Nuts and bolts of 4D-MRI for radiotherapy

Magnetic resonance imaging (MRI) is increasingly being used in the radiotherapy workflow because of its superior soft tissue contrast and high flexibility in contrast. In addition to anatomical and functional imaging, MRI can also be used to characterize the physiologically induced motion of both the tumor and organs-at-risk. Respiratory-correlated 4D-MRI has gained large interest as an alternative to 4D-CT for the characterization of respiratory motion throughout the thorax and abdomen. These 4D-MRI data sets consist of three spatial dimensions and the respiratory phase or amplitude over the fourth dimension (opposed to time-resolved 4D-MRI that represents time in the fourth dimension). Over the last 15 years numerous methods have been presented in literature. This review article provides a comprehensive overview of the various 4D-MRI techniques, and describes the differences in MRI data acquisition and 4D data set generation from a methodological point of view. The current status and future perspective of these techniques are highlighted, and the requirements for safe introduction into the clinic (e.g. method validation) are discussed

Image-driven, model-based 3D abdominal motion estimation for MR-guided radiotherapy

Respiratory motion introduces substantial uncertainties in abdominal radiotherapy for which traditionally large margins are used. The MR-Linac will open up the opportunity to acquire high resolution MR images just prior to radiation and during treatment. However, volumetric MRI time series are not able to characterize 3D tumor and organ-at-risk motion with sufficient temporal resolution. In this study we propose a method to estimate 3D deformation vector fields (DVFs) with high spatial and temporal resolution based on fast 2D imaging and a subject-specific motion model based on respiratory correlated MRI. In a pre-beam phase, a retrospectively sorted 4D-MRI is acquired, from which the motion is parameterized using a principal component analysis. This motion model is used in combination with fast 2D cine-MR images, which are acquired during radiation, to generate full field-of-view 3D DVFs with a temporal resolution of 476 ms. The geometrical accuracies of the input data (4D-MRI and 2D multi-slice acquisitions) and the fitting procedure were determined using an MR-compatible motion phantom and found to be 1.0-1.5 mm on average. The framework was tested on seven healthy volunteers for both the pancreas and the kidney. The calculated motion was independently validated using one of the 2D slices, with an average error of 1.45 mm. The calculated 3D DVFs can be used retrospectively for treatment simulations, plan evaluations, or to determine the accumulated dose for both the tumor and organs-at-risk on a subject-specific basis in MR-guided radiotherapy

Estimating dynamic 3D abdominal motion for radiation dose accumulation mapping using a PCA-based model and 2D navigators

International audienc

Optimal MRI sampling and binning for online 4D retrospective respiratory motion analysis of the abdomen

International audienc

Image-driven, model-based 3D abdominal motion estimation for MR-guided radiotherapy

Respiratory motion introduces substantial uncertainties in abdominal radiotherapy for which traditionally large margins are used. The MR-Linac will open up the opportunity to acquire high resolution MR images just prior to radiation and during treatment. However, volumetric MRI time series are not able to characterize 3D tumor and organ-at-risk motion with sufficient temporal resolution. In this study we propose a method to estimate 3D deformation vector fields (DVFs) with high spatial and temporal resolution based on fast 2D imaging and a subject-specific motion model based on respiratory correlated MRI. In a pre-beam phase, a retrospectively sorted 4D-MRI is acquired, from which the motion is parameterized using a principal component analysis. This motion model is used in combination with fast 2D cine-MR images, which are acquired during radiation, to generate full field-of-view 3D DVFs with a temporal resolution of 476 ms. The geometrical accuracies of the input data (4D-MRI and 2D multi-slice acquisitions) and the fitting procedure were determined using an MR-compatible motion phantom and found to be 1.0-1.5 mm on average. The framework was tested on seven healthy volunteers for both the pancreas and the kidney. The calculated motion was independently validated using one of the 2D slices, with an average error of 1.45 mm. The calculated 3D DVFs can be used retrospectively for treatment simulations, plan evaluations, or to determine the accumulated dose for both the tumor and organs-at-risk on a subject-specific basis in MR-guided radiotherapy

A planning strategy for combined motion-assisted/gated MR guided focused ultrasound treatment of the pancreas

