title: The TALON removable head frame system for stereotactic radiosurgery/radiotherapy: measurement of the repositioning accuracy.
abstract: OBJECTIVE
  To present the TALON removable head frame system as an immobilization device for single-fraction intensity-modulated stereotactic radiosurgery (IMRS) and fractionated stereotactic intensity-modulated radiotherapy (FS-IMRT); and to evaluate the repositioning accuracy by measurement of anatomic landmark coordinates in repeated computed tomography (CT) examinations.
  
  
  METHODS
  Nine patients treated by fractionated stereotactic intensity-modulated radiotherapy underwent repeated CTs during their treatment courses. We evaluated anatomic landmark coordinates in a total of 26 repeat CT data sets and respective x, y, and z shifts relative to their positions in the nine treatment-planning reference CTs. An iterative optimization algorithm was employed using a root mean square scoring function to determine the best-fit orientation of subsequent sets of anatomic landmark measurements relative to the original image set. This allowed for the calculation of the x, y, and z components of translation of the target isocenter for each repeat CT. In addition to absolute target isocenter translation, the magnitude (sum vector) of isocenter motion and the patient/target rotation about the three principal axes were calculated.
  
  
  RESULTS
  Anatomic landmark analysis over a treatment course of 6 weeks revealed a mean target isocenter translation of 0.95 +/- 0.55, 0.58 +/- 0.46, and 0.51 +/- 0.38 mm in x, y, and z directions, respectively. The mean magnitude of isocenter translation was 1.38 +/- 0.48 mm. The 95% confidence interval ([CI], mean translation plus two standard deviations) for repeated isocenter setup accuracy over the 6-week period was 2.34 mm. Average rotations about the x, y, and z axes were 0.41 +/- 0.36, 0.29 +/- 0.25, and 0.18 +/- 0.15 degrees, respectively. Analysis of the accuracy of the first repeated setup control, representative of single-fraction stereotactic radiosurgery situations, resulted in a mean target isocenter translation in the x, y, and z directions of 0.52 +/- 0.38, 0.56 +/- 0.30, and 0.46 +/- 0.25 mm, respectively. The mean magnitude of isocenter translation was 0.99 +/- 0.28 mm. The 95% confidence interval for these radiosurgery situations was 1.55 mm. Average rotations at first repeated setup control about the x, y, and z axes were 0.24 +/- 0.19, 0.19 +/- 0.17, and 0.19 +/- 0.12 degrees, respectively.
  
  
  CONCLUSIONS
  The TALON relocatable head frame was seen to be well suited for immobilization and repositioning of single-fraction stereotactic radiosurgery treatments. Because of its unique removable design, the system was also seen to provide excellent repeat immobilization and alignment for fractionated stereotactic applications. The exceptional accuracy for the single-fraction stereotactic radiosurgical application of the system was seen to deteriorate only slightly over a 6-week fractionated stereotactic treatment course.
authors.affiliation: Department of Radiation Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-9769, USA. bsalter@saci.org
authors.forename: B J
authors.initials: BJ
authors.lastname: Salter
authors.forename: M
authors.initials: M
authors.lastname: Fuss
authors.forename: D G
authors.initials: DG
authors.lastname: Vollmer
authors.forename: A
authors.initials: A
authors.lastname: Sadeghi
authors.forename: C A
authors.initials: CA
authors.lastname: Bogaev
authors.forename: D A
authors.initials: DA
authors.lastname: Cheek
authors.forename: T S
authors.initials: TS
authors.lastname: Herman
authors.forename: J M
authors.initials: JM
authors.lastname: Hevezi
mesh_terms: D000465:Algorithms; D001927:Brain Diseases / Q000532:radiotherapy; D016001:Confidence Intervals; D004867:Equipment Design; D006801:Humans; D007103:Immobilization; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed