A database for MR-based electrical properties tomography with in silico brain data-ADEPT.

PURPOSE: Several reconstruction methods for MR-based electrical properties tomography (EPT) have been developed. However, the lack of common data makes it difficult to objectively compare their performances. This is, however, a necessary precursor for standardizing and introducing this technique in the clinical setting. To enable objective comparison of the performances of reconstruction methods and provide common data for their training and testing, we created ADEPT, a database of simulated data for brain MR-EPT reconstructions. METHODS: ADEPT is a database containing in silico data for brain EPT reconstructions. This database was created from 25 different brain models, with and without tumors. Rigid geometric augmentations were applied, and different electrical properties were assigned to white matter, gray matter, CSF, and tumors to generate 120 different brain models. These models were used as input for finite-difference time-domain simulations in Sim4Life, used to compute the electromagnetic fields needed for MR-EPT reconstructions. RESULTS: Electromagnetic fields from 84 healthy and 36 tumor brain models were simulated. The simulated fields relevant for MR-EPT reconstructions (transmit and receive RF fields and transceive phase) and their ground-truth electrical properties are made publicly available through ADEPT. Additionally, nonattainable fields such as the total magnetic field and the electric field are available upon request. CONCLUSION: ADEPT will serve as reference database for objective comparisons of reconstruction methods and will be a first step toward standardization of MR-EPT reconstructions. Furthermore, it provides a large amount of data that can be exploited to train data-driven methods. It can be accessed from  https://doi.org/10.34894/V0HBJ8.

A reusable 3D printed brain-like phantom for benchmarking electrical properties tomography reconstructions.

PURPOSE: In MR electrical properties tomography (MR-EPT), electrical properties (EPs, conductivity and permittivity) are reconstructed from MR measurements. Phantom measurements are important to characterize the performance of MR-EPT reconstruction methods, since they allow knowledge of reference EPs values. To assess reconstruction methods in a more realistic scenario, it is important to test the methods using phantoms with realistic shapes, internal structures, and dielectric properties. In this work, we present a 3D printing procedure for the creation of realistic brain-like phantoms to benchmark MR-EPT reconstructions. METHODS: We created two brain-like geometries with three different compartments using 3D printing. The first geometry was filled once, while the second geometry was filled three times with different saline-gelatin solutions, resulting in a total of four phantoms with different EPs. The saline solutions were characterized using a probe. 3D MR-EPT reconstructions were performed from MR measurements at 3T. The reconstructed conductivity values were compared to reference values of the saline-gelatin solutions. The measured fields were also compared to simulated fields using the same phantom geometry and electrical properties. RESULTS: The measured fields were consistent with simulated fields. Reconstructed conductivity values were consistent with the reference (probe) conductivity values. This indicated the suitability of such phantoms for benchmarking MR-EPT reconstructions. CONCLUSION: We presented a new workflow to 3D print realistic brain-like phantoms in an easy and affordable way. These phantoms are suitable to benchmark MR-EPT reconstructions, but can also be used for benchmarking other quantitative MR methods.

A deep learning method for image-based subject-specific local SAR assessment.

PURPOSE: Local specific absorption rate (SAR) cannot be measured and is usually evaluated by offline numerical simulations using generic body models that of course will differ from the patient's anatomy. An additional safety margin is needed to include this intersubject variability. In this work, we present a deep learning-based method for image-based subject-specific local SAR assessment. We propose to train a convolutional neural network to learn a "surrogate SAR model" to map the relation between subject-specific B1+ maps and the corresponding local SAR. METHOD: Our database of 23 subject-specific models with an 8-transmit channel body array for prostate imaging at 7 T was used to build 5750 training samples. These synthetic complex B1+ maps and local SAR distributions were used to train a conditional generative adversarial network. Extra penalization for local SAR underestimation errors was included in the loss function. In silico and in vivo validation were performed. RESULTS: In silico cross-validation shows a good qualitative and quantitative match between predicted and ground-truth local SAR distributions. The peak local SAR estimation error distribution shows a mean overestimation error of 15% with 13% probability of underestimation. The higher accuracy of the proposed method allows the use of less conservative safety factors compared with standard procedures. In vivo validation shows that the method is applicable with realistic measurement data with impressively good qualitative and quantitative agreement to simulations. CONCLUSION: The proposed deep learning method allows online image-based subject-specific local SAR assessment. It greatly reduces the uncertainty in current state-of-the-art SAR assessment methods, reducing the time in the examination protocol by almost 25%.

