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. 2016;89(1058):20150452.
doi: 10.1259/bjr.20150452. Epub 2015 Dec 21.

Current status of cranial stereotactic radiosurgery in the UK

Alexis Dimitriadis  1   2   3 , Karen J Kirkby  4   5 , Andrew Nisbet  1   2 , Catharine H Clark  2   3
Affiliations

Current status of cranial stereotactic radiosurgery in the UK

Alexis Dimitriadis et al. Br J Radiol. 2016.

Abstract

Objective: To investigate and benchmark the current clinical and dosimetric practices in stereotactic radiosurgery (SRS) in the UK.

Methods: A detailed questionnaire was sent to 70 radiotherapy centres in the UK. 97% (68/70) of centres replied between June and December 2014.

Results: 21 centres stated that they are practising SRS, and a further 12 centres plan to start SRS by the end of 2016. The most commonly treated indications are brain metastases and acoustic neuromas. A large range of prescription isodoses that range from 45% to 100% between different radiotherapy centres was seen. Ionization chambers and solid-water phantoms are used by the majority of centres for patient-specific quality assurance, and thermoplastic masks for patient immobilization are more commonly used than fixed stereotactic frames. The majority of centres perform orthogonal kilovoltage X-rays for localization before and during delivery. The acceptable setup accuracy reported ranges from 0.1 to 2 mm with a mean of 0.8 mm.

Conclusion: SRS has been increasing in use in the UK and will continue to increase in the next 2 years. There is no current consensus between SRS centres as a whole, or even between SRS centres with the same equipment, on the practices followed. This indicates the need for benchmarking and standardization in SRS practices within the UK.

Advances in knowledge: This article outlines the current practices in SRS and provides a benchmark for reference and comparison with future research in this technique.

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Figures

Figure 1.
Figure 1.
The number of UK centres using equipment from each manufacturer indicated for stereotactic radiosurgery (SRS).
Figure 2.
Figure 2.
The average number of patients treated per month grouped under three frequencies. The equipment used in each group is also indicated on the chart. CK, CyberKnife; GK, Gamma Knife; LB, linear accelerator based; SRS, stereotactic radiosurgery; TT, tomotherapy.
Figure 3.
Figure 3.
The number of centres currently treating the indicated pathologies and expected increase by the end of 2016.
Figure 4.
Figure 4.
The percentage of centres using the indicated imaging modalities for stereotactic radiosurgery target and organ at risk definition (multiple answers were allowed). PET, positron emission tomography.
Figure 5.
Figure 5.
The percentage of centres using each treatment-planning system (TPS) and algorithms (multiple answers were allowed). AAA, analytical anisotropic algorithms; CC, collapsed cone; CCC, collapsed cone convolution; CK, CyberKnife; CSA, convolution-superposition algorithm; MC, Monte Carlo; OMP, Oncentra Master Plan®; SRS, stereotactic radiosurgery; TMR, tissue maximum ratio.
Figure 6.
Figure 6.
The most common prescription isodoses used in each centre.
Figure 7.
Figure 7.
Phantoms (a) and detector systems (b) used for quality assurance (QA) measurements. GK, Gamma Knife; IMRT, intensity-modulated radiotherapy.
Figure 8.
Figure 8.
The reported values of setup accuracy below which treatment is considered acceptable. The different equipment groups are indicated.
See this image and copyright information in PMC

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