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Aljaafari L, Bird D, Buckley DL, Al-Qaisieh B, Speight R. A systematic review of 4D magnetic resonance imaging techniques for abdominal radiotherapy treatment planning. Phys Imaging Radiat Oncol 2024; 31:100604. [PMID: 39071158 PMCID: PMC11283022 DOI: 10.1016/j.phro.2024.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Background and purpose Four-dimensional magnetic resonance imaging (4DMRI) has gained interest as an alternative to the current standard for motion management four-dimensional tomography (4DCT) in abdominal radiotherapy treatment planning (RTP). This review aims to assess the 4DMRI literature in abdomen, focusing on technical considerations and the validity of using 4DMRI for patients within radiotherapy protocols. Materials and methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across the Medline, Embase, Scopus, and Web of Science databases, covering all years up to December 31, 2023. The studies were grouped into two categories: 4DMRI reconstructed from 3DMRI acquisition; and 4DMRI reconstructed from multi-slice 2DMRI acquisition. Results A total of 39 studies met the inclusion criteria and were analysed to provide key findings. Key findings were 4DMRI had the potential to improve abdominal RTP for patients by providing accurate tumour definition and motion assessment compared to 4DCT. 4DMRI reconstructed from 3DMRI acquisition showed promise as a feasible approach for motion management in abdominal RTP regarding spatial resolution. Currently,the slice thickness achieved on 4DMRI reconstructed from multi-slice 2DMRI acquisitions was unsuitable for clinical purposes. Lastly, the current barriers for clinical implementation of 4DMRI were the limited availability of validated commercial solutions and the lack of larger cohort comparative studies to 4DCT for target delineation and plan optimisation. Conclusion 4DMRI showed potential improvements in abdominal RTP, but standards and guidelines for the use of 4DMRI in radiotherapy were required to demonstrate clinical benefits.
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Affiliation(s)
- Lamyaa Aljaafari
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
- King Saud bin Abdulaziz University for Health Sciences, Department of Diagnostic Radiology Faculty of Applied Medical Sciences, Alahssa, Saudi Arabia
| | - David Bird
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
| | - David L. Buckley
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom
| | - Bashar Al-Qaisieh
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
| | - Richard Speight
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
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Emin S, Rossi E, Myrvold Rooth E, Dorniok T, Hedman M, Gagliardi G, Villegas F. Clinical implementation of a commercial synthetic computed tomography solution for radiotherapy treatment of glioblastoma. Phys Imaging Radiat Oncol 2024; 30:100589. [PMID: 38818305 PMCID: PMC11137592 DOI: 10.1016/j.phro.2024.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
Background and Purpose Magnetic resonance (MR)-only radiotherapy (RT) workflow eliminates uncertainties due to computed tomography (CT)-MR image registration, by using synthetic CT (sCT) images generated from MR. This study describes the clinical implementation process, from retrospective commissioning to prospective validation stage of a commercial artificial intelligence (AI)-based sCT product. Evaluation of the dosimetric performance of the sCT is presented, with emphasis on the impact of voxel size differences between image modalities. Materials and methods sCT performance was assessed in glioblastoma RT planning. Dose differences for 30 patients in both commissioning and validation cohorts were calculated at various dose-volume-histogram (DVH) points for target and organs-at-risk (OAR). A gamma analysis was conducted on regridded image plans. Quality assurance (QA) guidelines were established based on commissioning phase results. Results Mean dose difference to target structures was found to be within ± 0.7 % regardless of image resolution and cohort. OARs' mean dose differences were within ± 1.3 % for plans calculated on regridded images for both cohorts, while differences were higher for plans with original voxel size, reaching up to -4.2 % for chiasma D2% in the commissioning cohort. Gamma passing rates for the brain structure using the criteria 1 %/1mm, 2 %/2mm and 3 %/3mm were 93.6 %/99.8 %/100 % and 96.6 %/99.9 %/100 % for commissioning and validation cohorts, respectively. Conclusions Dosimetric outcomes in both commissioning and validation stages confirmed sCT's equivalence to CT. The large patient cohort in this study aided in establishing a robust QA program for the MR-only workflow, now applied in glioblastoma RT at our center.
