Characterization of the radiation field surrounding the Leksell Gamma Knife® and shielding applications.

The aim of this study is to improve the characterization and modeling of the radiation field surrounding the Leksell Gamma Knife®-PerfexionTM. The improved characterization of the radiation field enables more accurate shielding calculations to be performed for the areas adjacent to the treatment room. With the aid of a high-purity germanium detector and a satellite dose rate meter, γ-ray spectra and ambient dose equivalent H*(10) data were acquired at various locations in the field of a Leksell Gamma Knife unit in a treatment room at Karolinska University Hospital, Sweden. These measurements were used to validate the results of the PEGASOS Monte Carlo simulation system with a PENELOPE kernel. The levels of the radiation that passes through the shielding of the machine (leakage radiation) are shown to be much lower than what is suggested by various bodies, e.g. the National Council on Radiation Protection and Measurements, to be used when calculating radiation shielding barriers. The results clearly indicate that Monte Carlo simulations may be used in structural shielding design calculations for γ rays from the Leksell Gamma Knife.

Variability in target delineation for cavernous sinus meningioma and anaplastic astrocytoma in stereotactic radiosurgery with Leksell Gamma Knife Perfexion.

BACKGROUND: Radiosurgery clinical practice relays on empirical observations and the experience of the practitioners involved in determining and delineating the target and therefore variability in target delineation might be expected for all the radiosurgery approaches, independent of the technique and the equipment used for delivering the treatment. The main aim of this study was to quantify the variability of target delineation for two radiosurgery targets expected to be difficult to delineate. The secondary aim was to investigate the dosimetric implications with respect to the plan conformity. The primary aim of the study has therefore a very general character, not being bound to one specific radiosurgery technique. MATERIALS AND METHODS: Twenty radiosurgery centers were asked to delineate one cavernous sinus meningioma and one astrocytoma and to plan the treatments for Leksell Gamma Knife Perfexion. The analysis of the delineated targets was based on the calculated 50 % agreement volume, AV50. The AV50 was compared to each delineated target by the concordance index and discordance index. The differences in location, size, and shape of the delineated targets were also analyzed using the encompassing volume compared to the common volume, i.e., the AV100, of all delineated structures. RESULTS: Target delineation led to major differences between the participating centers and therefore the AV50 was small in comparison to each delineated target volume. For meningioma, the AV50 was 5.90 cm(3), the AV100 was 2.60 cm(3), and the encompassing volume was 13.14 cm(3). For astrocytoma, the AV50 was 2.06 cm(3) while the AV100 was extremely small, only 0.05 cm(3), and the encompassing volume was 43.27 cm(3). These variations translate into corresponding discrepancies in plan conformity. CONCLUSIONS: Significant differences in shape, size, and location between the targets included in this study were identified and therefore the clinical implications of these differences should be further investigated.

Using Monte-Carlo-simulated radiation transport to calculate dose distribution in rats before irradiation with Leksell Gamma Knife 4C: technical note.

BACKGROUND: Gamma knife surgery (GKS) is used at subnecrotic doses for temporal lobe epilepsy (TLE) treatment. Rat models of TLE have been used to probe the mechanisms underlying GKS. Previous GKS studies on rats have used the Leksell GammaPlan (LGP) treatment planning system to determine the irradiation time to achieve the dose to deliver. Since LGP is not designed for such small structures, it is important to calibrate the system for the rat brain. METHODS: We have used a Monte Carlo simulation (MCS) radiation transport scheme, with CT data as anatomical and tissue-specific information, to simulate the dose distribution in a rat brain when using a Leksell Gamma Knife. RESULTS: We show how dose distributions obtained by MCS quantitatively compare to those predicted by LGP, and discuss whether LGP should be used for studies involving rats. The energy deposited when using the 4-mm collimators was calculated for targets on both sides of the rat brain in the dorsal hippocampus, which allowed us to determine the exact time to irradiate rats with a given dose. CONCLUSION: The MCS method used in this study can easily be used for future GKS studies on small animals when accurate dose distributions are required.

Investigation of intracranial peripheral dose arising from the treatment of large lesions with Leksell GammaKnife Perfexion.

This investigation involves quantifying the extent of intracranial peripheral dose arising from simulated targets situated in the skull-base or upper-spine region using the Leksell GammaKnife Perfexion treatment unit. For each of three spherical target volumes--denoted as Vs (4 cm3), VM (18 cm3), and VL (60 cm3)--three treatment plans were manually generated, one for each of the three collimator sizes--4, 8, and 16 mm. Each of the plans was delivered to a spherical dosimetry phantom with an insert containing EBT Gafchromic film. The total dose at 70 mm from the targets' edges, %D(70 mm), was measured as a function of elevation angle and expressed as a percentage of the prescription dose. The film insert was placed centered in the median sagittal plane (Leksell X = 100) and %D(70 mm) was measured for the angular range from 0 degree (superior/along Z axis) to 90 degrees (anterior/along Y axis). For a given collimator i, the irradiation time ti to treat a spherical target of volume V using the 50% isodose line was observed to follow a power-law relationship of the form ti = Ai(V/ Vi)n where Ai was the maximum dose divided by collimator dose rate and Vi was the volume encompassed by the 50% isodose line for a single shot. The mean value of n was 0.61 (range: 0.61-0.62). Along the superior (Z) direction (angle=0 degree) and up to angles of around 30 degrees, the %D(70 mm) was always highest for the 4 mm plans, followed by the 8 mm, followed by the 16 mm. In this angular range, the maximum measured %D(70 mm) was 1.7% of the prescription dose. The intracranial peripheral dose along the superior direction (combined scatter and leakage dose) resulting from irradiation of upper-spine or base-of-skull lesions is measured to be less than 2% of the prescription dose, even for very large (60 cm3) targets. The results of this study indicate that, for a given target volume, treatment plans consisting of only 4 mm shots yield larger peripheral dose in the superior direction than 8 mm shot only plans, which in turn yield larger peripheral dose than 16 mm shot only plans.

A simple and effective method for validation and measurement of collimator output factors for Leksell Gamma Knife Perfexion.

Accurate determination of collimator output factors is important for Leksell Gamma Knife radiosurgery. The new Leksell Gamma Knife Perfexion system has a completely redesigned collimator system and the collimator output factors are different from the other Leksell Gamma Knife models. In this study, a simple method was developed to validate the collimator output factors specifically for Leksell Gamma Knife Perfexion. The method uses double-shot exposures on a single film to eliminate repeated setups and the necessity to acquire dose calibration curves required for the traditional film exposure method. Using the method, the collimator output factors with respect to the 16 mm collimator were measured to be 0.929 +/- 0.009 and 0.817 +/- 0.012 for the 8 mm and the 4 mm collimator, respectively. These values are in agreement (within 2%) with the default values of 0.924 and 0.805 in the Leksell Gamma Plan treatment planning system. These values also agree with recently published results of 0.917 (8 mm collimator) and 0.818 (4 mm collimator) obtained from the traditional methods. Given the efficiency of the method, measurement and validation of the collimator output factors can be readily adopted in commissioning and quality assurance of a Leksell Gamma Knife Perfexion system.