Audit feasibility for geometric distortion in magnetic resonance imaging for radiotherapy.

BACKGROUND AND PURPOSE: Magnetic Resonance Imaging (MRI) is increasingly being used in radiotherapy (RT). However, geometric distortions are a known challenge of using MRI in RT. The aim of this study was to demonstrate feasibility of a national audit of MRI geometric distortions. This was achieved by assessing large field of view (FOV) MRI distortions on a number of scanners used clinically for RT. MATERIALS AND METHODS: MRI scans of a large FOV MRI geometric distortion phantom were acquired on 11 MRI scanners that are used clinically for RT in the UK. The mean and maximum distortions and variance between scanners were reported at different distances from the isocentre. RESULTS: For a small FOV representing a brain (100-150 mm from isocentre) all distortions were < 2 mm except for the maximum distortion of one scanner. For a large FOV representing a head and neck/pelvis (200-250 mm from isocentre) mean distortions were < 2 mm except for one scanner, maximum distortions were > 10 mm in some cases. The variance between scanners was low and was found to increase with distance from isocentre. CONCLUSIONS: This study demonstrated feasibility of the technique to be repeated in a country wide geometric distortion audit of all MRI scanners used clinically for RT. Recommendations were made for performing such an audit and how to derive acceptable limits of distortion in such an audit.

Technical Note: Efficient and accurate MRI-only based treatment planning of the prostate using bulk density assignment through atlas-based segmentation.

PURPOSE: This study investigates the dosimetric accuracy as well as the robustness of a bulk density assignment approach to magnetic resonance imaging (MRI)-only based treatment planning of the prostate, with bulk density regions automatically identified using atlas-based segmentation (ABS). METHODS: Twenty prostate radiotherapy patients received planning computed tomography (CT) and MRI scans and were treated with volumetric modulated arc therapy (VMAT). Two bulk densities were set, one for bone and one for soft tissue. The bone contours were created by using ABS followed by manual modification if considered necessary. A range of soft tissue and bone density pairs, between 0.95 and 1.03 g/cm3 with increments of 0.01 for soft tissue, and between 1.15 and 1.65 g/cm3 with increments of 0.05 for bone, were evaluated. Using the density pair giving the lowest dose difference compared to the CT-based dose, dose differences were calculated using both the manually modified bone contours and the bone contours from ABS. Contour overlap measurements between the ABS contours and the manually modified contours were calculated. RESULTS: The dose comparison shows a very good agreement with the CT when using 0.98 g/cm3 for soft tissue and 1.20 g/cm3 for bone, with a dose difference less than 1 % in average dose in all regions of interest. The mean Dice similarity coefficient for bone was 0.94 and the Mean Distance to Agreement was <1 mm in most cases. CONCLUSIONS: Using bulk density assignment on MR images with suitable densities for bone and soft tissue results in clinically acceptable dose differences compared to dose calculated on the CT, for both atlas-based and manual bone contours. This demonstrates that an integrated MRI-only pathway utilizing a bulk density assignment for two tissue types is a feasible and robust approach for patients with prostate cancer treated with VMAT.

Dosimetric effects of setup uncertainties on breast treatment delivery.

This study aimed to assess the dosimetric impact of setup errors during the delivery of radiotherapy to the breast, and use this information to make recommendations on intervention tolerances for portal imaging of breast treatments. Translational and rotational setup errors were simulated for 10 recent breast patients using an Oncentra MasterPlan treatment planning system. The effect of these errors on the breast and tumor bed target volumes receiving 95% and 107% of the prescribed dose were assessed. For the majority of patients, shifts of up to 10 mm or a 4 degrees patient rotation about the cranio-caudal axis had no significant effect on the dose distribution. Changes in dosimetry were more likely if the reference plan contained large hot or cold spots. For a typical patient, it is estimated that a shift of 5 mm in any one direction, or a 2 degrees patient rotation would not cause more than a 5% change in the target volume receiving between 95% and 107% of the prescribed dose. If combinations of errors occur, greater dosimetric changes would be expected. It is concluded that individual patient shifts of up to 5 mm or rotations about the cranio-caudal axis of 2 degrees or less are unlikely to affect dose-volume histogram parameters by an amount judged as clinically significant. Setup errors exceeding these values may cause large dosimetric changes for some patients, particularly those with larger hot or cold regions in the dose distribution, and intervention is therefore recommended.