Acceptance procedure for the linear accelerator component of the 1.5 T MRI-linac.

PURPOSE: To develop and implement an acceptance procedure for the new Elekta Unity 1.5 T MRI-linac. METHODS: Tests were adopted and, where necessary adapted, from AAPM TG106 and TG142, IEC 60976 and NCS 9 and NCS 22 guidelines. Adaptations were necessary because of the atypical maximum field size (57.4 × 22 cm), FFF beam, the non-rotating collimator, the absence of a light field, the presence of the 1.5 T magnetic field, restricted access to equipment within the bore, fixed vertical and lateral table position, and the need for MR image to MV treatment alignment. The performance specifications were set for stereotactic body radiotherapy (SBRT). RESULTS: The new procedure was performed similarly to that of a conventional kilovoltage x-ray (kV) image guided radiation therapy (IGRT) linac. Results were acquired for the first Unity system. CONCLUSIONS: A comprehensive set of tests was developed, described and implemented for the MRI-linac. The MRI-linac met safety requirements for patients and operators. The system delivered radiation very accurately with, for example a gantry rotation locus of isocenter of radius 0.38 mm and an average MLC absolute positional error of 0.29 mm, consistent with use for SBRT. Specifications for clinical introduction were met.

Transceive phase mapping using the PLANET method and its application for conductivity mapping in the brain.

PURPOSE: To demonstrate feasibility of transceive phase mapping with the PLANET method and its application for conductivity reconstruction in the brain. METHODS: Accuracy and precision of transceive phase (ϕ± ) estimation with PLANET, an ellipse fitting approach to phase-cycled balanced steady state free precession (bSSFP) data, were assessed with simulations and measurements and compared to standard bSSFP. Measurements were conducted on a homogeneous phantom and in the brain of healthy volunteers at 3 tesla. Conductivity maps were reconstructed with Helmholtz-based electrical properties tomography. In measurements, PLANET was also compared to a reference technique for transceive phase mapping, i.e., spin echo. RESULTS: Accuracy and precision of ϕ± estimated with PLANET depended on the chosen flip angle and TR. PLANET-based ϕ± was less sensitive to perturbations induced by off-resonance effects and partial volume (e.g., white matter + myelin) than bSSFP-based ϕ± . For flip angle = 25° and TR = 4.6 ms, PLANET showed an accuracy comparable to that of reference spin echo but a higher precision than bSSFP and spin echo (factor of 2 and 3, respectively). The acquisition time for PLANET was ~5 min; 2 min faster than spin echo and 8 times slower than bSSFP. However, PLANET simultaneously reconstructed T1 , T2 , B0 maps besides mapping ϕ± . In the phantom, PLANET-based conductivity matched the true value and had the smallest spread of the three methods. In vivo, PLANET-based conductivity was similar to spin echo-based conductivity. CONCLUSION: Provided that appropriate sequence parameters are used, PLANET delivers accurate and precise ϕ± maps, which can be used to reconstruct brain tissue conductivity while simultaneously recovering T1 , T2 , and B0 maps.

Deep learning-based reconstruction of in vivo pelvis conductivity with a 3D patch-based convolutional neural network trained on simulated MR data.

PURPOSE: To demonstrate that mapping pelvis conductivity at 3T with deep learning (DL) is feasible. METHODS: 210 dielectric pelvic models were generated based on CT scans of 42 cervical cancer patients. For all dielectric models, electromagnetic and MR simulations with realistic accuracy and precision were performed to obtain B1+ and transceive phase (ϕ± ). Simulated B1+ and ϕ± served as input to a 3D patch-based convolutional neural network, which was trained in a supervised fashion to retrieve the conductivity. The same network architecture was retrained using only ϕ± in input. Both network configurations were tested on simulated MR data and their conductivity reconstruction accuracy and precision were assessed. Furthermore, both network configurations were used to reconstruct conductivity maps from a healthy volunteer and two cervical cancer patients. DL-based conductivity was compared in vivo and in silico to Helmholtz-based (H-EPT) conductivity. RESULTS: Conductivity maps obtained from both network configurations were comparable. Accuracy was assessed by mean error (ME) with respect to ground truth conductivity. On average, ME < 0.1 Sm-1 for all tissues. Maximum MEs were 0.2 Sm-1 for muscle and tumour, and 0.4 Sm-1 for bladder. Precision was indicated with the difference between 90th and 10th conductivity percentiles, and was below 0.1 Sm-1 for fat, bone and muscle, 0.2 Sm-1 for tumour and 0.3 Sm-1 for bladder. In vivo, DL-based conductivity had median values in agreement with H-EPT values, but a higher precision. CONCLUSION: Anatomically detailed, noise-robust 3D conductivity maps with good sensitivity to tissue conductivity variations were reconstructed in the pelvis with DL.

