Abstract
Stereotactic body radiotherapy (SBRT) has become a widely accepted technique that is available on all modern linear accelerators (linacs) and specialized systems such as CyberKnife and Tomotherapy. The present chapter discusses some of the physics issues that require attention for SBRT, including how the sources of uncertainty factor into the selection of PTV margin; treatment planning considerations; and small-field dosimetry. The chapter includes selected literature that highlights key concepts, including recent international guidelines for safe practice.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
American College of Radiology. ACR-ASTRO practice parameter for the performance of stereotactic body radiation therapy, amended. 2014.
Timmerman RD, Kavanagh BD, Cho LC, Papiez L, Xing L. Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol. 2007;25(8):947–52.
Halvorsen PH, Cirino E, Das IJ, Garrett JA, Yang J, Yin FF, et al. AAPM-RSS medical physics practice guideline 9.a. for SRS-SBRT. J Appl Clin Med Phys. 2017;18(5):10–21.
Das IJ, Ding GX, Ahnesjö A. Small fields: nonequilibrium radiation dosimetry. Med Phys. 2008;35(1):206–15.
Wulf J, Hädinger U, Oppitz U, Olshausen B, Flentje M. Stereotactic radiotherapy of extracranial targets: CT-simulation and accuracy of treatment in the stereotactic body frame. Radiother Oncol. 2000;57(2):225–36.
Lax I, Blomgren H, Näslund I, Svanström R. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol. 1994;33(6):677–83.
Ford EC, Mageras GS, Yorke E, Ling CC. Respiration-correlated spiral CT: a method of measuring respiratory-induced anatomic motion for radiation treatment planning. Med Phys. 2003;30(1):88–97.
Guckenberger M, Wilbert J, Krieger T, Richter A, Baier K, Meyer J, et al. Four-dimensional treatment planning for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(1):276–85.
Solberg TD, Balter JM, Benedict SH, Fraass BA, Kavanagh B, Miyamoto C, et al. Quality and safety considerations in stereotactic radiosurgery and stereotactic body radiation therapy: executive summary. Pract Radiat Oncol. 2012;2(1):2–9.
Balter JM, Ten Haken RK, Lawrence TS, Lam KL, Robertson JM. Uncertainties in CT-based radiation therapy treatment planning associated with patient breathing. Int J Radiat Oncol Biol Phys. 1996;36(1):167–74.
Sonke JJ, Rossi M, Wolthaus J, van Herk M, Damen E, Belderbos J. Frameless stereotactic body radiotherapy for lung cancer using four-dimensional cone beam CT guidance. Int J Radiat Oncol Biol Phys. 2009;74(2):567–74.
Velec M, Moseley JL, Brock KK. Simplified strategies to determine the mean respiratory position for liver radiation therapy planning. Pract Radiat Oncol. 2014;4(3):160–6.
Peulen H, Belderbos J, Guckenberger M, Hope A, Grills I, van Herk M, et al. Target delineation variability and corresponding margins of peripheral early stage NSCLC treated with stereotactic body radiotherapy. Radiother Oncol. 2015;114(3):361–6.
Redmond KJ, Robertson S, Lo SS, Soltys SG, Ryu S, McNutt T, et al. Consensus contouring guidelines for postoperative stereotactic body radiation therapy for metastatic solid tumor malignancies to the spine. Int J Radiat Oncol Biol Phys. 2017;97(1):64–74.
Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012;83(5):e597–605.
Klein EE, Hanley J, Bayouth J, Yin FF, Simon W, Dresser S, et al. Task Group 142 report: quality assurance of medical accelerators. Med Phys. 2009;36(9):4197–212.
Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010;37(8):4078–101.
Du W, Gao S, Wang X, Kudchadker RJ. Quantifying the gantry sag on linear accelerators and introducing an MLC-based compensation strategy. Med Phys. 2012;39(4):2156–62.
