MR‐linac is the best modality for lung SBRT

Godley, A.; Zheng, Dandan; Rong, Yi

doi:10.1002/acm2.12615

Cited by 9 publications

(10 citation statements)

References 39 publications

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“…Though still currently in its early stages and rapidly developing, MR-linacs together with 4D imaging capabilities will likely enable lung SBRT to become an even powerful contender at treating inoperable NSCLC in the near future. 89,132,[338][339][340] 5. SUMMARY OF KEY POINTS…”

Section: B Investigated Solutionsmentioning

confidence: 99%

“…In the meantime, scan sequences can be exploited to produce 2D cine‐MRI orthogonal images in order to obtain pseudo‐3D information. Though still currently in its early stages and rapidly developing, MR‐linacs together with 4D imaging capabilities will likely enable lung SBRT to become an even powerful contender at treating inoperable NSCLC in the near future 89,132,338–340 …”

Section: Daily Image Guidance Of Lung Treatmentsmentioning

confidence: 99%

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A modern review of the uncertainties in volumetric imaging of respiratory‐induced target motion in lung radiotherapy

Vergalasova

Cai

2020

Medical Physics

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Radiotherapy has become a critical component for the treatment of all stages and types of lung cancer, often times being the primary gateway to a cure. However, given that radiation can cause harmful side effects depending on how much surrounding healthy tissue is exposed, treatment of the lung can be particularly challenging due to the presence of moving targets. Careful implementation of every step in the radiotherapy process is absolutely integral for attaining optimal clinical outcomes. With the advent and now widespread use of stereotactic body radiation therapy (SBRT), where extremely large doses are delivered, accurate, and precise dose targeting is especially vital to achieve an optimal risk to benefit ratio. This has largely become possible due to the rapid development of image-guided technology. Although imaging is critical to the success of radiotherapy, it can often be plagued with uncertainties due to respiratory-induced target motion. There has and continues to be an immense research effort aimed at acknowledging and addressing these uncertainties to further our abilities to more precisely target radiation treatment. Thus, the goal of this article is to provide a detailed review of the prevailing uncertainties that remain to be investigated across the different imaging modalities, as well as to highlight the more modern solutions to imaging motion and their role in addressing the current challenges.

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Section: B Investigated Solutionsmentioning

confidence: 99%

Section: Daily Image Guidance Of Lung Treatmentsmentioning

confidence: 99%

A modern review of the uncertainties in volumetric imaging of respiratory‐induced target motion in lung radiotherapy

Vergalasova

Cai

2020

Medical Physics

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“…MRgRT for certain treatments such as lung SBRT. 10 A second advantage sliding window IMRT and VMAT have over step-and-shoot delivery is reduced treatment time. 8 Faster treatments have the benefits of increasing throughput (so that more patients can benefit from the treatment) and decreasing discomfort (from, e.g., positional strain or a full bladder).…”

Section: Introductionmentioning

confidence: 99%

“…The dosimetric improvements include better dose homogeneity, PTV coverage, and OAR sparing. This has, in part, been used as an argument for VMAT being a better choice than MRgRT for certain treatments such as lung SBRT 10 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of cine imaging during multileaf collimator and gantry motion for real‐time magnetic resonance guided radiation therapy

Kielbasa

Meeks

Kelly

et al. 2020

J Applied Clin Med Phys

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Real-time magnetic resonance guided radiation therapy (MRgRT) uses 2D cine imaging for target tracking. This work evaluates the percent image uniformity (PIU) and spatial integrity of cine images in the presence of multileaf collimator (MLC) and gantry motion in order to simulate sliding window and volumetric modulated arc therapy (VMAT) conditions. Methods: Percent image uniformity and spatial integrity of cine images were measured (1) during MLC motion, (2) as a function of static gantry position, and (3) during gantry rotation. PIU was calculated according to the ACR MRI Quality Control Manual. Spatial integrity was evaluated by measuring the geometric distortion of 16 measured marker positions (10 cm or 15.225 cm from isocenter). Results: The PIU of cine images did not vary by more than 1% from static linac conditions during MLC motion and did not vary by more than 3% during gantry rotation. Banding artifacts were present during gantry rotation. The geometric distortion in the cine images was less than 0.88 mm for all points measured throughout MLC motion. For all static gantry positions, the geometric distortion was less than 0.88 mm at 10 cm from isocenter and less than 1.4 mm at 15.225 cm from isocenter. During gantry rotation, the geometric distortion remained less than 0.92 mm at 10 cm from isocenter and less than 1.60 mm at 15.225 cm from isocenter. Conclusion: During MLC motion, cine images maintained adequate PIU, and the geometric distortion of points within 15.225 cm from isocenter was less than the 1 mm threshold necessary for real-time target tracking and gating. During gantry rotation, PIU was negatively affected by banding artifacts, and spatial integrity was only maintained within 10 cm from isocenter. Future work should investigate the effects imaging artifacts have on real-time target tracking during MRgRT.

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“…MRI-LINACs combine an MRI with a LINAC, where the MRI enables imaging of the patients with optimal soft tissue contrast while the LINAC delivers radiation therapy [1]. MRI-LINACs present a unique opportunity to achieve real-time adaptive radiation therapy and reduce the margins of treatment volumes [2].…”

Section: Introductionmentioning

confidence: 99%