Verification of gamma knife based fractionated radiosurgery with newly developed head-thorax phantom

• Performance of the Extend™ system of Gamma knife in multi-session radiosurgery.
• Extend™ system based treatment verification using a patient simulating phantom.
• Designed head-thorax phantom suitable for other dosimetric audit purposes.

ObjectivePurpose of the study is to verify the Gamma Knife Extend™ system (ES) based fractionated stereotactic radiosurgery with newly developed head-thorax phantom.MethodsPhantoms are extensively used to measure radiation dose and verify treatment plan in radiotherapy. A human upper body shaped phantom with thorax was designed to simulate fractionated stereotactic radiosurgery using Extend™ system of Gamma Knife. The central component of the phantom aids in performing radiological precision test, dosimetric evaluation and treatment verification. A hollow right circular cylindrical space of diameter 7.0 cm was created at the centre of this component to place various dosimetric devices using suitable adaptors. The phantom is made of poly methyl methacrylate (PMMA), a transparent thermoplastic material. Two sets of disk assemblies were designed to place dosimetric films in (1) horizontal (xy) and (2) vertical (xz) planes. Specific cylindrical adaptors were designed to place thimble ionization chamber inside phantom for point dose recording along xz axis. EBT3 Gafchromic films were used to analyze and map radiation field. The focal precision test was performed using 4 mm collimator shot in phantom to check radiological accuracy of treatment. The phantom head position within the Extend™ frame was estimated using encoded aperture measurement of repositioning check tool (RCT). For treatment verification, the phantom with inserts for film and ion chamber was scanned in reference treatment position using X-ray computed tomography (CT) machine and acquired stereotactic images were transferred into Leksell Gammaplan (LGP). A patient treatment plan with hypo-fractionated regimen was delivered and identical fractions were compared using EBT3 films and in-house MATLAB codes.ResultsRCT measurement showed an overall positional accuracy of 0.265 mm (range 0.223 mm–0.343 mm). Gamma index analysis across fractions exhibited close agreement between LGP and film measured dose with ≥90% (max 93%) pixel pass rate at 1 mm of spatial and 1% of dosimetric tolerances. The focal precision test showed the variation of 0.465 mm between radiological and planned iso-centre.ConclusionsThe study demonstrated the suitability of newly developed head-thorax phantom for dosimetric verification of fractionated stereotactic radiosurgery using Extend™ system of Gamma Knife.