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High-Field MRI In-Room Guidance for Radiotherapy Adaptation

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Imaging and Interventional Radiology for Radiation Oncology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Intra-fractional motion is the main source of uncertainty when targeting treatment sites in the thorax and upper abdomen. Predominately periodic respiratory and cardiac-induced motion, and irregular gastrointestinal activity displace and deform targets and healthy organs compared to their observed position during treatment planning. Adapting treatment to this complex motion pattern requires precise and frequent on-board imaging. Current X-ray based in-room imaging techniques induce additional radiation exposure, suffer from poor soft-tissue contrast in the 2D projection images, and usually require implanted fiducial markers for guidance. In comparison, high-field magnetic resonance imaging (MRI) offers customizable, diagnostic-quality soft-tissue contrast and much greater flexibility in selecting the appropriate image dimension for detecting anatomical motion.

In this chapter we will first introduce the clinical rationale for in-room guidance based on MRI. A survey will highlight existing technical implementations while focussing on the Elekta Unity MR-linac. We will then identify suitable MRI techniques for radiotherapy adaptations. This will include an overview of typical sequences used for anatomical imaging. Several possible image dimensions, ranging from real-time 2D cine imaging to retrospectively sorted 4D motion models will be presented in detail. The resulting increase in observer confidence due to the higher image quality is complemented with an array of suitable inter-fractional and intra-fractional treatment adaptations based on on-line MRI. We will emphasize the benefits and challenges of several motion mitigation techniques including beam gating, dynamic tumour tracking, and intra-fractional re-planning based on on-line accumulated dose.

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Acknowledgements

The University Medical Center Utrecht (UMCU) is part of the Elekta MR-linac Consortium and we acknowledge financial and technical support from Elekta AB under research agreements. We are grateful to Uulke van der Heide, Tessa van de Lindt (both NKI) and Rob Tijssen (UMCU) for very useful discussions.

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  1. Department of Radiotherapy, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands

    Martin F. Fast & Markus Glitzner

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  1. Martin F. Fast
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Correspondence to Martin F. Fast .

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Editors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Regina G.H. Beets-Tan

  2. Humanitas University and Humanitas Clinical and Research Center, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Wim J. G. Oyen

  3. Department of Radiology, Radiation Oncology and Hematology Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Vincenzo Valentini

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Fast, M.F., Glitzner, M. (2020). High-Field MRI In-Room Guidance for Radiotherapy Adaptation. In: Beets-Tan, R., Oyen, W., Valentini, V. (eds) Imaging and Interventional Radiology for Radiation Oncology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-38261-2_8

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