Abstract:
PURPOSE/OBJECTIVES:To present our linac-based SRS procedural technique for medically and/or surgically refractory trigeminal neuralgia (TN) treatment and simultaneously report our clinical outcomes. MATERIALS AND METHODS:Twenty-seven refractory TN patients who were treated with a single fraction of 80 Gy to TN. Treatment delivery was performed with a 4 mm cone size using 7-arc arrangement with differential-weighting for Novalis-TX with six MV-SRS (1000 MU/min) beam and minimized dose to the brainstem. Before each treatment, Winston-Lutz quality assurance (QA) with submillimeter accuracy was performed. Clinical treatment response was evaluated using Barrow Neurological Institute (BNI) pain intensity score, rated from I to V. RESULTS:Out of 27 patients, 22 (81%) and 5 (19%) suffered from typical and atypical TN, respectively, and had median follow-up interval of 12.5 months (ranged: 1-53 months). For 80 Gy prescriptions, delivered total average MU was 19440 ± 611. Average beam-on-time was 19.4 ± 0.6 min. Maximum dose and dose to 0.5 cc of brainstem were 13.4 ± 2.1 Gy (ranged: 8.4-15.9 Gy) and 3.6 ± 0.4 Gy (ranged: 3.0-4.9 Gy), respectively. With a median follow-up of 12.5 months (ranged: 1-45 months) in typical TN patients, the proportion of patients achieving overall pain relief was 82%, of which half achieved a complete pain relief with BNI score of I-II and half demonstrated partial pain reduction with BNI score of IIIA-IIIB. Four typical TN patients (18%) had no response to radiosurgery treatment. Of the patients who responded to treatment, actuarial pain recurrence free survival rates were approximately 100%, 75%, and 50% at 12 months, 15 months, and 24 months, respectively. Five atypical TN patients were included, who did not respond to treatment (BNI score: IV-V). However, no radiation-induced cranial-toxicity was observed in all patients treated. CONCLUSION:Linac-based SRS for medically and/or surgically refractory TN is a fast, effective, and safe treatment option for patients with typical TN who had excellent response rates. Patients, who achieve response to treatment, often have durable response rates with moderate actuarial pain recurrence free survival. Longer follow-up interval is anticipated to confirm our clinical observations.
journal_name
J Appl Clin Med Physjournal_title
Journal of applied clinical medical physicsauthors
Pokhrel D,Sood S,McClinton C,Saleh H,Badkul R,Jiang H,Stepp T,Camarata P,Wang Fdoi
10.1002/acm2.12057subject
Has Abstractpub_date
2017-03-01 00:00:00pages
136-143issue
2issn
1526-9914journal_volume
18pub_type
杂志文章abstract::To monitor delivered dose and trigger plan adaptation when deviation becomes unacceptable, a clinical treatment dose (Tx-Dose) reconstruction system based on three-dimensional (3D)/four-dimensional (4D)-cone beam computed tomograpy (CBCT) images was developed and evaluated on various treatment sites, particularly for ...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12474
更新日期:2018-11-01 00:00:00
abstract::A quality assurance (QA) procedure was developed to evaluate the congruence between the cone-beam computed tomography (CBCT) image center and the radiation isocenter on a Varian Trilogy linac. In contrast to the published QA procedures, this method did not require a ball bearing (BB) phantom to be placed exactly at th...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v11i4.3297
更新日期:2010-07-02 00:00:00
abstract::The nonphysical wedge is a modality that uses computer-controlled jaw motion to generate wedge-shaped dose distributions. There are Varian enhanced dynamic wedges (EDWs) and Siemens virtual wedges (VWs). We recently commissioned dynamic wedges on both Varian and Siemens LINACs. The beam data, acquired with a Wellhofer...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v5i4.1964
更新日期:2004-10-01 00:00:00
abstract:PURPOSE:This study evaluates the feasibility of lung dose prediction based on target contour and patient anatomy for breast patients treated with proton therapy. METHODS:Fifty-two randomly selected patients were included in the cohort, who were treated to 50.4-66.4 Gy(RBE) to the left (36), right (15), or bilateral (1...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章,随机对照试验
doi:10.1002/acm2.12436
更新日期:2018-11-01 00:00:00
abstract::The longitudinal coverage of a LINAC-mounted CBCT scan is limited to the corresponding dimensional limits of its flat panel detector, which is often shorter than the length of the treatment field. These limits become apparent when fields are designed to encompass wide regions, as when providing nodal coverage. Therefo...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v13i4.3796
更新日期:2012-07-05 00:00:00
abstract:PURPOSE:To assess the noise characteristics of the new adaptive statistical iterative reconstruction (ASiR-V) in comparison to ASiR. METHODS:A water phantom was acquired with common clinical scanning parameters, at five different levels of CTDIvol . Images were reconstructed with different kernels (STD, SOFT, and BONE...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12253
更新日期:2018-03-01 00:00:00
abstract:PURPOSE:Multiple metrics are proposed to characterize and compare the complexity of helical tomotherapy (HT) plans created for different treatment sites. METHODS:A cohort composed of 208 HT plans from head and neck (105), prostate (51) and brain (52) tumor sites was considered. For each plan, 14 complexity metrics wer...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12895
