Cord dose specification and validation for stereotactic body radiosurgery of spine

Effective dose to a portion of the spinal cord in treatment segment, rather than the maximum point dose in the cord surface, was set as the dose limit in stereotactic-body radiosurgery (SBRS) of spine. Such a cord dose specification is sensitive to the volume size and position errors. Thus, we used stereotactic image guidance to minimize phantom positioning errors and compared the results of a 0.6-cm(3) Farmer ionization chamber and a 0.01-cm(3) compact ionization chamber to determine the detector size effect on 9 SBRS cases. The experimental errors ranging from 2% to 7% were estimated by the deviation of the mean dose in plans to the chamber with spatial displacements of 0.5 mm. The mean and measured doses for the large chamber to individual cases were significantly (approximately 17%) higher than the doses with the compact chamber placed at the same point. Our experimental results shown that the mean doses to the volume of interest could represent the measured cord doses. For the 9 patients, the mean doses to 10% of the cord were about 10 Gy, while the maximum cord doses varied from 11.6 to 17.6 Gy. The mean dose, possibly correlated with the cord complication, provided us an alternative and reliable cord dose specification in SBRS of spine.