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Clinical Implementation of BrainLAB’s Element Planning System for Intracranial SRS Treatments of Arteriovenous Malformations

N Shrestha, G Narayanasamy, P Sabouri, F Kalantari, F Xia, Z Su, R Panthi*, University of Arkansas for Medical Sci, Little Rock, AR

Presentations

PO-GePV-T-406 (Sunday, 7/10/2022)   [Eastern Time (GMT-4)]

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Purpose: The objective of this work is clinical implementation of Brainlab’s Elements cranial vascular module for Linac-based arteriovenous malformation (AVM) treatment.

Methods: MR Angiogram, CT, and DSA images of the patients were obtained and imported into the TPS. The MRA was fused with the DSA for target delineation. The treatment plan was created using the planning CT in the Brainlab with prescription doses ranged from 18 Gy – 24 Gy depending on the volume of the target. The target objectives of the clinical protocol chosen included 99% of the PTV (D99%) to be covered with the 100% isodose line. Non-coplanar plans using either three or four arcs were generated in Elements. The quality of each plan was measured conformity index (CI) and gradient index (GI). Timmerman single fraction (SRS) dose constraints were used for organs at risk (OAR’s). The physicians verified and approved all the treatment plans. All the plans underwent patient specific QA before delivery using the ArcCHECK system.

Results: A clinical workflow was created and so far, three AVM patients were treated successfully. Clinical aspects of imaging and treatment planning consideration are presented in retrospective setting. In all clinical cases, the treatment plans had a CI of 1.04 - 1.32 and GI of 2.80 - 3.06. IMRT QA was performed on all the treatment plans according gamma criteria of 3% dose difference and 2 mm distance to agreement criteria (DTA) with >95% pass rate.

Conclusion: A roadmap for implementing the AVM program using the Brainlab TPS was presented in this work with the purpose of aiding other centers. This work was based on our recent experience in implementing the AVM program using Brainlab Elements cranial vascular planning module and treating three patients to date in our clinic.

Keywords

Artero-venous Malformations, Stereotactic Radiosurgery

Taxonomy

TH- External Beam- Photons: intracranial stereotactic/SBRT

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