Understanding the physical relations governing the noise navigator.

PURPOSE: The noise navigator is a passive way to detect physiological motion occurring in a patient through thermal noise modulations measured by standard clinical radiofrequency receive coils. The aim is to gain a deeper understanding of the potential and applications of physiologically induced thermal noise modulations. METHODS: Numerical electromagnetic simulations and MR measurements were performed to investigate the relative contribution of tissue displacement versus modulation of the dielectric lung properties over the respiratory cycle, the impact of coil diameter and position with respect to the body. Furthermore, the spatial motion sensitivity of specific noise covariance matrix elements of a receive array was investigated. RESULTS: The influence of dielectric lung property variations on the noise variance is negligible compared to tissue displacement. Coil size affected the thermal noise variance modulation, but the location of the coil with respect to the body had a larger impact. The modulation depth of a 15 cm diameter stationary coil approximately 3 cm away from the chest (i.e. radiotherapy setup) was 39.7% compared to 4.2% for a coil of the same size on the chest, moving along with respiratory motion. A combination of particular noise covariance matrix elements creates a specific spatial sensitivity for motion. CONCLUSIONS: The insight gained on the physical relations governing the noise navigator will allow for optimized use and development of new applications. An optimized combination of elements from the noise covariance matrix offer new ways of performing, e.g. motion tracking.

Respiratory motion model based on the noise covariance matrix of a receive array.

PURPOSE: Tracking of the internal anatomy by means of a motion model that uses the MR-derived motion fields and noise covariance matrix (NCM) dynamic as a surrogate signal. METHODS: A 2D respiratory motion model was developed based on the MR-derived motion fields and the NCM of a receive array used in MRI. Temporal dynamics of the NCM were used as a motion surrogate for a linear correspondence motion model. The model performance was tested on five healthy volunteers with a liver as the target. The motion fields were calculated from the cineMR frames with an optical flow registration tool. RESULTS: The model estimated the liver motion with an average residual error of 2.3 mm (13% of the motion amplitude). The model formation takes 3 min and the model latency was 0.5 s in the current implementation. The limiting factor for the latency is the current update time of the NCM (0.48 s), which in principle can be reduced to 0.004 s with an alternative way to determine the NCM. CONCLUSIONS: The 2D respiratory motion of the liver can be effectively estimated with the linear motion model that uses the temporal behavior of the NCM as motion surrogate. Magn Reson Med 79:1730-1735, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Validating subject-specific RF and thermal simulations in the calf muscle using MR-based temperature measurements.

PURPOSE: Ongoing discussions occur to translate the safety restrictions on MR scanners from specific absorption rate (SAR) to thermal dose. Therefore, this research focuses on the accuracy of thermal simulations in human subjects during an MR exam, which is fundamental information in that debate. METHODS: Radiofrequency (RF) heating experiments were performed on the calves of 13 healthy subjects using a dedicated transmit-receive coil while monitoring the temperature with proton resonance frequency shift (PRFS) thermometry. Subject-specific models and one generic model were used for electromagnetic and thermal simulations using Pennes' bioheat equation, with the blood equilibration constant equaling zero. The simulations were subsequently compared with the experimental results. RESULTS: The mean B1+ equaled 15 µT in the center slice of all volunteers, and 95% of the voxels had errors smaller than 2.8 µT between the simulation and measurement. The intersubject variation in RF power to achieve the required B1+ was 11%. The resulting intersubject variation in median temperature rise was 14%. Thermal simulations underestimated the median temperature increase on average, with 34% in subject-specific models and 28% in the generic model. CONCLUSIONS: Although thermal measures are directly coupled to tissue damage and therefore suitable for RF safety assessment, insecurities in the applied thermal modeling limit their estimation accuracy. Magn Reson Med 77:1691-1700, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

MRI-based transfer function determination for the assessment of implant safety.

