Evaluation of Real-time Target Positioning Accuracy in Spinal Radiosurgery

Dong Joon Lee

doi:10.14316/pmp.2013.24.4.290

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Lee: Evaluation of Real-time Target Positioning Accuracy in Spinal Radiosurgery

Original Article

Progress in Medical Physics 2013;24(4):290-294.

Published online: 17 December 2013

DOI: https://doi.org/10.14316/pmp.2013.24.4.290

Evaluation of Real-time Target Positioning Accuracy in Spinal Radiosurgery

Dong Joon Lee

Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Stereotactic Radiosurgery require high accuracy and precision of patient positioning and target localization. We evaluate the real time positioning accuracy of isocenter using optic guided patient positioning system, ExacTrac (BrainLab, Germany), during spinal radiosurgery procedure. The system is based on real time detect multiple body markers attached on the selected patient skin landmarks. And a custom designed patient positioning verification tool (PPVT) was used to check the patient alignment and correct the patient repositioning before radiosurgery. In this study, We investigate the selected 8 metastatic spinal tumor cases. All type of tumors commonly closed to thoracic spinal code. To evaluate the isocenter positioning, real time patient alignment and positioning monitoring was carried out for comparing the current 3-dimensional position of markers with those of an initial reference positions. For a selected patient case, we have check the isocenter positioning per every 20 millisecond for 45 seconds during spinal radiosurgery. In this study, real time average isocenter positioning translation were 0.07±0.17 mm, 0.11±0.18 mm, 0.13±0.26 mm, and 0.20±0.37 mm in the x (lateral), y (longitudinal), z (vertical) directions and mean spatial error, respectively. And body rotations were 0.14±0.07^o, 0.11±0.07^o, 0.03±0.04^o in longitudinal, lateral, table directions and mean body rotation 0.20±0.11^o, respectively. In this study, the maximum mean deviation of real time isocenter positioning translation during spinal radiosurgery was acceptable accuracy clinically.

Keywords: Target positioning accuracy, Real time monitoring, Spinal radiosurgery

REFERENCES

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Fig. 1.

Custom designed Patient Positioning Verification Tool (PPVT) used to alignment and correct repositioning of the patient.

Fig. 2.

Representative spinal radiosurgery plan with radiation dose distribution. Tumor located left side of 9th thoracic spine include vertebral body.

Fig. 3.

InfraRed BodyMarker (IRBM) translations defined by real time monitoring during spine radiosurgery for selected metastatic spine tumor.

Fig. 4.

Isocenter positioning displacement defined by IRBD monitoring checked per every 20 millisecond for 45 seconds.

Table 1.

InfraRed BodyMarker (IRBM) translations defined by real time monitoring during spine radiosurgery for selected metastatic spine tumor. IRBM were placed on the patient's skin of the supine position.

IRBM	No.	Location	Translations (mm)			Translations mean (mm)
IRBM	No.	Location	Lateral	Longitudinal	Vertical	Translations mean (mm)
	1	Pelvis-1	0.05	0.06	0.03	0.08±0.01
	2	Pelvis-2	0.05	0.07	0.05	0.10±0.01
	3	Pelvis-3	0.08	0.15	0.58	0.18±0.03
	4	Pelvis-4	0.21	0.21	0.13	0.32±0.10
	5	Chest-1	0.39	0.83	0.42	1.00±1.01
	6	Chest-2	0.07	0.39	0.34	0.66±0.43
	7	Chest-3	0.07	0.39	0.30	0.51±0.25
	8	Chest-4	0.06	0.34	0.36	0.50±0.29
	9	Chest-5	0.11	0.36	0.58	0.70±0.48

Table 2.

Three dimensional target translations of selected 8 spinal tumor cases defined by Infrared body marker (IRBM).

Tumor location	CTV (cm³)	OAR type	No. of IRBM	Isocenter shift (mm) mean±SD			Body rotation (degree) mean±SD
Tumor location	CTV (cm³)	OAR type	No. of IRBM	Lateral direction	Longit. direction	Vertical direction	Longit. direction	Lateral direction	Table direction
T9	29.1	C	8	0.13±0.24	0.15±0.18	0.00±0.43	0.11±0.07	0.00±0.09	0.02±0.06
T2	19.3	A	8	0.06±0.15	0.04±0.10	0.02±0.09	0.02±0.07	0.10±0.08	0.03±0.03
T11	41.3	B	8	0.04±0.26	0.14±0.16	0.14±0.37	0.13±0.05	0.01±0.09	0.00±0.01
T3	23.0	B	8	0.03±0.09	0.10±0.10	0.12±0.19	0.09±0.09	0.03±0.05	0.09±0.07
T1	58.3	B	8	0.04±0.19	0.06±0.25	0.18±0.21	0.50±0.17	0.23±0.12	0.06±0.11
T8	39.9	B	9	0.08±0.15	0.03±0.16	0.10±0.19	0.06±0.02	0.14±0.04	0.03±0.01
T9	49.5	A	9	0.09±0.18	0.31±0.19	0.21±0.32	0.00±0.05	0.17±0.06	0.04±0.03
T8	28.8	B	9	0.09±0.06	0.08±0.29	0.26±0.30	0.17±0.04	0.16±0.02	0.00±0.01
Mean	36.1			0.07±0.17	0.11±0.18	0.13±0.26	0.14±0.07	0.11±0.07	0.03±0.04
Mean spatial error					0.20±0.37			0.20±0.11

OAR: spinal cord and cauda equina, OAR type (distance from OAR to tumor), type-A (isolated), type-B (＜3 mm closed), type-C (contact).

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