SU-F-T-252: An Investigation of Gamma Knife Frame Definition Error When Using a Pre-Planning Workflow.

PURPOSE: To determine causal factors related to high frame definition error when treating GK patients using a pre-planning workflow.

METHODS: 160 cases were retrospectively reviewed. All patients received treatment using a pre-planning workflow whereby stereotactic coordinates are determined from a CT scan acquired after framing using a fiducial box. The planning software automatically detects the fiducials and compares their location to expected values based on the rigid design of the fiducial system. Any difference is reported as mean and maximum frame definition error. The manufacturer recommends these values be less than 1.0 mm and 1.5 mm. In this study, frame definition error was analyzed in comparison with a variety of factors including which neurosurgeon/oncologist/physicist was involved with the procedure, number of post used during framing (3 or 4), type of lesion, and which CT scanner was utilized for acquisition. An analysis of variance (ANOVA) approach was used to statistically evaluate the data and determine causal factors related to instances of high frame definition error.

RESULTS: Two factors were identified as significant: number of post (p=0.0003) and CT scanner (p=0.0001). Further analysis showed that one of the four scanners was significantly different than the others. This diagnostic scanner was identified as an older model with localization lasers not tightly calibrated. The average value for maximum frame definition error using this scanner was 1.48 mm (4 posts) and 1.75 mm (3 posts). For the other scanners this value was 1.13 mm (4 posts) and 1.40 mm (3 posts).

CONCLUSION: In utilizing a pre-planning workflow the choice of CT scanner matters. Any scanner utilized for GK should undergo routine QA at a level appropriate for radiation oncology. In terms of 3 vs 4 post, it is hypothesized that three posts provide less stability during CT acquisition. This will be tested in future work.