The Role of Free-breathing GRASP MRI in Accurate Phase Matching with 4D-CT for Motion Representation in Liver Cancer Radiotherapy
Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology（华中科技大学同济医学院同济医院）；Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College（中国医学科学院北京协和医学院肿瘤医院/国家癌症中心/国家临床医学研究中心放射肿瘤科）；School of Electronic Engineering, Beijing University of Posts and Telecommunications（北京邮电大学电子工程学院）
Objective: To determine whether free-breathing golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) can represent respiratory-induced organ motion in patients with liver malignancies undergoing stereotactic body radiation therapy (SBRT). Methods: A retrospective analysis of 54 patients undergoing liver SBRT was conducted. Four-dimensional computed tomography (4D-CT), the gold standard for motion assessment, was used to characterize liver tumor motion. Image fusion was performed between free-breathing GRASP MRI and each respiratory phase of 4D-CT using an in-house registration program, with fusion quality quantified by maximum cross-correlation coefficient (MCC). Validation involved two blinded radiation oncologists: one repeated image fusion using the Eclipse-built-in module, while the other evaluated clinical relevance on a five-point scale. Results: The 50% respiratory phase of 4D-CT achieved the highest fusion quality with GRASP MRI, showing no significant differences compared to the 30% (P = 0.106), 40% (P = 0.632), and 60% (P = 0.792) phases. In contrast, fusion quality declined significantly beyond the mid-respiratory window (30%-60%), with poor fusion at the 0%, 10%, 20%, 80%, and 90% phases (P < 0.001). Validation by radiation oncologists corroborated these findings, with the 50% phase achieving the highest score. Subjective scores remained above 4 for phases 30%-70%, while scores for the remaining phases fell below 4. Conclusion: Free-breathing GRASP MRI cannot independently represent organ motion across all respiratory phases; it accurately characterizes motion only within the mid-respiratory phases (30%-60%), with optimal performance at the 50% phase. When used as a delineation standard in liver SBRT, GRASP MRI should be combined with 4D-CT or dynamic imaging modalities to ensure comprehensive motion assessment and accurate target volume definition.
Purpose: Respiratory gated radiation therapy (RGRT) is used to minimize the radiation dose to normal tissue in lung cancer patients. Determinations of the gating window in the respiratory phase of patients are important in RGRT but it is not easy. The objective of this study was to determine the optimal gating window with a visible guiding system in RGRT. Materials and Methods: Between April and October in 2014 the breathing signals of 23 lung cancer patients were recorded with a Real-time Position Management (RPM) respiratory gating system (Varian, USA). We performed statistical analysis with…
In multi-stage radiotherapy, a patient is treated in several stages separated by weeks or months. This regimen has been motivated mostly by radiobiological considerations, but also provides an approach to reduce normal tissue dose by exploiting tumor shrinkage. The paper considers the optimal design of multi-stage treatments, motivated by the clinical management of large liver tumors for which normal liver dose constraints prohibit the administration of an ablative radiation dose in a single treatment. We introduce a dynamic tumor model that incorporates three factors: radiation induced cell k…
Electron density maps must be accurately estimated to achieve valid dose calculation in MR-only radiotherapy. The goal of this study is to assess whether two deep learning models, the conditional generative adversarial network (cGAN) and the cycle-consistent generative adversarial network (cycleGAN), can generate accurate abdominal synthetic CT (sCT) images from 0.35T MR images for MR-only liver radiotherapy. A retrospective study was performed using CT images and 0.35T MR images of 12 patients with liver (n=8) and non-liver abdominal (n=4) cancer. CT images were deformably registered to the c…
Spatiotemporal fractionation schemes, that is, treatments delivering different dose distributions in different fractions, may lower treatment side effects without compromising tumor control. This is achieved by hypofractionating parts of the tumor while delivering approximately uniformly fractionated doses to the healthy tissue. Optimization of such treatments is based on biologically effective dose (BED), which leads to computationally challenging nonconvex optimization problems. Current optimization methods yield only locally optimal plans, and it has been unclear whether these are close to …
Respiratory-gated radiation therapy (RGRT) has been used to minimize the dose to normal tissue in lung-cancer radiotherapy. The present research aims to improve the regularity of respiration in RGRT using a video coached respiration guiding system. In the study, 16 patients with lung cancer were evaluated. The respiration signals of the patients were measured by a real-time position management (RPM) Respiratory Gating System (Varian, USA) and the patients were trained using the video coached respiration guiding system. The patients performed free breathing and guided breathing, and the respira…
Recently we have developed an algorithm for reconstructing volumetric images and extracting 3D tumor motion information from a single x-ray projection. We have demonstrated its feasibility using a digital respiratory phantom with regular breathing patterns. In this work, we present a detailed description and a comprehensive evaluation of the improved algorithm. The algorithm was improved by incorporating respiratory motion prediction. The accuracy and efficiency were then evaluated on 1) a digital respiratory phantom, 2) a physical respiratory phantom, and 3) five lung cancer patients. These e…
This study estimated the planning quality of intensity-modulated radiotherapy in 42 lung cancer cases to provide preliminary data for the development of a planning quality assurance algorithm. Organs in or near the thoracic cavity (ipsilateral lung, contralateral lung, heart, liver, esophagus, spinal cord, and bronchus) were selected as organs at risk (OARs). Radiotherapy plans were compared using the conformity index (CI), coverage index (CVI), and homogeneity index (HI) of the planning target volume (PTV), OAR-PTV distance and OAR-PTV overlap volume, and the V10Gy, V20Gy, and equivalent unif…
