Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy(SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRTtreatment delivery is provided.
The members of the Task Group wish to thank the AAPM Treatment Delivery Subcommittee members for their careful review and helpful suggestions of this report. Members of the AAPM Therapy Physics Committee and Professional Council also made significant contributions.
I. INTRODUCTION AND SCOPE
II. HISTORY AND RATIONALE FOR SBRT
III. CURRENT STATUS OF SBRT-PATIENT SELECTION CRITERIA
IV. SIMULATION IMAGING AND TREATMENT PLANNING
IV.A. Simulation imaging
IV.B. Data acquisition for mobile tumors, patient-specific tumor-motion determination, and respiratory motion management
IV.C. Imaging artifacts
IV.D. Treatment planning
IV.D.1. Dose heterogeneity, gradient and fall-off, and beam geometry
IV.D.2. Beam selection and beam geometry
IV.D.3. Calculation grid size
IV.D.4. Bioeffect-based treatment planning and SBRT
IV.D.5. Normal tissuedose tolerance
IV.E. Treatment plan reporting
V. PATIENT POSITIONING, IMMOBILIZATION, TARGET LOCALIZATION, AND DELIVERY
V.B. Image-guided localization
V.C. Localization, tumor-tracking, and gating techniques for respiratory motion management
V.C.1. Image-guided techniques
V.C.2. Optical tracking techniques
V.C.3. Respiratory gating techniques
V.D. Delivery data reporting
VI. SPECIAL DOSIMETRY CONSIDERATIONS
VI.A. Problems associated with dosimetry of small/narrow field geometry
VI.B. Problems associated with small-field heterogeneity calculations
VII. CLINICAL IMPLEMENTATION OF SBRT
VII.A. Establishing the scope and clinical goals of the SBRT program
VII.A.1. Equipment considerations
VII.A.2. Time and personnel considerations
VII.B. Acceptance, commissioning, and quality assurance
VII.C. Patient safety and the medical physicist
VII.D. Quality process improvement: Vigilance in the error reduction process in the treatment planning and delivery process
VIII. FUTURE DIRECTIONS
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