Summary
Background. A high degree of precision and accuracy in radiosurgery is a fundamental requirement for therapeutic success. Small radiation fields and steep dose gradients are clinically applied thus necessitating a dedicated quality assurance program in order to guarantee dosimetric and geometric accuracy.
Material and methods. A detailed analysis of the course of treatm ent independent of the irradiation technique used results in the so-called chain of uncertainties in radiosurgery (immobilisatio n, imaging, treat ment planning system, definition of regions of interest, mechanical accuracy, dose plann ing, dose verificatio n). Each link in this chain is analysed for accuracy and the established quality assurance procedu res are discussed. A “System Test” was used to check the whole chain of uncertainties simultaneously.
Results. The tests described are compatible with published reports on quality assurance in radiosurgery. In terms of accuracy the weakest link in the chain of uncert aint ies is stereotactic MR imaging. Geometric overall accuracy measured in the “System Test” is less than 0.7 mm.
Conclusion. The established quality assurance routin es have clinically been validated. MR imaging dominates geometric overa ll accuracy in radiosurgery, which can be limited to less than 1 mm by an adequate quality assurance protocol.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alexander III E. Loeffler JS, Lunsford LD (1993) Stereotactic radiosurge ry. McGraw-Hill
Bourland JD. McCollough KP (1994) Static field conforma l stereotactic radiosurgery: physical techniques. Int J Radiat Oncol Biol Phys 28: 471–479
Cardinale RM, Benedict SH. Wu Q. Zwicker RD. Gaballa HE. Mohan R (1998) A compa rison of three stereotac tic radiot herapy techniques: ARCS vs. noncoplan ar fixed fields vs. intensity modulation. Int J Radi at Oncol Biol Phys 42: 431–436
DIN 6875-1 (2004) Spezielle Bestrahlungseinrichtungen-Teil I: Perkut ane stereota ktische Bestrahlung. Kennmerkmale und besondere Prüfrnethoden. No rmena usschuss Radiologie (NAR ) im DIN Deutsches Institut für Normung e.V., Beuth Verlag. Berlin.
Engler MJ. Curran BH. Tsai JS. Sternick ES. Selles WD. Wazer DE. Mason WP. Sailor T. Mackie TR (1994) Fine tun ing of linear accelerator accessories for stereotactic radiotherapy. Int J Radiat Oncol Bioi Phys 28: 1001–1008
Ertl A. Saringer W. Heimberger K. Kindl P (1999) Quality assurance for the Leksell gamma unit: cons idering magnetic resonance image-distortion and delineation failure in the targeting of the internal auditory canal. Med Phys 26: 166–170
Friedman WA. Buatti JM. Bova FJ. Mendenhall WM (1997) Linac radiosurgery-a practical guide. Springer Berlin Heidelberg New York Tokyo.
