A phantom-based study and clinical implementation of brainlab's treatment planning system for radiosurgical treatments of arteriovenous malformations.
A phantom-based study and clinical implementation of brainlab's treatment planning system for radiosurgical treatments of arteriovenous malformations.
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Brainlab 动静脉畸形放射外科治疗计划系统的基于模型的研究和临床实施。
DOI：
10.1088/2057-1976/ac828f
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发表时间：
2022
影响因子：
1.4
通讯作者：
Zhong,Su
中科院分区：
文献类型：
--
作者：
Shrestha,Nishan;Narayanasamy,Ganesh;Kalantari,Faraz;Sabouri,Pouya;Xia,Fen;Zhong,Su
目的开发一种简单的、基于体模的方法，允许在动静脉畸形治疗之前对元素TPS颅血管模块进行试点应用和临床实施。方法开发一种定制的体模，以便在MRI和CT图像中可见。采集模型的高分辨率数字减影血管造影(DSA)和CT图像，并将其导入BrainLab Elements治疗计划系统。在颅脑血管规划模块中生成5个弧形的临床治疗计划，并使用配备HD-MLCS的VARIAN TrueBeam STX直线加速器和BrainLab ExacTrac成像系统进行非共面设置验证。使用放置在体模中的校准电离室来验证所提供的剂量。在验证了TPS工作流程后，我们提供了三名在本中心接受治疗的脑动静脉畸形患者作为回顾。结果电离室的计划剂量和测量剂量之间的差异小于1%。在成功的剂量验证研究之后，创建了临床工作流程。目前，已有3名AVM患者成功接受治疗。临床方面的成像和治疗计划考虑因素在回顾设置中提出。结论通过对BrainLab元素的进一步验证，使用定制的体模成功地实施了用于瓦里安TrueBeam上的脑动静脉畸形的颅内SRS治疗的脑血管计划模块，误差为1%。BrainLab Elements的脑血管模块成功地应用于临床工作流程中，治疗脑动静脉畸形患者。这篇手稿提供了使用BrainLab Elements TPS的基于无框架直线加速器的AVM治疗的临床实施指南。
PurposeDevelopment of a simple, phantom-based methodology allowing for pilot applications for the Elements TPS cranio-vascular module and clinical implementation prior to AVM treatments.MethodsA customized phantom was developed to be visible in MRI and CT images. High resolution digital subtraction angiograms (DSAs) and CT images of the phantom were acquired and imported into the Brainlab Elements treatment planning system. A clinical treatment plan with 5 arcs was generated in cranial vascular planning module and delivered to the phantom using a Varian TrueBeam STx Linac equipped with HD-MLCs and Brainlab ExacTrac imaging system for non-coplanar setup verification. The delivered dose was verified using a calibrated ionization chamber placed in the phantom. Upon verification of the TPS workflow, three patients with AVM who have been treated to date at our center using the Brainlab's cranial vascular module for AVM are presented here for retrospective review.ResultsThe difference between the planed and measured dose by the ionization chamber was found to be less than 1%. Following a successful dose verification study, a clinical workflow was created. Currently, three AVM patients have been treated successfully. Clinical aspects of imaging and treatment planning consideration are presented in retrospective setting.ConclusionsDose verification of the Brainlab Elements cranial vascular planning module for intracranial SRS treatments of AVM on Varian TrueBeam was successfully implemented using a custom-made phantom with< 1% discrepancy. The Brainlab Elements' cranial vascular module was successfully implemented in clinical workflow to treat patients with AVM. This manuscript provides a guideline for clinical implementation of frameless Linac-based AVM treatment using the Brainlab Elements TPS.