Abstract
We present frameless stereotactic radiosurgery using mobile CT, thermal plastic mask
fixation, a vacuum-form body immobilizer and micro-multileaf collimators. A linear
accelerator and a self-moving helical CT scanner gantry were installed in the same
room. The isocenter of irradiation can be also aligned with the center of the CT gantry
by rotating the couch. A thermal plastic mask and vacuum-form body immobilizer was
used for registration and immobilization. The advantages of this system are as follows:
1) Accurate and painless frameless fractionated irradiation can be performed smoothly,
as the patient's head is fixed without exchanging the couch from CT scanning to irradiation
system. 2) This mask system can be applied to children, infants or adults with a previous
craniotomy bone flap that must have a fixation pin placed into it. This system can
be also used for fractionated radiotherapy without painful skull pin-fixed frame.
3) 1 mm micro-multileaf collimators enable irregular contour irradiation. 4) Image
fusion (among CT, MRI, angiography, and PET) and 3D images can be used for irradiation
planning. 5) This system can be used on any part of the body. 6) This system can be
installed in any irradiation room without any extension or new construction.
Key words
Frameless stereotactic radiosurgery - mobile CT - mask immobilization - micro-multileaf
collimator
References
- 1
Arnord A, Bailey P, Harvey R A.
Intolerance of the primate brain stem and hypothalamus to conventional and high energy
radiations.
Neurol.
1954;
4
575-581
- 2
Cosgrove V P, Jahn U, Pfaender M, Bauer S, Budach V, Wurm R E.
Commissioning of a micro multi-leaf collimator and planning system for stereotactic
radiosurgery.
Radiother Oncol.
1999;
50
325-336
- 3
Danoff B F, Cowchock F S, Marquette C, Mulgrew L, Kramer S.
Assessment of the long-term effects of primary radiation therapy for brain tumors
in children.
Cancer.
1982;
49
1580-1586
- 4
Duffner P K, Cohen M E, Voorhess M L, MacGillivray M H, Brecher M L, Panahon A, Gilani B B.
Long-term effects of cranial irradiation on endocrine function in children with brain
tumors - a prospective study.
Cancer.
1985;
56
2189-2193
- 5
Dunbar S F, Tarbell N J, Kooy H M, Alexander 3rd E, Black P M, Barnes P D, Goumnerova L,
Scott R M, Pomeroy S L, La Vally B.
Stereotactic radiotherapy for pediatric and adult brain tumors: preliminary report.
Int J Radiat Oncol Biol Phys.
1994;
30
531-539
- 6
Flickinger J C, Schell M C, Larson D A.
Estimation of complications for linear accelerator radiosurgery with the integrated
logistic formula.
Int J Oncol Biol Phys.
1990;
19
143-148
- 7
Hamilton R J, Kuchnir F T, Pelizzari C A, Sweeney P J, Rubin S J.
Repositioning accuracy of a noninvasive head fixation system for stereotactic radiotherapy.
Med Phys.
1996;
23
1909-1917
- 8
Ito K, Kurita H, Sugasawa K, Mizuno M, Sasaki T.
Analysis of neuro-otological complications after radiosurgery for acoustic neurimomas.
Int Radiat Oncol Biol Phys.
1997;
39
983-988
- 9
Kabuto M, Kubota T, Kobayashi H, Handa Y, Sato K, Ishii H, Takeuchi H, Uno H, Arishima H,
Ido K, Ueda Y, Adachi M, Ishida M, Hasegawa Y, Yanagimoto M, Goto Y.
Intraoperative CT imaging system using a mobile CT scanner gantry mounted on floor-embedded
rails for neurosurgery.
No to Shinkei (Japanese).
1998;
50
1003-1008
- 10
Kramer S.
The hazards of therapeutic irradiation of the central nervous system.
Clin Neurosurg.
1968;
15
301-318
- 11
Kubo H D, Wilder R B, Pappas C T.
Impact of collimator leaf width on stereotactic radiosurgery and 3D conformal radiotherapy
treatment plans.
Int J Radiat Oncol Biol Phys.
1999;
44
937-945
- 12
Leber K A, Bergloff J, Pendl G.
Dose-response tolerance of visual pathways and cranial nerve of the cavernous sinus
to stereotactic radiosurgery.
J Neurosurg.
1998;
88
43-50
- 13
Linskey M E, Lunsford L D, Flickinger J C, Kondziolka D.
Stereotactic radiosurgery for acoustic tumors.
Neurosurg Clin N Am.
1992;
3
191-205
- 14
Marks J E, Baglan R J, Prassad S C, Blank W F.
Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation
and volume.
Int J Radiat Biol Phys.
1981;
7
243-252
- 15 Rubin P, Constine L S, Williams J P. Late effects of cancer treatment: Radiation
and drug toxicity. In: Perez CA, Brady LW (eds). Principles and practice of radiation
oncology 3rd ed. Philadelphia: Lippincott-Raven 1997: 155-211
- 16
Shirato H, Sakamoto T, Sawamura Y, Kagei K, Isu T, Kato T, Fukuda S, Suzuki K, Soma S,
Inuyama Y, Miyasaka K.
Comparison between observation policy and fractionated stereotactic radiotherapy (SRT)
as an initial management for vestibular schwannoma.
Int J Radiat Oncol Biol Phys.
1999;
44
545-550
- 17
Syndikus I, Tait D, Ashley S, Jannoun L.
Long-term follow-up of young children with brain tumors after irradiation.
Int J Radiat Oncol Biol Phys.
1994;
30
781-787
- 18
Tishler R B, Loeffler J S, Lunsford L D, Duma C, Alexander 3rd E, Kooy H M, Flickinger J C.
Tolerance of cranial nerve of the cavernous sinus radiosurgery.
Int J Radiat Biol Phys.
1993;
27
215-221
- 19
Withers H R.
Biologic basis of altered fractionation schemes.
Cancer.
1985;
55
2086-2095
H. Takeuchi,M. D.
Department of Neurosurgery · Fukui Medical University
23-3, Shimoaizuki, Matsuoka-cho, Yoshida-gun · Fukui 910-1193 · Japan
Telefon: +81-776-61-8387 ·
Fax: +81-776-61-8115
eMail: takeu@fmsrsa.fukui-med.ac.jp