Imaging performance of a high-field in-line magnetic resonance imaging linear accelerator with a patient rotation system for fixed-gantry radiotherapy

This paper describes the imaging performance of a high-field in-line MRI linear accelerator with a patient rotation system in-situ. Signal quality was quantified using signal-to-noise ratio (SNR) and RF uniformity maps. B0-field inhomogeneity was assessed using magnetic field mapping. SNR was evaluated with various entries into the Faraday cage which were required for extended couch translations. SNR varied between 103 and 87 across PRS rotation angles. Maximum B0-field inhomogeneity corresponded to 0.7 mm of geometric distortion. A 45 × 55 cm² aperture allowed PRS translation with no reduction in SNR. Imaging performance with the PRS in-situ was found to be acceptable.

[Hybrid radiotherapy machines: Evolution or revolution?]

The arrival of new hybrid radiotherapy machines with MRI or PET is announced as a milestone in radiotherapy management. Based on recent literature, we will describe the contribution of each of these modalities and the technological challenges that have already been or are still to be addressed.

MR simulation for prostate radiation therapy: effect of coil mounting position on image quality

OBJECTIVE

To eliminate the effects of body deformation for MR-based prostate treatment planning, coil mounts are essential. In this study, we evaluated the effect of the coil set-up on image quality.

METHODS

A custom-designed pelvic-shaped phantom was scanned by systematically increasing the anterior body-to-coil (BTC) distance from 30 to 90 mm. The image quality near the organs of interest was determined in order to characterize the relationship between image quality and BTC distance at the critical organ structures. The half intensity reduction (HIR) was calculated to determine the sensitivity of each organ structure to the BTC distance change.

RESULTS

As the BTC distance increased, the uniformity reduced at 3% per millimetre. The HIR value indicated that the bladder signal is most sensitive to the change in BTC distance. By maintaining a constant BTC distance set-up, the intensity uniformity was improved by 28% along the B0 directions.

CONCLUSION

Positioning the MRI coil on mounts can reduce body deformation but adversely degrades the image quality. The magnitude of this effect has been quantified for prostate MR simulation scanning. The coil needs to be positioned not only with a minimal but also uniform BTC distance in order to maximize image quality.

ADVANCES IN KNOWLEDGE

A method to characterize the effect on image quality due to the use of coil mounts was demonstrated. Coil mounts whose height can be adjusted individually to keep BTC distance constant are necessary to maintain a uniform image across the entire field of view.

Future radiation therapy: photons, protons and particles

Radiation therapy plays a critical role in the current management of cancer patients. The most common linear accelerator-based treatment device delivers photons of radiation. In an ever more precise fashion, state-of-the-art technology has recently allowed for both modulation of the radiation beam and imaging for this treatment delivery. This has resulted in better patient outcome with far fewer side effects than were achieved even a decade ago. Recently, a push has begun for proton therapy, which may have clinical advantage in select indications, although significant limitations for these devices have become apparent. In addition, currently, heavy particle therapy has been touted as a potential means to improve cancer patient outcomes. This article will highlight current benefits and drawbacks to modern radiation therapy and speculate on future tools that will likely dramatically improve radiation oncology.

Consistency evaluation between EGSnrc and Geant4 charged particle transport in an equilibrium magnetic field

Following the proposal by several groups to integrate magnetic resonance imaging (MRI) with radiation therapy, much attention has been afforded to examining the impact of strong (on the order of a Tesla) transverse magnetic fields on photon dose distributions. The effect of the magnetic field on dose distributions must be considered in order to take full advantage of the benefits of real-time intra-fraction imaging. In this investigation, we compared the handling of particle transport in magnetic fields between two Monte Carlo codes, EGSnrc and Geant4, to analyze various aspects of their electromagnetic transport algorithms; both codes are well-benchmarked for medical physics applications in the absence of magnetic fields. A water-air-water slab phantom and a water-lung-water slab phantom were used to highlight dose perturbations near high- and low-density interfaces. We have implemented a method of calculating the Lorentz force in EGSnrc based on theoretical models in literature, and show very good consistency between the two Monte Carlo codes. This investigation further demonstrates the importance of accurate dosimetry for MRI-guided radiation therapy (MRIgRT), and facilitates the integration of a ViewRay MRIgRT system in the University of Wisconsin-Madison's Radiation Oncology Department.