• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.26-30
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• 2008

Objective : The authors developed a stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C. Development and verification procedures were described in this article. Methods : The device was designed to satisfy three requirements. The mechanical accuracy in positioning was to be managed within 0.5 mm. The strength of the device and structure were to be compromised to provide enough strength to hold a small animal during irradiation and to interfere the gamma ray beam as little as possible. The device was to be used in combination with the Leksell G-$frame^{(R)}$ and $KOPF^{(R)}$ rat adaptor. The irradiation point was determined by separate imaging sequences such as plain X-ray images. Results : The absolute dose rate with the device in a Leksell Gamma Knife was 3.7% less than the value calculated from Leksell Gamma $Plan^{(R)}$. The dose distributions measured with $GAFCHROMIC^{(R)}$ MD-55 film corresponded to those of Leksell Gamma $Plan^{(R)}$ within acceptable range. The device was used in a series of rat experiments with a 4 mm helmet of Leksell Gamma Knife. Conclusion : A stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C has been developed so that it fulfilled above requirements. Absorbed dose and dose distribution at the center of a Gamma Knife helmet are in acceptable ranges. The device provides enough accuracy for stereotactic irradiation with acceptable practicality.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.144-145
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• 2002

Stereotactic radiotherapy is required to irradiate a small tumor accurately. The radiotherapy showing improves when making an accidental error little boundlessly. It is performed according to treatment planning that is established by the outside landmark of head. At present, when stereotactic radiotherapy for a head is done, the Leksell Flame is fixed on the head, and positioning based on the point and so on which it is in that fixed implement is performed. However, there are problems on the method done at present in the point such as reappearance when the fractionated irradiation method in which the Leksell Flame is removed and installed at every treatment is done because there are landmarks outside the head. Landmarks in the skull were decided, and that precision was examined for the purpose of the improvement of the radiation therapeutic gain. Linac-graphy with longitudinal and lateral view were taken with 6 MV photon beams. A distance to base point inside the skull, each film measured the angle from a center of the small irradiation field, and comparison was done. From the results, a large accidental error wasn't seen as a result of the measurement by every film. Stereotactic radiotherapy for a head treatment had an accidental error of about several millimeters when treatment positioning was done. Therefore, it was thought that there was no problem about an accidental error to arise by putting a landmark in the skull. And, because an accidental error was easy to discover, we thought that modification could be done easily. It was suggested that a landmark in the skull on thus study were useful for improvement of stereotactic radiotherapy.

• The Journal of Korean Society for Radiation Therapy
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• v.6 no.1
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• pp.146-153
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• 1994

A modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 41 cases of patients with anteriovenous malformation(AVM), astrocytoma, meningioma. etc. The treatment planning and dosimetry of small field for stereotactic radiosurgery with 10 MV X-ray isocentically mounted linear accelerator will be presented dose with field size, the central axis persent depth dose and the combined moving beam dose distribution. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor region was perfomed with dose planning computer system(Therac 2300) and was verified with film dosimetry. The more the number of strip and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. In this study, the using machine and method was as fellowing. 1) Apparatus : NELAC-1018 10MV X-ray 2) Strip No. : Select the 5-7 strips 3) Cone and field size are from $1{\times}1cm^2$ to $3.5{\times}3.5cm^2$, and special circular cone designed for the purpose of minimized the risk to normal tissue and those size are $0.7{\~}3.6cm{\phi}$.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.265-275
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• 2015

Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.

• Radiation Oncology Journal
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• v.13 no.4
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• pp.403-409
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• 1995

Purpose : Authors tried to enhance the safety and accuracy of radiosurgery by verifying stereotacitc target point in actual treatment position prior to irradiation. Materials and Methods : Before the actual treatment, several sections of anthropomorphic head phantom were used to create a condition of unknown coordinates of the target point. A film was sandwitched between the phantom sections and punctured by sharp needle tip. The tip of the needle represented the target point. The head phantom was fixed to the stereotactic ring and CT scan was done with CT localizer attached to the ring. After the CT scanning, the stereotactic coordinates of the target point were determined. The head phantom was secured to accelerator's treatment couch and the movement of laser isocenter to the stereotactic coordinates determined by CT scanning was performed using target positioner. Accelerator's anteroposterior and lateral portal films were taken using angiographic localizers. The stereotactic coordinates determined by analysis of portal films were compared with the stereotactic coordinates previously determined by CT scanning. Following the correction of discrepancy the head phantom was irradiated using a stereotactic technique of several arcs. After the irradiation, the film which was sandwitched between the phantom sections was developed and the degree of coincidence between the center of the radiation distribution with the target point represented by the hole in the film was measured. In the treatment of the actual patients, the way of determining the stereotactic coordinates with CT localizers and angiograuhic localizers was the same as the phantom study. After the correction of the discrepancy between two sets of coordinates, we proceeded to the irradiation of the actual patient. Results : In the phantom study, the agreement between the center of the radiation distribution and the localized target point was very good. By measuring optical density profiles of the sandwitched film along axes that intersected the target point, authors could confirm the discrepancy was 0.3 mm. In the treatment of an actual patient, the discrepancy between the stereotactic coordinates with CT localizers and angiographic localizers was 0.6 mm. Conclusion : By verifying stereotactic target point in actual treatment position prior to irradiation, the accuracy and safety of streotactic radiosurgery procedure were established.