Low DA, Li Z, Drzymala RE. Minimization of target positioning error in accelerator-based radiosurgery. Med Phys. 1995;22(4):443–8.
Lutz W, Winston KR, Maleki N. A system for stereotactic radiosurgery with a linear accelerator. Int J Radiat Oncol Biol Phys. 1988;14(2):373–81.
Rowshanfarzad P, Sabet M, O’Connor DJ, Greer PB. Isocenter verification for linac-based stereotactic radiation therapy: review of principles and techniques. J Appl Clin Med Phys. 2011;12(4):3645.
Hartmann GH, Bauer-Kirpes B, Serago CF, Lorenz WJ. Precision and accuracy of stereotactic convergent beam irradiations from a linear accelerator. Int J Radiat Oncol Biol Phys. 1994;28(2):481–92.
Moiseenko V, Lapointe V, James K, Yin L, Liu M, Pawlicki T. Biological consequences of MLC calibration errors in IMRT delivery and QA. Med Phys. 2012;39(4):1917–24.
Nithiyanantham K, Mani GK, Subramani V, Mueller L, Palaniappan KK, Kataria T. Analysis of direct clinical consequences of MLC positional errors in volumetric-modulated arc therapy using 3D dosimetry system. J Appl Clin Med Phys. 2015;16(5):296–305.
Bayouth JE, Morrill SM. MLC dosimetric characteristics for small field and IMRT applications. Med Phys. 2003;30(9):2545–52.
Ezzell GA, Galvin JM, Low D, Palta JR, Rosen I, Sharpe MB, et al. Guidance document on delivery, treatment planning, and clinical implementation of IMRT: report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee. Med Phys. 2003;30(8):2089–115.
Jaffray DA, Siewerdsen JH, Wong JW, Martinez AA. Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53(5):1337–49.
Bissonnette JP, Moseley DJ, Jaffray DA. A quality assurance program for image quality of cone-beam CT guidance in radiation therapy. Med Phys. 2008;35(5):1807–15.
Bissonnette JP, Balter PA, Dong L, Langen KM, Lovelock DM, Miften M, et al. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: a report of the AAPM TG-179. Med Phys. 2012;39(4):1946–63.
Paulson ES, Erickson B, Schultz C, Allen Li X. Comprehensive MRI simulation methodology using a dedicated MRI scanner in radiation oncology for external beam radiation treatment planning. Med Phys. 2015;42(1):28–39.
Ma L, Wang L, Tseng CL, Sahgal A. Emerging technologies in stereotactic body radiotherapy. Chin Clin Oncol. 2017;6(Suppl 2):S12.
Seibert TM, White NS, Kim GY, Moiseenko V, McDonald CR, Farid N, et al. Distortion inherent to magnetic resonance imaging can lead to geometric miss in radiosurgery planning. Pract Radiat Oncol. 2016;6(6):e319–e28.
Dong P, Lee P, Ruan D, Long T, Romeijn E, Yang Y, et al. 4pi non-coplanar liver SBRT: a novel delivery technique. Int J Radiat Oncol Biol Phys. 2013;85(5):1360–6.
Navarria P, Ascolese AM, Mancosu P, Alongi F, Clerici E, Tozzi A, et al. Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non small cell lung cancer (NSCLC). Radiother Oncol. 2013;107(3):414–8.
Thomas EM, Popple RA, Prendergast BM, Clark GM, Dobelbower MC, Fiveash JB. Effects of flattening filter-free and volumetric-modulated arc therapy delivery on treatment efficiency. J Appl Clin Med Phys. 2013;14(6):4328.
Foster RD, Speiser MP, Solberg TD. Commissioning and verification of the collapsed cone convolution superposition algorithm for SBRT delivery using flattening filter-free beams. J Appl Clin Med Phys. 2014;15(2):4631.
Ishii K, Okada W, Ogino R, Kubo K, Kishimoto S, Nakahara R, et al. A treatment-planning comparison of three beam arrangement strategies for stereotactic body radiation therapy for centrally located lung tumors using volumetric-modulated arc therapy. J Radiat Res. 2016;57(3):273–9.
