4D-MRI driven MR-guided online adaptive radiotherapy for abdominal stereotactic body radiation therapy on a high field MR-Linac: Implementation and initial clinical experience.
Elekta Unity
MR-Linac
MR-guided radiation therapy
SBRT
Journal
Clinical and translational radiation oncology
ISSN: 2405-6308
Titre abrégé: Clin Transl Radiat Oncol
Pays: Ireland
ID NLM: 101713416
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
06
11
2019
revised:
30
04
2020
accepted:
03
05
2020
entrez:
4
6
2020
pubmed:
4
6
2020
medline:
4
6
2020
Statut:
epublish
Résumé
In this report, we describe our implementation and initial clinical experience using 4D-MRI driven MR-guided online adaptive radiotherapy (MRgOART) for abdominal stereotactic body radiotherapy (SBRT) on the Elekta Unity MR-Linac. Eleven patients with abdominal malignancies were treated with free-breathing SBRT in three to five fractions on a 1.5 T MR-Linac. Online adaptive plans were generated using Adapt-To-Position (ATP) or Adapt-To-Shape (ATS) workflows based on motion averaged or mid-position images derived from a pre-beam 4D-MRI. A high performance server positioned on the local MR-Linac machine network was utilized for 4D-MR image reconstruction. A parallel contour editing approach was employed in the ATS workflow. Intravoxel incoherent motion (IVIM) and T2 mapping sequences were acquired during adaptive planning in both ATP and ATS workflows for treatment response monitoring. Adaptive plans were delivered under real-time cine image motion monitoring. The shortest 4D-MRI time-to-image was the motion averaged image, followed by mid position and respiratory binned images. In this cohert of patients, 50% of treatments utilized the ATS workflow; the remaining treatments utilized the ATP workflow. Mid-position images were utilized as daily planning images for two of the eleven patients. The mean daily adaptive plan secondary dose calculation and ArcCheck 3D Gamma passing rates were 97.5% (92.1-100.0%) and 99.3% (96.2-100.0%), respectively. The median overall treatment times for abdominal SBRT was 46 and 62 min for ATP and ATS workflows, respectively. We have successfully implemented and utilized a 4D-MRI driven MRgOART process with ATP and ATS workflows for free-breathing abdominal SBRT on a 1.5 T Elekta Unity MR-Linac.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
In this report, we describe our implementation and initial clinical experience using 4D-MRI driven MR-guided online adaptive radiotherapy (MRgOART) for abdominal stereotactic body radiotherapy (SBRT) on the Elekta Unity MR-Linac.
MATERIALS AND METHODS
METHODS
Eleven patients with abdominal malignancies were treated with free-breathing SBRT in three to five fractions on a 1.5 T MR-Linac. Online adaptive plans were generated using Adapt-To-Position (ATP) or Adapt-To-Shape (ATS) workflows based on motion averaged or mid-position images derived from a pre-beam 4D-MRI. A high performance server positioned on the local MR-Linac machine network was utilized for 4D-MR image reconstruction. A parallel contour editing approach was employed in the ATS workflow. Intravoxel incoherent motion (IVIM) and T2 mapping sequences were acquired during adaptive planning in both ATP and ATS workflows for treatment response monitoring. Adaptive plans were delivered under real-time cine image motion monitoring.
RESULTS
RESULTS
The shortest 4D-MRI time-to-image was the motion averaged image, followed by mid position and respiratory binned images. In this cohert of patients, 50% of treatments utilized the ATS workflow; the remaining treatments utilized the ATP workflow. Mid-position images were utilized as daily planning images for two of the eleven patients. The mean daily adaptive plan secondary dose calculation and ArcCheck 3D Gamma passing rates were 97.5% (92.1-100.0%) and 99.3% (96.2-100.0%), respectively. The median overall treatment times for abdominal SBRT was 46 and 62 min for ATP and ATS workflows, respectively.
CONCLUSION
CONCLUSIONS
We have successfully implemented and utilized a 4D-MRI driven MRgOART process with ATP and ATS workflows for free-breathing abdominal SBRT on a 1.5 T Elekta Unity MR-Linac.
Identifiants
pubmed: 32490218
doi: 10.1016/j.ctro.2020.05.002
pii: S2405-6308(20)30037-9
pmc: PMC7256110
doi:
Types de publication
Journal Article
Langues
eng
Pagination
72-79Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2020 The Authors.
Références
Magn Reson Med. 2018 Jun;79(6):3055-3071
pubmed: 29115689
Phys Med Biol. 2017 Apr 21;62(8):2910-2921
pubmed: 27997382
Phys Med Biol. 2018 Oct 23;63(21):21TR01
pubmed: 30272573
Semin Radiat Oncol. 2014 Jul;24(3):207-9
pubmed: 24931095
Med Phys. 2016 Apr;43(4):1713
pubmed: 27036569
Phys Med Biol. 2011 Aug 21;56(16):5119-29
pubmed: 21775790
Med Phys. 2016 Aug;43(8):4575
pubmed: 27487874
Radiother Oncol. 2019 Apr;133:156-162
pubmed: 30935572
Med Phys. 2008 May;35(5):1718-33
pubmed: 18561647
IEEE Trans Med Imaging. 2019 Jan;38(1):280-290
pubmed: 30080145
Med Phys. 2015 Jan;42(1):28-39
pubmed: 25563245
Radiother Oncol. 2019 Mar;132:114-120
pubmed: 30825959
Magn Reson Med. 2016 Feb;75(2):775-88
pubmed: 25809847
Phys Med Biol. 2001 Jan;46(1):1-10
pubmed: 11197664
Med Phys. 2011 Feb;38(2):754-64
pubmed: 21452713
Med Phys. 2008 Sep;35(9):3998-4011
pubmed: 18841851
Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1229-38
pubmed: 18313530
J Appl Clin Med Phys. 2019 Jul;20(7):28-38
pubmed: 31254376
Med Phys. 2008 Aug;35(8):3607-15
pubmed: 18777921
Radiat Oncol. 2019 Jun 6;14(1):95
pubmed: 31171025
Magn Reson Med. 2001 Oct;46(4):638-51
pubmed: 11590639
Phys Med Biol. 2017 Aug 21;62(18):7233-7248
pubmed: 28749375
Med Phys. 2018 Oct;45(10):4370-4376
pubmed: 30053325
Clin Transl Radiat Oncol. 2019 Apr 02;18:54-59
pubmed: 31341976
Magn Reson Med. 2016 May;75(5):2175-84
pubmed: 26059232
J Magn Reson Imaging. 2017 May;45(5):1325-1334
pubmed: 27545824