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Affiliation(s)
- Sevgi Emin
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Elia Rossi
- Department of Radiation Oncology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | | | - Torsten Dorniok
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mattias Hedman
- Department of Radiation Oncology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Giovanna Gagliardi
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Fernanda Villegas
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, 171 77 Stockholm, Sweden
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Riis HL, Chick J, Dunlop A, Tilly D. The Quality Assurance of a 1.5 T MR-Linac. Semin Radiat Oncol 2024; 34:120-128. [PMID: 38105086 DOI: 10.1016/j.semradonc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The recent introduction of a commercial 1.5 T MR-linac system has considerably improved the image quality of the patient acquired in the treatment unit as well as enabling online adaptive radiation therapy (oART) treatment strategies. Quality Assurance (QA) of this new technology requires new methodology that allows for the high field MR in a linac environment. The presence of the magnetic field requires special attention to the phantoms, detectors, and tools to perform QA. Due to the design of the system, the integrated megavoltage imager (MVI) is essential for radiation beam calibrations and QA. Additionally, the alignment between the MR image system and the radiation isocenter must be checked. The MR-linac system has vendor-supplied phantoms for calibration and QA tests. However, users have developed their own routine QA systems to independently check that the machine is performing as required, as to ensure we are able to deliver the intended dose with sufficient certainty. The aim of this work is therefore to review the MR-linac specific QA procedures reported in the literature.
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Affiliation(s)
- Hans Lynggaard Riis
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Joan Chick
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - David Tilly
- Department of Immunology, Genetics and Pathology, Medical Radiation Physics, Uppsala University, Uppsala, Sweden; Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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4
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Aldawsari AM, Al-Qaisieh B, Broadbent DA, Bird D, Murray L, Speight R. The role and potential of using quantitative MRI biomarkers for imaging guidance in brain cancer radiotherapy treatment planning: A systematic review. Phys Imaging Radiat Oncol 2023; 27:100476. [PMID: 37565088 PMCID: PMC10410581 DOI: 10.1016/j.phro.2023.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Background and purpose Improving the accuracy of brain tumour radiotherapy (RT) treatment planning is important to optimise patient outcomes. This systematic review investigates primary studies providing clinical evidence for the integration of quantitative magnetic resonance imaging (qMRI) biomarkers and MRI radiomics to optimise brain tumour RT planning. Materials and methods PubMed, Scopus, Embase and Web of Science databases were searched for all years until June 21, 2022. The search identified original articles demonstrating clinical evidence for the use of qMRI biomarkers and MRI radiomics for the optimization of brain cancer RT planning. Relevant information was extracted and tabulated, including qMRI metrics and techniques, impact on RT plan optimization and changes in target and normal tissue contouring and dose distribution. Results Nineteen articles met the inclusion criteria. Studies were grouped according to the qMRI biomarkers into: 1) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI; five studies); 2) diffusion tensor imaging (DTI; seven studies); and 3) MR spectroscopic imaging (MRSI; seven studies). No relevant MRI-based radiomics studies were identified. Integration of DTI maps offers the potential for improved organs at risk (OAR) sparing. MRSI metabolic maps are a promising technique for improving delineation accuracy in terms of heterogeneity and infiltration, with OAR sparing. No firm conclusions could be drawn regarding the integration of DWI metrics and PWI maps. Conclusions Integration of qMRI metrics into RT planning offers the potential to improve delineation and OAR sparing. Clinical trials and consensus guidelines are required to demonstrate the clinical benefits of such approaches.
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Affiliation(s)
- Abeer M. Aldawsari
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12371, Saudi Arabia
| | - Bashar Al-Qaisieh
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - David A. Broadbent
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - David Bird
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - Louise Murray
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7LP, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Richard Speight
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
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5
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Chick J, Alexander S, Herbert T, Huddart R, Ingle M, Mitchell A, Nill S, Oelfke U, Dunlop A, Hafeez S. Evaluation of non-vendor magnetic resonance imaging sequences for use in bladder cancer magnetic resonance image guided radiotherapy. Phys Imaging Radiat Oncol 2023; 27:100481. [PMID: 37655122 PMCID: PMC10465927 DOI: 10.1016/j.phro.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Hybrid systems that combine Magnetic Resonance Imaging (MRI) and linear accelerators are available clinically to guide and adapt radiotherapy. Vendor-approved MRI sequences are provided, however alternative sequences may offer advantages. The aim of this study was to develop a systematic approach for non-vendor sequence evaluation, to determine safety, accuracy and overall clinical application of two potential sequences for bladder cancer MRI guided radiotherapy. Non-vendor sequences underwent and passed clinical image qualitative review, phantom quality assurance, and radiotherapy planning assessments. Volunteer workflow tests showed the potential for one sequence to reduce workflow time by 27% compared to the standard vendor sequence.
