Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife
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Abstract
A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator.
This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient’s nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared.
Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm.
Conclusions: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.
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DOI: 10.7759/cureus.531
PubMed: 27081592
PubMed Central: 4829406
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife</title></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27081592</idno><idno type="pmc">4829406</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829406</idno><idno type="RBID">PMC:4829406</idno><idno type="doi">10.7759/cureus.531</idno><date when="????">????</date><idno type="wicri:Area/Pmc/Corpus">000619</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000619</idno><idno type="wicri:Area/Pmc/Curation">000619</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000619</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife</title></analytic><series><title level="j">Cureus</title><idno type="eISSN">2168-8184</idno><imprint><date when="????">????</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives </title><p>A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator.</p></sec><sec><title>Materials & methods</title><p>This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient’s nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared.</p></sec><sec><title>Results </title><p>Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm.</p><p>Conclusions: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Leksell, L" uniqKey="Leksell L">L Leksell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leksell, L" uniqKey="Leksell L">L Leksell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lindquist, C" uniqKey="Lindquist C">C Lindquist</name></author><author><name sortKey="Paddick, I" uniqKey="Paddick I">I Paddick</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hamilton, Rj" uniqKey="Hamilton R">RJ Hamilton</name></author><author><name sortKey="Kuchnir, Ft" uniqKey="Kuchnir F">FT Kuchnir</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sweeney, R" uniqKey="Sweeney R">R Sweeney</name></author><author><name sortKey="Bale, R" uniqKey="Bale R">R Bale</name></author><author><name sortKey="Vogele, M" uniqKey="Vogele M">M Vogele</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kooy, Hm" uniqKey="Kooy H">HM Kooy</name></author><author><name sortKey="Dunbar, Sf" uniqKey="Dunbar S">SF Dunbar</name></author><author><name sortKey="Tarbell, Nj" uniqKey="Tarbell N">NJ Tarbell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gill, Ss" uniqKey="Gill S">SS Gill</name></author><author><name sortKey="Thomas, Dg" uniqKey="Thomas D">DG Thomas</name></author><author><name sortKey="Warrington, Ap" uniqKey="Warrington A">AP Warrington</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Graham, Jd" uniqKey="Graham J">JD Graham</name></author><author><name sortKey="Warrington, Ap" uniqKey="Warrington A">AP Warrington</name></author><author><name sortKey="Gill, Ss" uniqKey="Gill S">SS Gill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruschin, M" uniqKey="Ruschin M">M Ruschin</name></author><author><name sortKey="Nayebi, N" uniqKey="Nayebi N">N Nayebi</name></author><author><name sortKey="Carlsson, P" uniqKey="Carlsson P">P Carlsson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schlesinger, D" uniqKey="Schlesinger D">D Schlesinger</name></author><author><name sortKey="Xu, Z" uniqKey="Xu Z">Z Xu</name></author><author><name sortKey="Taylor, F" uniqKey="Taylor F">F Taylor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Islam, Mk" uniqKey="Islam M">MK Islam</name></author><author><name sortKey="Purdie, Tg" uniqKey="Purdie T">TG Purdie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, W" uniqKey="Li W">W Li</name></author><author><name sortKey="Sie, F" uniqKey="Sie F">F Sie</name></author><author><name sortKey="Bootsma, G" uniqKey="Bootsma G">G Bootsma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruschin, M" uniqKey="Ruschin M">M Ruschin</name></author><author><name sortKey="Komljenovic, Pt" uniqKey="Komljenovic P">PT Komljenovic</name></author><author><name sortKey="Ansell, S" uniqKey="Ansell S">S Ansell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Jz" uniqKey="Wang J">JZ Wang</name></author><author><name sortKey="Rice, R" uniqKey="Rice R">R Rice</name></author><author><name sortKey="Pawlicki, T" uniqKey="Pawlicki T">T Pawlicki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, G" uniqKey="Li G">G Li</name></author><author><name sortKey="Ballangrud, A" uniqKey="Ballangrud A">A Ballangrud</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Masi, L" uniqKey="Masi L">L Masi</name></author><author><name sortKey="Casamassima, F" uniqKey="Casamassima F">F Casamassima</name></author><author><name sortKey="Polli, C" uniqKey="Polli C">C Polli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tryggestad, E" uniqKey="Tryggestad E">E Tryggestad</name></author><author><name