Gammaplan

Manufactured by Elekta

Sourced in Sweden

GammaPlan is a treatment planning software developed by Elekta. It is designed to assist medical professionals in the planning and delivery of gamma radiation therapy procedures. The software provides tools for visualizing and analyzing patient anatomy, as well as calculating and optimizing radiation dose distributions. GammaPlan is a key component of Elekta's comprehensive gamma radiation therapy solutions.

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Lab products found in correlation

17 protocols using gammaplan

Integrating DTI Tractography into Stereotactic Planning

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With GammaPlan open and with the standard treatment T1-and T2-weighted images already imported and verified, the CD containing the tract data was uploaded to the treatment workstation. The tractography data set was imported into GammaPlan (version 10.1; Elekta Instruments AB) using the native DICOM CD import function. The DICOM data sets were imported into the treatment planning session and coregistered with the main T1weighted stereotactic treatment volume.
The imported tract images appeared in gray scale in the DICOM format and were color coded with GammaPlan to facilitate clear identification. The GammaPlan software allowed critical tracts to be segmented as a structural volume and integrated into GammaPlan as an "organ at risk" during shot planning (Fig. 2). Furthermore, tract volumes could be subjected to standard dosimetric analysis using the measure function. A summary of the steps required to fully integrate DTI data into GammaPlan is given in Fig. 3.

Gavin C.G, & Ian Sabin H. (2016). Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery. Journal of neurosurgery, 125(Suppl 1).

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Stereotactic Radiosurgery Planning with Leksell Frame

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A Leksell Stereotactic Frame (Elekta Instruments AB, Stockholm, Sweden) model G was placed under local anesthesia. The plan and target dose selection were uploaded into the GammaPlan (Elekta Instruments AB) stereotactic treatment planning system prior contrast-enhanced MRI and exported into the Gamma Knife Perfexion console (Elekta Instruments AB) as previously described [10 (link)]. Online Resource 2 depicts a treatment plan for a patient with multiple targets.

Dono A., Amsbaugh M., Martir M., Smilie R.H., Riascos R.F., Zhu J.J., Hsu S., Kim D.H., Tandon N., Ballester L.Y., Blanco A.I, & Esquenazi Y. (2021). Genomic alterations predictive of response to radiosurgery in recurrent IDH-WT glioblastoma. Journal of neuro-oncology, 152(1), 153-162.

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Stereotactic MRI-Guided Gamma Knife Radiosurgery

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As an inclusion criterion for this study, stereotactic MRI had been used for localization and target definition. Our standard protocol is to perform T2-weighted and proton density imaging using 1.5-mm slices, TE 80 msec, TR 3000 msec, 256 matrix, number of signal averages 1. Gam-maPlan (Elekta AB) was used for dose planning. Treatments were delivered with the Gamma Knife model RBS 5000 (Nucletec) until 2001, Gamma Knife Model C (Elekta AB) until 2011, and Gamma Knife Perfexion (Elekta AB) thereafter in the RHH and all with Perfexion in the TRC. The number of treated patients gradually increased from 3 in 1995 to an annual average of 20 more recently (Fig. 2A). The median time between presentation and treatment was 1 year (0.1-34 years). Cavernous malformations were defined within the hemosiderin ring and were treated after complete resolution of the last hematoma, and a median dose of 12-13 Gy (depending on location) was given to the 50% prescription isodose level, excluding coexisting developmental venous anomalies. 27 Our standard treatment protocol has not changed essentially since 1995, apart from a significant reduction in the prescription dose from 15 to 12 Gy after 2000 (p < 0.001; Table 2).

Nagy G., Burkitt W., Stokes S.S., Bhattacharyya D., Yianni J., Rowe J.G., Kemeny A.A, & Radatz M.W.R. (2019). Contemporary radiosurgery of cerebral cavernous malformations: Part 1. Treatment outcome for critically located hemorrhagic lesions. Journal of neurosurgery, 130(6).

