Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-11T09:27:47.240Z Has data issue: false hasContentIssue false
  • English
  • Français

An evaluation of the BrainLAB 6D ExacTrac/Novalis Tx System for image-guided intracranial radiotherapy

Published online by Cambridge University Press:  01 September 2017

Claire Montgomery  and
Mark Collins
Claire Montgomery*
Affiliation:
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
Mark Collins
Affiliation:
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
*
Correspondence to: Claire Montgomery, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. Tel: 0131 537 2256. E-mail: claire.montgomery@nhslothian.scot.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

Stereotactic-fractionated radiotherapy and radiosurgery (RS) for benign and malignant intracranial lesions relies on a very high degree of accuracy in dose alignment due to the ablative dose delivered, and therefore requires a high-precision image guidance modality. The aim of this review is to investigate the localisation and verification accuracy performance of ExacTrac (ET) and Novalis Tx System.

Materials and methods

A systematic review of the database Science Direct was carried out using search terms ‘stereotactic radiotherapy (SRT)’ and ‘ET’. All articles before 2000 were excluded. Only articles that involved intracranial lesions, with the exception of one article, were included in the final review.

Results

Results from gold standard Hidden Target Tests and patient data show that patient position can be reproduced within 1·0 mm with the use of ET imaging. In addition, the 6 degrees of freedom algorithm function of ET allows for better translational accuracy as well optimal positioning when rotations are corrected for. Studies showed excellent correlation (p<0·01) between bony ET images and cone beam computed tomography (CBCT) soft tissue registration, evidencing the safe reliance of bony anatomy for image guidance via ET. Shifts were found to be comparable between CBCT and ET.

Conclusion

There is the need for regular calibration to prevent systematic errors and potential geographic miss. However, due to ET’s additional benefits, including reduced concomitant dose and faster imaging time, ET is the superior image guidance modality for RS/SRT in the treatment of intracranial lesions.