PURPOSE: We introduce a new MR-based method to determine the transfer function (TF) for radiofrequency (RF) safety assessment of active implantable medical devices. Transfer functions are implant-specific measures that relate the incident tangential electric field on an (elongated) implant to a scattered electric field at its tip. The proposed method allows for TF determination with a high spatial resolution in relatively fast measurements without requiring dedicated bench setups from MRI images. THEORY AND METHODS: The principle of reciprocity is used in conjunction with the potential to measure currents with MRI to determine TF. Low-flip angle 3D dual gradient echo MRI data are acquired with an implant as transceive antenna, which requires minimal hardware adaptations. The implant-specific TF is determined from the acquired MRI data, with two different postprocessing methods for comparison. RESULTS: TFs of linear and helical implants can be determined accurately (with a Pearson correlation coefficient R ≥ 0.7 between measurements and simulations, and a difference in field at the tip ΔEtip ≤ 19%) from relatively quick (t < 20 minutes) MRI acquisitions with (several) millimeter spatial resolution. CONCLUSION: Transfer function determination with MRI for RF safety assessment of implantable medical devices is possible. The proposed MR-based method allows for TF determination in more realistic exposure scenarios and solid media. Magn Reson Med 78:2449-2459, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Thermal noise variance of a receive radiofrequency coil as a respiratory motion sensor.

PURPOSE: Development of a passive respiratory motion sensor based on the noise variance of the receive coil array. METHODS: Respiratory motion alters the body resistance. The noise variance of an RF coil depends on the body resistance and, thus, is also modulated by respiration. For the noise variance monitoring, the noise samples were acquired without and with MR signal excitation on clinical 1.5/3 T MR scanners. The performance of the noise sensor was compared with the respiratory bellow and with the diaphragm displacement visible on MR images. Several breathing patterns were tested. RESULTS: The noise variance demonstrated a periodic, temporal modulation that was synchronized with the respiratory bellow signal. The modulation depth of the noise variance resulting from the respiration varied between the channels of the array and depended on the channel's location with respect to the body. The noise sensor combined with MR acquisition was able to detect the respiratory motion for every k-space read-out line. CONCLUSION: Within clinical MR systems, the respiratory motion can be detected by the noise in receive array. The noise sensor does not require careful positioning unlike the bellow, any additional hardware, and/or MR acquisition. Magn Reson Med 77:221-228, 2017. © 2016 Wiley Periodicals, Inc.

Dipole antennas for ultrahigh-field body imaging: a comparison with loop coils.

Although the potential of dipole antennas for ultrahigh-field (UHF) MRI is largely recognized, they are still relatively unknown to the larger part of the MRI community. This article intends to provide electromagnetic insight into the general operating principles of dipole antennas by numerical simulations. The major part focuses on a comparison study of dipole antennas and loop coils at frequencies of 128, 298 and 400 MHz. This study shows that dipole antennas are only efficient radiofrequency (RF) coils in the presence of a dielectric and/or conducting load. In addition, the conservative electric fields (E-fields) at the ends of a dipole are negligible in comparison with the induced E-fields in the center. Like loop coils, long dipole antennas perform better than short dipoles for deeply located imaging targets and vice versa. When the optimal element is chosen for each depth, loop coils have higher B1 (+) efficiency for shallow depths, whereas dipole antennas have higher B1 (+) efficiency for large depths. The cross-over point depth decreases with increasing frequency: 11.6, 6.2 and 5.0 cm for 128, 298 and 400 MHz, respectively. For single elements, loop coils demonstrate a better B1 (+) /√SARmax ratio for any target depth and any frequency. However, one example study shows that, in an array setup with loop coil overlap for decoupling, this relationship is not straightforward. The overlapping loop coils may generate increased specific absorption rate (SAR) levels under the overlapping parts of the loops, depending on the drive phase settings. Copyright © 2015 John Wiley & Sons, Ltd.

(1) H MRS in the human spinal cord at 7 T using a dielectric waveguide transmitter, RF shimming and a high density receive array.