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer.

OBJECTIVE: This study was conducted in order to determine the optimal timing of diffusion-weighted magnetic resonance imaging (DW-MRI) for prediction of pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. METHODS: Patients with esophageal adenocarcinoma or squamous cell carcinoma who planned to undergo nCRT followed by surgery were enrolled in this prospective study. Patients underwent six DW-MRI scans: one baseline scan before the start of nCRT and weekly scans during 5 weeks of nCRT. Relative changes in mean apparent diffusion coefficient (ADC) values between the baseline scans and the scans during nCRT (ΔADC(%)) were compared between pathologic complete responders (pCR) and non-pCR (tumor regression grades 2-5). The discriminative ability of ΔADC(%) was determined based on the c-statistic. RESULTS: A total of 24 patients with 142 DW-MRI scans were included. pCR was observed in seven patients (29%). ΔADC(%) from baseline to week 2 was significantly higher in patients with pCR versus non-pCR (median [IQR], 36% [30%, 41%] for pCR versus 16% [14%, 29%] for non-pCR, p = 0.004). The ΔADC(%) of the second week in combination with histology resulted in the highest c-statistic for the prediction of pCR versus non-pCR (0.87). The c-statistic of this model increased to 0.97 after additional exclusion of patients with a small tumor volume (< 7 mL, n = 3) and tumor histology of the resection specimen other than adenocarcinoma or squamous cell carcinoma (n = 1). CONCLUSION: The relative change in tumor ADC (ΔADC(%)) during the first 2 weeks of nCRT is the most predictive for pathologic complete response to nCRT in esophageal cancer patients. KEY POINTS: • DW-MRI during the second week of neoadjuvant chemoradiotherapy is most predictive for pathologic complete response in esophageal cancer. • A model including ΔADCweek 2was able to discriminate between pathologic complete responders and non-pathologic complete responders in 87%. • Improvements in future MRI studies for esophageal cancer may be obtained by incorporating motion management techniques.

Advanced patient-specific hyperthermia treatment planning.

Hyperthermia treatment planning (HTP) is valuable to optimize tumor heating during thermal therapy delivery. Yet, clinical hyperthermia treatment plans lack quantitative accuracy due to uncertainties in tissue properties and modeling, and report tumor absorbed power and temperature distributions which cannot be linked directly to treatment outcome. Over the last decade, considerable progress has been made to address these inaccuracies and therefore improve the reliability of hyperthermia treatment planning. Patient-specific electrical tissue conductivity derived from MR measurements has been introduced to accurately model the power deposition in the patient. Thermodynamic fluid modeling has been developed to account for the convective heat transport in fluids such as urine in the bladder. Moreover, discrete vasculature trees have been included in thermal models to account for the impact of thermally significant large blood vessels. Computationally efficient optimization strategies based on SAR and temperature distributions have been established to calculate the phase-amplitude settings that provide the best tumor thermal dose while avoiding hot spots in normal tissue. Finally, biological modeling has been developed to quantify the hyperthermic radiosensitization effect in terms of equivalent radiation dose of the combined radiotherapy and hyperthermia treatment. In this paper, we review the present status of these developments and illustrate the most relevant advanced elements within a single treatment planning example of a cervical cancer patient. The resulting advanced HTP workflow paves the way for a clinically feasible and more reliable patient-specific hyperthermia treatment planning.

Accuracy and precision of electrical permittivity mapping at 3T: the impact of three B1+ mapping techniques.

