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Intracranial stereotactic positioning systems: Report of the American
Association of Physicists in Medicine Radiation Therapy Committee Task Group No.
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Intracranial stereotactic positioning systems (ISPSs) are used to position patients prior
to precise radiation
treatment of localized lesions of the brain. Often, the lesion is
located in close proximity to critical anatomic features whose functions should be
maintained. Many types of ISPSs have been described in the literature and are commercially
available. These are briefly reviewed. ISPS systems provide two critical functions. The
first is to establish a coordinate system upon which a guided therapy can be applied. The
second is to provide a method to reapply the coordinate system to the patient such that
the coordinates assigned to the patient’s anatomy are identical from application to
application. Without limiting this study to any particular approach to ISPSs, this report
introduces nomenclature and suggests performance tests to quantify both the stability of
the ISPS to map diagnostic data to a coordinate system, as well as the ISPS’s ability to
be realigned to the patient’s anatomy. For users who desire to develop a new ISPS system,
it may be necessary for the clinical team to establish the accuracy and precision of each
of these functions. For commercially available systems that have demonstrated an
acceptable level of accuracy and precision, the clinical team may need to demonstrate
local ability to apply the system in a manner consistent with that employed during the
The level of accuracy and precision required of an individual ISPS system is dependent
upon the clinical protocol (e.g., fractionation, margin, pathology, etc.). Each clinical
team should provide routine quality assurance procedures that are sufficient to support the
assumptions of accuracy and precision used during the planning process. The testing of ISPS systems can be
grouped into two broad categories, type testing, which occurs prior to general
commercialization, and site testing, performed when a commercial system is installed
at a clinic. Guidelines to help select the appropriate tests as well as
recommendations to help establish the required frequency of testing are provided. Because
of the broad scope of different systems, it is important that both the manufacturer and
user rigorously critique the system and set QA tests appropriate to the particular device
and its possible weaknesses. Major recommendations of the Task Group include: introduction
of a new nomenclature for reporting repositioning accuracy; comprehensive analysis of patient
characteristics that might adversely affect positioning accuracy; performance of
immediately before each treatment to establish that there are no gross positioning errors; a
general request to the Medical Physics community for improved QA tools; implementation of
weekly portal imaging (perhaps cone beam CT in the future) as a method of tracking fractionated
patients (as per TG 40); and periodic routine reviews of positioning accuracy.
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