Multimodal MRI is the state of the art method for clinical diagnostics and therapy monitoring of the spinal cord, with MRS being an emerging modality that has the potential to detect relevant changes of the spinal cord tissue at an earlier stage and to enhance specificity. Methodological challenges related to the small dimensions and deep location of the human spinal cord inside the human body, field fluctuations due to respiratory motion, susceptibility differences to adjacent tissue such as vertebras and pulsatile flow of the cerebrospinal fluid hinder the clinical application of (1) H MRS to the human spinal cord. Complementary to previous studies that partly addressed these problems, this work aims at enhancing the signal-to-noise ratio (SNR) of (1) H MRS in the human spinal cord. To this end a flexible tight fit high density receiver array and ultra-high field strength (7 T) were combined. A dielectric waveguide and dipole antenna transmission coil allowed for dual channel RF shimming, focusing the RF field in the spinal cord, and an inner-volume saturated semi-LASER sequence was used for robust localization in the presence of B1 (+) inhomogeneity. Herein we report the first 7 T spinal cord (1) H MR spectra, which were obtained in seven independent measurements of 128 averages each in three healthy volunteers. The spectra exhibit high quality (full width at half maximum 0.09 ppm, SNR 7.6) and absence of artifacts and allow for reliable quantification of N-acetyl aspartate (NAA) (NAA/Cr (creatine) 1.31 ± 0.20; Cramér-Rao lower bound (CRLB) 5), total choline containing compounds (Cho) (Cho/Cr 0.32 ± 0.07; CRLB 7), Cr (CRLB 5) and myo-inositol (mI) (mI/Cr 1.08 ± 0.22; CRLB 6) in 7.5 min in the human cervical spinal cord. Thus metabolic information from the spinal cord can be obtained in clinically feasible scan times at 7 T, and its benefit for clinical decision making in spinal cord disorders will be investigated in the future using the presented methodology. Copyright © 2016 John Wiley & Sons, Ltd.

Improved steering of the RF field of traveling wave MR with a multimode, coaxial waveguide.

PURPOSE: Magnetic resonance imaging of humans at high magnetic field strengths is strongly influenced by the interference of the radiofrequency (RF) electromagnetic field and the body. To minimize this effect, multiple RF sources could be used. A novel setup (called multimode, coaxial waveguide) is proposed that facilitates RF shimming based on the traveling waves. METHODS: The multimode, coaxial waveguide combines the coaxial waveguide, cylindrical waveguide, high dielectric permittivity lining, and eight radial stub antennas. Each antenna excites multiple waveguide modes. Based on modes orthogonality, a method was devised to decompose an excitation pattern of single stub antenna into waveguide modes. RESULTS: The number of modes present in the excitation pattern of a single stub antenna increased with the higher effective permittivity of the dielectric lining. Thus, RF shimming performance of the setup was improved. An average homogeneity of 10% was demonstrated for a single slice of each principle plane in the human head at 7 T. CONCLUSION: Traveling wave RF shimming is feasible both in axial and longitudinal directions and is improved with an increased amount of orthogonal waveguide modes. Nevertheless, with the currently available RF amplifiers at 7 T, the performance of the setup is limited to low flip angles.

Improved RF performance of travelling wave MR with a high permittivity dielectric lining of the bore.

Application of travelling wave MR to human body imaging is restricted by the limited peak power of the available RF amplifiers. Nevertheless, travelling wave MR advantages like a large field of view excitation and distant location of transmit elements would be desirable for whole body MRI. In this work, improvement of the B1+ efficiency of travelling wave MR is demonstrated. High permittivity dielectric lining placed next to the scanner bore wall effectively reduces attenuation of the travelling wave in the longitudinal direction and at the same time directs the radial power flow toward the load. First, this is shown with an analytical model of a metallic cylindrical waveguide with the dielectric lining next to the wall and loaded with a cylindrical phantom. Simulations and experiments also reveal an increase of B1+ efficiency in the center of the bore for travelling wave MR with a dielectric lining. Phantom experiments show up to a 2-fold gain in B1+ with the dielectric lining. This corresponds to a 4-fold increase in power efficiency of travelling wave MR. In vivo experiments demonstrate an 8-fold signal-to-noise ratio gain with the dielectric lining. Overall, it is shown that dielectric lining is a constructive method to improve efficacy of travelling wave MR.

High-resolution MRI of the carotid arteries using a leaky waveguide transmitter and a high-density receive array at 7 T.

A setup for 7T MRI of the carotid arteries in the neck was designed and constructed. Separate dedicated arrays were used for transmit and receive. For the transmit array, single-side adapted dipole antennas were mounted on a dielectric pillow, which was shown to serve as a leaky waveguide, efficiently distributing B1 into the neck. Risk assessment was performed by simulations. Phantom measurements were performed to establish optimal positions of the antennas on the pillow. Using two antennas, a dual transmit setup was created. In vivo B1 (+) maps with different shim configurations were acquired to assess transmit performance. This effective transmit array was used in combination with a dedicated 30 channel small element receive coil. High-resolution in vivo turbo spin echo images were acquired to demonstrate the excellent performance of the setup.