PURPOSE: To investigate the sequence-specific impact of B1+ amplitude mapping on the accuracy and precision of permittivity reconstruction at 3T in the pelvic region. METHODS: B1+ maps obtained with actual flip angle imaging (AFI), Bloch-Siegert (BS), and dual refocusing echo acquisition mode (DREAM) sequences, set to a clinically feasible scan time of 5 minutes, were compared in terms of accuracy and precision with electromagnetic and Bloch simulations and MR measurements. Permittivity maps were reconstructed based on these B1+ maps with Helmholtz-based electrical properties tomography. Accuracy and precision in permittivity were assessed. A 2-compartment phantom with properties and size similar to the human pelvis was used for both simulations and measurements. Measurements were also performed on a female volunteer's pelvis. RESULTS: Accuracy was evaluated with noiseless simulations on the phantom. The maximum B1+ bias relative to the true B1+ distribution was 1% for AFI and BS and 6% to 15% for DREAM. This caused an average permittivity bias relative to the true permittivity of 7% to 20% for AFI and BS and 12% to 35% for DREAM. Precision was assessed in MR experiments. The lowest standard deviation in permittivity, found in the phantom for BS, measured 22.4 relative units and corresponded to a standard deviation in B1+ of 0.2% of the B1+ average value. As regards B1+ precision, in vivo and phantom measurements were comparable. CONCLUSIONS: Our simulation framework quantitatively predicts the different impact of B1+ mapping techniques on permittivity reconstruction and shows high sensitivity of permittivity reconstructions to sequence-specific bias and noise perturbation in the B1+ map. These findings are supported by the experimental results.

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy.

BACKGROUND: In patients diagnosed with rectal cancer, dose escalation is currently being investigated in a large number of studies. Since there is little known on gross tumor volume (GTV) inter-fraction motion for rectal cancer, a wide variety in margins is used. Purpose of this study is to quantify GTV inter-fraction motion statistics on different timescales and to give estimates of planning target volume (PTV) margins. MATERIAL AND METHODS: Thirty-two patients, diagnosed with rectal cancer, were included. To investigate motion from week-to-week, 16 patients underwent a pretreatment and five weekly MRIs, prior to a radiotherapy (RT) fraction of the chemoradiotherapy treatment. To investigate motion from day-to-day, the remaining 16 patients underwent five daily MRIs before each fraction in one week of RT. GTV was delineated on all scans according to guidelines. Scans were aligned on bony anatomy with the first MRI. For both datasets separately, GTV inter-fraction motion was determined based on center-of-gravity displacement. Therefrom, systematic and random errors were determined in left/right (LR), anterior/posterior and cranial/caudal (CC) direction. PTV margin estimates were calculated and evaluated on GTV coverage. RESULTS: Systematic and random errors were found in the range of 2.3-4.8 mm and 1.5-3.3 mm from week-to-week, and 1.8-4.5 mm and 1.8-4.0 mm from day-to-day, respectively. On both timescales, similar motion patterns were found; the most motion was observed in CC whilst the least motion was observed in LR. On the week-to-week data more systematic and less random motion was observed compared to the day-to-day data. Overall, only slight differences in margin estimates were found. Derived PTV margin estimates were found to give adequate GTV coverage. CONCLUSION: GTV inter-fraction motion, on a week-to-week and day-to-day timescale, can be accounted for using motion statistics presented in this study.

DW-MRI and DCE-MRI are of complementary value in predicting pathologic response to neoadjuvant chemoradiotherapy for esophageal cancer.