sortKey="Christian, M" uniqKey="Christian M">M Christian</name></author><author><name sortKey="Ford, E" uniqKey="Ford E">E Ford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Herk, M" uniqKey="Van Herk M">M van Herk</name></author><author><name sortKey="Remeijer, P" uniqKey="Remeijer P">P Remeijer</name></author><author><name sortKey="Rasch, C" uniqKey="Rasch C">C Rasch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, W" uniqKey="Li W">W Li</name></author><author><name sortKey="Craig, T" uniqKey="Craig T">T Craig</name></author><author><name sortKey="Cho, Y" uniqKey="Cho Y">Y Cho</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Cureus</journal-id><journal-id journal-id-type="iso-abbrev">Cureus</journal-id><journal-id journal-id-type="issn">2168-8184</journal-id><journal-title-group><journal-title>Cureus</journal-title></journal-title-group><issn pub-type="epub">2168-8184</issn><publisher><publisher-name>Cureus</publisher-name><publisher-loc>Palo Alto (CA)</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27081592</article-id><article-id pub-id-type="pmc">4829406</article-id><article-id pub-id-type="doi">10.7759/cureus.531</article-id><article-categories><subj-group subj-group-type="heading"><subject>Radiation Oncology</subject></subj-group><subj-group><subject>Medical Physics</subject></subj-group></article-categories><title-group><article-title>Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife</article-title></title-group><contrib-group><contrib contrib-type="editor"><name><surname>Muacevic</surname><given-names>Alexander</given-names></name></contrib><contrib contrib-type="editor"><name><surname>Adler</surname><given-names>John R</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Li</surname><given-names>Winnie</given-names></name><xref ref-type="aff" rid="aff-35934">1</xref></contrib><contrib contrib-type="author"><name><surname>Bootsma</surname><given-names>Gregory</given-names></name><xref ref-type="aff" rid="aff-34139">2</xref></contrib><contrib contrib-type="author"><name><surname>Von Schultz</surname><given-names>Oscar</given-names></name><xref ref-type="aff" rid="aff-33882">3</xref></contrib><contrib contrib-type="author"><name><surname>Carlsson</surname><given-names>Per</given-names></name><xref ref-type="aff" rid="aff-33882">3</xref></contrib><contrib contrib-type="author"><name><surname>Laperriere</surname><given-names>Normand</given-names></name><xref ref-type="aff" rid="aff-35934">1</xref></contrib><contrib contrib-type="author"><name><surname>Millar</surname><given-names>Barbara-Ann</given-names></name><xref ref-type="aff" rid="aff-35934">1</xref></contrib><contrib contrib-type="author"><name><surname>Jaffray</surname><given-names>David</given-names></name><xref ref-type="aff" rid="aff-35934">1</xref></contrib><contrib contrib-type="author"><name><surname>Chung</surname><given-names>Caroline</given-names></name><xref ref-type="aff" rid="aff-34139">2</xref></contrib></contrib-group><aff id="aff-35934"><label>1</label> Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON</aff><aff id="aff-34139"><label>2</label> Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON</aff><aff id="aff-33882"><label>3</label> Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden</aff><author-notes><corresp id="cor1">Winnie Li <email>winnie.li@rmp.uhn.on.ca</email></corresp></author-notes><pub-date date-type="pub" publication-format="electronic"><day>13</day><month>3</month><year>2016</year></pub-date><pub-date date-type="collection" publication-format="electronic"><month>3</month><year>2016</year></pub-date><volume>8</volume><issue>3</issue><elocation-id>e531</elocation-id><history><date date-type="received"><day>26</day><month>2</month><year>2016</year></date><date date-type="accepted"><day>11</day><month>3</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016, Li et al.</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Li et al.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri xlink:href="http://www.cureus.com/articles/4255-preliminary-evaluation-of-a-novel-thermoplastic-mask-system-with-intra-fraction-motion-monitoring-for-future-use-with-image-guided-gamma-knife">This article is available from http://www.cureus.com/articles/4255-preliminary-evaluation-of-a-novel-thermoplastic-mask-system-with-intra-fraction-motion-monitoring-for-future-use-with-image-guided-gamma-knife</self-uri><abstract><sec><title>Objectives </title><p>A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator.</p></sec><sec><title>Materials & methods</title><p>This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient’s nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared.</p></sec><sec><title>Results </title><p>Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm.</p><p>Conclusions: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.</p></sec></abstract><kwd-group kwd-group-type="author"><kwd>immobilization</kwd><kwd>intra-fraction motion</kwd><kwd>cone beam</kwd><kwd>stereotatic radiosurgery</kwd><kwd>optical tracking</kwd></kwd-group></article-meta><notes><p content-type="disclaimer">The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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