title: The clinical application of plugging patterns for the Leksell gamma knife.
abstract: OBJECTIVE
  In this report the authors explore the use of standardized plugging templates in formulating stereotactic radiosurgery dose plans for the Leksell gamma knife.
  
  
  METHODS
  Unplugged gamma knife dose plans previously used in the treatment of patients with trigeminal neuralgia (TN) and vestibular schwannoma (VS) were studied. Standardized plugging templates were then superimposed on these plans, and their effects on the conformity index of tumors and the transposition of the radiation field from the brainstem to the cerebrospinal fluid spaces for the trigeminal cases were examined.
  
  
  CONCLUSIONS
  The standardized plugging templates significantly increased the conformity indices in cases of VS plans and for TN. Plugging significantly reduced the brainstem exposure to radiation while at the same time not altering the length of the trigeminal nerve being treated. Standardized plugging templates may therefore be a useful tool in optimizing dose plans.
authors.affiliation: National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, England. paul.vaughan@sth.nhs.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Vaughan
authors.forename: Anna
authors.initials: A
authors.lastname: Hampshire
authors.forename: Tracy
authors.initials: T
authors.lastname: Soanes
authors.forename: Andras
authors.initials: A
authors.lastname: Kemeny
authors.forename: Matthias
authors.initials: M
authors.lastname: Radatz
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rowe
authors.forename: Lee
authors.initials: L
authors.lastname: Walton
mesh_terms: D006801:Humans; D009464:Neuroma, Acoustic / Q000601:surgery*; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods*; D014277:Trigeminal Neuralgia / Q000601:surgery*