PURPOSE: To explore the potential benefit and complementary value of a multiparametric approach using diffusion-weighted (DW-) and dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) for prediction of response to neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer. MATERIAL AND METHODS: Forty-five patients underwent both DW-MRI and DCE-MRI prior to nCRT (pre), during nCRT (week 2-3) (per) and after completion of nCRT, but prior to esophagectomy (post). Subsequently, histopathologic tumor regression grade (TRG) was assessed. Tumor apparent diffusion coefficient (ADC) and area-under-the-concentration time curve (AUC) were calculated for DW-MRI and DCE-MRI, respectively. The ability of these parameters to predict pathologic complete response (pCR, TRG1) or good response (GR, TRG ≤ 2) to nCRT was assessed. Furthermore the complementary value of DW-MRI and DCE-MRI was investigated. RESULTS: GR was found in 22 (49%) patients, of which 10 (22%) patients showed pCR. For DW-MRI, the 75th percentile (P75) ΔADCpost-pre was most predictive for GR (c-index = 0.75). For DCE-MRI, P90 ΔAUCper-pre was most predictive for pCR (c-index = 0.79). Multivariable logistic regression analyses showed complementary value when combining DW-MRI and DCE-MRI for pCR prediction (c-index = 0.89). CONCLUSIONS: Both DW-MRI and DCE-MRI are promising in predicting response to nCRT in esophageal cancer. Combining both modalities provides complementary information, resulting in a higher predictive value.

Adaptive bulk motion exclusion for improved robustness of abdominal magnetic resonance imaging.

Non-Cartesian magnetic resonance imaging (MRI) sequences have shown great promise for abdominal examination during free breathing, but break down in the presence of bulk patient motion (i.e. voluntary or involuntary patient movement resulting in translation, rotation or elastic deformations of the body). This work describes a data-consistency-driven image stabilization technique that detects and excludes bulk movements during data acquisition. Bulk motion is identified from changes in the signal intensity distribution across different elements of a multi-channel receive coil array. A short free induction decay signal is acquired after excitation and used as a measure to determine alterations in the load distribution. The technique has been implemented on a clinical MR scanner and evaluated in the abdomen. Six volunteers were scanned and two radiologists scored the reconstructions. To show the applicability to other body areas, additional neck and knee images were acquired. Data corrupted by bulk motion were successfully detected and excluded from image reconstruction. An overall increase in image sharpness and reduction of streaking and shine-through artifacts were seen in the volunteer study, as well as in the neck and knee scans. The proposed technique enables automatic real-time detection and exclusion of bulk motion during MR examinations without user interaction. It may help to improve the reliability of pediatric MRI examinations without the use of sedation.

Improving the arterial input function in dynamic contrast enhanced MRI by fitting the signal in the complex plane.

PURPOSE: Dynamic contrast enhanced (DCE) imaging is a widely used technique in oncologic imaging. An essential prerequisite for obtaining quantitative values from DCE-MRI is the determination of the arterial input function (AIF). However, it is very challenging to accurately estimate the AIF using MR. A comprehensive model, which uses complex data instead of either magnitude or phase, was developed to improve AIF estimation. THEORY AND METHODS: The model was first applied to simulated data. Subsequently, the accuracy of the estimated contrast agent concentration was validated in a phantom. Finally the method was applied to existing DCE scans of 13 prostate cancer patients. RESULTS: The complex signal method combines the complementary strengths of the magnitude and phase method, increasing the precision and accuracy of concentration estimation in simulated and phantom data. The in vivo AIFs show a good agreement between arterial voxels (standard deviation in the peak and tail equal 0.4 mM and 0.12 mM, respectively). Furthermore, the dynamic behavior closely followed the AIF obtained with DCE-CT in the same patients (mean correlation coefficient: 0.92). CONCLUSION: By using the complex signal, the AIF estimation becomes more accurate and precise. This might enable patient specific AIFs, thereby improving the quantitative values obtained from DCE-MRI. Magn Reson Med 76:1236-1245, 2016. © 2015 Wiley Periodicals, Inc.

Feasibility of measuring thermoregulation during RF heating of the human calf muscle using MR based methods.

PURPOSE: One of the main safety concerns in MR is heating of the subject due to radiofrequency (RF) exposure. Recently was shown that local peak temperatures can reach dangerous values and the most prominent parameter for accurate temperature estimations is thermoregulation. Therefore, the goal of this research is testing the feasibility of measuring thermoregulation in vivo using MR methods. THEORY AND METHODS: The calves of 13 volunteers were scanned at 3 tesla. A Proton Resonance Frequency Shift method was used for temperature measurement. Arterial Spin Labeling and phase contrast scans were used for perfusion and flow measurements respectively. The calves were monitored during extreme RF exposure (20 W/kg, 16 min) and after physical exercise. RESULTS: Temperature increases due to RF absorption (range of the 90th percentile of all volunteers: 1.1-2.5°C) matched with the reference skin temperature changes. Increases in perfusion and flow were defined on the whole leg and normalized to baseline. Perfusion showed a significant increase due to RF heating (ratio compared with baseline: 1.28 ± 0.37; P < 0.05), the influence of exercise was much greater, however (2.97 ± 2.45, P < 0.01). CONCLUSION: This study represents a first exploration of measuring thermoregulation, which will become essential when new safety guidelines are based on thermal dose.

