SBRT treatment planning and delivery were conducted as previously described [47 (link),48 (link)]. Briefly, four to six stranded gold fiducials (1013- 2-2, Best Medical International, Inc., Springfield, VA, USA) were placed into the prostate with two to three needle applicators via a trans-rectal or trans-perineal approach. Fused computed tomography (CT) and magnetic resonance magnetic resonance (MR) images were used for treatment planning. The clinical target volume (CTV) included the prostate and the proximal seminal vesicles. The planning target volume (PTV) equaled the CTV expanded 3 mm posteriorly and 5 mm in all other dimensions. The prescription dose was 35-36.25 Gy to the PTV delivered in five fractions of 7-7.25 Gy over one to two weeks. The prescription isodose line was limited to ≥ 75%, which limited the maximum prostatic urethra dose to 133% of the prescription dose. The membranous urethra was contoured and evaluated with dose-volume histogram analysis during treatment planning using Multiplan (Accuray Inc., Sunnyvale, CA). The dose-volume histogram (DVH) goal was for < 50% membranous urethra to receive 37 Gy. To minimize the risk of local recurrence, the dose to the prostatic urethra was not constrained [49 (link)]. Prostate position was verified during treatment using paired, orthogonal x-ray images [50 (link)].
Multiplan
Manufactured by Accuray
Sourced in United States
Multiplan is a dedicated radiation therapy planning system developed by Accuray. It provides advanced treatment planning capabilities for clinicians to design and optimize radiation therapy treatments. The system offers tools for contouring, dose computation, and plan optimization to support the delivery of precise and personalized radiation treatments.
Automatically generated - may contain errors
Lab products found in correlation
Cyberknife, by Accuray (3 mentions)
Iplan, by Brainlab (2 mentions)
Precision, by Accuray (2 mentions)
M6 2017 2021, by Accuray (2 mentions)
Cyberknife g4, by Accuray (2 mentions)
Light speed ultra 16 slice, by GE Healthcare (1 mentions)
Novalis, by Brainlab (1 mentions)
Somatom definition as, by Siemens (1 mentions)
Brilliance big bore, by Philips (1 mentions)
Ge lightspeed 64 slice ct, by GE Healthcare (1 mentions)
Synchrony respiratory tracking system, by Accuray (1 mentions)
24 protocols using multiplan
1
Stereotactic Body Radiation Therapy for Prostate Cancer
2
Stereotactic Body Radiation Therapy for Prostate
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Stereotactic body radiation therapy treatment planning and delivery were conducted as previously described (25 (link), 26 (link)). Briefly, gold fiducials were placed into the prostate. Fused CT and MR images were used for treatment planning. The clinical target volume (CTV) included the prostate and the proximal seminal vesicles. The planning target volume (PTV) equaled the CTV expanded 3 mm posteriorly and 5 mm in all other dimensions. The prescription dose was 35–36.25 Gy to the PTV delivered in five fractions of 7–7.25 Gy over 1–2 weeks (27 (link)). The prescription isodose line was limited to ≥75%. The bladder and membranous urethra were contoured and evaluated with dose–volume histogram analysis during treatment planning using Multiplan (Accuray Inc., Sunnyvale, CA, USA) inverse treatment planning. Critical structure dose constraints were as previously described (26 (link)). To minimize the risk of local recurrence, no attempt was made to limit the dose to the prostatic urethra. Target position was verified during treatment using paired, orthogonal X-ray images (25 (link), 28 (link)).
3
Stereotactic Radiosurgery for Renal Nerve Ablation
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Computed tomography (CT) scans were obtained and treatment planning was performed using CyberHeart’s CardioPlan™ software in combination with Accuray’s Multiplan™ for highly localized dose delivery for stereotactic radiosurgical ablation of the renal nerves using CyberKnife (Figures 1 -2 ).
The miniswine underwent placement of a fiducial percutaneously under general anesthesia at the renal vein, through the inferior vena cava (IVC). In order to achieve renal nerve ablation, a prescription dose (40-50 Gy) of radiation was delivered under image guidance bilaterally to the aortic-renal ganglion or circumferential to the renal arteries using stereotactic radiosurgery (Figures3 -4 ). Synchrony motion management was used for intraprocedural tracking and the state-of-the-art CyberHeart RS was used to deliver radiation for the ablation.
