An assessment of set up position for MRI scanning for the purposes of rectal cancer radiotherapy treatment planning.

INTRODUCTION: A magnetic resonance (MR) scanner for radiotherapy treatment simulation was commissioned in our department in June 2013. Practical set up and MR image quality trade-offs using a variety of patient positions and immobilisation devices routinely used in the treatment planning of rectal cancer patients were considered. The study also aimed to investigate the MR compatibility of the device materials with a focus on temperature changes during routine clinical examinations. METHODS: Ten volunteers were scanned: (1) Prone on a Civco Contoura Bellyboard (BBB), (2) Prone on a Civco MR Series Bellyboard (WBB), (3) Prone with no bellyboard and (4) Supine. All scans were performed with a T2 weighted (T2 -w) turbo spin echo (TSE) sequence. Images were scored by five assessors for: (1) ease of identifying specific organs, (2) overall image quality and (3) signal to noise ratio (SNR). Temperature changes were measured for each volunteer in each position. RESULTS: Both expert scores and SNR analysis demonstrated that images obtained in the supine position allowed for easier and clearer delineation of the organs. Image factors such as artefacts and noise, along with the overall image quality, also performed better in the supine position. The carbon fibre bellyboard did not demonstrate significant heating during scanning with the T2 -w TSE transverse sequence. CONCLUSIONS: A supine position was determined to be superior to the other positions in a majority of comparisons. The volunteers did not experience any increased temperature changes during scanning on the bellyboard in comparison to the other positions.

The integration of MRI in radiation therapy: collaboration of radiographers and radiation therapists.

The increased utilisation of magnetic resonance imaging (MRI) in radiation therapy (RT) has led to the implementation of MRI simulators for RT treatment planning and influenced the development of MRI-guided treatment systems. There is extensive literature on the advantages of MRI for tumour volume and organ-at-risk delineation compared to computed tomography. MRI provides both anatomical and functional information for RT treatment planning (RTP) as well as quantitative information to assess tumour response for adaptive treatment. Despite many advantages of MRI in RT, introducing an MRI simulator into a RT department is a challenge. Collaboration between radiographers and radiation therapists is paramount in making the best use of this technology. The cross-disciplinary training of radiographers and radiation therapists alike is an area rarely discussed; however, it is becoming an important requirement due to detailed imaging needs for advanced RT treatment techniques and with the emergence of hybrid treatment systems. This article will discuss the initial experiences of a radiation oncology department in implementing a dedicated MRI simulator for RTP, with a focus on the training required for both radiographer and RT staff. It will also address the future of MRI in RT and the implementation of MRI-guided treatment systems, such as MRI-Linacs, and the role of both radiation therapists and radiographers in this technology.

High-risk CTV delineation for cervix brachytherapy: Application of GEC-ESTRO guidelines in Australia and New Zealand.

INTRODUCTION: Image-based brachytherapy for cervical cancer using MRI has been implemented in Australia and New Zealand. The aims of this study were to measure variability in High-risk CTV (HR-CTV) delineation and evaluate dosimetric consequences of this. METHODS: Nine radiation oncologists, one radiation therapist and two radiologists contoured HR-CTV on 3T MRI datasets from ten consecutive patients undergoing cervical brachytherapy at a single institution. Contour comparisons were performed using the Dice Similarity Coefficient (DSC) and Mean Absolute Surface Distance (MASD). Two reference contours were created for brachytherapy planning: a Simultaneous Truth and Performance Level Estimation (STAPLE) and a consensus contour (CONSENSUS). Optimized plans (8 Gy) for both these contours were applied to individual participant's contours to assess D90 and D100 coverage of HR CTV. To compare variability in dosimetry, relative standard deviation (rSD) was calculated. RESULTS: Good concordance (mean DSC≥0.7, MASD≤5 mm) was achieved in 8/10 cases when compared to the STAPLE reference and 6/10 cases when compared to the CONSENSUS reference. Greatest variation was visually seen in the cranio-caudal direction. The average mean rSD across all patients was 27% and 34% for the STAPLE HR-CTV D90 and D100, respectively, and 28% and 35% for the CONSENSUS HR-CTV D90 and D100. Delineation uncertainty resulted in an average dosimetric uncertainty of ±1.5-1.6 Gy per fraction based on an 8 Gy prescribed fraction. CONCLUSIONS: Delineation of HR-CTV for cervical cancer brachytherapy was consistent amongst observers, suggesting similar interpretation of GEC-ESTRO guidelines. Despite the good concordance, there was dosimetric variation noted, which could be clinically significant.