Objective: To develop and evaluate a combined motion-assisted/gated MRHIFU heating strategy designed to accelerate the treatment procedure by reducing the required number of sonications to ablate a target volume in the pancreas. Methods: A planning method for combined motion-assisted/gated MRHIFU using 4D-MRI and motion characterization is introduced. Six healthy volunteers underwent 4D-MRI for target motion characterization on a 3.0-T clinical scanner. Using displacement patterns, simulations were performed for all volunteers for three sonication approaches: gated, combined motion-assisted/gated, and static. The number of sonications needed to ablate the pancreas head was compared. The influence of displacement amplitude and target volume size was investigated. Spherical target volumes (8, 15, 20 and 34 mL) and displacement amplitudes ranging from 5 to 25 mm were evaluated. For this case, the number of sonications required to ablate the whole target was determined. Results: The number of required sonications was lowest for a static target, 62 on average (range 49-78). The gated approach required most sonications, 126 (range 97-159). The combined approach was almost as efficient as the hypothetical static case, with an average of 78 (range 53-123). Simulations showed that with a 5-mm displacement amplitude, the target could be treated by making use of motion-assisted MRHIFU sonications only. In that case, this approach allowed the lowest number of sonication, while for 10 mm and above, the number of required sonications increased. Conclusion: The use of a combined motion-assisted/gated MRHIFU strategy may accelerate tumor ablation in the pancreas when respiratory-induced displacement amplitudes are between 5 and 10 mm

A planning strategy for combined motion-assisted/gated MR guided focused ultrasound treatment of the pancreas

Objective: To develop and evaluate a combined motion-assisted/gated MRHIFU heating strategy designed to accelerate the treatment procedure by reducing the required number of sonications to ablate a target volume in the pancreas. Methods: A planning method for combined motion-assisted/gated MRHIFU using 4D-MRI and motion characterization is introduced. Six healthy volunteers underwent 4D-MRI for target motion characterization on a 3.0-T clinical scanner. Using displacement patterns, simulations were performed for all volunteers for three sonication approaches: gated, combined motion-assisted/gated, and static. The number of sonications needed to ablate the pancreas head was compared. The influence of displacement amplitude and target volume size was investigated. Spherical target volumes (8, 15, 20 and 34 mL) and displacement amplitudes ranging from 5 to 25 mm were evaluated. For this case, the number of sonications required to ablate the whole target was determined. Results: The number of required sonications was lowest for a static target, 62 on average (range 49-78). The gated approach required most sonications, 126 (range 97-159). The combined approach was almost as efficient as the hypothetical static case, with an average of 78 (range 53-123). Simulations showed that with a 5-mm displacement amplitude, the target could be treated by making use of motion-assisted MRHIFU sonications only. In that case, this approach allowed the lowest number of sonication, while for 10 mm and above, the number of required sonications increased. Conclusion: The use of a combined motion-assisted/gated MRHIFU strategy may accelerate tumor ablation in the pancreas when respiratory-induced displacement amplitudes are between 5 and 10 mm

A planning strategy for combined self-scanned/gated MR- HIFU treatment in the pancreas

International audienc

A planning strategy for combined self-scanned/gated MR- HIFU treatment in the pancreas

International audienc

Optimizing 4-dimensional magnetic resonance imaging data sampling for respiratory motion analysis of pancreatic tumors

Purpose: To determine the optimum sampling and binning strategy for retrospective reconstruction of 4D-MR data for non-rigid motion characterization of tumor and organs at risk for radiotherapy purposes. Material and Methods: For optimization, we compared two surrogate signals (external respiratory bellows and internal MR navigator), three binning methods (absolute amplitude, phase and a hybrid method, relative amplitude binning) and two MR sampling strategies (cartesian and radial) in terms of efficiency, image quality and robustness. Using the optimized protocol, three pancreatic cancer patients were scanned to calculate the 4D motion. ROI analysis was performed to characterize the respiratory induced motion of the tumor and organs at risk simultaneously.Results: The MRI navigator was found to be a more reliable surrogate for pancreatic motion than the respiratory bellows signal. Relative amplitude binning offered the best binning in terms of filling efficiency and intra-phase amplitude variation. Radial sampling is most benign for undersampling artifacts and intra-view motion. Motion characterization revealed inter-organ and inter-patient variation, as well as heterogeneity within the tumor. Conclusions: A robust 4D-MRI method, based on clinically available protocols, is presented and successfully applied to characterize the abdominal motion in pancreatic cancer patients