Implicit neural representation for free-breathing MR fingerprinting (INR-MRF): co-registered 3D whole-liver water T1, water T2, proton density fat fraction, and R2* mapping
Purpose: To develop an algorithm for real-time volumetric image reconstruction and 3D tumor localization based on a single x-ray projection image for lung cancer radiotherapy. Methods: Given a set of volumetric images of a patient at N breathing phases as the training data, we perform deformable image registration between a reference phase and the other N-1 phases, resulting in N-1 deformation vector fields (DVFs). These DVFs can be represented efficiently by a few eigenvectors and coefficients obtained from principal component analysis (PCA). By varying the PCA coefficients, we can generate n…
Respiratory motion during radiotherapy causes uncertainty in the tumor's location, which is typically addressed by an increased radiation area and a decreased dose. As a result, the treatments' efficacy is reduced. The recently proposed hybrid MR-linac scanner holds the promise to efficiently deal with such respiratory motion through real-time adaptive MR-guided radiotherapy (MRgRT). For MRgRT, motion-fields should be estimated from MR-data and the radiotherapy plan should be adapted in real-time according to the estimated motion-fields. All of this should be performed with a total latency of …
The MR-Linac is a combination of an MR-scanner and radiotherapy linear accelerator (Linac) which holds the promise to increase the precision of radiotherapy treatments with MR-guided radiotherapy by monitoring motion during radiotherapy with MRI, and adjusting the radiotherapy plan accordingly. Optimal MR-guidance for respiratory motion during radiotherapy requires MR-based 3D motion estimation with a latency of 200-500 ms. Currently this is still challenging since typical methods rely on MR-images, and are therefore limited by the 3D MR-imaging latency. In this work, we present a method to pe…
Purpose: Anthropomorphic phantoms can be used in radiotherapy to confirm dose distributions. In this work, a prototype phantom with a deformable chest wall was created based on real human. Methods: A technique similar to 3-dimensional printing was utilized, which involved collecting computed tomography (CT) images of a patient as a reference, contouring the organs, projecting them onto polystyrene panels, and pouring appropriate material into them. Balloons attached to a ventilator and an air compressor were used to periodically generate a breathing cycle. A silicone tumor was also implanted i…
Hybrid MRI-linac (MRL) systems enable daily multiparametric quantitative MRI to assess tumor response to radiotherapy. Magnetic Resonance Fingerprinting (MRF) may provide time efficient means of rapid multiparametric quantitative MRI. The accuracy of MRF, however, relies on adequate control over system imperfections, such as eddy currents and B1+, which are different and not as well established on MRL systems compared to diagnostic systems. In this study we investigate the technical feasibility of gradient spoiled 2D MRF on a 1.5T MRL. We show with phantom experiments that the MRL generates re…
Purpose: To develop and evaluate a free-breathing respiratory motion compensated 4D (3D+respiration) $T_2$-weighted turbo spin echo sequence with application to radiology and MR-guided radiotherapy. Methods: k-space data are continuously acquired using a rewound Cartesian acquisition with spiral profile ordering (rCASPR) to provide matching contrast to the conventional linear phase encode ordering and to sort data into multiple respiratory phases. Low-resolution respiratory-correlated 4D images were reconstructed with compressed sensing and used to estimate non-rigid deformation vector fields,…
Purpose: To assess the fiducial motion in abdominal stereotactic body radiotherapy (SBRT) using the cone-beam computed tomography (CBCT) projections acquired for pre-treatment patient set-up. Materials and Methods: Pre-treatment CBCT projections and anterior-posterior (AP) and lateral (LAT) pair of fluoroscopic sequences of 7 pancreatic and 6 liver SBRT patients with implanted fiducials were analyzed for 49 treatment fractions retrospectively. A tracking algorithm based on template matching and sequential stereo triangulation algorithms was used to track the fiducials in the CBCT projections a…
With the recent introduction of the MR-LINAC, an MR-scanner combined with a radiotherapy LINAC, MR-based motion estimation has become of increasing interest to (retrospectively) characterize tumor and organs-at-risk motion during radiotherapy. To this extent, we introduce low-rank MR-MOTUS, a framework to retrospectively reconstruct time-resolved non-rigid 3D+t motion-fields from a single low-resolution reference image and prospectively undersampled k-space data acquired during motion. Low-rank MR-MOTUS exploits spatio-temporal correlations in internal body motion with a low-rank motion model,…
A Novel Automatic Real-time Motion Tracking Method in MRI-guided Radiotherapy Using Enhanced Tracking-Learning-Detection Framework with Automatic Segmentation
Beijing University of Posts and Telecommunications（北京邮电大学）；National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College（国家癌症中心/国家癌症临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院）
A No-Reference Medical Image Quality Assessment Method Based on Automated Distortion Recognition Technology: Application to Preprocessing in MRI-guided Radiotherapy
Beijing University of Posts and Telecommunications（北京邮电大学）；National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College（中国医学科学院北京协和医学院国家癌症中心/国家癌症临床医学研究中心/肿瘤医院）
Spatiotemporal Gaussian representation-based dynamic reconstruction and motion estimation framework for time-resolved volumetric MR imaging (DREME-GSMR)
The Advanced Imaging and Informatics for Radiation Therapy (AIRT) Laboratory（先进成像与放射治疗信息学（AIRT）实验室）；The Medical Artificial Intelligence and Automation (MAIA) Laboratory（医学人工智能与自动化（MAIA）实验室）；Department of Radiation Oncology, University of Texas Southwestern Medical Center（德克萨斯大学西南医学中心放射肿瘤科）；Department of Medical Physics, Memorial Sloan Kettering Cancer Center（纪念斯隆凯特琳癌症中心医学物理系）
