MRI-guided mid-position liver radiotherapy: Validation of image processing and registration steps

Lindt, Tessa N. van de; Fast, Martin F.; Kranen, S. Van; Nowee, Marlies E.; Jansen, E.P.M.; Heide, Uulke A. van der; Sonke, Jan‐Jakob

doi:10.1016/j.radonc.2019.06.007

Cited by 30 publications

(20 citation statements)

References 34 publications

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“…In the present study an ITV concept was applied for motion management. Alternative motion management strategies such as MLC-tracking, a ''mid-position approach" or respiratory gating including audiovisual feedback are currently studied or already in routine use [19,[28][29][30]. All these techniques come with specific advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac – Feasibility, workflow data and patient acceptance

Gani

Boeke

McNair

et al. 2021

Clinical and Translational Radiation Oncology

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Introduction: Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac. Methods: Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5. Results: Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from ''patient identity check" until ''beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months). Conclusion: Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT.

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Section: Discussionmentioning

confidence: 99%

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac – Feasibility, workflow data and patient acceptance

Gani

Boeke

McNair

et al. 2021

Clinical and Translational Radiation Oncology

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“…Available motion management strategies to compensate for intrafractional breathing-related organ motion in conventional image-guided liver SBRT can be categorized into: 1) non-gated techniques (with or without mechanical abdominal compression) using the adoption of the ITV or mid-position concept; 2) respiratory-gated techniques, including use of a breath-hold ‘immobilization’ approach; or 3) real-time tumor tracking ( 73 , 74 ). Due to the relatively poor soft tissue contrast in conventional SBRT using CBCT, frequently the tumor cannot be directly visualized, and implantation of fiducial markers next to the tumor or other surrogates is needed to facilitate image-guidance ( 75 , 76 ).…”

Section: Motion Management For Liver Mrgrtmentioning

confidence: 99%

MR-Guided Radiotherapy for Liver Malignancies

et al. 2021

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MR guided radiotherapy represents one of the most promising recent technological innovations in the field. The possibility to better visualize therapy volumes, coupled with the innovative online adaptive radiotherapy and motion management approaches, paves the way to more efficient treatment delivery and may be translated in better clinical outcomes both in terms of response and reduced toxicity. The aim of this review is to present the existing evidence about MRgRT applications for liver malignancies, discussing the potential clinical advantages and the current pitfalls of this new technology.

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“…Furthermore, plan adaptation according to daily position of target volume and organs at risk (OAR) can be effectively performed using cone beam CT (CBCT) or MRI available at the treatment machine [11]. Depending on the anatomical position, 4D-imaging to account for intra-fraction motion may be required to provide the technology for online adaptive image-guided radiation therapy [12][13][14][15]. Finally, a number of studies have identified multiparametric functional imaging as an ideal tool to assess dedicated molecular biomarkers containing information about biological characteristics or response prognosis with respect to outcome [16][17][18][19].…”

Section: Imagingmentioning

confidence: 99%

Adapting training for medical physicists to match future trends in radiation oncology

Clark

Gagliardi

Heijmen

et al. 2019

Physics and Imaging in Radiation Oncology

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MRI-guided mid-position liver radiotherapy: Validation of image processing and registration steps

Cited by 30 publications

References 34 publications

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac – Feasibility, workflow data and patient acceptance

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac – Feasibility, workflow data and patient acceptance

MR-Guided Radiotherapy for Liver Malignancies

Adapting training for medical physicists to match future trends in radiation oncology

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