Supine Craniospinal Radiation
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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 Radiationfrom Simulation toTreatment


Indications
Indications

  • Medulloblastoma

  • Some Leukemias

  • Dessimated Ependymoma

  • Germinomas

  • Lymphomas



Pediatric brain tumors
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



Supine technique
Supine technique fossa

  • 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


Simulation
Simulation fossa

  • ACC U Fix insert with bear claw shoulder retractors

  • Aquaplast mask

  • Vac U bag for lower extremities

  • indexing bar


Indexing bar
Indexing Bar fossa

  • Bar should be placed where it is comfortable for patient (possibly below feet)

  • Vac lock should be made to “lock” on to indexing


Reference marks csi
Reference Marks fossaCSI

  • Use 3 point set ups at every opportunity

  • Possible patient will have 3 isocenters

  • Only shift patient longitudinally


Treatment planning
Treatment planning fossa

  • 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



2 nd control points
2 fossand Control Points


3 rd control points
3 fossard Control Points






Key points
Key Points fossa

  • Proper immobilization for the whole body

  • Effort to mark all 3 point set ups

  • Proper Record and Verify


  • Anesthesiologist Happy! fossa

  • 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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