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Affiliation(s)
- Joan Chick
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Sophie Alexander
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Trina Herbert
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Robert Huddart
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Manasi Ingle
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Adam Mitchell
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Simeon Nill
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Uwe Oelfke
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Alex Dunlop
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Shaista Hafeez
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
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Cook N, Shelton N, Gibson S, Barnes P, Alinaghi-Zadeh R, Jameson MG. ACPSEM position paper: the safety of magnetic resonance imaging linear accelerators. Phys Eng Sci Med 2023; 46:19-43. [PMID: 36847966 PMCID: PMC10030425 DOI: 10.1007/s13246-023-01224-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
Magnetic Resonance Imaging linear-accelerator (MRI-linac) equipment has recently been introduced to multiple centres in Australia and New Zealand. MRI equipment creates hazards for staff, patients and others in the MR environment; these hazards must be well understood, and risks managed by a system of environmental controls, written procedures and a trained workforce. While MRI-linac hazards are similar to the diagnostic paradigm, the equipment, workforce and environment are sufficiently different that additional safety guidance is warranted. In 2019 the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) formed the Magnetic Resonance Imaging Linear-Accelerator Working Group (MRILWG) to support the safe clinical introduction and optimal use of MR-guided radiation therapy treatment units. This Position Paper is intended to provide safety guidance and education for Medical Physicists and others planning for and working with MRI-linac technology. This document summarises MRI-linac hazards and describes particular effects which arise from the combination of strong magnetic fields with an external radiation treatment beam. This document also provides guidance on safety governance and training, and recommends a system of hazard management tailored to the MRI-linac environment, ancillary equipment, and workforce.
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Affiliation(s)
- Nick Cook
- Christchurch Hospital, Christchurch, New Zealand
| | - Nikki Shelton
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | | | | | - Reza Alinaghi-Zadeh
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia.
- University of New South Wales, Sydney, Australia.
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Grigo J, Masitho S, Fautz HP, Voigt R, Schonath M, Oleszczuk A, Uder M, Heiss R, Fietkau R, Putz F, Bert C. Usability of magnetic resonance images acquired at a novel low-field 0.55 T scanner for brain radiotherapy treatment planning. Phys Imaging Radiat Oncol 2023; 25:100412. [PMID: 36969504 PMCID: PMC10037089 DOI: 10.1016/j.phro.2023.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Background and Purpose Low-field magnetic resonance imaging (MRI) may offer specific advantages over high-field MRI, e.g. lower susceptibility-dependent distortions and simpler installation. The study aim was to evaluate if a novel 0.55 T MRI scanner provides sufficient image accuracy and quality for radiotherapy (RT) treatment planning. Material and methods The geometric accuracy of images acquired at a low-field MRI scanner was evaluated in phantom measurements regarding gradient non-linearity-related distortions. Patient-induced B0-susceptibility changes were investigated via B0-field-mapping in ten volunteers. Patients were positioned in RT-setup using a 3D-printed insert for the head/neck-coil that was tested for sufficient signal-to-noise-ratio (SNR). The suitability of the MRI-system for detection of metastases was evaluated in eleven patients. In comparison to diagnostic images, acquired at ≥1.5 T, three physicians evaluated the detectability of metastases by counting them in low- and high-field-images, respectively. Results The phantom measurements showed a high imaging fidelity after 3D-distortion-correction with (1.2 ± 0.9) mm geometric distortion in 10 cm radius from isocentre. At the edges remaining distortions were greater than at 1.5 T. The mean susceptibility-induced distortions in the head were (0.05 ± 0.05) mm and maximum 0.69 mm. SNR analysis showed that optimised positioning of RT-patients without signal loss in the head/neck-coil was possible with the RT-insert. No significant differences (p = 0.48) in detectability of metastases were found. Conclusion The 0.55 T MRI system provided sufficiently geometrically accurate and high-resolution images that can be used for RT-planning for brain metastases. Hence, modern low-field MRI may contribute to simply access MRI for RT-planning after further investigations.
