Image Application in Single Isocenter Multiple Target SRS

Single isocenter multiple target stereotactic radiosurgery (SIMT-SRS) has potentially emerged as a new pillar in radio-immune combination therapy for the management of brain metastasis. Accuracy and efficiency are pushed to a higher level in the era of the linear accelerator-based SIMT-SRS. This short review focuses on patient selection, image preparation, patient simulation, electronic portal imaging device (EPID) QA, and the patient treatment process in the SIMT-SRS treatment only. Image-relevant recommendations and guidelines are presented and contrast application, acquisition efficiency, and alignment accuracy of CT and MRI images are explored. With guidance, the SIMT-SRS can be implemented with high precision and efficiency. 1 mm or 0.5 mm and non-uniform PTV margin expansion for all targets would become possible. It will enhance cancer killing effect in radio-immune combination therapy. General routine daily, monthly, and annual linear accelerator image quality assurances are excluded.