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Preliminary dosimetric comparison between fixed and rotating source stereotactic radiosurgery systems.

Emily Draeger1, Zhe Jay Chen1, James E Hansen1

  • 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.

Journal of Applied Clinical Medical Physics
|January 20, 2023
PubMed
Summary

The Akesis Galaxy RTi (AK) system offers comparable cranial stereotactic radiosurgery (SRS) dosimetric results to the Leksell Gamma Knife (GK), often with significantly reduced treatment times. Further studies are ongoing to validate these findings in larger patient cohorts.

Keywords:
Gamma Kniferotating source gamma systemstereotactic radiosurgery

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Area of Science:

  • Medical Physics
  • Radiosurgery
  • Oncology

Background:

  • The Akesis Galaxy RTi (AK) is a novel rotational 60Co-based cranial stereotactic radiosurgery (SRS) system.
  • Comparisons of SRS systems often use stylized phantoms, but dosimetric performance with realistic anatomy against the Leksell Gamma Knife (GK) has not been characterized for rotating systems.

Purpose of the Study:

  • To benchmark the dosimetric performance of the AK system against the GK system.
  • To retrospectively replan previously treated GK patients on the AK system to compare plan quality.

Main Methods:

  • Thirteen patients previously treated with GK Icon were replanned on the AK system using identical prescription doses and isodoses.
  • Plans were evaluated using target coverage metrics (Dmin, Dmean, D95%, V150%) and dose conformity indices (CI, selectivity, Paddick CI, GI).
  • The patient cohort included diverse pathologies: brain metastases, schwannomas, pituitary adenomas, trigeminal neuralgias, and arteriovenous malformations.

Main Results:

  • AK plans utilized fewer shots and larger collimation, leading to statistically significant reductions in treatment time (p=0.047) by up to 88.4 minutes, while maintaining comparable target V100%.
  • For metastatic cases, GK showed higher Dmin (p=0.008), while AK showed higher V150% (p=0.028).
  • For non-metastatic cases, GK demonstrated superior conformity index (CI) (p=0.025) and gradient index (GI) (p=0.044).

Conclusions:

  • The AK system achieves largely comparable dosimetric results to the GK system.
  • Shorter treatment times are a notable advantage of the AK system.
  • Further investigation with a larger patient cohort is warranted to confirm these findings.