkby Prof Andrew Nisbet Dr Catharine Clark Dr Anthony Palmer
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Alexis DimitriadisProf Karen Kirkby
Prof Andrew NisbetDr Catharine Clark
Dr Anthony Palmer
Assessing the geometric and dosimetric accuracy of Stereotactic Radiosurgery
(SRS)
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Stereotaxy (“Stereo” & “Taxis”)
Clark, R. & Horsley, V. (1906) Br. Med. J. 1799–1800
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Used on humans in 1947
Spiegel, E., Wycis, H. T., Marks, M. & Lee, A. J. (1947) Science 80;106, 349–350
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First “Stereotactic Radiosurgery” treatment in 1950
Leksell, L. (1950) . Acta Chir. Scand. 99, 229–233
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Stereotactic Radiosurgery (SRS)
Definition by Leksell:
“The administration, through the intact skull, of a single high dose of radiation, stereotactically directed to an intracranial region of interest. May be from X-rays, gamma rays, protons or heavy particles”
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Key development for SRS
• Lars Leksell – 1950
• Gamma Knife – 1953
• Particle SRS – Late 50’s (Berkley & Harvard)
• Linac-based SRS – 80’s (ARG, ITA, USA, GER)
• Early-90’s dedicated SRS-linacs
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Motivation
• Minimise delivery errors and clinical complications
• Improve patient care for a large number of pathologies
• Enhance standardisation in SRS
Challenges
• Variety of SRS practices
• Small field photon dosimetry
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Methods
• Survey to investigate current practices (Submitted to BJR: “Current practices of SRS in the UK” – under review)
• Suitable phantom
• Suitable detectors
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STE2EV Anthropomorphic phantom (CIRS, VI, USA)
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Methods
Detectors:
• Radiochromic film (Gafchromic EBT-3 or EBT-XD)
• Plastic Scintillation Detector (Exradin W1)
• Alanine
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Gafchromic EBT-XD
Palmer, A., Dimitriadis, A., Nisbet, A. and Clark C.H. (2015) Phys Med Biol 21;60(22) 8741-52
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Plastic Scintillation Detector (PSD)
Beierholm, A., Behrens, C.F. and Andersen, C.E. (2014) Radiat. Meas. 69, 50–56Carasco et al. (2015) Med. Phys. 42, 297–304
A26 EDGE PSD
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0 1 2 3 4 5 6 7 8 9 100.3
0.4
0.5
0.6
0.7
0.8
0.9
1
W1
A26
EDGE
Square Field size (in cm)
Out
put
Fact
or
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Alanine Pellets for measuring small photon fields
Hussein, M. et al. (2013) Radiother. Oncol. 108, 78–85
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Results
Gamma analysis:98.3% agreement at 3% (local), 1.5 mm criteria.
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Results Alanine PSD
Location TPS(in Gy)
Alanine(in Gy)
TPS(in Gy)
PSD(in Gy)
Target 1 26.98 26.70 26.96 27.10
Target 2 26.64 26.32
Target 3 26.07 25.80
Target 4 25.43 24.95
Location TPS(in Gy)
Alanine(in Gy)
TPS(in Gy)
PSD(in Gy)
OAR 1 2.64 2.90 2.73 2.95OAR 2 2.92 3.14OAR 3 3.15 3.21OAR 4 3.24 3.35
Absolute dose comparisons between TPS and detectors in agreement within +/- 0.3 Gy
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Contents
•What is SRS?
•Why is this project important?
•Methods
• Results
• Conclusions
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Conclusions• Suitable methodology for dosimetric assessment
• Tested on GK, CK and LB platforms
Future work
• Visit 2 more centres to complete pilot study
• Develop methodology for assessing the geometric accuracy
• Go on tour!
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References• Beierholm, A., Behrens, C.F, and Andersen, C.E. Dosimetric characterization
of the Exradin W1 plastic scintillator detector through comparison with an in-house developed scintillator system. Radiat. Meas. 69, 50–56 (2014).• Carasco et al. Characterization of the Exradin W1 scintillator for use in
radiotherapy. Med. Phys. 42, 297–304 (2015).• Clark, R. & Horsley, V. On a method of investigating the deep ganglia and
tracts of the central nervous system (cerebellum). Br. Med. J. 1799–1800 (1906).• Hussein, M. et al. A methodology for dosimetry audit of rotational
radiotherapy using a commercial detector array. Radiother. Oncol. 108, 78–85 (2013).• Leksell, L. A stereotaxic apparatus for intracerebral surgery. Acta Chir. Scand.
99, 229–233 (1950).• Palmer, A., Dimitriadis, A., Nisbet, A., Clark, C.H. Evaluation of Gafchromic
EBT-XD film, with comparison to EBT3 film, and application in high dose radiotherapy verification. Phys Med Biol 21;60(22) 8741-52 (2015).• Spiegel, E., Wycis, H. T., Marks, M. & Lee, A. J. Stereotaxic apparatus for
operations on the human brain. Science 80;106, 349–350 (1947).