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Workflow guide to delivering a safe breast treatment using a novel stereotactic radiation delivery system
Elizabeth M Nichols, Mariana Guerrero, Sarah Mcavoy, Terri Biggins, Byong Yong and Stewart J Becker

The GammaPod (Xcision Medical Systems; Columbia, MD) is a breast-only stereotactic radiosurgery device. Its capabilities, commissioning, and use have been described previously.(1-8) The GammaPod is currently used for single-fraction boosts to the lumpectomy cavity and accelerated partial-breast irradiation (APBI). Similar to the GammaKnife, the GammaPod uses a large number of non-coplanar Co-60 beams to produce a sharp dose fall-off. This rapid dose fall-off along with its unique geometry and vacuum-assisted immobilization system enables the GammaPod to reduce the amount of heart and normal breast tissue treated. Previous studies have shown that the amount of normal tissue treated correlates with cosmetic outcomes (9). Initial clinical trial experience has shown encouraging results with the GammaPod comparing favorably to standard techniques such as brachytherapy and VMAT.(10)

The GammaPod workflow was initially developed by a team of physicians, physicists, nurses, and therapists. This workflow consists of patient selection, daily quality assurance (QA), breast cup fitting, CT imaging, treatment planning, and treatment.

Keywords: GammaPod, breast, APBI, stereotactic radiosurgery, stereotactic body radiotherapy

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