Kim J, Wen N, Jin JY, Walls N, Kim S, Li H, et al. Clinical commissioning and use of the Novalis Tx linear accelerator for SRS and SBRT. J Appl Clin Med Phys. 2012;13(3):3729.
Fürweger C, Prins P, Coskan H, Heijmen BJ. Characteristics and performance of the first commercial multileaf collimator for a robotic radiosurgery system. Med Phys. 2016;43(5):2063.
Schuring D, Hurkmans CW. Developing and evaluating stereotactic lung RT trials: what we should know about the influence of inhomogeneity corrections on dose. Radiat Oncol. 2008;3:21.
Martens C, Reynaert N, De Wagter C, Nilsson P, Coghe M, Palmans H, et al. Underdosage of the upper-airway mucosa for small fields as used in intensity-modulated radiation therapy: a comparison between radiochromic film measurements, Monte Carlo simulations, and collapsed cone convolution calculations. Med Phys. 2002;29(7):1528–35.
Woo MK, Cunningham JR. The validity of the density scaling method in primary electron transport for photon and electron beams. Med Phys. 1990;17(2):187–94.
Subramanian SV, Subramani V, Thirumalai Swamy S, Gandhi A, Chilukuri S, Kathirvel M. Is 5 mm MMLC suitable for VMAT-based lung SBRT? A dosimetric comparison with 2.5 mm HDMLC using RTOG-0813 treatment planning criteria for both conventional and high-dose flattening filter-free photon beams. J Appl Clin Med Phys. 2015;16(4):112–24.
Tanyi JA, Summers PA, McCracken CL, Chen Y, Ku LC, Fuss M. Implications of a high-definition multileaf collimator (HD-MLC) on treatment planning techniques for stereotactic body radiation therapy (SBRT): a planning study. Radiat Oncol. 2009;4:22.
Ruschin M, Sahgal A, Iradji S, Soliman H, Leavens C, Lee Y. Investigation of two linac head designs for treating brain metastases with hypofractionated volumetric modulated arc radiotherapy. Br J Radiol. 2016 Jul;89(1063):20160093.
DeLuca P, Jones D, Gahbauer R, Whitmore G, Wambersie A. Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). J ICRU Rep. 2010;83
Menzel HG, DeLuca P, Mackie TR, Boone JM, Brandan ME, Burns DT, et al. ICRU report 91: prescribing, recording, and reporting of stereotactic treatments with small photon beams. J ICRU. 2014;14(2)
Hua C, Chang J, Yenice K, Chan M, Amols H. A practical approach to prevent gantry-couch collision for linac-based radiosurgery. Med Phys. 2004;31(7):2128–34.
Sauer OA. Calculation of dose distributions in the vicinity of high-Z interfaces for photon beams. Med Phys. 1995;22(10):1685–90.
Vatnisky S, Meghzifene A, Christaki K, Palmans H, Andrew P, Saiful Huq M, et al. IAEA TRS-483. Dosimetry of small fields used in external beam radiotherapy: an international code of practice for reference and relative dose determination. International Atomic Energy Agency. 2017.
Bjärngard BE, Tsai JS, Rice RK. Doses on the central axes of narrow 6-MV x-ray beams. Med Phys. 1990;17(5):794–9.
Sánchez-Doblado F, Hartmann GH, Pena J, Roselló JV, Russiello G, Gonzalez-Castaño DM. A new method for output factor determination in MLC shaped narrow beams. Phys Med. 2007;23(2):58–66.
Alfonso R, Andreo P, Capote R, Huq MS, Kilby W, Kjäll P, et al. A new formalism for reference dosimetry of small and nonstandard fields. Med Phys. 2008;35(11):5179–86.
Aspradakis MM, Byme H, Palmans S, Duane S, Conway J, Warrington AP, et al. IPEM report 103: small field MV photon dosimetry. 2010.