Design of a radiative surface coil array element at 7 T: the single-side adapted dipole antenna.

Ultra high field MR imaging (≥7 T) of deeply located targets in the body is facing some radiofrequency-field related challenges: interference patterns, reduced penetration depth, and higher Specific Absorbtion Ratio (SAR) levels. These can be alleviated by redesigning the elements of the transmit or transceive array. This is because at these high excitation field (B(1) ) frequencies, conventional array element designs may have become suboptimal. In this work, an alternative design approach is presented, regarding coil array elements as antennas. Following this approach, the Poynting vector of the element should be oriented towards the imaging target region. The single-side adapted dipole antenna is a novel design that fulfills this requirement. The performance of this design as a transmit coil array element has been characterized by comparison with three other, more conventional designs using finite difference time domain (FDTD) simulations and B +1 measurements on a phantom. Results show that the B +1 level at the deeper regions is higher while maintaining relatively low SAR levels. Also, the B +1 field distribution is more symmetrical and more uniform, promising better image homogeneity. Eight radiative antennas have been combined into a belt-like surface array for prostate imaging. T(1) -weighted (T1W) and T(2) -weighted (T2W) volunteer images are presented along with B +1 measurements to demonstrate the improved efficiency.

The noise navigator for MRI-guided radiotherapy: an independent method to detect physiological motion.

Motion is problematic during radiotherapy as it could lead to potential underdosage of the tumor, and/or overdosage in organs-at-risk. A solution is adaptive radiotherapy guided by magnetic resonance imaging (MRI). MRI allows for imaging of target volumes and organs-at-risk before and during treatment delivery with superb soft tissue contrast in any desired orientation, enabling motion management by means of (real-time) adaptive radiotherapy. The noise navigator, which is independent of the MR signal, could serve as a secondary motion detection method in synergy with MR imaging. The feasibility of respiratory motion detection by means of the noise navigator was demonstrated previously. Furthermore, from electromagnetic simulations we know that the noise navigator is sensitive to tissue displacement and thus could in principle be used for the detection of various types of motion. In this study we demonstrate the detection of various types of motion for three anatomical use cases of MRI-guided radiotherapy, i.e. torso (bulk movement and variable breathing), head-and-neck (swallowing) and cardiac. Furthermore, it is shown that the noise navigator can detect bulk movement, variable breathing and swallowing on a hybrid 1.5 T MRI-linac system. Cardiac activity detection through the noise navigator seems feasible in an MRI-guided radiotherapy setting, but needs further optimization. The noise navigator is a versatile and fast (millisecond temporal resolution) motion detection method independent of MR signal that could serve as an independent verification method to detect the occurrence of motion in synergy with real-time MRI-guided radiotherapy.

The noise navigator: a surrogate for respiratory-correlated 4D-MRI for motion characterization in radiotherapy.

Respiratory-correlated 4D-MRI can characterize respiratory-induced motion of tumors and organs-at-risk for radiotherapy treatment planning and is a necessity for image guidance of moving tumors treated on an MRI-linac. Essential for 4D-MRI generation is a robust respiratory surrogate signal. We investigated the feasibility of the noise navigator as respiratory surrogate signal for 4D-MRI generation. The noise navigator is based on the respiratory-induced modulation of the thermal noise variance measured by the receive coils during MR acquisition and thus is inherently present and synchronized with MRI data acquisition. Additionally, the noise navigator can be combined with any rectilinear readout strategy (e.g. radial and cartesian) and is independent of MR image contrast and imaging orientation. For radiotherapy applications, the noise navigator provides a robust respiratory signal for patients scanned with an elevated coil setup. This is particularly attractive for widely used cartesian sequences where currently a non-interfering self-navigation means is lacking for MRI-based simulation and MRI-guided radiotherapy. The feasibility of 4D-MRI generation with the noise navigator as respiratory surrogate signal was demonstrated for both cartesian and radial readout strategies in radiotherapy setup on four healthy volunteers and two radiotherapy patients on a dedicated 1.5 T MRI scanner and two radiotherapy patients on a 1.5 T MRI-linac system. Moreover, the respiratory-correlated 4D-MR images showed liver motion comparable to a reference 2D cine MRI series for the volunteers. For 2D cartesian cine MRI acquisitions, both the noise navigator and respiratory bellows were benchmarked against an image navigator. Respiratory phase detection based on the noise navigator agreed 1.4 times better with the image navigator than the respiratory bellows did. For a 3D Stack-of-Stars acquisitions, the noise navigator was compared to radial self-navigation and a 1.7 times higher respiratory phase detection agreement was observed than for the respiratory bellows compared to radial self-navigation.

