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Title: SU-G-JeP2-11: Polymer Gels as 3D QA Devices in Magnetic Resonance-Guided Radiation Therapy

Abstract

Purpose: To demonstrate the potential of polymer gels to serve as 3D QA devices in MR-guided radiotherapy. Methods: Custom-designed polymer gel dosimeters (MGS Research, Madison, CT) were centered on the penumbras of a radiation field, parallel to the magnetic field lines inside a 1.5 T MR scanner integrated with a 7 MV linac (MR-Linac). 15 Gy were delivered perpendicular to the magnetic field. Coronal MR images were acquired with a 2D balanced-Fast Field Echo (b-FFE) sequence in real-time during irradiation and with a 2D spin echo sequence at different times after irradiation. Signal intensities (SI) were measured inside and outside the radiation field on b-FFE images obtained during irradiation. Spin-spin relaxation rate (R2) maps were calculated from images after irradiation and penumbra widths were calculated from these maps. Results: A difference in SI between areas of the dosimeter inside and outside of the radiation field could be measured immediately after the beam was turned on. The difference in SI increased throughout the duration of the exposure. R2 values from immediately after irradiation were 83% of those measured 24h post-irradiation. At 1h after irradiation, the R2 values were 87% of those at 24h indicating that polymerization of the gel was stillmore » ongoing. At 24h postirradiation the width of the 80/20 penumbra on the left field edge measured 6.5 mm and on the right 5.6 mm. Conclusion: The MR-Linac allows for MR imaging during treatment and measurements of 3D dose distributions with steep dose gradients without having to transfer dosimeters for read-out. The results showed promise for polymer gels as relative 3D QA devices to verify radiation treatment plans delivered by an MR-Linac. To our knowledge, this was the first time that polymer gels were used for real-time image acquisition. Further investigations into the application of polymer gel dosimetry on MR-Linac are ongoing.« less

Authors:
 [1];  [2];  [3]; ;  [4];  [1]
  1. University of Houston, Houston, TX (United States)
  2. (United States)
  3. MR Therapy, Philips healthTech, Cleveland, OH (United States)
  4. UT MD Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
22649377
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BIOMEDICAL RADIOGRAPHY; DOSEMETERS; IMAGES; IRRADIATION; LINEAR ACCELERATORS; MAGNETIC FIELDS; MAGNETS; POLYMER GEL DOSIMETRY; POLYMERIZATION; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY

