Avoiding a Collision in Gamma Knife Radiosurgery : A Modified Mask Fixation Method

Objective@#: The latest version of the Leksell Gamma Knife IconTM allows for mask- and frame-based fixation. Although mask fixation provides fractionated treatment and immobilization using a noninvasive method, it is not free from collision. The authors investigated the collision problem with a modified mask fixation method. @*Methods@#: This study presents a case of two meningiomas in the frontal area, where a collision occurs in the occipital area. A modified mask fixation method was introduced to avoid the collision : first, the edges of the head cushion were cut off and polystyrene beads with a diameter of approximately 5 cm were removed. Next, the head cushion was sealed using a stapler. Finally, the head cushion was flattened in the adapter. We compared the shot coordinates, 3-dimensional (3D) error, clearance distance, and vertical depth of the head cushion between the initial and modified mask fixations. @*Results@#: When comparing the initial and modified mask fixations, the difference in the shot coordinates was +10.5 mm along the y-axis, the difference in the 3D error was approximately 18 mm, and the difference in clearance was -10.2 mm. The head cushion was approximately 8 mm deeper in the modified mask fixation. @*Conclusion@#: Based on these findings, we recommend a modified mask fixation method for gamma knife radiosurgery using ICON with a collision.

Proton Beam Radiotherapy for Pediatric Gliomas: Early Outcomes and Dose Comparison / 임상소아혈액종양

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan. METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69). RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area. CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.

Proton Beam Radiotherapy for Pediatric Gliomas: Early Outcomes and Dose Comparison / 임상소아혈액종양

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan.METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69).RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area.CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.

Recent Advances in Nuclear Medicine Imaging Instrumentation / 핵의학분자영상

This review introduces advances in clinical and pre-clinical single photon emission computed tomography (SPECT) and positron emission tomography (PET) providing noninvasive functional images of biological processes. Development of new collimation techniques such as multi-pinhole and slit-slat collimators permits the improvement of system spatial resolution and sensitivity of SPECT. Application specific SPECT systems using smaller and compact solid-state detector have been customized for myocardial perfusion imaging with higher performance. Combined SPECT/CT providing improved diagnostic and functional capabilities has been introduced. Advances in PET and CT instrumentation have been incorporated in the PET/CT design that provide the metabolic information from PET superimposed on the anatomic information from CT. Improvements in the sensitivity of PET have achieved by the fully 3D acquisition with no septa and the extension of axial field-of-view. With the development of faster scintillation crystals and electronics, time-of-flight (TOF) PET is now commercially available allowing the increase in the signal-to-noise ratio by incorporation of TOF information into the PET reconstruction process. Hybrid PET/SPECT/CT systems has become commercially available for molecular imaging in small animal models. The pre-clinical systems have improved spatial resolution using depth-of-interaction measurement and new collimators. The recent works on solid state detector and dual modality nuclear medicine instrumentations incorporating MRI and optical imagers will also be discussed.

Development of a Small Animal Positron Emission Tomography Using Dual-Layer Phoswich Detector and Position Sensitive Photomultiplier Tube: Preliminary Results / 대한핵의학회잡지

PURPOSE: The purpose of this study was to develop a small animal PET using dual layer phoswich detector to minimize parallax error that degrades spatial resolution at the outer part of field-of-view (FOV). MATERIALS AND METHODS: A simulation tool GATE (Geant4 Application for Tomographic Emission) was used to derive optimal parameters of small PET, and PET was developed employing the parameters. Lutetium Oxyorthosilicate (LSO) and Lutetium-Yttrium Aluminate-Perovskite (LuYAP) was used to construct dual layer phoswitch crystal. 8 X 8 arrays of LSO and LuYAP pixels, 2 mm X 2 mm X 8 mm in size, were coupled to a 64-channel position sensitive photomultiplier tube. The system consisted of 16 detector modules arranged to one ring configuration (ring inner diameter 10 cm, FOV of 8 cm). The data from phoswich detector modules were fed into an ADC board in the data acquisition and preprocessing PC via sockets, decoder block, FPGA board, and bus board. These were linked to the master PC that stored the events data on hard disk. RESULTS: In a preliminary test of the system, reconstructed images were obtained by using a pair of detectors and sensitivity and spatial resolution were measured. Spatial resolution was 2.3 mm FWHM and sensitivity was 10.9 cps/micro Ci at the center of FOV. CONCLUSION: The radioactivity distribution patterns were accurately represented in sinograms and images obtained by PET with a pair of detectors. These preliminary results indicate that it is promising to develop a high performance small animal PET.

A Computer Simulation for Small Animal Iodine-125 SPECT Development / 대한핵의학회잡지

PURPOSE: Since I-125 emits low energy (27-35 keV) radiation, thinner crystal and collimator could be employed and, hence, it is favorable to obtain high quality images. The purpose of this study was to derive the optimized parameters of I-125 SPECT using a new simulation tool, GATE (Geant4 Application for Tomographic Emission). MATERIALS AND METHODS: To validate the simulation method, gamma camera developed by Weisenberger et al. was modeled. NaI (Tl) plate crystal was used and its thickness was determined by calculating detection efficiency. Spatial resolution and sensitivity curves were estimated by changing variable parameters for parallel-hole and pinhole collimator. Performances of I-125 SPECT equipped with the optimal collimator were also estimated. RESULTS: In the validation study, simulations were found to agree well with experimental measurements in spatial resolution (4%) and sensitivity (3%). In order to acquire 98% gamma ray detection efficiency, NaI (Tl) thickness was determined to be 1 mm. Hole diameter (mm), length (mm) and shape were chosen to be 0.2: 5: square and 0.5: 10: hexagonal for high resolution (HR) and general purpose (GP) parallel-hole collimator, respectively. Hole diameter, channel height and acceptance angle of pinhole (PH) collimator were determined to be 0.25 mm, 0.1 mm and 90 degree. The spatial resolutions of reconstructed image of the I-125 SPECT employing HR: GP: PH were 1.2: 1.7: 0.8 mm. The sensitivities of HR: GP: PH were 39.7: 71.9: 5.5 cps/MBq. CONCLUSION: The optimal crystal and collimator parameters for I-125 imaging were derived by simulation using GATE. The results indicate that excellent resolution and sensitivity imaging is feasible using I-125 SPECT.