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Spine Stereotactic Radiosurgery Systems : Comparison Between Brainlab Elements and Eclipse RapidArc

G Deshazer*, E Galhardo , M Bimali , S Morrill , J Penagaricano , G Narayanasamy , University of Arkansas for Medical Sciences, Little Rock, AR


(Tuesday, 7/16/2019) 10:30 AM - 11:00 AM

Room: Exhibit Hall | Forum 1

Purpose: This study is a dosimetric comparison between spine Stereotactic Radiosurgery (SRS) plans in Brain Elements TPS tailored specifically to spine to those created in Eclipse RapidArc.

Methods: Twenty spine patients treated at our institution were replanned in Brainlab Elements ver 1.5 and Varian Eclipse TPS ver 15.5. For this study, the clinical target volume (CTV) included the vertebral body (cervical, thoracic or lumbar spine), and the target was prescribed 16 Gy to 95% of the CTV. Dose objectives for the study included CTV D5% <20 Gy, as well as spinal cord D0.035cc < 14 Gy and D10% < 10 Gy. Plan evaluation metrics include inverse Paddick conformity index (IPCI), homogeneity index (HI), and gradient index (GI). Wilcoxon signed rank was used to assess dosimetric differences between the two planning systems. False discovery rate adjusted p-values < 0.05 were used to determine whether the differences were statistically significant.

Results: BBoth TPS produced clinically acceptable plans. The Elements plans resulted in significantly lower spinal cord D0.035cc dose (8.54±1.27 Gy) compared to the Eclipse plans (12.60±2.67 Gy) with a p-values < 0.001. CI were comparable for Elements and Eclipse plans with 1.24±0.072 and 1.18±0.043 respectively. GI was smaller for Elements (3.69±0.383) compared to Eclipse plans (4.22±0.479) and HI were slightly higher for Elements and Eclipse plans with 1.24±0.0362 and 1.04±0.01 respectively (p-value < 0.001). Max target doses were considerably higher in Elements plans (21.09±1.80 Gy) when compared to the Eclipse (17.00±22.8 Gy).

Conclusion: The smart target optimization and planning approach in Elements spine module produces dosimetrically superior plan with significantly lower spinal cord dose. The dose gradient index for the Elements plans was smaller; however, Elements plans provided a higher max target dose than Eclipse plans.


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