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Goodburn RJ, Philippens MEP, Lefebvre TL, Khalifa A, Bruijnen T, Freedman JN, Waddington DEJ, Younus E, Aliotta E, Meliadò G, Stanescu T, Bano W, Fatemi‐Ardekani A, Wetscherek A, Oelfke U, van den Berg N, Mason RP, van Houdt PJ, Balter JM, Gurney‐Champion OJ. The future of MRI in radiation therapy: Challenges and opportunities for the MR community. Magn Reson Med 2022; 88:2592-2608. [PMID: 36128894 PMCID: PMC9529952 DOI: 10.1002/mrm.29450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.
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Affiliation(s)
- Rosie J. Goodburn
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | | | - Thierry L. Lefebvre
- Department of PhysicsUniversity of CambridgeCambridgeUnited Kingdom
- Cancer Research UK Cambridge Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Aly Khalifa
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Tom Bruijnen
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | | | - David E. J. Waddington
- Faculty of Medicine and Health, Sydney School of Health Sciences, ACRF Image X InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Eyesha Younus
- Department of Medical Physics, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric Aliotta
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Gabriele Meliadò
- Unità Operativa Complessa di Fisica SanitariaAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
| | - Teo Stanescu
- Department of Radiation Oncology, University of Toronto and Medical Physics, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Wajiha Bano
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Ali Fatemi‐Ardekani
- Department of PhysicsJackson State University (JSU)JacksonMississippiUSA
- SpinTecxJacksonMississippiUSA
- Department of Radiation OncologyCommunity Health Systems (CHS) Cancer NetworkJacksonMississippiUSA
| | - Andreas Wetscherek
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Uwe Oelfke
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Nico van den Berg
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Ralph P. Mason
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Petra J. van Houdt
- Department of Radiation OncologyNetherlands Cancer InstituteAmsterdamNetherlands
| | - James M. Balter
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Oliver J. Gurney‐Champion
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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Whiteside L, McDaid L, Hales RB, Rodgers J, Dubec M, Huddart RA, Choudhury A, Eccles CL. To see or not to see: Evaluation of magnetic resonance imaging sequences for use in MR Linac-based radiotherapy treatment. J Med Imaging Radiat Sci 2022; 53:362-373. [PMID: 35850925 DOI: 10.1016/j.jmir.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE This work evaluated the suitability of MR derived sequences for use in online adaptive RT workflows on a 1.5 Tesla (T) MR-Linear Accelerator (MR Linac). MATERIALS/METHODS Non-patient volunteers were recruited to an ethics approved MR Linac imaging study. Participants attended 1-3 imaging sessions in which a combination of DIXON, 2D and 3D volumetric T1 and T2 weighted images were acquired axially, with volunteers positioned using immobilisation devices typical for radiotherapy to the anatomical region being scanned. Images from each session were appraised by three independent reviewers to determine optimal sequences over six anatomical regions: head and neck, female and male pelvis, thorax (lung), thorax (breast/chest wall) and abdomen. Site specific anatomical structures were graded by the perceived ability to accurately contour a typical organ at risk. Each structure was independently graded on a 4-point Likert scale as 'Very Clear', 'Clear', 'Unclear' or 'Not visible' by observers, consisting of radiographers (therapeutic and diagnostic) and clinicians. RESULTS From July 2019 to September 2019, 18 non-patient volunteers underwent 24 imaging sessions in the following anatomical regions: head and neck (n=3), male pelvis (n=4), female pelvis (n=5), lung/oesophagus (n=5) abdomen (n=4) and chest wall/breast (n=3). T2 sequences were the most preferred for perceived ability to contour anatomy in both male and female pelvis. For all other sites T1 weighted DIXON sequences were most favourable. CONCLUSION This study has determined the preferential sequence selection for organ visualisation, as a pre-requisite to our institution adopting MR-guided radiotherapy for a more diverse range of disease sites.
