SRS and SBRT and advanced dosimetry: Duke experiences

Abstract

Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) are among the most demanding of radiation therapy techniques in terms of requirements for high accuracy and conformality of treatment delivery. Compared to conventional treatments, they require specialized high-precision equipment (including high specification medical accelerators and alignment frames), extensive imaging (including multi-modal and motion management methods), specialized Quality Assurance protocols, and increased person-power effort. In addition, the high dose-per-fraction renders SRS/SBRT a high-stakes treatment setting, where small errors may cause significant treatment morbidity in normal healthy tissue. All of these issues combine to render SRS/SBRT one of the most opportunistically rich and clinically important areas for advanced dosimetry research. Some of the applications of advanced 3D dosimetry to SRS and SBRT and small field treatment verification are explored. Applications include base of skull IMRT, single-isocenter multi-lesion radiosurgery, pre-clinical precision treatments, interpreting the clinical significance of 3D QA data, remote dosimetry, dosimetry in magnetic fields, trigeminal neuralgia, rodent-morphic dosimetry, motion, and small field commissioning.