Assessment of unintended shifts during frame-based stereotactic radiosurgery using cone beam computed tomography image guidance



To investigate the frequency, magnitude and possible causes of frame-shifts that may occur between treatment planning and treatment delivery when performing Gamma Knife radiosurgery with rigid frame-based immobilization.


Differences between computed tomography (CT) framed fiducial stereotactic coordinate reference and cone beam computed tomography stereotactic coordinates after image registration were recorded for 49 frame-based GK radiosurgery cases performed using the Gamma Knife Icon. Parameters recorded include rotational shifts, translational shifts, and the GK-computed Maximum Shot Displacement (MSD) between the two stereotactic coordinate spaces. Other patient-specific parameters were collected and linear regression analysis was performed to evaluate predictors of increased displacement.


The median values of rotational shifts were: pitch 0.14°, yaw 0.17°, and roll 0.13°. The median absolute values of translational shifts were: left–right 0.39 mm, anteroposterior 0.14 mm, and superior-inferior 0. 22 mm. The median value of MSD was 0.71 mm. Twelve cases (24.5%) had a MSD of greater than 1.0 mm. Male gender was associated with increased MSD (p = 0.013) and translational shifts (root-mean-squared value, p = 0.017). Cases with large differences between right and left sided pin lengths were also associated with increased MSD (p = 0.011).


The use of CBCT image guidance in frame-based GK radiosurgery allows unintended frame shifts to be identified and corrected. A significant fraction (24.5%) of patients had large enough shifts to result in a MSD of greater than 1.0 mm. Male gender and eccentrically placed frames were associated with increased MSD, and particular care should be taken in these cases.

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DSS, JLP, ARH, TDM, RR, SMH, BM, SK, DMT, LAV: Conception and design. DSS, ARH, JLP, TDM, DMT, LAV: Data collection. DSS, ARH, DMT, LAV: Data analysis and interpretation. DSS, TDM, DMT, LAV: Manuscript writing. DSS, JLP, TDM, RR, SMH, BM, SK, ARH, DMT, LAV: Final approval of manuscript.

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Correspondence to Daniel M. Trifiletti.

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Dr. Trifiletti receives unrelated clinical trial research funding from Novocure and publishing fees from Springer. The remaining authors have nothing to disclose.

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Seneviratne, D.S., Hadley, A.R., Peterson, J.L. et al. Assessment of unintended shifts during frame-based stereotactic radiosurgery using cone beam computed tomography image guidance. J Neurooncol 148, 273–279 (2020).

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  • Frame
  • Gamma-knife
  • Stereotactic shifts
  • Radiosurgery
  • Intracranial displacement