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Comparison of SRS Techniques for Brain Metastases

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We used the image data of six patients with three to four brain metastases who received SRS treatment at our institution. The study was approved by our Institutional Review Board (IRB). The cases were planned with GammaPlan^®, the Gamma Knife Perfexion TPS (Elekta AB, Stockholm Sweden), and Eclipse™ TPS using RapidArc^®, a particular implementation of VMAT (Varian Medical Systems, Palo Alto, CA, USA) on Varian delivery systems, the more recent versions of which, allow for the delivery of multiple non-coplanar arcs. Each of the GK plans was designed by an experienced GK physicist and approved by an attending neurosurgeon and radiation oncologist. All RapidArc plans were generated by an experienced physicist dedicated to SRS.

Liu H., Andrews D.W., Evans J.J., Werner-Wasik M., Yu Y., Dicker A.P, & Shi W. (2016). Plan Quality and Treatment Efficiency for Radiosurgery to Multiple Brain Metastases: Non-Coplanar RapidArc vs. Gamma Knife. Frontiers in Oncology, 6, 26.

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MRI Assessment of Tumor Growth

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MRI scans of all animal brains were obtained after tumour implantation to assess the tumour growth using a Bruker Pharmascan 7T small animal MRI (Bruker Biospin MRI GmnH, Ettingen, Germany). Axial T1- and T2-weighted images were obtained as previously described [10 (link)]. The tumour volumes at treatment and follow-up MRI were calculated in Gamma Plan (Elekta Instrument AB, Stockholm, Sweden).

Netland I.A., Førde H.E., Sleire L., Leiss L., Rahman M.A., Skeie B.S., Miletic H., Enger P.Ø, & Goplen D. (2016). Treatment with the PI3K inhibitor buparlisib (NVP-BKM120) suppresses the growth of established patient-derived GBM xenografts and prolongs survival in nude rats. Journal of Neuro-Oncology, 129, 57-66.

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Volumetric Measurement of Vestibular Schwannomas

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Tumor volume measurements were manually or semi-automatically performed slice-by-slice with ITK-SNAP software (version 3.8.0) or GammaPlan (version 11.3, Elekta AB, Stockholm, Sweden) on postcontrast T1-weighted sequences or thin-slice heavily T2-weighted sequences, depending on the availability of MR images of sufficient quality (further specified in Supplementary Table S1).^{15 (link)} The minimum slice thickness required was 5 mm in postcontrast T1-weighted sequences or 2 mm in thin-slice heavily T2-weighted sequences. Either ITK-SNAP or GammaPlan was consistently used for all measurements within a patient to avoid any inter-software variability. Annotation was performed by the authors (S.S., S.C., P.L., and J.V.) with 3–21 years of experience in volumetric segmentation of VSs. Based on the results of an inter-observer variability study with the same annotators (S.C., et al., unpublished manuscript, 2023), the interrater correlation coefficient was 0.995, demonstrating excellent agreement between annotators.
The significant volumetric threshold for growth and shrinkage was defined as a longitudinal relative change in volume of ≥ 10%. Follow-up duration was calculated from the date of VS diagnosis to the date of the last follow-up.

Schouten S.M., Cornelissen S., Langenhuizen P.P., Jansen T.T., Mulder J.J., Derks J., Verheul J.B, & Kunst H.P. (2023). Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas: A longitudinal volumetric study. Neuro-Oncology Advances, 6(1), vdad144.

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Leksell Gamma Knife Radiosurgery Protocol

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All treatments were performed using the Leksell Gamma knife (Elekta AB) model Perfexion. On the day of treatment, the Leksell frame G was applied to the patient’s head under local anesthesia. A high resolution and thin-slice volumetric gadolinium-enhanced MRI scan was obtained before treatment. Using the GammaPlan (Elekta AB) software, the neurosurgeon, and medical physicists designed the dose plan. The radiosurgery isodose and marginal dose prescribed were usually determined based on the Radiation Therapy Oncology Group (RTOG) 90-05 dosing guidelines with modification [9] . The treatments were usually designed to deliver 50% of the maximal dose to the margins of the target in a single fraction. The final prescription dose expressed as a marginal dose, number of shots which is number of isocenters used in the planning of GKS and other associated treatment parameters were summarized in Table 1. All patients were followed-up, with the first MRI approximately 6 weeks after GKS, then at 3-month intervals.

Xu Q., Wu P., Feng Y., Ye K., Tong Y, & Zhou Y. (2014). Gamma Knife Surgery for Brain Metastasis from Hepatocellular Carcinoma. PLoS ONE, 9(2), e88317.

