PURPOSE: We implemented magnetic resonance-guided breath-hold stereotactic body radiation therapy in combination with visual feedback using the MRIdian system. Both accuracy of gated delivery and reproducibility of tumor positions were studied. METHODS AND MATERIALS: Tumor tracking is realized through repeated magnetic resonance imaging in a single sagittal plane at 4 frames per second with deformable image registration. An in-room monitor allowed visualization of the tracked gross tumor volume (GTV) contour and the planning target volume (PTV) (GTV + 3 mm), which was the gating boundary. For each delivery, a predefined threshold-region of interest percentage (ROI%) allows a percentage of GTV area to be outside the gating boundary before a beam-hold is triggered. Accuracy of gated delivery and tumor position reproducibility during breath-holds was analyzed for 15 patients (87 fractions) with lung, adrenal, and pancreas tumors. For each fraction, we analyzed (1) reproducibility of system-tracked GTV centroid position within the PTV; (2) geometric coverage of GTV area within the PTV; (3) treatment duty cycle efficiency; (4) effects of threshold ROI% settings on treatment duty cycle efficiency and GTV area coverage; and (5) beam-off latency effect on mean GTV coverage. RESULTS: For lung, adrenal, and pancreatic tumors, grouped 5th to 95th percentile distributions of GTV centroid positions in the dorsoventral direction, relative to PTV-center of mass (COM), were, respectively, -3.3 mm to 2.8 mm, -2.5 mm to 3.7 mm, and -4.4 mm to 2.9 mm. Corresponding distributions in the craniocaudal direction were -2.6 mm to 4.6 mm, -4.1 mm to 4.4 mm, and -4.4 mm to 4.5 mm, respectively. Mean GTV areas encompassed during beam-on for all fractions were 94.6%, 94.3%, and 95.3% for lung, adrenal, and pancreas tumors, respectively. Mean treatment duty cycle efficiency ranged from 67% to 87% for these tumors. Use of higher threshold-ROI% resulted in increased duty cycle efficiency, at the cost of a small decrease in GTV area coverage. The beam-off latency had a marginal impact on the GTV coverage. CONCLUSIONS: Gated stereotactic body radiation therapy delivery during breath-hold, real-time magnetic resonance guidance resulted in at least 95% geometric GTV coverage in lung, adrenal, and pancreatic tumors.
PURPOSE: We implemented magnetic resonance-guided breath-hold stereotactic body radiation therapy in combination with visual feedback using the MRIdian system. Both accuracy of gated delivery and reproducibility of tumor positions were studied. METHODS AND MATERIALS: Tumor tracking is realized through repeated magnetic resonance imaging in a single sagittal plane at 4 frames per second with deformable image registration. An in-room monitor allowed visualization of the tracked gross tumor volume (GTV) contour and the planning target volume (PTV) (GTV + 3 mm), which was the gating boundary. For each delivery, a predefined threshold-region of interest percentage (ROI%) allows a percentage of GTV area to be outside the gating boundary before a beam-hold is triggered. Accuracy of gated delivery and tumor position reproducibility during breath-holds was analyzed for 15 patients (87 fractions) with lung, adrenal, and pancreas tumors. For each fraction, we analyzed (1) reproducibility of system-tracked GTV centroid position within the PTV; (2) geometric coverage of GTV area within the PTV; (3) treatment duty cycle efficiency; (4) effects of threshold ROI% settings on treatment duty cycle efficiency and GTV area coverage; and (5) beam-off latency effect on mean GTV coverage. RESULTS: For lung, adrenal, and pancreatic tumors, grouped 5th to 95th percentile distributions of GTV centroid positions in the dorsoventral direction, relative to PTV-center of mass (COM), were, respectively, -3.3 mm to 2.8 mm, -2.5 mm to 3.7 mm, and -4.4 mm to 2.9 mm. Corresponding distributions in the craniocaudal direction were -2.6 mm to 4.6 mm, -4.1 mm to 4.4 mm, and -4.4 mm to 4.5 mm, respectively. Mean GTV areas encompassed during beam-on for all fractions were 94.6%, 94.3%, and 95.3% for lung, adrenal, and pancreas tumors, respectively. Mean treatment duty cycle efficiency ranged from 67% to 87% for these tumors. Use of higher threshold-ROI% resulted in increased duty cycle efficiency, at the cost of a small decrease in GTV area coverage. The beam-off latency had a marginal impact on the GTV coverage. CONCLUSIONS: Gated stereotactic body radiation therapy delivery during breath-hold, real-time magnetic resonance guidance resulted in at least 95% geometric GTV coverage in lung, adrenal, and pancreatic tumors.
Authors: Benjamin Lewis; Anamaria Guta; Stacie Mackey; H Michael Gach; Sasa Mutic; Olga Green; Taeho Kim Journal: J Appl Clin Med Phys Date: 2021-01-15 Impact factor: 2.102
Authors: Rosie J Goodburn; Marielle E P Philippens; Thierry L Lefebvre; Aly Khalifa; Tom Bruijnen; Joshua N Freedman; David E J Waddington; Eyesha Younus; Eric Aliotta; Gabriele Meliadò; Teo Stanescu; Wajiha Bano; Ali Fatemi-Ardekani; Andreas Wetscherek; Uwe Oelfke; Nico van den Berg; Ralph P Mason; Petra J van Houdt; James M Balter; Oliver J Gurney-Champion Journal: Magn Reson Med Date: 2022-09-21 Impact factor: 3.737
Authors: Paul J Keall; Caterina Brighi; Carri Glide-Hurst; Gary Liney; Paul Z Y Liu; Suzanne Lydiard; Chiara Paganelli; Trang Pham; Shanshan Shan; Alison C Tree; Uulke A van der Heide; David E J Waddington; Brendan Whelan Journal: Nat Rev Clin Oncol Date: 2022-04-19 Impact factor: 65.011
Authors: William A Hall; Eric S Paulson; Uulke A van der Heide; Clifton D Fuller; B W Raaymakers; Jan J W Lagendijk; X Allen Li; David A Jaffray; Laura A Dawson; Beth Erickson; Marcel Verheij; Kevin J Harrington; Arjun Sahgal; Percy Lee; Parag J Parikh; Michael F Bassetti; Clifford G Robinson; Bruce D Minsky; Ananya Choudhury; Robert J H A Tersteeg; Christopher J Schultz Journal: Eur J Cancer Date: 2019-10-12 Impact factor: 9.162
Authors: Fabian Weykamp; Philipp Hoegen; Sebastian Klüter; C Katharina Spindeldreier; Laila König; Katharina Seidensaal; Sebastian Regnery; Jakob Liermann; Carolin Rippke; Stefan A Koerber; Carolin Buchele; Jürgen Debus; Juliane Hörner-Rieber Journal: Front Oncol Date: 2021-06-09 Impact factor: 6.244
Authors: Eugene J Koay; Alexander N Hanania; William A Hall; Cullen M Taniguchi; Neal Rebueno; Sten Myrehaug; Katharine L Aitken; Laura A Dawson; Christopher H Crane; Joseph M Herman; Beth Erickson Journal: Pract Radiat Oncol Date: 2020-02-13