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Supine Craniospinal Radiation from Simulation to Treatment

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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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Presentation Transcript
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
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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
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
Simulation
  • ACC U Fix insert with bear claw shoulder retractors
  • Aquaplast mask
  • Vac U bag for lower extremities
  • indexing bar
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 marks csi
Reference MarksCSI
  • Use 3 point set ups at every opportunity
  • Possible patient will have 3 isocenters
  • Only shift patient longitudinally
treatment planning
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
key points
Key Points
  • Proper immobilization for the whole body
  • Effort to mark all 3 point set ups
  • Proper Record and Verify
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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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