Treatment Planning for Self-Shielded Radiosurgery. Cureus Adler, J. R., Schweikard, A., Achkire, Y., Blanck, O., Bodduluri, M., Ma, L., Zhang, H. 2017; 9 (9): e1663


A five degreeof freedom, robotic,radiosurgical system dedicated to the brain is currently under development. In the proposed design, the machine is entirely self-shielded. The main advantage of a self-shielded system is the simplification of the system's installation, which can reduce the cost of radiosurgery. In this way, more patients can benefit from this minimally invasive and highly effective type of procedure. For technical reasons, space inside the shielded region is limited, which leads to constraints on the design. Here,two axes of rotation move a 3-megavolt linear accelerator around the patient's head at a source axis distance of 400 millimeters (mm), while the integrated patient table is characterized by two additional rotational, and one translational,degrees of freedom. Eight cone collimators of different diameters are available. The system can change the collimator automatically during treatment, using a collimator wheel. Since the linear accelerator can only move with two rotational axes, it is not possible to reposition the beam translationally (as it is in six degrees of freedom robotic radiosurgery). To achieve translational repositioning, it is necessary to move the patient couch. Thus, translational repositioning must be kept to a minimum during treatment. Our goal in this contribution is a preliminary investigation of dose distributions attainable with this type of design. Thus, we do not intend to design and evaluate the treatment planning system itself, but rather to establish that appropriate dose distributions can be achieved with this designunder realistic clinical circumstances. Our simulation suggests that dose gradients and conformity for complex target shapes, corresponding to state-of-the-art systems, can be achieved with this construction, althougha detailed evaluation of the system itself would be needed in the future.

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