This document discusses stereotactic radiation therapy and the importance of precision in delivering localized radiation treatment. It uses the analogy of golf to explain the technical factors involved in stereotactic radiation, including geometry, accuracy, reproducibility, and power. High precision is needed for both palliative and curative treatments of cancers like brain metastases. Treatment planning and quality assurance aim to ensure the radiation is delivered exactly as planned to minimize risk while maximizing tumor coverage. New technologies like 6 degree of freedom couches and pretreatment imaging help improve accuracy and efficiency of stereotactic radiation treatments.

1. STEREOTACTIC RADIATION
Improving Our Short Game
Matthew Katz, MD
October 6 2014

2. Radiation Therapy
Purpose
Cure
 Organ Preservation
Relief of Symptoms

3. Radiation and Golf
 Human factors
 Technical/Physical Factors
 Geometry
 Accuracy
 Reproducibility
 Power
Credit: Ben Hogan

4. Need for High Precision
Palliative
 Brain metastasis
 Spinal metastasis
Curative
 Lung cancer
 Liver
Retreatment
 Past radiation
Delivered in 1-5
treatments

5. Stereotactic Radiation
 3D coordinate system
localizes area for
treatment
Radiosurgery = single
dose
 SBRT = 5 treatments or
less

6. Immobilization for Accuracy
Framed
Frameless

7. Goal = Par 2
Quality Assurance
Treatment Planning
Simulation

8. Getting to the Green
Neurosurgery Radiation Oncology

9. Treatment Planning and QA
Established stroke
 Angle of approach aligning
beam to tumor, or “target”
 Power (dose)
Dry run and safety
checks complete before
patient arrives
No adjusting approach
on the fly

10. Treatment room = Green
Multidisciplinary
Team
Neurosurgery
Radiation Oncology
Radiology
Treatment Planning
Radiation Therapists
Nursing

11. Stereotactic = Long putt
• <1 - 5 mm
accuracy
• Low tolerance
for change in
conditions
• No Mulligans

12. Our Pros on the Green
Ensure correct
treatment delivery
Execution of ideal
approach
Efficiency, comfort for
patient

13. Ensuring It’s Safe To Treat

14. Varian TrueBeam

15. Staying Even Par
6 Degrees of Freedom (6DOF)

16. Imaging Before Treatment
Pretreatment
Ensure accurate treatment
 Less time to treatment =
better accuracy
Source: Dave Pelz

17. Advantages of 6DOF Couch
Less chance of patient
moving before
treatment
More accurate, more
comfortable
More efficient, less
waiting time

18. Thank you

19. Questions?
Contact me
 Email: Matthew.Katz@lowellgeneral.org
 Twitter: @subatomicdoc