Citation Formats

Roed, Y, UT MD Anderson Cancer Center, Houston, TX, Kadbi, M, Wang, J, Ibbott, G, and Pinsky, L. SU-G-JeP2-11: Polymer Gels as 3D QA Devices in Magnetic Resonance-Guided Radiation Therapy. United States: N. p., 2016. Web. doi:10.1118/1.4957031.
Roed, Y, UT MD Anderson Cancer Center, Houston, TX, Kadbi, M, Wang, J, Ibbott, G, & Pinsky, L. SU-G-JeP2-11: Polymer Gels as 3D QA Devices in Magnetic Resonance-Guided Radiation Therapy. United States. doi:10.1118/1.4957031.
Roed, Y, UT MD Anderson Cancer Center, Houston, TX, Kadbi, M, Wang, J, Ibbott, G, and Pinsky, L. 2016. "SU-G-JeP2-11: Polymer Gels as 3D QA Devices in Magnetic Resonance-Guided Radiation Therapy". United States. doi:10.1118/1.4957031.
@article{osti_22649377,
title = {SU-G-JeP2-11: Polymer Gels as 3D QA Devices in Magnetic Resonance-Guided Radiation Therapy},
author = {Roed, Y and UT MD Anderson Cancer Center, Houston, TX and Kadbi, M and Wang, J and Ibbott, G and Pinsky, L},
abstractNote = {Purpose: To demonstrate the potential of polymer gels to serve as 3D QA devices in MR-guided radiotherapy. Methods: Custom-designed polymer gel dosimeters (MGS Research, Madison, CT) were centered on the penumbras of a radiation field, parallel to the magnetic field lines inside a 1.5 T MR scanner integrated with a 7 MV linac (MR-Linac). 15 Gy were delivered perpendicular to the magnetic field. Coronal MR images were acquired with a 2D balanced-Fast Field Echo (b-FFE) sequence in real-time during irradiation and with a 2D spin echo sequence at different times after irradiation. Signal intensities (SI) were measured inside and outside the radiation field on b-FFE images obtained during irradiation. Spin-spin relaxation rate (R2) maps were calculated from images after irradiation and penumbra widths were calculated from these maps. Results: A difference in SI between areas of the dosimeter inside and outside of the radiation field could be measured immediately after the beam was turned on. The difference in SI increased throughout the duration of the exposure. R2 values from immediately after irradiation were 83% of those measured 24h post-irradiation. At 1h after irradiation, the R2 values were 87% of those at 24h indicating that polymerization of the gel was still ongoing. At 24h postirradiation the width of the 80/20 penumbra on the left field edge measured 6.5 mm and on the right 5.6 mm. Conclusion: The MR-Linac allows for MR imaging during treatment and measurements of 3D dose distributions with steep dose gradients without having to transfer dosimeters for read-out. The results showed promise for polymer gels as relative 3D QA devices to verify radiation treatment plans delivered by an MR-Linac. To our knowledge, this was the first time that polymer gels were used for real-time image acquisition. Further investigations into the application of polymer gel dosimetry on MR-Linac are ongoing.},
doi = {10.1118/1.4957031},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To assess MR signal contrast for different ferrous ion compounds used in Fricke-type gel dosimeters for real-time dose measurements for MR-guided radiation therapy applications. Methods: Fricke-type gel dosimeters were prepared in 4% w/w gelatin prior to irradiation in an integrated 1.5 T MRI and 7 MV linear accelerator system (MR-Linac). 4 different ferrous ion (Fe2?) compounds (referred to as A, B, C, and D) were investigated for this study. Dosimeter D consisted of ferrous ammonium sulfate (FAS), which is conventionally used for Fricke dosimeters. Approximately half of each cylindrical dosimeter (45 mm diameter, 80 mm length) was irradiated tomore » ∼17 Gy. MR imaging during irradiation was performed with the MR-Linac using a balanced-FFE sequence of TR/TE = 5/2.4 ms. An approximate uncertainty of 5% in our dose delivery was anticipated since the MR-Linac had not yet been fully commissioned. Results: The signal intensities (SI) increased between the un-irradiated and irradiated regions by approximately 8.6%, 4.4%, 3.2%, and 4.3% after delivery of ∼2.8 Gy for dosimeters A, B, C, and D, respectively. After delivery of ∼17 Gy, the SI had increased by 24.4%, 21.0%, 3.1%, and 22.2% compared to the un-irradiated regions. The increase in SI with respect to dose was linear for dosimeters A, B, and D with slopes of 0.0164, 0.0251, and 0.0236 Gy{sup −1} (R{sup 2} = 0.92, 0.97, and 0.96), respectively. Visually, dosimeter A had the greatest optical contrast from yellow to purple in the irradiated region. Conclusion: This study demonstrated the feasibility of using Fricke-type dosimeters for real-time dose measurements with the greatest optical and MR contrast for dosimeter A. We also demonstrated the need to investigate Fe{sup 2+} compounds beyond the conventionally utilized FAS compound in order to improve the MR signal contrast in 3D dosimeters used for MR-guided radiation therapy. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. LH- 102SPS.« less
  • Purpose: Synthetic-CTs(synCTs) are essential for MR-only treatment planning. However, the performance of synCT for IGRT must be carefully assessed. This work evaluated the accuracy of synCT and synCT-generated DRRs and determined their performance for IGRT in brain cancer radiation therapy. Methods: MR-SIM and CT-SIM images were acquired of a novel anthropomorphic phantom and a cohort of 12 patients. SynCTs were generated by combining an ultra-short echo time (UTE) sequence with other MRI datasets using voxel-based weighted summation. For the phantom, DRRs from synCT and CT were compared via bounding box and landmark analysis. Planar (MV/KV) and volumetric (CBCT) IGRT performancemore » were evaluated across several platforms. In patients, retrospective analysis was conducted to register CBCTs (n=34) to synCTs and CTs using automated rigid registration in the treatment planning system using whole brain and local registration techniques. A semi-automatic registration program was developed and validated to rigidly register planar MV/KV images (n=37) to synCT and CT DRRs. Registration reproducibility was assessed and margin differences were characterized using the van Herk formalism. Results: Bounding box and landmark analysis of phantom synCT DRRs were within 1mm of CT DRRs. Absolute 2D/2D registration shift differences ranged from 0.0–0.7mm for phantom DRRs on all treatment platforms and 0.0–0.4mm for volumetric registrations. For patient planar registrations, mean shift differences were 0.4±0.5mm (range: −0.6–1.6mm), 0.0±0.5mm, (range: −0.9–1.2mm), and 0.1±0.3mm (range: −0.7–0.6mm) for the superior-inferior(S-I), left-right(L–R), and anterior-posterior(A-P) axes, respectively. Mean shift differences in volumetric registrations were 0.6±0.4mm (range: −0.2–1.6mm), 0.2±0.4mm (range: −0.3–1.2mm), and 0.2±0.3mm (range: −0.2–1.2mm) for S-I, L–R, and A–P axes, respectively. CT-SIM and synCT derived margins were within 0.3mm. Conclusion: DRRs generated via synCT agreed well with CT-SIM. Planar and volumetric registrations to synCT-derived targets were comparable to CT. This validation is the next step toward clinical implementation of MR-only planning for the brain. The submitting institution has research agreements with Philips Healthcare. Research sponsored by a Henry Ford Health System Internal Mentored Grant.« less
