A phantom study of the geometric accuracy of computed tomographic and magnetic resonance imaging stereotactic localization with the Leksell stereotactic system

OBJECTIVE: To assess the spatial accuracy of magnetic resonance imaging (MRI) and computed tomographic stereotactic localization with the Leksell stereotactic system. METHODS: The phantom was constructed in the shape of a box, 164 mm in each dimension, with three perpendicular arrays of solid acrylic rod, 5 mm in diameter and spaced 30 mm apart within the phantom. In this study, images from two different MRI scanners and a computed tomographic scanner were obtained using the same Leksell (Elekta Instruments, Stockholm, Sweden) head frame placement. The coordinates of the rod images in the three principal planes were measured by using a tool provided with Leksell GammaPlan software (Elekta Instruments, Norcross, CA) and were compared with the physical phantom measurements. RESULTS: The greatest distortion was found around the periphery, and the least distortion (<1.5 mm) was present in the middle and most other areas of the phantom. In the phantom study using computed tomography, the mean values of the maximum errors for the x, y, and z axes were 1.0 mm (range, 0.2-1.3 mm), 0.4 mm (range, 0.1-0.8 mm), and 3.8 mm (range, 1.9-5.1 mm), respectively. The mean values of the maximum errors when using the Philips MRI scanner (Philips Medical Systems, Shelton, CT) were 0.9 mm (range, 0.4-1.7 mm), 0.2 mm (range, 0.0-0.7 mm), and 1.9 mm (range, 1.3-2.3 mm), respectively. Using the Siemens MRI scanner (Siemens Medical Systems, New York, NY), these values were 0.4 mm (range, 0.0-0.7 mm), 0.6 mm (range, 0.0-1.0 mm), and 1.6 mm (range, 0.8-2.0 mm), respectively. The geometric accuracy of the MRI scans when using the Siemens scanner was greatly improved after the implementation of a new software patch provided by the manufacturer. The accuracy also varied with the direction of phase encoding. CONCLUSION: The accuracy of target localization for most intracranial lesions during stereotactic radiosurgery can be achieved within the size of a voxel, especially by using the Siemens MRI scanner at current specifications and with a new software patch. However, caution is warranted when imaging peripheral lesions, where the distortion is greatest.