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Affiliation(s)
- Lee Whiteside
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom.
| | - Lisa McDaid
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - Rosie B Hales
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - John Rodgers
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - Michael Dubec
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, United Kingdom
| | - Robert A Huddart
- The Institute of Cancer Research, London UK; The Royal Marsden, London, United Kingdom
| | - Ananya Choudhury
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, United Kingdom
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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10
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Daly M, McWilliam A, Radhakrishna G, Choudhury A, Eccles CL. Radiotherapy respiratory motion management in hepatobiliary and pancreatic malignancies: a systematic review of patient factors influencing effectiveness of motion reduction with abdominal compression. Acta Oncol 2022; 61:833-841. [PMID: 35611555 DOI: 10.1080/0284186x.2022.2073186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effectiveness of abdominal compression for motion management in hepatobiliary-pancreatic (HPB) radiotherapy has not been systematically evaluated. METHODS & MATERIALS A systematic review was carried out using PubMed/Medline, Cochrane Library, Web of Science, and CINAHL databases up to 1 July 2021. No date restrictions were applied. Additional searches were carried out using the University of Manchester digital library, Google Scholar and of retrieved papers' reference lists. Studies conducted evaluating respiratory motion utilising imaging with and without abdominal compression in the same patients available in English were included. Studies conducted in healthy volunteers or majority non-HPB sites, not providing descriptive motion statistics or patient characteristics before and after compression in the same patients or published without peer-review were excluded. A narrative synthesis was employed by tabulating retrieved studies and organising chronologically by abdominal compression device type to help identify patterns in the evidence. RESULTS The inclusion criteria were met by 6 studies with a total of 152 patients. Designs were a mix of retrospective and prospective quantitative designs with chronological, non-randomised recruitment. Abdominal compression reduced craniocaudal respiratory motion in the majority of patients, although in four studies there were increases seen in at least one direction. The influence of patient comorbidities on effectiveness of compression, and/or comfort with compression was not evaluated in any study. CONCLUSION Abdominal compression may not be appropriate for all patients, and benefit should be weighed with potential increase in motion or discomfort in patients with small initial motion (<5 mm). Patient factors including male sex, and high body mass index (BMI) were found to impact the effectiveness of compression, however with limited evidence. High-quality studies are warranted to fully assess the clinical impact of abdominal compression on treatment outcomes and toxicity prospective in comparison to other motion management strategies.
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Affiliation(s)
- Mairead Daly
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
| | | | - Ananya Choudhury
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
| | - Cynthia L Eccles
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
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11
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Nousiainen K, Mäkelä T, Peltonen JI. Characterizing geometric distortions of 3D sequences in clinical head MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2022; 35:983-995. [PMID: 35657535 PMCID: PMC9596562 DOI: 10.1007/s10334-022-01020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/20/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
Objective Phantoms are often used to estimate the geometric accuracy in magnetic resonance imaging (MRI). However, the distortions may differ between anatomical and phantom images. This study aimed to investigate the applicability of a phantom-based and a test-subject-based method in evaluating geometric distortion present in clinical head-imaging sequences. Materials and methods We imaged a 3D-printed phantom and test subjects with two MRI scanners using two clinical head-imaging 3D sequences with varying patient-table positions and receiver bandwidths. The geometric distortions were evaluated through nonrigid registrations: the displaced acquisitions were compared against the ideal isocenter positioning, and the varied bandwidth volumes against the volume with the highest bandwidth. The phantom acquisitions were also registered to a computed tomography scan. Results Geometric distortion magnitudes increased with larger table displacements and were in good agreement between the phantom and test-subject acquisitions. The effect of increased distortions with decreasing receiver bandwidth was more prominent for test-subject acquisitions. Conclusion Presented results emphasize the sensitivity of the geometric accuracy to positioning and imaging parameters. Phantom limitations may become an issue with some sequence types, encouraging the use of anatomical images for evaluating the geometric accuracy.
