Wurm Reinhard E, Erbel Stephan, Schwenkert Isabel, Gum Franz, Agaoglu Daniel, Schild Reinhard, Schlenger Lorenz, Scheffler Dirk, Brock Mario, Budach Volker
Department of Radiation Oncology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Neurosurgery. 2008 May;62(5 Suppl):A11-7; discussion A17-8. doi: 10.1227/01.neu.0000325932.34154.82.
To evaluate our initial experience with Novalis (BrainLAB, Heimstetten, Germany) frameless image-guided noninvasive radiosurgery.
The system combines the dedicated Novalis linear accelerator with ExacTrac X-Ray 6D, an infrared camera and a kilovolt stereoscopic x-ray imaging system, a noninvasive mask system, and ExacTrac robotics for patient positioning in six degrees of freedom. Reference cranial skeletal structures are radiographically imaged and automatically fused to digital reconstructed radiographs calculated from the treatment planning computed tomographic scan to find the target position and accomplish automatic real-time tracking before and during radiosurgery. We present the acceptance testing and initial experience in 15 patients with 19 intracranial lesions treated between December 2005 and June 2006 at the Charité by frameless image-guided radiosurgery with doses between 12 and 20 Gy prescribed to the target-encompassing isodose.
Phantom tests showed an overall system accuracy of 1.04 +/- 0.47 mm, with an average in-plane deviation of 0.02 +/- 0.96 mm for the x-axis and 0.02 +/- 0.70 mm for the y-axis. After infrared-guided patient setup of all patients, the overall average translational deviation determined by stereoscopic x-ray verification was 1.5 +/- 1.3 mm, and the overall average rotational deviation was 1.0 +/- 0.8 degree. The data used for radiosurgery, after stereoscopic x-ray verification and correction, demonstrated an overall average setup error of 0.31 +/- 0.26 mm for translation and 0.26 +/- 0.23 degree for rotation.
This initial evaluation demonstrates the system accuracy and feasibility of Novalis image-guided noninvasive radiosurgery for intracranial benign and malignant lesions.
评估我们使用诺瓦利斯（BrainLAB，德国海姆斯泰滕）无框架图像引导非侵入性放射外科手术的初步经验。
该系统将专用的诺瓦利斯直线加速器与ExacTrac X射线6D、红外摄像机和千伏立体X射线成像系统、非侵入性面罩系统以及用于患者六自由度定位的ExacTrac机器人相结合。对颅骨参考结构进行放射成像，并自动与根据治疗计划计算机断层扫描计算得出的数字重建射线照片融合，以找到目标位置，并在放射外科手术前和手术过程中实现自动实时跟踪。我们展示了2005年12月至2006年6月在夏里特医院对15例患有19个颅内病变的患者进行无框架图像引导放射外科手术的验收测试和初步经验，规定给予靶区等剂量线12至20 Gy的剂量。
体模测试显示系统总体精度为1.04±0.47毫米，x轴平面内平均偏差为0.02±0.96毫米，y轴平面内平均偏差为0.02±0.70毫米。在对所有患者进行红外引导的患者设置后，通过立体X射线验证确定的总体平均平移偏差为1.5±1.3毫米，总体平均旋转偏差为1.0±0.8度。经过立体X射线验证和校正后用于放射外科手术的数据显示，平移的总体平均设置误差为0.31±0.26毫米，旋转的总体平均设置误差为0.26±0.23度。
这一初步评估证明了诺瓦利斯图像引导非侵入性放射外科手术治疗颅内良性和恶性病变的系统准确性和可行性。
