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Supine Craniospinal Radiation from Simulation to Treatment

Supine Craniospinal Radiation from Simulation to Treatment. Indications. Medulloblastoma Some Leukemias Dessimated Ependymoma Germinomas Lymphomas. Medulloblastoma. Pediatric Brain Tumors. Of pediatric brain tumors, ½ orginate in the posterior fossa Medulloblastoma are the most common

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Supine Craniospinal Radiation from Simulation to Treatment

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  1. Supine Craniospinal Radiationfrom Simulation toTreatment

  2. Indications • Medulloblastoma • Some Leukemias • Dessimated Ependymoma • Germinomas • Lymphomas

  3. Medulloblastoma

  4. Pediatric Brain Tumors • Of pediatric brain tumors, ½ orginate in the posterior fossa • Medulloblastoma are the most common • Highly maglinant • Tend to seed alond the neuraxis following CSF pathways

  5. Of pediatric brain tumors, ½ orginate in the posterior fossa • Medulloblastoma are the most common • Highly maglinant • Tend to seed alond the neuraxis following CSF pathways • Radiosensitive • Treat Craniospinal axis plus Posterior Fossa

  6. Supine technique • Texas Methodist Hospital Houston, Texas • Michael South, CMD • Patient treated supine not prone • Patient more stable and comfortable • If anesthesia required easier to maintain airway • No junction changes

  7. Simulation • ACC U Fix insert with bear claw shoulder retractors • Aquaplast mask • Vac U bag for lower extremities • indexing bar

  8. Indexing Bar • Bar should be placed where it is comfortable for patient (possibly below feet) • Vac lock should be made to “lock” on to indexing

  9. Reference MarksCSI • Use 3 point set ups at every opportunity • Possible patient will have 3 isocenters • Only shift patient longitudinally

  10. Treatment planning • Up to 3 isocenters • All MLC, no custom blocking • Daily junction feathering using Step N Shoot • Synergy C machine of choice • Table kick to 90 degrees on inferior spine • Gantry angled to match divergence of superior spine and collimator rotated 90 degrees

  11. Initial Control Points

  12. 2nd Control Points

  13. 3rd Control Points

  14. Initial Dose Distribution

  15. MLC's on Elekcta Accelerators

  16. Dose Distribution approved

  17. Why do my portal images look so funny?

  18. Key Points • Proper immobilization for the whole body • Effort to mark all 3 point set ups • Proper Record and Verify

  19. Anesthesiologist Happy! • TMH paper offers a viable option to supine CSI • Patient comfortable and stable • Less field set up errors • Only longitudinal shifts, no coronal or saggital shifts

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