  • Purpose: Evaluate a large-field MRI phantom for assessment of geometric distortion in whole-body MRI for real-time MR guided radiation therapy. Methods: A prototype CIRS large-field MRI distortion phantom consisting of a PMMA cylinder (33 cm diameter, 30 cm length) containing a 3D-printed orthogonal grid (3 mm diameter rods, 20 mm apart), was filled with 6 mM NiCl{sub 2} and 30 mM NaCl solution. The phantom was scanned at 1.5T and 3.0T on a GE HDxt and Discovery MR750, respectively, and at 0.35T on a ViewRay system. Scans were obtained with and without 3D distortion correction to demonstrate the impact ofmore » such corrections. CT images were used as a reference standard for analysis of geometric distortion, as determined by a fully automated gradient-search method developed in Matlab. Results: 1,116 grid points distributed throughout a cylindrical volume 28 cm in diameter and 16 cm in length were identified and analyzed. With 3D distortion correction, average/maximum displacements for the 1.5, 3.0, and 0.35T systems were 0.84/2.91, 1.00/2.97, and 0.95/2.37 mm, respectively. The percentage of points with less than (1.0, 1.5, 2.0 mm) total displacement were (73%, 92%, 97%), (54%, 85%, 97%), and (55%, 90%, 99%), respectively. A reduced scan volume of 20 × 20 × 10 cm{sup 3} (representative of a head and neck scan volume) consisting of 420 points was also analyzed. In this volume, the percentage of points with less than (1.0, 1.5, 2.0 mm) total displacement were (90%, 99%, 100%), (63%, 95%, 100%), and (75%, 96%, 100%), respectively. Without 3D distortion correction, average/maximum displacements were 1.35/3.67, 1.67/4.46, and 1.51/3.89 mm, respectively. Conclusion: The prototype large-field MRI distortion phantom and developed software provide a thorough assessment of 3D spatial distortions in MRI. The distortions measured were acceptable for RT applications, both for the high field strengths and the system configuration developed by ViewRay.« less
  • Purpose: Magnetic resonance imaging/diffusion weighted-imaging (MRI/DWI)-guided high-dose-rate (HDR) brachytherapy and {sup 18}F-fluorodeoxyglucose (FDG) — positron emission tomography/computed tomography (PET/CT)-guided intensity modulated radiation therapy (IMRT) for the definitive treatment of cervical cancer is a novel treatment technique. The purpose of this study was to report our analysis of dose-volume parameters predicting gross tumor volume (GTV) control. Methods and Materials: We analyzed the records of 134 patients with International Federation of Gynecology and Obstetrics stages IB1-IVB cervical cancer treated with combined MRI-guided HDR and IMRT from July 2009 to July 2011. IMRT was targeted to the metabolic tumor volume and lymph nodesmore » by use of FDG-PET/CT simulation. The GTV for each HDR fraction was delineated by use of T2-weighted or apparent diffusion coefficient maps from diffusion-weighted sequences. The D100, D90, and Dmean delivered to the GTV from HDR and IMRT were summed to EQD2. Results: One hundred twenty-five patients received all irradiation treatment as planned, and 9 did not complete treatment. All 134 patients are included in this analysis. Treatment failure in the cervix occurred in 24 patients (18.0%). Patients with cervix failures had a lower D100, D90, and Dmean than those who did not experience failure in the cervix. The respective doses to the GTV were 41, 58, and 136 Gy for failures compared with 67, 99, and 236 Gy for those who did not experience failure (P<.001). Probit analysis estimated the minimum D100, D90, and Dmean doses required for ≥90% local control to be 69, 98, and 260 Gy (P<.001). Conclusions: Total dose delivered to the GTV from combined MRI-guided HDR and PET/CT-guided IMRT is highly correlated with local tumor control. The findings can be directly applied in the clinic for dose adaptation to maximize local control.« less
  • Purpose: The aims of this work are to describe the workflow and initial clinical experience treating patients with an MRI-guided radiotherapy (MRIGRT) system. Methods: Patient treatments with a novel MR-IGRT system started at our institution in mid-January. The system consists of an on-board 0.35-T MRI, with IMRT-capable delivery via doubly-focused MLCs on three {sup 60} Co heads. In addition to volumetric MR-imaging, real-time planar imaging is performed during treatment. So far, eleven patients started treatment (six finished), ranging from bladder to lung SBRT. While the system is capable of online adaptive radiotherapy and gating, a conventional workflow was used tomore » start, consisting of volumetric imaging for patient setup using visible tumor, evaluation of tumor motion outside of PTV on cine images, and real-time imaging. Workflow times were collected and evaluated to increase efficiency and evaluate feasibility of adding the adaptive and gating features while maintaining a reasonable patient throughput. Results: For the first month, physicians attended every fraction to provide guidance on identifying the tumor and an acceptable level of positioning and anatomical deviation. Average total treatment times (including setup) were reduced from 55 to 45 min after physician presence was no longer required and the therapists had learned to align patients based on soft-tissue imaging. Presently, the source strengths were at half maximum (7.7K Ci each), therefore beam-on times will be reduced after source replacement. Current patient load is 10 per day, with increase to 25 anticipated in the near future. Conclusion: On-board, real-time MRI-guided RT has been incorporated into clinical use. Treatment times were kept to reasonable lengths while including volumetric imaging, previews of tumor movement, and physician evaluation. Workflow and timing is being continuously evaluated to increase efficiency. In near future, adaptive and gating capabilities of the system will be implemented.« less