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Multiple Brain Mets SRS

Clinical results – The first 10 cases

Assuta Medical Center, Tel Aviv—a radiosurgery center of excellence and Novalis site—pioneered the clinical implementation of Brainlab Multiple Brain Mets SRS software. Ten early cases were selected for review of the entire treatment planning and delivery process. See clinical results
Automatic Brain Metastases Planning_Header_BrainMets with leafs_14Aug12-Automatic Brain Metastases Planning_Header_BrainMets with leafs_14Aug12_OLD
Consistent automated planning


Brainlab software consistently and rapidly generates plans for the efficient treatment of multiple metastases. The software automatically creates a volumetrically optimized radiosurgery plan in a matter of minutes after all metastases have been outlined, allowing the clinical user to focus on reviewing and approving the plan.
  • Offers automatic prescription selection based on tumor volume criteria
  • Different treatment options are possible based on a clinical paradigm selection—from single fraction radiosurgery to fractionated SRS or SRT
  • Automatically selects a group of metastases, but has the ability to unselect metastases that should not be treated under the automated single isocenter (i.e. easy clustering of regional subgroups)
Optimized highly conformal dose


Multiple Brain Mets SRS has a patented algorithm that uses up to 10 arcs at five table positions. Each arc automatically delivers a dose to a sub group of metastases, if two metastases line up in the direction of the leaf motion, the software adds another arc in the reverse direction, treating the second metastases in line. This concept leads to optimized conformal treatments combined with low dose spread to the rest of the brain.
  • Optimization of multi-leaf collimator apertures and collimator angles for highly conformal beam delivery
  • Comprehensive assessment of dose distribution related to each metastasis
  • Automatic 3D dose visualizations for individual tumor prescription and half prescription IDL
  • Global 3D dose projection visualization for complete normal tissue dose evaluation
  • Individual Conformity Index calculations for each metastases
Fast and efficient treatment delivery


Current treatment patterns offer radiosurgery only for patients with one metastasis. For multiple metastases, time increases at the same rate as the number of targets. Multiple Brain Mets SRS software enables ‘monitor-unit’ and time-efficient treatment while minimizing dose to healthy tissue. Treatment delivery and planning time can be reduced drastically, even for up to 10 metastatic tumors in the brain.
  • Treatment of up to 10 metastases without repositioning the patient
  • Arcs rotate forward and backward at the same table position, covering any metastasis either by the first or the second arc
  • To avoid exposing normal tissue to an unnecessary dose, metastases lining up in the direction of leaf-motion are not treated simultaneously
Feasible hypo-fractionation


Multiple Brain Mets SRS offers clinicians the possibility for hypo-fractionated treatments. Current practice patterns call for lowering the single fraction treatment dose when treating large metastases or the combined volume of all metastases. This new software enables efficient radiosurgery planning and delivery while minimizing dose to normal tissue and offering new, practical possibilities for larger volumes and higher number of metastases, even for hypo-fractionated treatments.
  • Multiple Brain Mets SRS makes for hypo-fractionated treatments of multiple targets feasible
  • Enables higher biologically effective dose while potentially keeping the risk of necrosis down
  • Allows for re-oxygenation of the tumor in between the fractions
Straightforward implementation with ExacTrac


Challenges appear for patient positioning as the detrimental effects of remaining rotations are magnified when the isocenter shifts are outside the volume of the lesion. The single isocenter approach of the software speeds up treatment delivery by setting up to five couch angles during treatment. Brainlab ExacTrac® robotic alignment is therefore essential for treatments of multiple metastases.
  • ExacTrac robotic positioning eliminates angular deviation that may result in incomplete target coverage and conformity index degradation
  • Provides internal verification of the patient’s position regardless of couch and gantry angle
  • Even at non-coplanar couch angles and during beam-on, ExacTrac can detect potential misalignment of the patient
  • Complete stereotactic workflow including highly accurate treatment and positioning