Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects

Lombardo, Elia; Dhont, Jennifer; Page, Denis; Garibaldi, Cristina; Künzel, Luise A.; Hurkmans, Coen; Tijssen, Rob H.N.; Paganelli, Chiara; Liu, Paul Z.Y.; Keall, Paul J.; Riboldi, Marco; Kurz, Christopher; Landry, Guillaume; Cusumano, Davide; Fusella, Marco; Placidi, Lorenzo

doi:10.1016/j.radonc.2023.109970

Cited by 11 publications

(3 citation statements)

References 104 publications

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“…These changes can be tumour shrinkage/growth, patient’s weight gain/loss, or differences in the filling of the stomach, bowel, rectum, bladder and cavities [115] . Thus, adaptive strategies have gained a large interest in the radiotherapy community, not only as stand-alone concepts but also in combination with intrafractional motion management strategies [116] , [117] . Especially in PT adaptive solutions are favourable to compensate for the sensitivity of particle range to density variations along the beam path [118] .…”

Section: Technological Capabilities For Motion Managementmentioning

confidence: 99%

A review of the clinical introduction of 4D particle therapy research concepts

Knäusl,

Belotti,

Bertholet

et al. 2024

Physics and Imaging in Radiation Oncology

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Section: Technological Capabilities For Motion Managementmentioning

confidence: 99%

A review of the clinical introduction of 4D particle therapy research concepts

Knäusl,

Belotti,

Bertholet

et al. 2024

Physics and Imaging in Radiation Oncology

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“…Accurate LV determination by reliable, effective contouring is paramount to accurately quantify e.g., D mean and V20% [38] . For its use in online-adaptive, conventional radiotherapy (RT) under image guidance, such as MR-guided RT (MRgRT), computational speed could also be crucial [39] . While CT-based 4D-PBS-PT planning benefits from an extensive software toolbox for automated lung contouring and volume determination, the availability of such programs for MRI-based segmentation is extremely limited.…”

Section: Introductionmentioning

confidence: 99%

Automatic lung segmentation of magnetic resonance images: A new approach applied to healthy volunteers undergoing enhanced Deep-Inspiration-Breath-Hold for motion-mitigated 4D proton therapy of lung tumors

Missimer,

Emert,

Lomax

et al. 2024

Physics and Imaging in Radiation Oncology

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“…An often cited rule of thumb is that to compensate for respiratory motion, the maximum time budget for this entire image-track-adapt cycle is 500 ms. Over the last years, many promising attempts have been made to unify MRI with real-time adaptation. 175 Here, we see again an interesting role for deep learning, as trained neural networks are one of the fastest known methods able to accurately infer a very large amount of information like volumetric motion fields 176 and accompanying uncertainties 177 from very minimal MRI data.…”

Section: Accelerating Treatmentmentioning

confidence: 96%

Advancing the frontiers of MR-guided radiotherapy for pancreatic cancer

Grimbergen

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Pancreatic cancer is among the deadliest types of cancer, and effective and safe treatment remains challenging. MR-guided radiotherapy, a noninvasive, low-toxic, local treatment, has recently emerged as a new treatment option for inoperable pancreatic cancer. The aim of this thesis was to explore several technical developments for the planning and delivery of radiotherapy for pancreatic cancer on the 1.5 T MR-Linac. These developments are needed to transform contemporary MR-guided radiotherapy into a next-generation treatment for pancreatic cancer, which extensively capitalizes on the capabilities of the 1.5 T MR-Linac. In the first part of this thesis, we focused on (online adaptive) treatment planning. The conventional MRI sequences for online treatment adaptation are prone to blurring artifacts due to respiratory motion, but we found that motion-robust radial MRI sequences can result in much sharper, higher quality images, potentially increasing delineation accuracy and speed. Next, we founded a worldwide consortium of MR-Linac centers to create a consensus protocol on treatment planning for pancreatic cancer. We hope that this collaboration will harmonize the large variations currently found in protocols and strategies between centers around the world that treat pancreatic cancer on the 1.5 T MR-Linac. The second part revolved around intrafraction motion and treatment delivery. The onboard imaging system of the MR-Linac allowed us to fully characterize pancreatic tumor motion during treatment, in terms of respiratory motion, tumor drift, and their respective variations on a day-to-day and patient-to-patient basis. The measured intrafraction motion was used for retrospective dose calculation, thereby allowing us to evaluate whether the tumor motion during irradiation had lead to dosimetric errors such as tumor underdosage or OAR overdosage. We found that this dosimetric impact is generally modest, but small drifts are potentially much more problematic than large respiratory amplitudes. We further developed intrafraction dose accumulation by designing a 3D dynamic MRI scan capable of capturing complete volumetric information in real-time, allowing for advanced deformable dose accumulation. Lastly, we report on the first patients, all with upper abdominal tumors, treated with active motion management on the 1.5 T MR-Linac. This system is capable of fully MR-based respiratory gating, and is enhanced with baseline drift correction capabilities. We showed through dosimetric analysis that this system improves congruence between the planned dose and delivered dose. To conclude, MR-guided radiotherapy has opened the way for a new, safe, local treatment for inoperable pancreatic cancer. The full potential of the MR-Linac, however, has been far from realized. This thesis has shown that MRI is an incredibly versatile tool that can be used in every facet of the online adaptive workflow, allowing us to gain more insight into the treatment and ultimately optimizing the planning and delivery. Ablative radiotherapy for pancreatic cancer with the 1.5 T MR-Linac is one of the most intricate procedures in external beam radiotherapy, and the ongoing developments will only further increase complexity. Therefore, the informal dissemination of clinical experiences and treatment techniques, as well as collaboration between MR-Linac centers, remains crucial for further advancement of radiotherapy for pancreatic cancer.

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Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects

Cited by 11 publications

References 104 publications

A review of the clinical introduction of 4D particle therapy research concepts

A review of the clinical introduction of 4D particle therapy research concepts

Automatic lung segmentation of magnetic resonance images: A new approach applied to healthy volunteers undergoing enhanced Deep-Inspiration-Breath-Hold for motion-mitigated 4D proton therapy of lung tumors

Advancing the frontiers of MR-guided radiotherapy for pancreatic cancer

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