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  1. Home
  3. Computed Tomography Simulation For Gamma Knife Radiosurgery: Impact On Target Coverage.
  1. Home
  3. Computed Tomography Simulation For Gamma Knife Radiosurgery: Impact On Target Coverage.

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Computed Tomography Simulation for Gamma Knife Radiosurgery: Impact on Target Coverage.

Sridhar Yaddanapudi1, Steven M Herchko1, Deepak K Shrestha1

  • 1Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA.

Journal of Medical Physics
|April 6, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

A traditional computed tomography (CT) simulation scan is unnecessary for Leksell Gamma Knife® Icon™ stereotactic radiosurgery. Both MRI-CBCT and MRI-CT-CBCT workflows demonstrated similar target coverage, proving non-inferiority.

Keywords:
Co-registrationGamma Knifeframeframelessworkflow

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Medical Imaging

Background:

  • Stereotactic radiosurgery (SRS) planning relies on accurate image co-registration.
  • Leksell Gamma Knife® Icon™ utilizes MRI, CT simulation, and CBCT for treatment planning.
  • Evaluating workflow efficiency and necessity of each imaging modality is crucial.

Purpose of the Study:

  • To assess the effectiveness of omitting traditional CT simulation in the Leksell Gamma Knife® Icon™ workflow.
  • To compare target coverage between workflows with and without CT simulation.
  • To determine if a CT simulation scan is essential for SRS using the Icon™ system.

Main Methods:

  • Retrospective analysis of 50 frame-based and 55 frameless SRS cases treated between August 2020 and December 2022.
  • Comparison of two workflows: MRI-CT-CBCT (traditional) vs. MRI-CBCT (CT-omitted).
  • Assessment of target coverage using prescription isodose line percentage.

    • Main Results:

    • No significant difference in target coverage between the MRI-CT-CBCT and MRI-CBCT workflows.
    • Mean coverage differences were -1.20% ± 1.43% (frame-based) and -1.06% ± 1.51% (frameless).
    • The MRI-CBCT workflow was found to be non-inferior to the MRI-CT-CBCT workflow.

    Conclusions:

    • A traditional CT simulation scan is not necessary for Leksell Gamma Knife® Icon™ SRS.
    • The MRI-CBCT workflow provides comparable and effective target coverage.
    • Streamlining SRS workflows by omitting CT simulation is feasible and efficient.