Total workflow uncertainty of frameless radiosurgery with the Gamma Knife Icon cone‐beam computed tomography

OBJECTIVE: Frameless treatment with the Gamma Knife Icon is still relatively new as a treatment option. As a result, additional confidence/knowledge about the uncertainty that exists within each portion of the treatment workflow could be gained especially regarding steps that have not been previously studied in the literature. METHODS: The Icon base delivery device (Perfexion) uncertainty is quantified and validated. The novel portions of the Icon such as mask immobilization, cone‐beam computed tomography image guidance, and the intrafraction motion management methods are studied specifically and to a greater extent to determine a total workflow uncertainty of frameless treatment with the Icon. RESULTS: The uncertainty of each treatment workflow step has been identified with the total workflow uncertainty being identified in this work as 1.3 mm with a standard deviation of 0.51 mm. CONCLUSION: The total uncertainty of frameless treatment with the Icon has been evaluated and this data may indicate the need for setup margin in this setting with data that could be used by other institutions to calculate needed setup margin per their preferred recipe after validation of this data in their context.