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Affiliation(s)
- Katri Nousiainen
- HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Department of Physics, University of Helsinki, Helsinki, Finland.
| | - Teemu Mäkelä
- HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Juha I Peltonen
- HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Theocharis S, Pappas EP, Seimenis I, Kouris P, Dellios D, Kollias G, Karaiskos P. Geometric distortion assessment in 3T MR images used for treatment planning in cranial Stereotactic Radiosurgery and Radiotherapy. PLoS One 2022; 17:e0268925. [PMID: 35605005 PMCID: PMC9126373 DOI: 10.1371/journal.pone.0268925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
Magnetic Resonance images (MRIs) are employed in brain Stereotactic Radiosurgery and Radiotherapy (SRS/SRT) for target and/or critical organ localization and delineation. However, MRIs are inherently distorted, which also impacts the accuracy of the Magnetic Resonance Imaging/Computed Tomography (MRI/CT) co-registration process. In this phantom-based study, geometric distortion is assessed in 3T T2-weighted images (T2WIs), while the efficacy of an MRI distortion correction technique is also evaluated. A homogeneous polymer gel-filled phantom was CT-imaged before being irradiated with 26 4-mm Gamma Knife shots at predefined locations (reference control points). The irradiated phantom was MRI-scanned at 3T, implementing a T2-weighted protocol suitable for SRS/SRT treatment planning. The centers of mass of all shots were identified in the 3D image space by implementing an iterative localization algorithm and served as the evaluated control points for MRI distortion detection. MRIs and CT images were spatially co-registered using a mutual information algorithm. The inverse transformation matrix was applied to the reference control points and compared with the corresponding MRI-identified ones to evaluate the overall spatial accuracy of the MRI/CT dataset. The mean image distortion correction technique was implemented, and resulting MRI-corrected control points were compared against the corresponding reference ones. For the scanning parameters used, increased MRI distortion (>1mm) was detected at areas distant from the MRI isocenter (>5cm), while median radial distortion was 0.76mm. Detected offsets were slightly higher for the MRI/CT dataset (0.92mm median distortion). The mean image distortion correction improves geometric accuracy, but residual distortion cannot be considered negligible (0.51mm median distortion). For all three datasets studied, a statistically significant positive correlation between detected spatial offsets and their distance from the MRI isocenter was revealed. This work contributes towards the wider adoption of 3T imaging in SRS/SRT treatment planning. The presented methodology can be employed in commissioning and quality assurance programmes of corresponding treatment workflows.
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Affiliation(s)
- Stefanos Theocharis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios P. Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kouris
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dellios
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kollias
- Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- * E-mail:
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Boulanger M, Nunes JC, Chourak H, Largent A, Tahri S, Acosta O, De Crevoisier R, Lafond C, Barateau A. Deep learning methods to generate synthetic CT from MRI in radiotherapy: A literature review. Phys Med 2021; 89:265-281. [PMID: 34474325 DOI: 10.1016/j.ejmp.2021.07.027] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE In radiotherapy, MRI is used for target volume and organs-at-risk delineation for its superior soft-tissue contrast as compared to CT imaging. However, MRI does not provide the electron density of tissue necessary for dose calculation. Several methods of synthetic-CT (sCT) generation from MRI data have been developed for radiotherapy dose calculation. This work reviewed deep learning (DL) sCT generation methods and their associated image and dose evaluation, in the context of MRI-based dose calculation. METHODS We searched the PubMed and ScienceDirect electronic databases from January 2010 to March 2021. For each paper, several items were screened and compiled in figures and tables. RESULTS This review included 57 studies. The DL methods were either generator-only based (45% of the reviewed studies), or generative adversarial network (GAN) architecture and its variants (55% of the reviewed studies). The brain and pelvis were the most commonly investigated anatomical localizations (39% and 28% of the reviewed studies, respectively), and more rarely, the head-and-neck (H&N) (15%), abdomen (10%), liver (5%) or breast (3%). All the studies performed an image evaluation of sCTs with a diversity of metrics, with only 36 studies performing dosimetric evaluations of sCT. CONCLUSIONS The median mean absolute errors were around 76 HU for the brain and H&N sCTs and 40 HU for the pelvis sCTs. For the brain, the mean dose difference between the sCT and the reference CT was <2%. For the H&N and pelvis, the mean dose difference was below 1% in most of the studies. Recent GAN architectures have advantages compared to generator-only, but no superiority was found in term of image or dose sCT uncertainties. Key challenges of DL-based sCT generation methods from MRI in radiotherapy is the management of movement for abdominal and thoracic localizations, the standardization of sCT evaluation, and the investigation of multicenter impacts.
