Inverse planning in Gamma Knife radiosurgery: A comparative planning study |
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| Institution: | 1. CTU – Faculty of Nuclear Sciences and Physical Engineering, Prague, Czech Republic;2. UJP PRAHA a.s., Prague, Czech Republic;3. National Radiation Protection Institute v.v.i., Prague, Czech Republic;1. Department of Radiation Convergence Engineering, Yonsei University, Wonju, South Korea;2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea;3. Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, United States;1. Medical Radiation Physics, Stockholm University and Karolinska Institutet, Sweden;2. Department of Radiation Oncology, University of Toronto and University Health Network-Princess Margaret Cancer Centre, Canada;3. Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan;4. Gamma Knife Department, Hygeia Hospital, Athens, Greece;5. Department of Radiation Oncology, Medical Biophysics, IBBME, University of Toronto and University Health Network-Princess Margaret Cancer Centre/TECHNA, Canada;1. University of Washington, Department of Radiation Oncology, Seattle, WA, USA;2. University of Miami, Department of Radiation Oncology, Miami, FL, USA;3. Loma Linda University Medical Center, Loma Linda, CA, USA;4. Pancea Medical Pvt. Ltd, Bangalore, India;5. PSG Hospital, Coimbatore, India;1. Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;2. Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575, Japan;3. Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;4. Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan;5. Department of Endovascular Neurosurgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan |
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| Abstract: | PurposeTo determine the advantages of inverse planning using a prerelease version of Leksell Gamma Knife® (LGK) Lightning (Elekta AB, Sweden) compared to manual forward planning.MethodsThirty-eight patients with metastases (MET, n = 15), vestibular schwannomas (VS, n = 11) and meningiomas (MEN, n = 12), treated with LGK Icon? at our institution, were analyzed retrospectively. For each case, an inverse (inv) and inverse full coverage (fc) treatment plan was generated using LGK Lightning and compared to the clinical plans. Several dosimetry and efficiency characteristics were compared for each indication. The mean, median difference and interquartile range were reported and the significance was assessed with a paired-sample Wilcoxon test (significance level < 0.05). Further, the inter operator variability was analyzed for multiple users.ResultsInv and fc treatment plans show improved target coverage (up to 3.6%) for all analyzed paradigms. For inv plans, the selectivity is enhanced (MET: 2.9%; VS: 1.8%; MEN: 1%) and the organ at risk doses are significantly reduced (VS: up to 4.5%; MEN: up to 17.5%). For inv and fc plans, the beam on time (BOT) is shortened (MET: up to 7.9%; benign tumors: 49.5%). The inter operator variability analysis shows similar treatment plan quality with small differences in plan efficiency (difference in BOT: 1–3.3 min).ConclusionsLGK Lightning allows to generate improved LGK treatment plans regarding plan quality with reduced BOT compared to manual forward plans. The inter operator variability showed that multiple users with different experiences can generate similar treatment plan quality using LGK Lightning. |
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| Keywords: | Gamma Knife Lightning Radiosurgery Inverse planning |
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