Frameless angiogram-based stereotactic radiosurgery for treatment of arteriovenous malformations.
Purpose: Stereotactic radiosurgery (SRS) is an effective alternative to microsurgical resection or embolization for definitive treatment of arteriovenous malformations (AVMs). Digital subtraction angiography (DSA) is the gold standard for pretreatment diagnosis and characterization of vascular anato...
| Publicado en: | International Journal of Radiation Oncology, Biology, Physics Vol. 84; no. 1; pp. 274 - 283 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Pergamon Press - An Imprint of Elsevier Science
Sep2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104494492&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104494492 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03603016 1ZQ jtl: International Journal of Radiation Oncology, Biology, Physics issn: 03603016 maglogo: N pubinfo: dt: Sep2012 vid: 84 iid: 1 pid: 2410 pub: Pergamon Press - An Imprint of Elsevier Science artinfo: ui: 104494492 NLM22284685 2011653156 10.1016/j.ijrobp.2011.10.044 NLM22284685 104494492 ppf: 274 ppct: 9 formats: tig: atl: Frameless angiogram-based stereotactic radiosurgery for treatment of arteriovenous malformations. aug: au: Lu XQ Mahadevan A Mathiowitz G Lin PJ Thomas A Kasper EM Floyd SR Holupka E La Rosa S Wang F Stevenson MA Lu, Xing-Qi Mahadevan, Anand Mathiowitz, George Lin, Pei-Jan P Thomas, Ajith Kasper, Ekkehard M Floyd, Scott R Holupka, Edward La Rosa, Salvatore affil: Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA sug: subj: Arteriovenous Malformations Surgery Radiosurgery Equipment and Supplies Radiosurgery Methods Algorithms Angiography, Digital Subtraction Methods Arteriovenous Malformations Radiography Cerebral Angiography Methods Human Image Processing, Computer Assisted Methods Immobilization Equipment and Supplies Phantoms, Imaging Radiosurgery Trends Reproducibility of Results Tomography, X-Ray Computed Methods ab: Purpose: Stereotactic radiosurgery (SRS) is an effective alternative to microsurgical resection or embolization for definitive treatment of arteriovenous malformations (AVMs). Digital subtraction angiography (DSA) is the gold standard for pretreatment diagnosis and characterization of vascular anatomy, but requires rigid frame (skull) immobilization when used in combination with SRS. With the advent of advanced proton and image-guided photon delivery systems, SRS treatment is increasingly migrating to frameless platforms, which are incompatible with frame-based DSA. Without DSA as the primary image, target definition may be less than optimal, in some cases precluding the ability to treat with a frameless system. This article reports a novel solution. Methods and Materials: Fiducial markers are implanted into the patient's skull before angiography. Angiography is performed according to the standard clinical protocol, but, in contrast to the previous practice, without the rigid frame. Separate images of a specially designed localizer box are subsequently obtained. A target volume projected on DSA can be transferred to the localizer system in three dimensions, and in turn be transferred to multiple CT slices using the implanted fiducials. Combined with other imaging modalities, this "virtual frame" approach yields a highly precise treatment plan that can be delivered by frameless SRS technologies. Results: Phantom measurements for point and volume targets have been performed. The overall uncertainty of placing a point target to CT is 0.4 mm. For volume targets, deviation of the transformed contour from the target CT image is within 0.6 mm. The algorithm and software are robust. The method has been applied clinically, with reliable results. Conclusions: A novel and reproducible method for frameless SRS of AVMs has been developed that enables the use of DSA without the requirement for rigid immobilization. Multiple pairs of DSA can be used for better conformality. Further improvement, including using nonimplanted fiducials, is potentially feasible. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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