Hartmann GH (1995) Quality assura nce prog ram on stereotactic radiosurgery. Springer Berlin Heidelberg New York Tokyo
IEC 60601-2-11 (1997) Medical elect rical equipment-part 2: particular requirements for the safety of gamma beam therapy equipment. International Electro technical Commission. Technical Committee No 62. Electr ical Equip ment in medical practice
Jess A. Kreiner HJ. Heck B. Wowra B. Mack A (2003) Bestrahlungsplanung bei kleinen complex geformten Läsionen und ihre exper imentelle Verifikation. Z Med Phys 13: 16–21
Lomax NJ. Scheib SG (2003) Quant ifying the degree of conformity in radiosurgery treatment planning. Int J Radiat Oncol Biol Phys 55: 1409–1419
Mack A, Mack G, Weltz D, Scheib S, Böttcher H, Seifert V (2003) High precision film dosimetry with GAFCHROMIC® films for quality assurance when using small fields. Med Phys 30: 2399–2409
Mack A, Mack G, Weltz D, Hones A, Jess A. Wowra B. Czempiel H, Heck B, Kreiner HJ, Seifert V, Böttcher H (2003) Qualitätssicherung im stereotaktischen Raum. Bestimmung der Genauigkeit von Ort und Dosis bei Einzeit-Bestrahlungen. Strahlentherapie und Onkologie 179:760–766
Mack A (2002) Verification of dose plans using film dosimetry for quality assurance in radiosurgery. In: Kondziolka D (ed) Radiosurgery. Karger, Basel. vol4, pp 213–227
Mack A, Czempiel H, Kreiner HJ, Durr G, Wowra B (2002) Quality assurance in stereotactic space, a system test for verifying the accuracy of aim in radiosurgery. Med Phys 29: 561–568
Mack A, Weltz D, Czempiel H, Beck B, Kreiner HJ, Wolff R. Mack G (2002) Experimentally determined 3-d dose distributions of small, complex targets. J Neurosurg [Suppl] 5(97): 551–555
Mack A, Scheib SG, Major J, Gianolini S, Pazmandi G. Feist H, Czempiel H, Kreiner HJ (2002) Precision dosimetry for narrow photon beams used in radiosurgery-determination of gamma knife output factors. Med Phys 29: 2080–2089
Maitz AH, Wu A, Lunsford LD, Flickinger JC, Kondziolka D, Bloomer WD (1995) Quality assurance for gamma knife stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 32: 1465–1471
Phillips MH (1993) Physical aspects of stereotactic radiosurgery. Plenum Medical Book Company, New York London
Ramaseshan R, Heydarian M (2003) Comprehensive quality assurance for stereotactic radiosurgery treatments. Phys Med Biol 48: N199–205
Rosenzweig DP, Schell MC, Numaguchi Y (1998) Quality assurance in linac-based stereot actic radiosurgery and radiotherapy. Med Dosim 23: 147–151
Schad LR, Ehricke HH. Wowra B et al (1992) Correction of spatial distortion in magnetic resonance angiography for radiosurgical treatment planning of cerebral arteriovenous malformations. Magn Reson Imaging 10:609–621
Scheib SG. Gianolini S. Haller D. Wellis GN, Siegried J (2000) VOLUMESERIES: a software tool for target volume follow-up studies with computerized tomography and magnetic resonance imaging. J Neurosurg [Suppl] 3(93): 203–207
Scheib SG, Gianolini S (2002) Methodology of threedimensional dosimetric dose verification in radiosurgery. In: Kondziolka D (ed) Radiosurgery. Karger, Basel, vol 4, pp 203–212
Scheib SG. Gianolini S (2002) Three-dimensional dose verification using BANG gel: a clinical example. J Neurosurg [Suppl] 5(97): 582–587
Scheib SG. Mack A. Lomax NJ. Gianolini S, Hones A. Rieker M. Weltz D (2003) Quality assurance in stereotactic radiosurgery according E-DIN 6875-1. Proceedings of the joint meeting of the Swiss Society of Radiation Biology and Medical Physics and the Scientific Association of Swiss Radiation Oncology. Geneva. April 3–5
Schell MC. Bova FJ, Larson DA, Leavitt DD, Lutz WR, Podgorsak A, Wu A (1995) AAPM Report No. 54. Stereotactic radiosurgery. Report of Task Group 42. American Institute of Physics, New York, NY
Wowra B. Czempiel H, Cibis R. Horstmann GA (1997) Profil der ambulanten Radiochirurgie mit dem Gamma-Knife-System. Teil I: Methode und multizentrisches Bestrahlungskonzept. Radiologe 37: 995–1002
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer-Verlag Wien
About this paper
Cite this paper
Scheib, S.G., Gianolini, S., Lomax, N.J., Mack, A. (2004). High Precision Radiosurgery and Technical Standards. In: Wowra, B., Muacevic, A., Tonn, JC. (eds) Gamma Knife Radiosurgery. Acta Neurochirurgica Supplements, vol 91. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0583-2_2
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0583-2_2
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7200-1
Online ISBN: 978-3-7091-0583-2
eBook Packages: Springer Book Archive