Almond PR, Biggs PJ, Coursey BM, Hanson WF, Huq MS, Nath R, et al. AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med Phys. 1999;26(9):1847–70.
McEwen M, DeWerd L, Ibbott G, Followill D, Rogers DW, Seltzer S, et al. Addendum to the AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon beams. Med Phys. 2014;41(4):041501.
Andreo P, Huq MS, Westermark M, Song H, Tilikidis A, DeWerd L, et al. Protocols for the dosimetry of high-energy photon and electron beams: a comparison of the IAEA TRS-398 and previous international codes of practice. International Atomic Energy Agency. Phys Med Biol. 2002;47(17):3033–53.
Smit K, van Asselen B, Kok JG, Aalbers AH, Lagendijk JJ, Raaymakers BW. Towards reference dosimetry for the MR-linac: magnetic field correction of the ionization chamber reading. Phys Med Biol. 2013;58(17):5945–57.
Bouchard H, Seuntjens J. Ionization chamber-based reference dosimetry of intensity modulated radiation beams. Med Phys. 2004;31(9):2454–65.
Agostinelli S, Garelli S, Piergentili M, Foppiano F. Response to high-energy photons of PTW31014 PinPoint ion chamber with a central aluminum electrode. Med Phys. 2008;35(7):3293–301.
Capote R, Sánchez-Doblado F, Leal A, Lagares JI, Arráns R, Hartmann GH. An EGSnrc Monte Carlo study of the microionization chamber for reference dosimetry of narrow irregular IMRT beamlets. Med Phys. 2004;31(9):2416–22.
Andersson J, Kaiser FJ, Gómez F, Jäkel O, Pardo-Montero J, Tölli H. A comparison of different experimental methods for general recombination correction for liquid ionization chambers. Phys Med Biol. 2012;57(21):7161–75.
Ralston A, Tyler M, Liu P, McKenzie D, Suchowerska N. Over-response of synthetic microDiamond detectors in small radiation fields. Phys Med Biol. 2014;59(19):5873–81.
Westermark M, Arndt J, Nilsson B, Brahme A. Comparative dosimetry in narrow high-energy photon beams. Phys Med Biol. 2000;45(3):685–702.
Zhu XR, Allen JJ, Shi J, Simon WE. Total scatter factors and tissue maximum ratios for small radiosurgery fields: comparison of diode detectors, a parallel-plate ion chamber, and radiographic film. Med Phys. 2000;27(3):472–7.
Francescon P, Cora S, Cavedon C, Scalchi P, Reccanello S, Colombo F. Use of a new type of radiochromic film, a new parallel-plate micro-chamber, MOSFETs, and TLD 800 microcubes in the dosimetry of small beams. Med Phys. 1998;25(4):503–11.
Aguirre JF, Alvarez P, Ibbott GG, Followwill DS, editors. Testing, commissioning, and validating an optically stimulated luminescence (OSL) dosimetry system for mailed dosimetry at the Radiological Physics Center. Standards, Applications and Quality Assurance in Medical Radiation Dosimetry (IDOS). Vienna: IAEA; 2010.
Mack A, Scheib SG, Major J, Gianolini S, Pazmandi G, Feist H, et al. Precision dosimetry for narrow photon beams used in radiosurgery-determination of Gamma Knife output factors. Med Phys. 2002;29(9):2080–9.
Pantelis E, Antypas C, Petrokokkinos L, Karaiskos P, Papagiannis P, Kozicki M, et al. Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels. Med Phys. 2008;35(6):2312–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lee, Y., Sarfehnia, A., Ruschin, M. (2019). Physics of Stereotactic Body Radiotherapy. In: Trifiletti, D., Chao, S., Sahgal, A., Sheehan, J. (eds) Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-16924-4_17
Download citation
DOI: https://doi.org/10.1007/978-3-030-16924-4_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-16923-7
Online ISBN: 978-3-030-16924-4
eBook Packages: MedicineMedicine (R0)