The miniswine underwent placement of a fiducial percutaneously under general anesthesia at the renal vein, through the inferior vena cava (IVC). In order to achieve renal nerve ablation, a prescription dose (40-50 Gy) of radiation was delivered under image guidance bilaterally to the aortic-renal ganglion or circumferential to the renal arteries using stereotactic radiosurgery (Figures
4
CyberKnife SRS for Intracranial AVMs
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We performed a retrospective review of patients with intracranial AVMs treated with CyberKnife SRS from December 1st, 2005 to February 1st, 2011 at Georgetown University Hospital and the University of North Carolina at Chapel Hill. Patients who had undergone single fraction SRS for intracranial AVM with or without endovascular embolization and had received at least one follow-up imaging study were included. All patients were treated by an interdisciplinary team of radiation oncologists and neurosurgeons. High resolution CTA images with or without MRA were obtained from all patients for pre-treatment planning. A planning target volume (PTV) and critical structures were manually delineated by the treating neurosurgeon with the PTV encompassing the contour of the AVM with a 1 mm margin (Figure 1 ). All treatment planning was performed on pre-treatment CTA imaging, and when available, using fused MRA/CTA imaging. The treating isodose and prescription dose were determined by the treating radiation oncologist in consultation with the treating neurosurgeon, and took into account the AVM nidus, overall volume, proximity to critical structures, and previous treatment history. Treatment plans were generated using an inverse planning method by the CyberKnife treatment software (Multiplan, Accuray).
5
Stereotactic Radiosurgery for Brain Tumors
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HSRS was performed using the Radiosurgery System (Accuray, Sunnyvale, CA, USA). Patients were immobilized with a custom thermoplastic mask and underwent both computed tomography (CT, GE Light speed Ultra 16 Slice, USA) examinations with a slice thickness of 1.25 mm and MRI with a slice thickness of 2 mm acquired from both T1 postcontrast and T2 flair images. CT and MRI scans were then fused using the planning system for contouring.
Radiation oncologists, neurosurgeons, and radiation physicists participated in tumour delineation, planning, and dose selection. Gross tumour volume (GTV) was defined as the gadolinium-enhanced tumour on the T1-weighted series. The clinical tumour volume (CTV) was considered equal to the GTV. The planning target volume (PTV) was a uniform 2 mm expansion of the CTV, and FLAIR abnormalities were not included in the treatment volume. Multiplan (Accuray, Sunnyvale, CA, USA) software was used for inverse planning. The prescribed dose to PTV was determined according to the target volume, site, previous irradiation volume and total dose, and the interval between treatments.
The use of systemic therapy after HSRS was decided by the treating physicians. Thus, the regimens were individualized, and most commonly, bevacizumab, temozolomide or clinical trials were recommended.
Radiation oncologists, neurosurgeons, and radiation physicists participated in tumour delineation, planning, and dose selection. Gross tumour volume (GTV) was defined as the gadolinium-enhanced tumour on the T1-weighted series. The clinical tumour volume (CTV) was considered equal to the GTV. The planning target volume (PTV) was a uniform 2 mm expansion of the CTV, and FLAIR abnormalities were not included in the treatment volume. Multiplan (Accuray, Sunnyvale, CA, USA) software was used for inverse planning. The prescribed dose to PTV was determined according to the target volume, site, previous irradiation volume and total dose, and the interval between treatments.
The use of systemic therapy after HSRS was decided by the treating physicians. Thus, the regimens were individualized, and most commonly, bevacizumab, temozolomide or clinical trials were recommended.
6
Stereotactic Radiosurgery for Tumor Treatment
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Tumors were treated using LINAC (Novalis, BrainLAB, Munich, Germany) and robotic (Cyberknife, Accuray; Sunnyvale, USA) based SRS. Patients were immobilized in supine position on the treatment table, using a commercial stereotactic mask fixation system. The iPlan (Brain LAB, Munich, Germany) and MultiPlan (Accuray, Sunnyvale, USA) treatment planning system were used to generate radiosurgery plans. Target volumes were delineated slice by slice in axial view, using postcontrast thin-slice (1 mm) gadolinium-enhanced T1- and T2-weighted axial magnet resonance imaging (MRI) sequences fused with thin-slice (0.75 mm) planning computed tomography scans. Target definition and dose prescriptions were based on international consensus guidelines (13 (link)). A single fraction of 12 Gy with a mean prescription isodose line of 94% (range, 85–99) and 78% (range, 52–90) was prescribed for the Novalis and Cyberknife systems, respectively.