An optimization framework to maximize signal-to-noise ratio in simultaneous multi-slice body imaging.

Parallel imaging is essential for the acceleration of abdominal and pelvic 2D multi-slice imaging, in order to reduce scan time and mitigate motion artifacts. Controlled Aliasing In Parallel Imaging Results IN Higher Acceleration (CAIPIRINHA) accelerated imaging has been shown to increase the signal-to-noise ratio (SNR) significantly compared with in-plane parallel imaging with similar acceleration. We hypothesize that for CAIPIRINHA-accelerated abdominal imaging the consistency of image quality and SNR is more difficult to achieve due to the subject-specific coil sensitivity profiles, caused by (1) flexible coil placement; (2) variations in anatomy; and (3) variations in scan coverage along the superior-inferior direction. To test this, a mathematical framework is introduced that calculates the (retained) SNR for in-plane and simultaneous multi-slice (SMS)-accelerated acquisitions. Moreover, this framework was used to optimize the sampling pattern by maximizing the local SNR within a region of interest (ROI) through non-linear, RF-induced CAIPIRINHA slice shifts. The framework was evaluated on 14 healthy subjects and the optimized sampling pattern was compared with in-plane acceleration and CAIPIRINHA acceleration with linear slice shifts, which are primarily used in brain imaging. We demonstrate that the field of view (FOV) in the superior-inferior direction, the coil positioning and the individual anatomy have a large impact on the image SNR (changes up to 50% for varying coil positions and 40% differences between subjects) and image artifacts for simultaneous multi-slice acceleration. Consequently, sampling patterns have to be optimized for acquisitions employing different FOVs and ideally on an individual basis. Optimization of the sampling pattern, which exploits non-linear shifts between slices, showed a considerable SNR increase (10-30%) for higher acceleration factors. The framework outlined in this article can be used to optimize sampling patterns for a broad range of accelerated body acquisitions on an individual basis. Copyright © 2015 John Wiley & Sons, Ltd.

Compensating for magnetic field inhomogeneity in multigradient-echo-based MR thermometry.

PURPOSE: MR thermometry (MRT) is a noninvasive method for measuring temperature that can potentially be used for radio frequency (RF) safety monitoring. This application requires measuring absolute temperature. In this study, a multigradient-echo (mGE) MRT sequence was used for that purpose. A drawback of this sequence, however, is that its accuracy is affected by background gradients. In this article, we present a method to minimize this effect and to improve absolute temperature measurements using MRI. THEORY: By determining background gradients using a B0 map or by combining data acquired with two opposing readout directions, the error can be removed in a homogenous phantom, thus improving temperature maps. METHODS: All scans were performed on a 3T system using ethylene glycol-filled phantoms. Background gradients were varied, and one phantom was uniformly heated to validate both compensation approaches. Independent temperature recordings were made with optical probes. RESULTS: Errors correlated closely to the background gradients in all experiments. Temperature distributions showed a much smaller standard deviation when the corrections were applied (0.21°C vs. 0.45°C) and correlated well with thermo-optical probes. CONCLUSION: The corrections offer the possibility to measure RF heating in phantoms more precisely. This allows mGE MRT to become a valuable tool in RF safety assessment.

Intersubject local SAR variation for 7T prostate MR imaging with an eight-channel single-side adapted dipole antenna array.