更新日期:2020-07-01 00:00:00
abstract::Many head-and-neck cancer (HNC) patients treated with radiotherapy suffer significant anatomical changes due to tumor shrinkage or weight loss. The purpose of this study was to assess dose changes over target volumes and organs at risk during intensity-modulated radiotherapy for HNC patients. Sixteen HNC IMRT patients...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v13i6.3723
更新日期:2012-11-08 00:00:00
abstract::A method to evaluate the electron beam energy constancy by employing the computed radiography (CR) system has been developed. In this method, a right triangular plastic wedge is used to produce a curve of the CR storage phosphor plate signal versus the wedge thickness. The curve, which resembles the percentage depth i...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v10i4.2911
更新日期:2009-10-15 00:00:00
abstract::We describe a method for independently verifying the dose distributions from pre- and post-implant brachytherapy source distributions. Monte Carlo calculations have been performed to characterize the three-dimensional dose distribution in water phantom from a low-energy brachytherapy source. The calculations are perfo...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v4i1.2543
更新日期:2003-01-01 00:00:00
abstract:INTRODUCTION:Designing a radiation plan that optimally delivers both target coverage and normal tissue sparing is challenging. There are limited tools to determine what is dosimetrically achievable and frequently the experience of the planner/physician is relied upon to make these determinations. PlanIQ software provid...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12165
更新日期:2017-09-01 00:00:00
abstract::The aim of this study was to assess the performance of a gantry-mounted detector system and a couch set detector system using a systematic multileaf collimator positional error manually introduced for volumetric-modulated arc therapy. Four head and neck and esophagus VMAT plans were evaluated by measurement using an e...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v15i3.4495
更新日期:2014-05-08 00:00:00
abstract::Atlas-based autosegmentation is an established tool for segmenting structures for CT-planned head and neck radiotherapy. MRI is being increasingly integrated into the planning process. The aim of this study is to assess the feasibility of MRI-based, atlas-based autosegmentation for organs at risk (OAR) and lymph node ...
journal_title:Journal of applied clinical medical physics
pub_type: 临床试验,杂志文章
doi:10.1120/jacmp.v17i4.6051
更新日期:2016-07-08 00:00:00
abstract:INTRODUCTION:The purpose of this study was to present the optimization process of CT parameters to reduce patient exposure during bone SPECT/CT without affecting the quality of SPECT images with attenuation correction (AC). MATERIAL AND METHODS:A fillable phantom reflecting realistic bone scintigraphy conditions was d...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.13069
更新日期:2020-10-27 00:00:00
abstract:PURPOSE:To establish a streamlined end-to-end test of a 6 degrees-of-freedom (6DoF) robotic table using a 3D printed phantom for periodic quality assurance. METHODS:A 3D printed phantom was fabricated with translational and rotational offsets and an imbedded central ball-bearing (BB). The phantom underwent each step o...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12227
更新日期:2018-01-01 00:00:00
abstract::We clarified the relationship between the display size of MRI images and observer performance using a digital contrast-detail (d-CD) phantom. The d-CD phantom was developed using Microsoft Visual Basic 2010 Express. It had a 512 × 512 matrix in size and a total of 100 holes, whose diameter increased stepwise from 4 to...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v17i1.5876
更新日期:2016-01-08 00:00:00
abstract::The American Association of Physicists in Medicine Task Group 36 (AAPM TG-36) data can be used to estimate peripheral dose (PD) distributions outside the primary radiation field. However, the report data does not apply to linear accelerators equipped with a multileaf collimator (MLC) and universal wedge (UW). Tertiary...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v3i4.2554
更新日期:2002-10-01 00:00:00
abstract::The purpose was to assess the variability in automated translational head/neck setup corrections computed from several different imaging modalities and rigid registration methods using patient anatomy. Shifts were calculated using three commercial and one in-house automated rigid registration methods for nine head/nec...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v12i1.3337
更新日期:2010-10-13 00:00:00
abstract::The QFix EncompassTM stereotactic radiosurgery (SRS) immobilization system consists of a thermoplastic mask that attaches to the couch insert to immobilize patients treated with intracranial SRS. This study evaluates the dosimetric impact and verifies a vendor provided treatment planning system (TPS) model in the Ecli...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12387
更新日期:2018-07-01 00:00:00
abstract::The purpose of this work is to prospectively assess the setup accuracy that can be achieved with a stereotactic body localizer (SBL) in immobilizing patients for stereotactic intensity-modulated radiotherapy (IMRT) for prostate cancer. By quantifying this important factor and target mobility in the SBL, we expect to p...
