title: Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife.
abstract: OBJECTIVES : A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator.
  
  
  METHODS
  This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient's nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared. RESULTS : Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm.
  
  
  CONCLUSIONS
  This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON.
authors.forename: Winnie
authors.initials: W
authors.lastname: Li
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bootsma
authors.affiliation: Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden.
authors.forename: Oscar
authors.initials: O
authors.lastname: Von Schultz
authors.affiliation: Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON.
authors.forename: Normand
authors.initials: N
authors.lastname: Laperriere
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON.
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Millar
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON.
authors.forename: David
authors.initials: D
authors.lastname: Jaffray
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chung
keywords: cone beam; immobilization; intra-fraction motion; optical tracking; stereotatic radiosurgery