PURPOSE: Surface transmit arrays used in ultra-high field body MRI require local specific absorption rate (SAR) assessment. As local SAR cannot be measured directly, local SAR is determined by simulations using dielectric patient models. In this study, the inter-patient local SAR variation is investigated for 7T prostate imaging with the single-side adapted dipole antenna array. METHOD: Four-dedicated dielectric models were created by segmenting Dixon water-fat separated images that were obtained from four subjects with a 1.5T scanner and the surface array in place. Electromagnetic simulations were performed to calculate the SAR distribution for each model. Radio frequency (RF) exposure variations were determined by analyzing the SAR(10g) distributions (1) with one element active, (2) using a Q-matrix eigenvalue/eigenvector approach, (3) with the maximum potential SAR in each voxel, and (4) for a phase shimmed prostate measurement. RESULTS: Maximum potential local SAR levels for 1 W time-averaged accepted power per transmit channel range from 4.1 to 7.1 W/kg. CONCLUSION: These variations show that one model is not sufficient to determine safe scan settings. For the operation of the surface array conservative power settings were derived based on a worst-case SAR evaluation and the most SAR-sensitive body model.

Robust reconstruction of B1 (+) maps by projection into a spherical functions space.

PURPOSE: Several parallel transmit MRI techniques require knowledge of the transmit radiofrequency field profiles (B1 (+) ). During the past years, various methods have been developed to acquire this information. Often, these methods suffer from long measurement times and produce maps exhibiting regions with poor signal-to-noise ratio and artifacts. In this article, a model-based reconstruction procedure is introduced that improves the robustness of B1 (+) mapping. THEORY AND METHODS: The missing information from undersampled B1 (+) maps and the regions of poor signal to noise ratio are reconstructed through projection into the space of spherical functions that arise naturally from the solution of the Helmholtz equations in the spherical coordinate system. RESULTS: As a result, B1 (+) data over a limited range of the field of view/volume is sufficient to reconstruct the B1 (+) over the full spatial domain in a fast and robust way. The same model is exploited to filter the noise of the measured maps. Results from simulations and in vivo measurements confirm the validity of the proposed method. CONCLUSION: A spherical functions model can well approximate the magnetic fields inside the body with few basis terms. Exploiting this compression capability, B1 (+) maps are reconstructed in regions of unknown or corrupted values.

Transmit and receive RF fields determination from a single low-tip-angle gradient-echo scan by scaling of SVD data.

PURPOSE: A new method, called Transmit and Receive Patterns from Low-Tip-angle gradient-Echo Images (TRIPLET), is described which simultaneously maps the B1+ and B1- fields of a transmit/receive radiofrequency coil array. The input data are low-tip-angle gradient-echo images, which can be acquired in a relatively short scanning time. THEORY AND METHODS: For each voxel in the field of view, a matrix can be assembled with the low-tip-angle gradient-echo image values of the radiofrequency coil array. Applying the singular value decomposition to those matrices, datasets are obtained which show a high resemblance with the true B1+ and B1- fields. These datasets are a voxel-wise scaled version of the true radiofrequency maps. The channel independent scaling parameters can be found by implicitly forcing the reconstructed fields to be solutions of the Maxwell equations. This is achieved by introducing a multipole expansion consisting of Bessel/Fourier functions. RESULTS: Two FDTD simulated radiofrequency fields for two coil array combinations at 7 T and a measured, in vivo dataset at 7 T are investigated to illustrate the singular value decomposition analysis of the low-tip-angle gradient-echo images and to show how the B1+ and B1- fields can be reconstructed by Transmit and Receive Patterns from Low-Tip-angle gradient-Echo Images. CONCLUSION: The Transmit and Receive Patterns from Low-Tip-angle gradient-Echo Images algorithm can convert the datasets from singular value decomposition analysis of low-tip-angle gradient-echo images to true B1+ and B1- fields.

Electrical properties tomography in the human brain at 1.5, 3, and 7T: a comparison study.

