A dosimetric analysis of a spine SBRT specific treatment planning system

Daniel L. Saenz, Richard L Crownover, Sotirios Stathakis, Nikos Papanikolaou

Research output: Contribution to journalArticle

Abstract

Purpose: The Brainlab Elements treatment planning system utilizes distinct modules for treatment planning specific to stereotactic treatment sites including single or multiple brain lesions as well as spine. This work investigates the hypothesis that an optimization tailored specifically to spine can in fact create dosimetrically superior plans to those created in more general use treatment planning systems (TPS). Methods: Ten spine patients at our institution were replanned in Brainlab Elements, Phillips Pinnacle3, and Elekta Monaco. The planning target volume (PTV) included the vertebral body (in either the thoracic or lumbar spine), pedicles, and transverse processes. In all plans, the target was prescribed 20 Gy to 95% of the PTV. Objectives for the study included D5%<25 Gy and spinal cord D0.035cc < 14 Gy. Plans were evaluated by the satisfaction of the objectives as well total monitor units (MU), gradient index (GI), conformity index (CI), and dose gradient (distance between 100% and 50% isodose lines) in a selected slice between the vertebral body and spinal cord. Results: All TPS produced clinically acceptable plans. The sharpest dose gradient was achieved with Elements (mean 3.3 ± 0.2 mm). This resulted in lowest spinal cord maximum point doses (6.6 ± 1.0 Gy). Gradient indices were also the smallest for Elements (3.6 ± 0.5). Further improvement in gradient index and spinal cord sparing were not performed due to the subsequent violation of the PTV D5% < 25 Gy constraint or the loss of conformity due to the loss of coverage at the PTV-spinal canal interface. Conclusions: Brainlab Elements planning which relies on arc duplication to specifically optimize for spine anatomy did result in dosimetrically superior plans while holding prescription levels constant. While any planning system can improve upon specific dosimetric objectives, the simultaneous satisfaction of all constraints was best achieved with Brainlab Elements.

Original languageEnglish (US)
JournalJournal of Applied Clinical Medical Physics
DOIs
StateAccepted/In press - Jan 1 2018

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spine
planning
Spine
Spinal Cord
Planning
spinal cord
Monaco
gradients
Therapeutics
Spinal Canal
dosage
Prescriptions
Anatomy
Thorax
canals
anatomy
Brain
Canals
lesions
brain

Keywords

  • Monte Carlo
  • spine
  • stereotactic body radiosurgery
  • treatment planning

ASJC Scopus subject areas

  • Radiation
  • Instrumentation
  • Radiology Nuclear Medicine and imaging

Cite this

A dosimetric analysis of a spine SBRT specific treatment planning system. / Saenz, Daniel L.; Crownover, Richard L; Stathakis, Sotirios; Papanikolaou, Nikos.

In: Journal of Applied Clinical Medical Physics, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose: The Brainlab Elements treatment planning system utilizes distinct modules for treatment planning specific to stereotactic treatment sites including single or multiple brain lesions as well as spine. This work investigates the hypothesis that an optimization tailored specifically to spine can in fact create dosimetrically superior plans to those created in more general use treatment planning systems (TPS). Methods: Ten spine patients at our institution were replanned in Brainlab Elements, Phillips Pinnacle3, and Elekta Monaco. The planning target volume (PTV) included the vertebral body (in either the thoracic or lumbar spine), pedicles, and transverse processes. In all plans, the target was prescribed 20 Gy to 95{\%} of the PTV. Objectives for the study included D5{\%}<25 Gy and spinal cord D0.035cc < 14 Gy. Plans were evaluated by the satisfaction of the objectives as well total monitor units (MU), gradient index (GI), conformity index (CI), and dose gradient (distance between 100{\%} and 50{\%} isodose lines) in a selected slice between the vertebral body and spinal cord. Results: All TPS produced clinically acceptable plans. The sharpest dose gradient was achieved with Elements (mean 3.3 ± 0.2 mm). This resulted in lowest spinal cord maximum point doses (6.6 ± 1.0 Gy). Gradient indices were also the smallest for Elements (3.6 ± 0.5). Further improvement in gradient index and spinal cord sparing were not performed due to the subsequent violation of the PTV D5{\%} < 25 Gy constraint or the loss of conformity due to the loss of coverage at the PTV-spinal canal interface. Conclusions: Brainlab Elements planning which relies on arc duplication to specifically optimize for spine anatomy did result in dosimetrically superior plans while holding prescription levels constant. While any planning system can improve upon specific dosimetric objectives, the simultaneous satisfaction of all constraints was best achieved with Brainlab Elements.",
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