To enable real-time adaptive magnetic resonance imaging-guided radiotherapy (MRIgRT) by obtaining time-resolved three-dimensional (3D) deformation vector fields (DVFs) with high spatiotemporal resolution and low latency (< 500 ms). Theory and Methods:Respiratory-resolved T 1 -weighted 4D-MRI of 27 patients with lung cancer were acquired using a golden-angle radial stack-of -stars readout. A multiresolution convolutional neural network (CNN) called TEMPEST was trained on up to 32× retrospectively undersampled MRI of 17 patients, reconstructed with a nonuniform fast Fourier transform, to learn optical flow DVFs. TEMPEST was validated using 4D respiratory-resolved MRI, a digital phantom, and a physical motion phantom. The time-resolved motion estimation was evaluated in-vivo using two volunteer scans, acquired on a hybrid MR-scanner with integrated linear accelerator. Finally, we evaluated the model robustness on a publicly-available four-dimensional computed tomography (4D-CT) dataset. Results: TEMPEST produced accurate DVFs on respiratory-resolved MRI at 20-fold acceleration, with the average end-point-error < 2 mm, both on respiratory-sorted MRI and on a digital phantom. TEMPEST estimated accurate time-resolved DVFs on MRI of a motion phantom, with an error < 2 mm at 28× undersampling. On two volunteer scans, TEMPEST accurately estimated motion compared to the self -navigation signal using 50 spokes per dynamic (366× undersampling).At this undersampling factor,DVFs were estimated within 200 ms, including MRI acquisition. On fully sampled CT data, we achieved a target registration error of 1.87 ± 1.65 mm without retraining the model.
Conclusion:A CNN trained on undersampled MRI produced accurate 3D DVFs with high spatiotemporal resolution for MRIgRT.