journal_title:Journal of applied clinical medical physics
pub_type: 临床试验,杂志文章
doi:10.1120/jacmp.v5i2.1947
更新日期:2004-04-01 00:00:00
abstract::The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensit...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v16i1.5126
更新日期:2015-01-08 00:00:00
abstract::This study investigates the dosimetry and radiobiological model variation when a second photon arc was added to prostate volumetric-modulated arc therapy (VMAT) using the single-arc technique. Dosimetry and radiobiological model comparison between the single-arc and double-arc prostate VMAT plans were performed on fiv...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v14i3.4053
更新日期:2013-05-06 00:00:00
abstract::Doses in Leksell GammaPlan (Elekta, Stockholm, Sweden) are calculated for each shot by summing the contribution from the 201 radiation beams emitted by the Gamma Knife (Elekta), weighted for attenuation in the tissue traversed. The patient's head is modeled based on 24 skull measurements, from which the depth to the c...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v8i3.2377
更新日期:2007-07-17 00:00:00
abstract:PURPOSE:The GammaPod is a dedicated prone breast stereotactic radiosurgery (SRS) machine composed of 25 cobalt-60 sources which rotate around the breast to create highly conformal dose distributions for boosts, partial-breast irradiation, or neo-adjuvant SRS. We describe the development and validation of a patient-spec...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12778
更新日期:2019-12-01 00:00:00
abstract::Performing a procedure on the wrong patient or site is one of the greatest errors that can occur in medicine. The addition of automation has been shown to reduce errors in many processes. In this work we explore the use of an automated patient identification process using optical surface imaging for radiotherapy treat...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v17i2.6066
更新日期:2016-03-08 00:00:00
abstract::The objective of this work is the investigation of intense pulsed light (IPL) photoepilation using Monte Carlo simulation to model the effect of the output dosimetry with millisecond exposure used by typical commercial IPL systems. The temporal pulse shape is an important parameter, which may affect the biological tis...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v13i5.3702
更新日期:2012-09-06 00:00:00
abstract::The case of a 50-year-old man affected by a rhabdomiosarcoma metastatic lesion in the left flank Is reported. The patient was addressed to 50.4 Gy radiotherapy with concomitant chemotherapy in order to locally control the lesion. A Tri-60-Co magnetic resonance hybrid radiotherapy unit was used for treatment delivery a...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12575
更新日期:2019-06-01 00:00:00
abstract:OBJECT:The purpose of this study was to compare two methods of stereotactic localization in Gamma Knife treatment planning: cone beam computed tomography (CBCT) or fiducial. While the fiducial method is the traditional method of localization, CBCT is now available for use with the Gamma Knife Icon. This study seeks to ...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1002/acm2.12745
更新日期:2019-11-01 00:00:00
abstract::The GafChromic XR Type R film is a relatively new product for recording high radiation dose in interventional radiological procedures. Means of measuring the film response were studied in this investigation. Two handheld reflective-type densitometers of different models were compared in the range of 0-8 Gy. They were ...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v4i4.2501
更新日期:2003-10-01 00:00:00
abstract::The purpose of this study was to perform comprehensive measurements and testing of a Novalis Tx linear accelerator, and to develop technical guidelines for com-missioning from the time of acceptance testing to the first clinical treatment. The Novalis Tx (NTX) linear accelerator is equipped with, among other features,...
journal_title:Journal of applied clinical medical physics
pub_type: 杂志文章
doi:10.1120/jacmp.v13i3.3729
更新日期:2012-05-10 00:00:00