7
Hypofractionated Prostate Cancer SBRT
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Simulation, contouring, and treatment planning were performed using our institutional protocol (11 (link)). Patients underwent a treatment planning CT and pelvic MRI at least one week after placement of 4 to 6 gold fiducial markers in the prostate. The clinical target volume (CTV) included the prostate and proximal seminal vesicles. The planning target volume (PTV) was expanded 3 mm posteriorly and 5 mm in all other directions from the CTV. The bladder and rectum were contoured structures that were evaluated on dose-volume histogram analysis during treatment planning using Multiplan (Accuray Inc, Sunnyvale, CA) inverse treatment planning. Five fractions of 7-7.25 Gy were delivered to the PTV over one to two weeks.
The bladder volume receiving 37 Gy was limited to ≤ 5 cc and the rectal volume receiving 36 Gy was limited to ≤ 1 cc. Additional bladder dose constraints included volume less than 40% receiving 50% of prescribed dose and volume less than 10% receiving less than 100% of the prescribed dose. For the rectum, secondary dose constraints included volume less than 40% receiving 50% of prescribed dose, volume less than 25% receiving 75% of prescribed dose, volume less than 20% receiving 80% of the dose, volume less than 10% receiving 90% of the dose, and volume less than 5% receiving 100% of prescription dose.
The bladder volume receiving 37 Gy was limited to ≤ 5 cc and the rectal volume receiving 36 Gy was limited to ≤ 1 cc. Additional bladder dose constraints included volume less than 40% receiving 50% of prescribed dose and volume less than 10% receiving less than 100% of the prescribed dose. For the rectum, secondary dose constraints included volume less than 40% receiving 50% of prescribed dose, volume less than 25% receiving 75% of prescribed dose, volume less than 20% receiving 80% of the dose, volume less than 10% receiving 90% of the dose, and volume less than 5% receiving 100% of prescription dose.
8
Prostate SBRT with Fiducial Markers
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Four or more gold fiducial markers were implanted transperineally into the prostate. After 7 days, patients underwent magnetic resonance imaging and thin-cut computed tomography scan. Fused computed tomography and magnetic resonance images were used for treatment planning. The prostate, seminal vesicles, rectum, bladder, penile bulb, and bowel were contoured. The clinical target volume (CTV) included the prostate and proximal seminal vesicles. The planning target volume (PTV) equaled the CTV expanded by 3 mm posteriorly and 5 mm in all other dimensions. A prescription dose of 36.25 Gy, delivered in five fractions, was prescribed to the PTV. The prescription dose covered at least 95% of the PTV, normalized to the 75–85% isodose line [median homogeneity index of 1.27 (range, 1.24–1.41)]. The rectal dose–volume goals were as follows: <50% of the rectal volume receiving 50% of the prescribed dose, <20% receiving 80% of the dose, <10% receiving 90% dose, and <5% receiving 100% of the dose. Treatments were given over 5 consecutive days. All SBRT treatment plans were generated on MultiPlan (version 2.2.0; Accuray Inc.).
9
Dynamic Phantom CT-based Radiation Therapy
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Image data of a dynamic motion phantom (CIRS Dynamic Thorax Phantom model 008A; Computerized Imaging Reference Systems, Inc. Norfolk, VA, USA) were acquired by computed tomography (CT) (SOMATOM Definition AS; Siemens, Munich, Germany). CT images were acquired at a tube voltage, current, and section thickness of 120 kV, 200 mA, and 1 mm, respectively. This phantom can reproduce the motion of the target and the body surface (Figure 1 ). The data were exported into a treatment planning system (MultiPlan®, Accuray), and a test plan was created to irradiate a simulated PTV in the phantom from 10 directions (Figure 2 ).
10
Fiducial-Guided SBRT for Prostate Cancer
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As a pre-treatment, all patients underwent ultrasound-guided placement of three gold fiducial markers for daily imaging guidance. Only two patients were injected with periprostatic hydrogel spacers (SpaceOAR; Augmenix, Inc., Bedford, MA), but they were not included in the final analysis. Images of 1.25 mm thickness were used for planning CT. Clinical target volume (CTV) margins of 1 mm posteriorly and 3 mm in other dimensions were added to the GTV. However, the area that overlapped with the rectal or bladder mucosa was removed from the CTV. PTV margins of 2 mm in all directions were added to the CTV. Multiplan (Accuray Inc., Sunnyvale, CA, USA) was used as the planning system. The dose constraints have been described previously [14 (link)]. In summary, the prescribed dose was adjusted to 75–85% of the peak dose, and the PTV minimum dose was set to > 70% of the peak dose. The goal for the urethra minimum dose was > 95% and the maximum dose was < 102%. A urethral maximum dose of < 110% was permitted. During irradiation, the prostate position was checked and corrected at intervals of 20–60 s using fiducial marker tracking, and the treatment time was adjusted to ≤ 35 min.
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