Keywords

BrainLABimage-guided radiotherapyradiotherapy
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 3 , September 2017 , pp. 326 - 333
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Murphy, M, Chang, S D, Gibbs, I C et al. Patterns of patient movement during frameless image-guided radiosurgery. Int J Oncol Biol Phys 2003; 55 (5): 1400–1408.CrossRefGoogle ScholarPubMed
2. Verbakel, W F A R, Lagerwaard, F J, Verduin, A J E, Heukelom, S, Slotman, B J, Cuijpers, J P. The accuracy of frameless stereotactic intracranial radiosurgery. Radiother Oncol 2010; 97: 390–394.Google Scholar
3. Tanyi, J A, Doss, E J, Kato, C M et al. Dynamic conformal cranial stereotactic radiosurgery: implications of multileaf collimator margin on dose-volume metrics. Br J Radiol 2012; 85: e1058–e1066.Google Scholar
4. Cyber Museum of Neurosurgey. Stereostatic Exhibit 1992. http:/www.neurosurgery.org/cybermuseum/stereotactichall/92exhibit Accessed on 10th December 2015.Google Scholar
5. Guckenberger, M, Baier, K, Guenther, I et al. Reliability of the bony anatomy in image-guided stereotactic radiotherapy of brain metastases. Int J Oncol Biol Phys 2007; 69 (1): 294–301.Google Scholar
6. Lo, W L, Yang, K Y, Huang, Y J, Chen, W F, Liao, C C, Huang, Y H. Experience with Novalis stereotactic radiosurgery for vestibular schwannomas. Clin Neurol Neurosurg 2014; 121: 30–34.Google Scholar
7. Badakhshi, H, Barelkowski, T, Wust, P, Budach, V, Boehmer, D, Graf, R. Intrafraction variations in linac-based image guided radiosurgery of intracranial lesions. Cancer Radiother 2013; 17 (7): 664–667.Google Scholar
8. BrainLAB. http:/www.brainlab.com/en/radiosurgery-products/novalis/. Accessed on 10th December 2015.Google Scholar
9. Chang, Z, Wang, Z, Ma, J, O’Daniel, J C, Kirkpatirck, J, Yin, F F. 6D image guidance for spinal non-invasive stereotactic body radiation therapy: comparison between ExacTrac X-ray 6D with kilo-voltage cone-beam CT. Radiother Oncol 2010; 95: 116–121.CrossRefGoogle ScholarPubMed
10. Jin, J-Y, Yin, F-F, Tenn, S E, Medin, P M, Solberg, D. Use of the BrainLAB ExacTrac 6D system in image guided radiotherapy. Med Dosim. 2008; 33 (2): 124–134.Google Scholar
11. Gevaert, T, Verellen, D, Tournal, K et al. Setup accuracy of the Novalis ExacTrac 6DOF system for frameless radiosurgery. Int J Oncol Biol Phys 2012; 82 (5): 1627–1635.CrossRefGoogle ScholarPubMed
12. Ohtakara, K, Hayashi, S, Tanaka, H et al. Clinical comparison of positional accuracy and stability between dedicated versus conventional masks for immobilisation in cranial stereotactic radiotherapy using 6-degree-of-freedom image guidance system-integrated platform. Radiother Oncol 2012; 102: 198–205.Google Scholar
13. Tideman, A, Carl, J. ExacTrac X-ray and beam isocentres—what’s the difference? Med Phys. 2012; 39 (3): 1418–1423.CrossRefGoogle Scholar
14. Jani, S K, Weinsyein, G, Shah, N et al. Performance of an ExacTrac image guidance system in mask-based cranial radiotherapy on a Classic Novalis Machine: a five year experience. Int J Oncol Biol Phys 2010; S78 (3): 765.Google Scholar
15. Lesiuk, M J, Spencer, D P, Chan, A K, Voroney, J-P, Lau, H. Image-guided treatment of fractionated stereotactic radiotherapy patients: a quantitative analysis of pre- and post-treatment orthogonal kV images of patients immobilised with thermoplastic masks. J Med Imaging Radiat Sci 2012; 43: 239–244.CrossRefGoogle ScholarPubMed
16. Verellen, D, Soete, G, Linthout, N, Van Acker, S, De Roover, P, Ving-Hung, V. Quality assurance of a system for improved target localisation and patient set-up that combines real-time infrared tracking and stereoscopic X-ray imaging. Radiother Oncol 2003; 67: 129–141.Google Scholar
17. Wurm, R E, Erbel, S, Schwenkert, I. Novalis frameless image guided non-invasive radiosurgery: initial experience. Neurosurgery 2008; 62: A11–A17.Google Scholar
18. Iwai, Y, Ishibashi, K, Wantanabe, Y, Uemura, G, Yamanaka, K. Functional preservation after planned partial resection followed by Gamma Knife radiosurgery for large vestibular schwannomas. World Neurosurg 2015; 84 (2): 292–300.Google Scholar
19. Elliott, A, Hebb, A L O, Walling, S, Morris, D P, Bance, M. Hearing preservation in vestibular schwannoma management. Am J Otolaryngol Head Neck Med Surg 2015; 36: 526–534.Google Scholar
20. Mathis, S. Radiosurgery: Gamma Knife versus adapted linear accelerator. HTA-Projekbericht47. Vienna, Austria, 2010.Google Scholar
21. Pinkham, M B, Whitfield, G A, Brada, M. New developments in intracranial stereotactic radiotherapy for metastases. Clin Oncol. 2015; 27: 316–323.Google Scholar
22. Linthout, N, Verellen, D, Tournel, K, Reynders, T, Duchateau, M, Storme, G. Assessment of secondary patient motion induced by automated couch movement during on-line 6 dimensional repositioning in prostate cancer treatment. Radiother Oncol 2007; 83: 168–174.Google Scholar
23. Jin, J, Ryu, S, Faber, K. 2D-3D image fusion for accurate target localisation and evaluation of a mask based stereotactic system in fractionated stereotactic radiotherapy of cranial lesions. Med Phys. 2006; 33: 4557–4566.Google Scholar
24. Verellen, D, Soete, G, Erbel, S. Comment on ‘Image guided patient positioning: if one cannot correct for rotational offsets in external-beam radiotherapy setup, how should rotational offsets be managed?’ Med Phys. 2007; 34: 1880–1883.Google Scholar
25. Gevaert, T, Verellen, D, Engeld, B et al. Clinical evaluation of robotic 6-degree of freedom treatment couch for frameless radiosurgery. Int J Oncol Biol Phys 2012; 83 (1): 467–474.CrossRefGoogle ScholarPubMed
26. Ma, J, Chang, Z, Wang, Z, Wu, Q J, Kirkpatrick, J P, Yin, F F. ExacTrac X-ray 6 degree-of-freedom image-guidance for intercranial non-invasive stereotactic radiotherapy: comparison with kilo-voltage cone-beam CT. Radiother Oncol 2009; 93: 602–608.Google Scholar
27. Chang, Z, Wang, Z, Ma, J et al. Six degree-of-freedom image guidance for frameless intracranial stereotactic radiosurgery with kilo-voltage cone-beam-CT. J Nucl Med Radiat Ther 2010; 1: 101–107.Google Scholar
28. Tanyi, J, Casey, K, Kato, C, Marquez, C, Laub, W, Fuss, M. Comparison of image-guidance modalities for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT). Int J Oncol Biol 2011; 81 (2): S826–S827.Google Scholar
29. Hoogeman, M S, Nuyttens, J, Levendag, P, Heumen, B J M. Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging. Int J Oncol Biol 2008; 70 (2): 609–618.Google Scholar