SU-G-BRC-06: Evaluation of a Novel Radiosurgery Software for Treating Multiple Brain Metastases Simultaneously in a Single Fraction




To evaluate a new, automated brain metastases planning software designed to treat up to ten brain metastases simultaneously.


We treated 61 patients with multiple brain metastases using the Elements software by BrainLab (Munich, Germany). Patients had between 2–10 metastases ranging from 0.01–8.64 cc. Dose prescription was 18–24 Gy. Plans use up to 5 non-coplanar arcs with a single isocenter at the metastases’ center of mass. The high degree of automation shortens the planning time to 15–20 minutes per patient.For comparison we planned 21 of the patients using Rapid Arc (Varian, Palo Alto CA) (RA). We used two coplanar arcs so as to keep planning times comparable to the Elements. We also planned 8 patients using iPlan software (BrainLab). We compared conformity index (CI), volume of brain receiving over 12 Gy (V12) and mean brain dose (MBD) for the three different planning systems (TPSs).


Plans from all TPSs were judged clinically acceptable. V12 and MBD were not statistically significantly different between TPSs.CI between RA and Elements was similar, however for iPlan CI was significantly worse compared to both RA and Elements (p<0.001). RA plans took approximately 40 minutes to plan (despite fusion and contouring being done in the Elements), and iPlan plans over an hour each. Delivery times were approximately 30 minutes for Elements, 10 minutes for RA, and up to 300 minutes for iPlan.


Elements plans had good CI values and low brain doses. While treatment times for Elements were longer than for RA, 30 minutes is a significant improvement over conventional radiosurgery techniques where each metastasis is treated individually and delivery times to 10 metastases are close to 300 minutes.BrainLab Elements is a novel software allowing fast, automated planning and efficient irradiation of multiple brain metastases with minimal dose to healthy brain.