SU‐E‐T‐230: Creating a Large Number of Focused Beams with Variable Patient Head Tilt to Improve Dose Fall‐Off for Brain Radiosurgery

Abstract

Purpose:To develop a treatment delivery and planning strategy by increasing the number of beams to minimize dose to brain tissue surrounding a target, while maximizing dose coverage to the target.Methods:We analyzed 14 different treatment plans via Leksell PFX and 4C. For standardization, single tumor cases were chosen. Original treatment plans were compared with two optimized plans. The number of beams was increased in treatment plans by varying tilt angles of the patient head, while maintaining original isocenter and the beam positions in the x‐, y‐ and z‐axes, collimator size, and beam blocking. PFX optimized plans increased beam numbers with three pre‐set tilt angles, 70, 90, 110, and 4C optimized plans increased beam numbers with tilt angles increasing arbitrarily from range of 30 to 150 degrees. Optimized treatment plans were compared dosimetrically with original treatment plans.Results:Comparing total normal tissue isodose volumes between original and optimized plans, the low‐level percentage isodose volumes decreased in all plans. Despite the addition of multiple beams up to a factor of 25, beam‐on times for 1 tilt angle versus 3 or more tilt angles were comparable (<1 min.). In 64% (9/14) of the studied cases, the volume percentage decrease by >5%, with the highest value reaching 19%. The addition of more tilt angles correlates to a greater decrease in normal brain irradiated volume. Selectivity and coverage for original and optimized plans remained comparable.Conclusion:Adding large number of additional focused beams with variable patient head tilt shows improvement for dose fall‐off for brain radiosurgery. The study demonstrates technical feasibility of adding beams to decrease target volume