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Intrafraction stability using full head mask for brain stereotactic radiotherapy.

Jun Tomihara1,2, Jun Takatsu3, Satoru Sugimoto3

  • 1Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Journal of Applied Clinical Medical Physics
|August 4, 2021
PubMed
Summary

The Double Shell Positioning System (DSPS) offers accurate immobilization for stereotactic radiotherapy. Combining DSPS with a mouthpiece further enhances accuracy for brain metastasis treatment.

Keywords:
interfractional setup errorintrafractional setup errormouthpieceplanning target volume marginstereotactic radiosurgery

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Area of Science:

  • Radiotherapy and Oncology
  • Medical Physics
  • Neurosurgery

Background:

  • Stereotactic radiotherapy (SRT) for brain metastases requires high precision.
  • Accurate patient immobilization is crucial for effective dose delivery and minimizing off-target radiation.
  • Thermoplastic masks are commonly used for immobilization, but their accuracy can vary.

Purpose of the Study:

  • To evaluate the geometric and dosimetric accuracy of a new thermoplastic mask system, the Double Shell Positioning System (DSPS).
  • To compare the immobilization accuracy of DSPS alone versus DSPS combined with a mouthpiece.
  • To assess the impact of immobilization accuracy on dose delivery in SRT for brain metastases.

Main Methods:

  • Thirty-one patients with brain metastases undergoing SRT were enrolled.
  • Patients were immobilized using either DSPS alone (n=9) or DSPS with a mouthpiece (n=22).
  • Cone beam computed tomography (CBCT) and a six-degree of freedom couch were used for patient repositioning and error analysis. Inter- and intrafractional setup errors and Planning Target Volume (PTV) margins were calculated. Delivered doses were compared to planned doses.

Main Results:

  • The DSPS combined with a mouthpiece showed significantly smaller interfractional setup errors compared to DSPS alone (p=0.03).
  • Intrafractional setup errors were similar between the two groups.
  • PTV margins were smaller when using DSPS with a mouthpiece (0.75-0.90 mm) compared to DSPS alone (0.72-1.37 mm). Dose differences were within 1% for both groups.

Conclusions:

  • The DSPS provides adequate immobilization accuracy for SRT.
  • Combining DSPS with a mouthpiece significantly improves immobilization accuracy, leading to potentially smaller PTV margins.
  • This enhanced accuracy is critical for precise dose delivery in the treatment of brain metastases.