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In the pursuit of perfect planning: comparison between Lightning Inverse Planning and GammaPlan Wizard for gamma knife radiosurgery Cover

In the pursuit of perfect planning: comparison between Lightning Inverse Planning and GammaPlan Wizard for gamma knife radiosurgery

Open Access
|Jun 2025

Figures & Tables

FIGURE 1.

Comparison of the planning time according to each modality and pathology.
GBM = glioblastoma multiform; IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR: Lightning® with consideration of risk structure; M+OP = Manual planning with optimization; Men = meningioma; Met = metastasis; Pit And = pituitary adenoma; VS = vestibular schwannoma
Comparison of the planning time according to each modality and pathology. GBM = glioblastoma multiform; IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR: Lightning® with consideration of risk structure; M+OP = Manual planning with optimization; Men = meningioma; Met = metastasis; Pit And = pituitary adenoma; VS = vestibular schwannoma

FIGURE 2.

Results of the dose received by the cochlea’s Modiolos in a vestibular schwannoma plan.
IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR = Lightning® with consideration of risk structure; M+OP = Manual planning with optimization
Results of the dose received by the cochlea’s Modiolos in a vestibular schwannoma plan. IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR = Lightning® with consideration of risk structure; M+OP = Manual planning with optimization

FIGURE 3.

Dose received by optic structures in one (A) and three (B) sessions plans for meningiomas. Dose received by optic structures in one (C) and three (D) sessions plans for pituitary adenomas.
IP = Inverse planning; LWR = Lightning® with consideration of risk structure; LNR = Lightning® with no consideration of risk structure; M+OP = Manual planning with optimization
Dose received by optic structures in one (A) and three (B) sessions plans for meningiomas. Dose received by optic structures in one (C) and three (D) sessions plans for pituitary adenomas. IP = Inverse planning; LWR = Lightning® with consideration of risk structure; LNR = Lightning® with no consideration of risk structure; M+OP = Manual planning with optimization

FIGURE 4.

Scatter plot correlation between time to plan in minutes and tumor volume. (A): Lightning® with no consideration of risk structure (r = 0.84, p < 0.0001); (B): Lightning® with consideration of risk structure (r = 0.45, p = 0.2); (C): Inverse planning (r = 0.74, p < 0.0001); (D): Manual planning with optimization (r = 0.03, p = 0.8).
OAR = organs at risk
Scatter plot correlation between time to plan in minutes and tumor volume. (A): Lightning® with no consideration of risk structure (r = 0.84, p < 0.0001); (B): Lightning® with consideration of risk structure (r = 0.45, p = 0.2); (C): Inverse planning (r = 0.74, p < 0.0001); (D): Manual planning with optimization (r = 0.03, p = 0.8). OAR = organs at risk

FIGURE 5.

Dose-volume histogram (DVH) for clival meningioma (A and B) plan comparing Lightning® with (LWR) and without risk (LNR) structures to a simulation of treatment planning with forward planning with (A) showing tumor results, and (B) showing the organs at risk (OAR) results. Dose-volume histogram for clival meningioma plan (C and D) comparing LWR and LNR to a simulation of treatment planning with forward planning with and without consideration of the OAR. (C) showing tumor results, and (D) showing the OAR results.
Dose-volume histogram (DVH) for clival meningioma (A and B) plan comparing Lightning® with (LWR) and without risk (LNR) structures to a simulation of treatment planning with forward planning with (A) showing tumor results, and (B) showing the organs at risk (OAR) results. Dose-volume histogram for clival meningioma plan (C and D) comparing LWR and LNR to a simulation of treatment planning with forward planning with and without consideration of the OAR. (C) showing tumor results, and (D) showing the OAR results.

Median results and intervals for the patients with separated by pathology and planning techniques