PURPOSE: To investigate the effect of magnetic field strength on the validity of two assumptions (namely, the "transceive phase assumption" and the "phase-only reconstruction") for electrical properties tomography (EPT) at 1.5, 3, and 7T. THEORY: Electrical properties tomography is a method to map the conductivity and permittivity using MRI; the B1 (+) amplitude and phase is required as input. The B1 (+) phase, however, cannot be measured and is therefore deduced from the measurable transceive phase using the transceive phase assumption. Also, earlier studies showed that the B1 (+) amplitude is not always required for a reliable conductivity reconstruction; this is the so-called "phase-only conductivity reconstruction." METHODS: Electromagnetic simulations and MRI measurements of phantoms and the human head. RESULTS: Reconstructed conductivity and permittivity maps based on B1 (+) distributions at 1.5, 3, and 7T were compared to the expected dielectric properties. The noise level of measurements was also determined. CONCLUSION: The transceive phase assumption is most accurate for low-field strengths and low permittivity and in symmetric objects. The phase-only conductivity reconstruction is only applicable at 1.5 and 3T for the investigated geometries. The measurement precision was found to benefit from a higher field strength, which is related to increased signal-to-noise ratio (SNR) and increased curvature of the B1 (+) field.

Coaxial waveguide for travelling wave MRI at ultrahigh fields.

At high magnetic fields the performance of a volume-type body coil inside a human sized MR-scanner is influenced by the waveguide action of the scanner's bore. This can result in undesirable strong radio frequency fields B1+) outside the coil's target volume. A radio frequency (RF) transmit system, exploiting this waveguide action of the bore, is proposed in this work. A coaxial waveguide section is introduced between the antenna and the imaging region. It is shown that the coaxial waveguide has several advantages over the initially proposed travelling wave setup based on the cylindrical waveguide. First, a novel radio frequency matching principle (based on the transmission line impedance matching) is feasible with the coaxial waveguide achieving better radio frequency transmission characteristics, such as homogeneity and power efficiency of B1+ field. In case of body torso imaging, the coaxial waveguide prevents unwanted specific absorptive rate (SAR) deposition outside the target region and thus, effectively decreases local peak SAR values by factor of 5. A 3-fold B1+ gain in the prostate can be achieved with the coaxial waveguide in comparison with the initially proposed travelling wave setup.

Intrafraction motion analysis in online adaptive radiotherapy for esophageal cancer.

Intrafraction motion during magnetic resonance (MR)-guided dose delivery of esophageal cancer tumors was retrospectively analyzed. Deformable image registration of cine-MR series resulted in gross tumor volume motion profiles in all directions, which were subsequently filtered to isolate respiratory and drift motion. A large variability in intrafraction motion patterns was observed between patients. Median 95% peak-to-peak motion was 7.7 (3.7 - 18.3) mm, 2.1 (0.7 - 5.7) mm and 2.4 (0.5 - 5.6) mm in cranio-caudal, left-right and anterior-posterior directions, relatively. Furthermore, intrafraction drift was generally modest (<5mm). A patient specific approach could lead to very small margins (<3mm) for most patients.

Recurrence characteristics after focal salvage HDR brachytherapy in prostate cancer.

BACKGROUND AND PURPOSE: Radiorecurrent prostate cancer is often confined to the prostate, predominantly near the index lesion. The purpose of this study was to look at recurrence characteristics in patients treated with focal salvage high dose-rate (HDR) brachytherapy. MATERIALS AND METHODS: Patients treated with MRI-guided HDR brachytherapy, with a single fraction of 19 Gy from July 2013 to October 2021 as focal salvage treatment, were prospectively included in the current study. Imaging data were collected regarding the occurrence of local, regional and distant recurrences, including location of local recurrences (LR) in relation to the HDR radiotherapy field. RESULTS: One hundred seventy-five patients were included after focal salvage HDR brachytherapy (median follow-up 36 months (IQR 23-50)). Three-years biochemical recurrence-free survival, LR-free survival, in-field LR-free survival, out-of-field LR-free survival, any-recurrence-free survival and ADT-free survival were 43% (95%CI 34%-52%), 51% (41%-61%), 70% (61%-80%), 92% (88%-97%), 42% (32%-52%) and 86% (80%-92%), respectively. Larger GTV-size and shorter PSA doubling time were associated with in-field LR in multivariable analysis. CONCLUSION: After focal salvage HDR brachytherapy with a dose of 1x19 Gy for local prostate cancer recurrence, subsequent recurrences are mostly local and in-field.