Alexis Dimitriadis Prof Karen Kirkby Prof Andrew Nisbet Dr Catharine Clark Dr Anthony Palmer.

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Presentation transcript:

Alexis Dimitriadis Prof Karen Kirkby Prof Andrew Nisbet Dr Catharine Clark Dr Anthony Palmer

Contents What is SRS? Why is this project important? Methods Results Conclusions

Contents What is SRS? Why is this project important? Methods Results Conclusions

Stereotaxy (“Stereo” & “Taxis”) Clark, R. & Horsley, V. (1906) Br. Med. J. 1799–1800

Used on humans in 1947 Spiegel, E., Wycis, H. T., Marks, M. & Lee, A. J. (1947) Science 80;106, 349–350

First “Stereotactic Radiosurgery” treatment in 1950 Leksell, L. (1950). Acta Chir. Scand. 99, 229–233

Stereotactic Radiosurgery (SRS) Definition by Leksell: “The administration, through the intact skull, of a single high dose of radiation, stereotactically directed to an intracranial region of interest. May be from X-rays, gamma rays, protons or heavy particles”

Key development for SRS Lars Leksell – 1950 Gamma Knife – 1953 Particle SRS – Late 50’s (Berkley & Harvard) Linac-based SRS – 80’s (ARG, ITA, USA, GER) Early-90’s dedicated SRS-linacs

Contents What is SRS? Why is this project important? Methods Results Conclusions

Contents What is SRS? Why is this project important? Methods Results Conclusions

Motivation Minimise delivery errors and clinical complications Improve patient care for a large number of pathologies Enhance standardisation in SRS Challenges Variety of SRS practices Small field photon dosimetry

Contents What is SRS? Why is this project important? Methods Results Conclusions

Contents What is SRS? Why is this project important? Methods Results Conclusions

Methods Survey to investigate current practices (Submitted to BJR: “Current practices of SRS in the UK” – under review) Suitable phantom Suitable detectors

STE 2 EV Anthropomorphic phantom (CIRS, VI, USA)

Methods Detectors: Radiochromic film (Gafchromic EBT-3 or EBT-XD) Plastic Scintillation Detector (Exradin W1) Alanine

Gafchromic EBT-XD Palmer, A., Dimitriadis, A., Nisbet, A. and Clark C.H. (2015) Phys Med Biol 21;60(22)

Plastic Scintillation Detector (PSD) Beierholm, A., Behrens, C.F. and Andersen, C.E. (2014) Radiat. Meas. 69, 50–56 Carasco et al. (2015) Med. Phys. 42, 297–304 A26EDGEPSD

Alanine Pellets for measuring small photon fields Hussein, M. et al. (2013) Radiother. Oncol. 108, 78–85

Contents What is SRS? Why is this project important? Methods Results Conclusions

Results Gamma analysis: 98.3% agreement at 3% (local), 1.5 mm criteria.

Results Alanine PSD Location TPS (in Gy) Alanine (in Gy) TPS (in Gy) PSD (in Gy) Target Target Target Target Location TPS (in Gy) Alanine (in Gy) TPS (in Gy) PSD (in Gy) OAR OAR OAR OAR Absolute dose comparisons between TPS and detectors in agreement within +/- 0.3 Gy

Contents What is SRS? Why is this project important? Methods Results Conclusions

Suitable methodology for dosimetric assessment Tested on GK, CK and LB platforms Future work Visit 2 more centres to complete pilot study Develop methodology for assessing the geometric accuracy Go on tour!

References Beierholm, A., Behrens, C.F, and Andersen, C.E. Dosimetric characterization of the Exradin W1 plastic scintillator detector through comparison with an in-house developed scintillator system. Radiat. Meas. 69, 50–56 (2014). Carasco et al. Characterization of the Exradin W1 scintillator for use in radiotherapy. Med. Phys. 42, 297–304 (2015). Clark, R. & Horsley, V. On a method of investigating the deep ganglia and tracts of the central nervous system (cerebellum). Br. Med. J. 1799–1800 (1906). Hussein, M. et al. A methodology for dosimetry audit of rotational radiotherapy using a commercial detector array. Radiother. Oncol. 108, 78– 85 (2013). Leksell, L. A stereotaxic apparatus for intracerebral surgery. Acta Chir. Scand. 99, 229–233 (1950). Palmer, A., Dimitriadis, A., Nisbet, A., Clark, C.H. Evaluation of Gafchromic EBT-XD film, with comparison to EBT3 film, and application in high dose radiotherapy verification. Phys Med Biol 21;60(22) (2015). Spiegel, E., Wycis, H. T., Marks, M. & Lee, A. J. Stereotaxic apparatus for operations on the human brain. Science 80;106, 349–350 (1947).