Dosimetric validation of a magnetic resonance image gated radiotherapy system using a motion phantom and radiochromic film.

PurposeMagnetic resonance image (MRI) guided radiotherapy enables gating directly on the target position. We present an evaluation of an MRI-guided radiotherapy system's gating performance using an MRI-compatible respiratory motion phantom and radiochromic film. Our evaluation is geared toward validation of our institution's clinical gating protocol which involves planning to a target volume formed by expanding 5 mm about the gross tumor volume (GTV) and gating based on a 3 mm window about the GTV.MethodsThe motion phantom consisted of a target rod containing high-contrast target inserts which moved in the superior-inferior direction inside a body structure containing background contrast material. The target rod was equipped with a radiochromic film insert. Treatment plans were generated for a 3 cm diameter spherical planning target volume, and delivered to the phantom at rest and in motion with and without gating. Both sinusoidal trajectories and tumor trajectories measured during MRI-guided treatments were used. Similarity of the gated dose distribution to the planned, motion-frozen, distribution was quantified using the gamma technique.ResultsWithout gating, gamma pass rates using 4%/3 mm criteria were 22-59% depending on motion trajectory. Using our clinical standard of repeated breath holds and a gating window of 3 mm with 10% target allowed outside the gating boundary, the gamma pass rate was 97.8% with 3%/3 mm gamma criteria. Using a 3 mm window and 10% allowed excursion, all of the patient tumor motion trajectories at actual speed resulting in at least 95% gamma pass rate at 4%/3 mm.ConclusionsOur results suggest that the device can be used to compensate respiratory motion using a 3 mm gating margin and 10% allowed excursion results in conjunction with repeated breath holds. Full clinical validation requires a comprehensive evaluation of tracking performance in actual patient images, outside the scope of this study

Expanding the use of real-time electromagnetic tracking in radiation oncology.

In the past 10 years, techniques to improve radiotherapy delivery, such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT) for both inter- and intrafraction tumor localization, and hypofractionated delivery techniques such as stereotactic body radiation therapy (SBRT), have evolved tremendously. This review article focuses on only one part of that evolution, electromagnetic tracking in radiation therapy. Electromagnetic tracking is still a growing technology in radiation oncology and, as such, the clinical applications are limited, the expense is high, and the reimbursement is insufficient to cover these costs. At the same time, current experience with electromagnetic tracking applied to various clinical tumor sites indicates that the potential benefits of electromagnetic tracking could be significant for patients receiving radiation therapy. Daily use of these tracking systems is minimally invasive and delivers no additional ionizing radiation to the patient, and these systems can provide explicit tumor motion data. Although there are a number of technical and fiscal issues that need to be addressed, electromagnetic tracking systems are expected to play a continued role in improving the precision of radiation delivery

MRI of the lung (3/3)-current applications and future perspectives

BACKGROUND: MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. METHODS: Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. RESULTS: In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a "buffet" of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. CONCLUSION: New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations

Focal Spot, Spring 2004

https://digitalcommons.wustl.edu/focal_spot_archives/1096/thumbnail.jp

Magnetic resonance imaging of lung cancer in the presence of respiratory motion: Dynamic keyhole and audio visual biofeedback

Breath-to-breath variations in breathing can cause image artefacts. Day-to-day variations can cause a disagreement of position and volume between planning and treatment throughout radiotherapy procedures, requiring a larger treatment margin and longer treatment time. An advanced radiotherapy system requires: (1) a fast imaging technique for the compensation of breathing variations and/or (2) a respiratory motion management technique for the control of breathing variations. A novel MRI reconstruction method called “Dynamic keyhole” was proposed as a fast imaging technique. This thesis investigated (1) the concept of this method in terms of the improvement in temporal resolution with healthy volunteer MRI datasets and (2) the applicability of real-time lung tumour localization in terms of the accuracy of tumour motion and shape with lung cancer patient MRI datasets. The dynamic keyhole method achieved an increase in imaging frequency by up to a factor of five when compared with full k-space methods whilst achieving sub-millimetre tumour motion accuracy and preserving tumour shape within 98%. AV biofeedback respiratory guidance was used for healthy volunteers and lung cancer patients. This thesis investigated the impact of AV biofeedback on (1) intra- and inter-fraction lung tumour motion using cine-MRI, (2) inter-fraction lung tumour position and intra-fraction tumour volume using breath-hold MRI and (3) the improvement in image quality and the reduction in scan time using respiratory-gated MRI. AV biofeedback respiratory guidance improved intra- and inter-fraction tumour motion and position reproducibility, and intra-fraction tumour volume consistency. In addition, it was found to improve image quality and reduce scan time. The performance of the dynamic keyhole method and AV biofeedback respiratory guidance shown in this thesis illustrates potential advantages of real-time tumour imaging and tumour motion management in the course of lung cancer radiotherapy

Feasibility of automated 3-dimensional magnetic resonance imaging pancreas segmentation.

PurposeWith the advent of MR guided radiotherapy, internal organ motion can be imaged simultaneously during treatment. In this study, we evaluate the feasibility of pancreas MRI segmentation using state-of-the-art segmentation methods.Methods and materialT2 weighted HASTE and T1 weighted VIBE images were acquired on 3 patients and 2 healthy volunteers for a total of 12 imaging volumes. A novel dictionary learning (DL) method was used to segment the pancreas and compared to t mean-shift merging (MSM), distance regularized level set (DRLS), graph cuts (GC) and the segmentation results were compared to manual contours using Dice's index (DI), Hausdorff distance and shift of the-center-of-the-organ (SHIFT).ResultsAll VIBE images were successfully segmented by at least one of the auto-segmentation method with DI >0.83 and SHIFT ≤2 mm using the best automated segmentation method. The automated segmentation error of HASTE images was significantly greater. DL is statistically superior to the other methods in Dice's overlapping index. For the Hausdorff distance and SHIFT measurement, DRLS and DL performed slightly superior to the GC method, and substantially superior to MSM. DL required least human supervision and was faster to compute.ConclusionOur study demonstrated potential feasibility of automated segmentation of the pancreas on MRI images with minimal human supervision at the beginning of imaging acquisition. The achieved accuracy is promising for organ localization

Focal Spot, Fall/Winter 2000

https://digitalcommons.wustl.edu/focal_spot_archives/1086/thumbnail.jp

Focal Spot, Fall/Winter 2002/2003

https://digitalcommons.wustl.edu/focal_spot_archives/1092/thumbnail.jp