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Affiliation(s)
- M Boulanger
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Jean-Claude Nunes
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
| | - H Chourak
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; CSIRO Australian e-Health Research Centre, Herston, Queensland, Australia
| | - A Largent
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, USA
| | - S Tahri
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - O Acosta
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - R De Crevoisier
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - C Lafond
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - A Barateau
- Univ. Rennes 1, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
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Speight R, Tyyger M, Schmidt MA, Liney G, Johnstone R, Eccles CL, Dubec M, George B, Henry A, Herbert T, Nyholm T, Mahmood F, Korhonen J, Sims R, Tijssen RHN, Vanhoutte F, Busoni S, Lacornerie T, McCallum H. IPEM Topical Report: an international IPEM survey of MRI use for external beam radiotherapy treatment planning. Phys Med Biol 2021; 66:075007. [PMID: 33631729 DOI: 10.1088/1361-6560/abe9f7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 11/12/2022]
Abstract
Introduction/Background. Despite growing interest in magnetic resonance imaging (MRI), integration in external beam radiotherapy (EBRT) treatment planning uptake varies globally. In order to understand the current international landscape of MRI in EBRT a survey has been performed in 11 countries. This work reports on differences and common themes identified.Methods. A multi-disciplinary Institute of Physics and Engineering in Medicine working party modified a survey previously used in the UK to understand current practice using MRI for EBRT treatment planning, investigate how MRI is currently used and managed as well as identify knowledge gaps. It was distributed electronically within 11 countries: Australia, Belgium, Denmark, Finland, France, Italy, the Netherlands, New Zealand, Sweden, the UK and the USA.Results. The survey response rate within the USA was <1% and hence these results omitted from the analysis. In the other 10 countries the survey had a median response rate of 77% per country. Direct MRI access, defined as either having a dedicated MRI scanner for radiotherapy (RT) or access to a radiology MRI scanner, varied between countries. France, Italy and the UK reported the lowest direct MRI access rates and all other countries reported direct access in ≥82% of centres. Whilst ≥83% of centres in Denmark and Sweden reported having dedicated MRI scanners for EBRT, all other countries reported ≤29%. Anatomical sites receiving MRI for EBRT varied between countries with brain, prostate, head and neck being most common. Commissioning and QA of image registration and MRI scanners varied greatly, as did MRI sequences performed, staffing models and training given to different staff groups. The lack of financial reimbursement for MR was a consistent barrier for MRI implementation for RT for all countries and MR access was a reported important barrier for all countries except Sweden and Denmark.Conclusion. No country has a comprehensive approach for MR in EBRT adoption and financial barriers are present worldwide. Variations between countries in practice, equipment, staffing models, training, QA and MRI sequences have been identified, and are likely to be due to differences in funding as well as a lack of consensus or guidelines in the literature. Access to dedicated MR for EBRT is limited in all but Sweden and Denmark, but in all countries there are financial challenges with ongoing per patient costs. Despite these challenges, significant interest exists in increasing MR guided EBRT planning over the next 5 years.
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Affiliation(s)
- Richard Speight
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Marcus Tyyger
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Maria A Schmidt
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Gary Liney
- Ingham Institute for Applied Medical Research & Liverpool Cancer Therapy Centre, Liverpool, Sydney, NSW 2170, Australia
| | - Robert Johnstone
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | - Michael Dubec
- The Christie NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | - Ben George
- University of Oxford and GenesisCare, Oxford, United Kingdom
| | - Ann Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom
| | - Trina Herbert
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Tufve Nyholm
- Department of Radiation Sciences, Umeå University, Sweden
| | - Faisal Mahmood
- Odense University Hospital, Laboratory of Radiation Physics, Odense, Denmark and University of Southern Denmark, Department of Clinical Research, Denmark
| | - Juha Korhonen
- Department of Medical Imaging and Radiation Therapy, Kymenlaakso Central Hospital, Kotka, Finland
| | - Rick Sims
- Auckland Radiation Oncology, Epsom, Auckland, New Zealand and Icon Cancer Centres, Cairns, QLD, Australia
| | - Rob H N Tijssen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Simone Busoni
- Department of Health Physics, AOU Careggi (Firenze University Hospital), Firenze, Italy
| | | | - Hazel McCallum
- Translational and Clinical Research Institute, Newcastle University and Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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