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Stereotactic Radiosurgery for Head and Neck Tumors

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GKRS was performed on a Leksell Gamma Knife Perfexion or ICON unit. In brief, a Leksell headframe was applied followed by contrast-enhanced stereotactic magnetic resonance imaging (MRI) of the brain using a 3.0 Tesla unit. GammaPlan^® (Elekta AB, Stockholm, Sweden) was used to develop a treatment plan with a dose selected based on the size of the target as well as prior IMRT dose. Patients were treated with 4 point (two anterior and two posterior) stereotactic frame immobilization, and no special accommodations were made for regions in the prior low-dose IMRT volumes.
The highest priority for GK planning was to keep the optics (chiasm and optic nerves) to below the tolerance doses. Inverse-planning using the GammaPlan treatment planning system was generally used to achieve plan conformality. Dose was selected in order to keep the optics under tolerance and to achieve an equivalent dose of at least 70 Gy (2 Gy/fraction). Physician discretion was used as some histologies such as adenoid cystic carcinoma may have been treated with more aggressive dosing. As the GammaPlan system inverse planning selects shot location automatically, there was no effort on the planners to minimize angles used heavily by EBRT. The plan was reviewed by central nervous system specialists and the treating head and neck physician.

Farris J.C., Steber C.R., Black P.J., Chan M.D., Ververs J.D., Cramer C.K., Browne J.D., Waltonen J.D., Sullivan C.A., Patwa H.S., Laxton A.W., Tatter S.B., Frizzell B.A., Porosnicu M., Lycan T.W., Greven K.M, & Hughes R.T. (2022). Intensity‐modulated radiotherapy with planned Gamma Knife radiosurgery boost for head and neck cancer with extensive disease in proximity to critical structures. Head & Neck, 44(11), 2571-2578.

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Gamma Knife Radiosurgery for Retreatment

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GKRS was performed on a Leksell Gamma Knife Perfexion or ICON unit. In brief, a Leksell headframe was applied followed by contrast‐enhanced stereotactic magnetic resonance imaging (MRI) of the brain using a 3.0 Tesla unit. GammaPlan® (Elekta AB, Stockholm, Sweden) was used to develop a treatment plan with a dose selected based on the size of the target as well as prior IMRT dose. Patients were treated with 4 point (two anterior and two posterior) stereotactic frame immobilization, and no special accommodations were made for regions in the prior low‐dose IMRT volumes.
The highest priority for GK planning was to keep the optics (chiasm and optic nerves) to below the tolerance doses. Inverse‐planning using the GammaPlan treatment planning system was generally used to achieve plan conformality. Dose was selected in order to keep the optics under tolerance and to achieve an equivalent dose of at least 70 Gy (2 Gy/fraction). Physician discretion was used as some histologies such as adenoid cystic carcinoma may have been treated with more aggressive dosing. As the GammaPlan system inverse planning selects shot location automatically, there was no effort on the planners to minimize angles used heavily by EBRT. The plan was reviewed by central nervous system specialists and the treating head and neck physician.

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Gamma Knife Radiosurgery for Dural AVFs

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After local anesthesia had been applied, a Leksell stereotactic frame (Elekta Instrument AB, Stockholm, Sweden) was rigidly fixed on the patient's head, following which digital subtraction angiography images and contrast-enhanced brain MRI (1–2-mm thickness) were acquired. These images were sent to a GammaPlan computer (Elekta Instruments AB, Stockholm, Sweden) and the region of interest was planned [Figure 1]. A 201 cobalt-60 source gamma knife system (Model C, Elekta Instruments) was used. After complete planning, the patient's head and frame were fixed in a collimator helmet and the treatment was performed until the conformal field encompassed the treatment volume. For dural AVFs, the treatment dose ranged from 13 to 18 Gy at an isodose level of 50%. The dose was determined on the basis of the target volume (the larger the volume, the smaller the dose) and whether critical organs (e.g., optical apparatus or brain stem) were near the radiation target. For abnormal AVFs which drained into the sinus wall, the target was along the involved sinus wall [8 (link)]. Arterial feeders and cortical drainage veins were not considered treatment targets.

Wang G.C., Chen K.P., Chiu T.L, & Su C.F. (2017). Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: A single-center experience. Tzu-Chi Medical Journal, 29(1), 18-23.

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