A method to improve dose gradient for robotic radiosurgery.

For targets with substantial volume, collimators of relatively large size are usually selected to minimize the treatment time in robotic radiosurgery. Their large penumbrae may adversely affect the dose gradient around the target. In this study, we implement and evaluate an inner-shell planning method to increase the dose gradient and reduce dose to normal tissues. Ten patients previously treated with CyberKnife M6 system were randomly selected with the only criterion being that PTV be larger than 2 cm(3). A new plan was generated for each patient in which the PTV was split into two regions: a 5 mm inner shell and a core, and a 7.5 mm Iris collimator was exclusively applied to the shell, with other appropriate collimators applied to the core depending on its size. The optimization objective, functions, and constraints were the same as in the corresponding clinical plan. The results were analyzed for V12 Gy, V9 Gy, V5 Gy, and gradient index (GI). Volume reduction was found for the inner-shell method at all studied dose levels as compared to the clinical plans. The absolute dose-volume reduction ranged from 0.05 cm(3) to 18.5 cm(3) with a mean of 5.6 cm(3) for 12 Gy, from 0.2 cm(3) to 38.1 cm(3) with a mean of 9.8 cm(3) for 9 Gy, and from 1.5 cm(3) to 115.7 cm(3) with a mean of 24.8 cm(3) for 5 Gy, respectively. The GI reduction ranged from 3.2% to 23.6%, with a mean of 12.6%. Paired t-test for GI has a p-value of 0.0014. The range for treatment time increase is from -3 min to 20 min, with a mean of 7.0 min. We conclude that irradiating the PTV periphery exclusively with the 7.5 mm Iris collimator, rather than applying mixed collimators to the whole PTV, can substantially improve the dose gradient, while maintaining good coverage, conformity, and reasonable treatment time.