CoverageVestibular schwannomaMeningiomaMetastasisCavitiesPituitary Adenoma
Meadian Volume (CC)1.3776.3386.559511.45254.267
Planning TechniqueLNRLWRIPM+OPLNRLWRIPM+OPLNRLWRIPM+OPLNRLWRIPM+OPLNRLWRIPM+OP
Time to plan (min:sec)00:10.9 (± 00:02.2)00:09.7 (± 00:00.8)00:18.0 (± 00:01.2)00:34.8 (± 00:20.9)00:36.4 (± 01:31.7)01:00.5 (± 01:33.8)00:44.4 (± 00:21.9)01:49.5 (± 01:51.9)00:47.3 (± 00:05.9)-00:44.1 (± 00:02.0)02:10.9 (± 02:28.3)00:53.7 (± 00:59)02:15.7 (± 00:13.8)01:14.2 (± 00:13.6)02:53.0 (± 01:35.9)00:26.1 (± 00:01.3)00:42.8 (± 00:00.9)00:49.4 (± 00:12.5)01:38.4 (± 00:38.0)
Shots48 (± 10.81)42 (± 6.27)5 (± 0.46)7 (± 3.82)74 (± 28.24)69 (± 35.39)28 (± 4.44)18 (± 10.55)54.5 (± 2.18)-27 (± 0.24)18.5 (± 0.97)79.5 (± 29.78)112 (± 36.03)35.5 (± 2.58)31 (± 3.43)52 (± 9.53)69 (± 9.12)28 (± 13.9)23 (± 6.44)
Coverage0.98 (± 0.005)0.96 (± 0.004)0.88 (± 0.014)0.91 (± 0.03)0.99 (± 0.002)0.99 (± 0.002)0.91 (± 0.003)0.90 (± 0.006)0.99 (± 0.005)-0.91 (± 0.013)0.915 (± 0.011)0.99 (± 0.009)0.99 5 (± 0.007)0.915 (± 0.017)0.905 (± 0.012)0.99 (± 0.0007)0.99 (± 0.0031)0.92 (± 0.0005)0.91 (± 0.0017)
Selectivity0.86 (± 0.001)0.87 (±0.002)0.94 (± 0.077)0.92 (±1.78)0.81 (± 0.01)0.83 (± 0.01)0.92 (± 0.01)0.89 (± 0.01)0.74 (± 0.036)-0.90 (± 0.035)0.90 (± 0.028)0.745 (± 0.09)0.785 (± 0.048)0.90 (± 0.05)0.895 (± 0.03)0.775 (± 0.03)0.765 (± 0.03)0.94 (± 0.01)0.93 (± 0.01)
Gradient Index2.49 (± 0.13)2.51 (± 0.18)2.61 (± 0.27)3.17 (± 0.31)2.55 (± 0.14)2.505 (± 0.03)2.88 (± 0.11)3.085 (± 0.43)2.77 (± 0.01)-3.01 (± 0.13)3.19 (± 0.18)2.88 (± 0.29)2.58 (± 0.28)2.86 (± 0.34)3.235 (± 0.63)2.58 (± 0.056)2.65 (± 0.043)2.78 (± 0.199)3.12 (± 0.005)
Delivery Time (min)37.3 (± 4.19)49.3 (± 8.87)27.8 (± 3.92)24 (± 1.22)47.3 (± 1.44)66.2 (± 0.57)47.2 (± 6.77)30.9 (± 10.47)43.1 (± 7.33)-52.95 (± 0.06)56.35 (± 0.61)54.4 (± 7.18)77.6 (± 21.48)75.4 (± 7.66)63.8 (± 9.92)43.9 (± 17.58)49 (± 19.54)105.9 (± 0.09)55.5 (± 7.75)

Median results and intervals for the 38 simulation-patients_ Median tumor volume was 6_356cc

GeneralLNRLWRIPM+OP
Time to plan (min:sec)00:36.4 (± 00:53.2)00:34.1 (± 00:22.9)00:50.6 (± 00:20.7)01:52.6 (± 00:16.6)
Shots63 (± 23.3)69 (± 33.8)27.5 (± 7.5)20 (± 7.8)
Coverage0.99 (± 0.14)0.99 (± 0.32)0.92 (± 0.43)0.91 (± 0.27)
Selectivity0.78 (± 2.1)0.82 (± 0.69)0.92 (± 1.93)0.90 (± 1.78)
Gradient Index2.63 (± 0.01)2.53 (± 0.05)2.88 (± 0.03)3.17 (± 0.26)
Delivery Time (min)46.45 (± 0.68)49.3 (± 3.49)52.5 (± 11.75)47.85 (± 10.04)

Median of the parameters evaluated with Lightning® (LNR and LWR) and Wizard® (IP and M+OP) and their difference in percentage

Lightning (LNR and LWR)Wizard (M+OP and IP)Difference
TP (min:sec)00:35.301:21.6-57%
Shots77.523.75226%
Coverage0.990.9158
Selectivity0.80.91-12%
GI2.583.025-15%
DT (min)47.87550.175-5%
DOI: https://doi.org/10.2478/raon-2025-0039 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 285 - 292
Submitted on: Nov 4, 2025
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Accepted on: Apr 15, 2025
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Published on: Jun 21, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Victor Goulenko, Robert J Plunkett, Matthew B Podgorsak, Dheerendra Prasad, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.