Читать книгу Leksell Radiosurgery - Группа авторов - Страница 47

The 2017 generation ICON system represents a significant advance for patients and treatment teams who have little experience with Leksell radiosurgery or those who believe that fractionation has radiobiological merit [7]. At present, the limitations of this first-generation device significantly limits its role for brain targets that have proven to be well treated by prior Leksell SRS models. Of course, with frame fixation it can be used as a Perfexion device.

The technology can be improved in future releases. The second CBCT is redundant, unnecessary, and time consuming. The current device and software represent significant over engineering that actually reduces patient comfort and tolerance. The second CBCT adds significantly to the total mask on time but does not improve patient safety. The patient flow should be: imaging, dose planning, mask making, CBCT, and start of treatment if the stereotactic registration and the dose plan co-register well. The speed of acquisition of the CBCT must be reduced by half. The planning computer and treatment computer must be the same machine so that there is rapid and seamless interaction between the dose planning computer and the CBCT data, eliminating long delays in data transfer between two different computers. The intrafraction motion detection system must be mounted on a telescoping device similar to what is used in image guidance in the neurosurgical operating room. Future improvements in the ICON system may include a more comfortable and less restrictive but still effective mask immobilization system. Such improvements will likely happen if the comprehensive experience of actual users is incorporated into future designs. It is expected that advise based on user experiences will improve the treatment procedure and patient care.