Supine Craniospinal Radiation
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Supine Craniospinal Radiation from Simulation to Treatment PowerPoint PPT Presentation


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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 Radiation from Simulation to Treatment

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Supine Craniospinal Radiationfrom Simulation toTreatment


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

  • Highly maglinant

  • Tend to seed alond the neuraxis following CSF pathways


  • 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


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


Simulation

  • ACC U Fix insert with bear claw shoulder retractors

  • Aquaplast mask

  • Vac U bag for lower extremities

  • indexing bar


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


Reference MarksCSI

  • Use 3 point set ups at every opportunity

  • Possible patient will have 3 isocenters

  • Only shift patient longitudinally


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


Initial Control Points


2nd Control Points


3rd Control Points


Initial Dose Distribution


MLC's on Elekcta Accelerators


Dose Distribution approved


Why do my portal images look so funny?


Key Points

  • Proper immobilization for the whole body

  • Effort to mark all 3 point set ups

  • Proper Record and Verify


  • 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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