• Progress in Medical Physics
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• v.3 no.1
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• pp.53-62
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• 1992

Stereotactic implantation of intracranial lesions, and the development of stereotactic convergent irradiation, radiosurgery, techniques have to obtain the accurate coordinates of the tumor locations and that of critical organ. Computed tomography(CT) provides relatively precise imformations of tumor localization and surround the normal organs for conventional radiotherapy. This CT image use to extend for stereotactic radiosurgery procedures. Since the convergent irradiation technique in linear accelerator requires the target center coincident with gantry isocenter or radosurgery frame, the target coordinates must be described in accurately. We used the BRW stereotactic system for describing the target position in CT images This algorithm provides the coordinate conversions for orthogonal or non-orthogonal CT scan image. In this experiments, the target positions have shown the small discripancy within :to.3mm uncertanty in several known target positions in the phantom through the provided programs and it compared to that of BRW stereotactic systems.

• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.1-7
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• 2012

Objective : The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis. Methods : A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets. Results : Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild. Conclusion : In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.

• Radiation Oncology Journal
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• v.10 no.2
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• pp.137-145
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• 1992

Three-dimensional dose calculations based on CT images are fundamental to stereotactic radiosurgery for small intracranial tumor. In our stereotactic radiosurgery program, irradiations have been performed using the 6 MV photon beam of linear accelerator after stereotactic CT investigations of the target center through the beam's-eye view and the coordinates of BRW frame converted to that of radiosurgery. Also we can describe the tumor diameter and the shape in three dimensional configuration. Non-coplanar irradiation technique was developed that it consists of a combination of a moving field with a gantry angle of $140^{\circ}$, and a horizontal couch angle of $200^{\circ}C$ around the isocenter. In this radiosurgery technique, we provide the patient head setup in the base-ring holder and rotate around body axis. The total gantry moving range shows angle of 2520 degrees via two different types of gantry movement in a plane perpendicular to the axis of patient. The 3-D isodose curves overlapped to the tumor contours in screen and analytic dose profiles in calculation area were provided to calculate the thickness of $80\%$ of tumor center dose to $20\%$ of that. Furtheremore we provided the 3-D dose profiles in entire calculation plane. In this experiments, measured isodose curves in phantom irradiation have shown very similiar to that of computer generations.

• Progress in Medical Physics
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• v.9 no.2
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• pp.89-94
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• 1998

To make practical application of the MR image for stereotactic radiosurgery, the target point-achieved by acquisition of MR image in stereotactic radiosurgery planning system must agree with the actual isocenter of irradiation in real treatment. And the amount of distortion of the MR image must be known to make a correction for the agreement. A radish containing abundant water content was chosen as a homogeneous phantom for the purpose of verification of the agreement in this experiment. A dosimetric film was firmly attached to the small specially fabricated acryl plate and needle puncture was made through the film just into the acryl plate and a drop of oil was dropped into the hole of the film. The acryl plate with film was inserted into the radish and the dorp of oil represented the target point in MR image. After the image acquisition by stereotatic radiosurgery planning system, we achieved stereotactic coordinate of the target point represented by the oil drop. And we proceeded to actual irradiation to the target point according to the procedure of stereotactic radiosurgery. After the irradiation, the film in the radish was developed and processed and the degree of coincidence between the center of the radiation distribution and the target point represented by the hole in the film was measured. The discrepancy between two points was under 0.5 mm. so we could confirm good coincidence in homogeneous phantom such as radish. On the other hand, authors tried to use our home-made device for estimation of distortion of MR image.

• Radiation Oncology Journal
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• v.7 no.1
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• pp.101-112
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• 1989

The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distribution. The collimator scatter correction factors of small fields $(1\times1\~3\times3cm^2)$ were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for $1\timesl\;and\;3\times3cm^2$ fields could be derived with the same acuracy by interpolating between measured values for larger fields and calculated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under $2\%$ within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10MV x-ray beam.