Technical feasibility of magnetic resonance fingerprinting on a 1.5T MRI-linac.

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 [Formula: see text], 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 reliable MRF signals that are temporally stable during the day and have good agreement with spin-echo reference measurements. Subsequent in-vivo MRF scans in healthy volunteers and a patient with a colorectal liver metastasis showed good image quality, where the quantitative values of selected organs corresponded with the values reported in literature. Therefore we conclude that gradient spoiled 2D MRF is feasible on a 1.5T MRL with similar performance as on a diagnostic system. The precision and accuracy of the parametric maps are sufficient for further investigation of the clinical utility of MRF for online quantitatively MRI-guided radiotherapy.

Fast contour propagation for MR-guided prostate radiotherapy using convolutional neural networks.

PURPOSE: To quickly and automatically propagate organ contours from pretreatment to fraction images in magnetic resonance (MR)-guided prostate external-beam radiotherapy. METHODS: Five prostate cancer patients underwent 20 fractions of image-guided external-beam radiotherapy on a 1.5 T MR-Linac system. For each patient, a pretreatment T2-weighted three-dimensional (3D) MR imaging (MRI) scan was used to delineate the clinical target volume (CTV) contours. The same scan was repeated during each fraction, with the CTV contour being manually adapted if necessary. A convolutional neural network (CNN) was trained for combined image registration and contour propagation. The network estimated the propagated contour and a deformation field between the two input images. The training set consisted of a synthetically generated ground truth of randomly deformed images and prostate segmentations. We performed a leave-one-out cross-validation on the five patients and propagated the prostate segmentations from the pretreatment to the fraction scans. Three variants of the CNN, aimed at investigating supervision based on optimizing segmentation overlap, optimizing the registration, and a combination of the two were compared to results of the open-source deformable registration software package Elastix. RESULTS: The neural networks trained on segmentation overlap or the combined objective achieved significantly better Hausdorff distances between predicted and ground truth contours than Elastix, at the much faster registration speed of 0.5 s. The CNN variant trained to optimize both the prostate overlap and deformation field, and the variant trained to only maximize the prostate overlap, produced the best propagation results. CONCLUSIONS: A CNN trained on maximizing prostate overlap and minimizing registration errors provides a fast and accurate method for deformable contour propagation for prostate MR-guided radiotherapy.

Dosimetric impact of soft-tissue based intrafraction motion from 3D cine-MR in prostate SBRT.

To investigate the dosimetric impact of intrafraction translation and rotation motion of the prostate, as extracted from daily acquired post-treatment 3D cine-MR based on soft-tissue contrast, in extremely hypofractionated (SBRT) prostate patients. Accurate dose reconstruction is performed by using a prostate intrafraction motion trace which is obtained with a soft-tissue based rigid registration method on 3D cine-MR dynamics with a temporal resolution of 11 s. The recorded motion of each time-point was applied to the planning CT, resulting in the respective dynamic volume used for dose calculation. For each treatment fraction, the treatment delivery record was generated by proportionally splitting the plan into 11 s intervals based on the delivered monitor units. For each fraction the doses of all partial plan/dynamic volume combinations were calculated and were summed to lead to the motion-affected fraction dose. Finally, for each patient the five fraction doses were summed, yielding the total treatment dose. Both daily and total doses were compared to the original reference dose of the respective patient to assess the impact of the intrafraction motion. Depending on the underlying motion of the prostate, different types of motion-affected dose distributions were observed. The planning target volumes (PTVs) ensured CTV_30 (seminal vesicles) D99% coverage for all patients, CTV_35 (prostate corpus) coverage for 97% of the patients and GTV_50 (local boost) for 83% of the patients when compared against the strict planning target D99% value. The dosimetric impact due to prostate intrafraction motion in extremely hypofractionated treatments was determined. The presented study is an essential step towards establishing the actual delivered dose to the patient during radiotherapy fractions.