
Trigeminal neuralgia (TN) is a chronic condition that causes severe, shock-like pain on one side of the face. In its most severe form, it can be so debilitating that it is often referred to as the "suicide disease." The first-line treatment for TN is medication, but if symptoms persist despite medication, surgical options are considered. CyberKnife (CK) stereotactic radiosurgery (SRS) is an effective treatment that targets and destroys specific trigeminal nerve fibers using multiple precisely-shaped beams of ionizing radiation from a linear accelerator mounted on a robotic arm. Treatment utilizes a fixed 5 mm diameter circular collimator, targeting the nerve root entry zone or cisternal segment. Given the small target volume and the proximity to the brainstem, ensuring geometric and dosimetric precision is critical for the successful delivery of radiation therapy. Aim: This study compares the PSQA results for patients receiving CK SRS. The measurements of the dose distributions were conducted using two dosimetric systems: Gafchromic EBT3 film dosimetry and an SRS MapCheck diode array inserted into a StereoPhan phantom. Materials and Methods: The SRS MapCheck was inserted into the StereoPhan, a dedicated PMMA phantom for dose distribution verification. Both relative array calibration (for detector sensitivity) and absolute dose calibration (converting measurement counts to an absolute dose) were conducted according to the manufacturer's protocols. The software functionality allows for implementing temperature, beam angle, field size, and dose rate corrections. The Stereotactic Dose Verification phantom, made up of blue water slabs, allows for precisely positioning a 5 x 5 cm2 EBT3 film in its exact center during the dose distribution measurements. The dose-response curves were fitted in the range from 0 to 5 Gy to the function X(D)= (A + BD) / (D + C), where X(D) represents film response value on the dose D, and A, B, and C are constants. The Epson V850 Perfection scanner, working in a transmission mode, was used to acquire 48-bit RGB images at a resolution of 72 dpi. The so-called “One San” recalibration protocol was followed to convert from PV to the dose. For each dose distribution, three film pieces were used: one applied in the measurement, an unexposed one, and a piece exposed to a known dose. The expected dose distributions in the film and detector array planes were calculated by overlaying the patient specific plan generated in the Precision Treatment Planning System (TPS) onto computed tomography scans of the verification phantoms. Gamma index analysis was conducted using SNC Patient software for the SRS MapCheck and FilmQA Pro for the EBT3 film dosimetry system to assess the agreement between the planned and measured dose distributions. Results: All treatment plans validated with the SRS MapCheck met the established acceptance criteria, achieving global gamma passing rates exceeding 95% with the 3%/1 mm criterion and a threshold of 10%. For all PSQA measurements verified using the film dosimetry system, the global gamma passing rates also consistently exceeded 95% when applying a 3%/1 mm criterion and a 10% threshold. Conclusion: Both Gafchromic EBT3 film dosimetry and the SRS MapCheck diode array provide reliable and effective methods for routine pretreatment verification in CyberKnife stereotactic radiosurgery. While the SRS MapCheck dosimetry system demonstrated superior agreement between planned and measured dose distributions, the high spatial resolution, tissue equivalence, and independence from beam angle, energy, and dose rate make the EBT3 Gafchromic film dosimetry system a valuable tool in the dosimetric validation process. The measurements confirmed the dosimetric and geometric correctness of the CK SRS treatment administered to patients suffering from TN.
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