Abstract
Calvarial reconstruction following resection of tumors involving the skull is often followed by stereotactic radiosurgery. Prior studies have addressed the effects of various cranioplasty materials on dose distributions in linac‐based radiosurgery. We aim to determine the effects of titanium mesh implants on Gamma Knife dose. Radiation backscatter and transmission were measured for eight types of titanium mesh using film, ion chamber, and Theratron Co‐60 teletherapy device. A single mesh was selected for Gamma Knife irradiation using a CaSO4 skull filled with ballistics gel. Dose profiles for reconstructed and intact skulls were compared with the planning system prediction at 2.5 and 5.5 cm depth. Titanium contact backscatter and transmission dose perturbations ranged from ‐18% to 23%. Radiation dose measured at 1.5 cm below the calvarial implant increased by 0.5% to 3.3% relative to bone. Measured Gamma Knife dose profile diameters agreed with expected profiles. Maximum dose within the intact phantom was 3% less than planned due to skull attenuation. Maximum dose within the reconstructed phantom was between the intact phantom and planned doses. Titanium mesh implants and hydroxyapatite cranioplasty result in minimal alteration (<3%) in the delivered Gamma Knife dose.PACS number: 87.00
Highlights
Reconstruction of the calvarium with thin titanium mesh implants (≤ 0.7 mm thickness) after neurosurgical intervention can be followed by stereotactic radiosurgery (SRS)
A few publications have addressed the effects of thin titanium mesh implants on dose distributions in linac-based radiosurgery.[1,2] Several other investigators have studied perturbation of Co-60 and linac-based radiotherapy dose from thicker metallic materials such as aneurysm clips and coils,(3-5) as well as head and neck reconstruction devices. [6,7,8,9,10,11,12,13,14] there are at present no studies evaluating the effects of cranial metallic implants on dose distributions in Gamma Knife (GK) SRS
Backscattered and transmitted dose perturbations are pronounced at the surface of the titanium mesh, and to a lesser degree with the hydroxyapatite cranioplasty
Summary
Reconstruction of the calvarium with thin titanium mesh implants (≤ 0.7 mm thickness) after neurosurgical intervention can be followed by stereotactic radiosurgery (SRS). A popular radiosurgery system is the Gamma Knife (GK), using 201 focused Co-60 sources. A few publications have addressed the effects of thin titanium mesh implants on dose distributions in linac-based radiosurgery.[1,2] Several other investigators have studied perturbation of Co-60 and linac-based radiotherapy dose from thicker metallic materials such as aneurysm clips and coils,(3-5) as well as head and neck reconstruction devices. [6,7,8,9,10,11,12,13,14] there are at present no studies evaluating the effects of cranial metallic implants on dose distributions in GK SRS. 55 Rakowski et al.: Gamma Knife titanium mesh dose A few publications have addressed the effects of thin titanium mesh implants on dose distributions in linac-based radiosurgery.[1,2] Several other investigators have studied perturbation of Co-60 and linac-based radiotherapy dose from thicker metallic materials such as aneurysm clips and coils,(3-5) as well as head and neck reconstruction devices. [6,7,8,9,10,11,12,13,14] there are at present no studies evaluating the effects of cranial metallic implants on dose distributions in GK SRS.
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