MR-PROTECT : Clinical feasibility of a prostate MRI-only radiotherapy treatment workflow and investigation of acceptance criteria
(2020) In Radiation Oncology 15(1).- Abstract
Background: Retrospective studies on MRI-only radiotherapy have been presented. Widespread clinical implementations of MRI-only workflows are however limited by the absence of guidelines. The MR-PROTECT trial presents an MRI-only radiotherapy workflow for prostate cancer using a new single sequence strategy. The workflow incorporated the commercial synthetic CT (sCT) generation software MriPlanner™ (Spectronic Medical, Helsingborg, Sweden). Feasibility of the workflow and limits for acceptance criteria were investigated for the suggested workflow with the aim to facilitate future clinical implementations. Methods: An MRI-only workflow including imaging, post imaging tasks, treatment plan creation, quality assurance and treatment... (More)
Background: Retrospective studies on MRI-only radiotherapy have been presented. Widespread clinical implementations of MRI-only workflows are however limited by the absence of guidelines. The MR-PROTECT trial presents an MRI-only radiotherapy workflow for prostate cancer using a new single sequence strategy. The workflow incorporated the commercial synthetic CT (sCT) generation software MriPlanner™ (Spectronic Medical, Helsingborg, Sweden). Feasibility of the workflow and limits for acceptance criteria were investigated for the suggested workflow with the aim to facilitate future clinical implementations. Methods: An MRI-only workflow including imaging, post imaging tasks, treatment plan creation, quality assurance and treatment delivery was created with questionnaires. All tasks were performed in a single MR-sequence geometry, eliminating image registrations. Prospective CT-quality assurance (QA) was performed prior treatment comparing the PTV mean dose between sCT and CT dose-distributions. Retrospective analysis of the MRI-only gold fiducial marker (GFM) identification, DVH- analysis, gamma evaluation and patient set-up verification using GFMs and cone beam CT were performed. Results: An MRI-only treatment was delivered to 39 out of 40 patients. The excluded patient was too large for the predefined imaging field-of-view. All tasks could successfully be performed for the treated patients. There was a maximum deviation of 1.2% in PTV mean dose was seen in the prospective CT-QA. Retrospective analysis showed a maximum deviation below 2% in the DVH-analysis after correction for rectal gas and gamma pass-rates above 98%. MRI-only patient set-up deviation was below 2 mm for all but one investigated case and a maximum of 2.2 mm deviation in the GFM-identification compared to CT. Conclusions: The MR-PROTECT trial shows the feasibility of an MRI-only prostate radiotherapy workflow. A major advantage with the presented workflow is the incorporation of a sCT-generation method with multi-vendor capability. The presented single sequence approach are easily adapted by other clinics and the general implementation procedure can be replicated. The dose deviation and the gamma pass-rate acceptance criteria earlier suggested was achievable, and these limits can thereby be confirmed. GFM-identification acceptance criteria are depending on the choice of identification method and slice thickness. Patient positioning strategies needs further investigations to establish acceptance criteria.
(Less)
- author
- Persson, Emilia LU ; Jamtheim Gustafsson, Christian LU ; Ambolt, Petra ; Engelholm, Silke ; Ceberg, Sofie LU ; Bäck, Sven LU ; Olsson, Lars E. LU and Gunnlaugsson, Adalsteinn LU
- organization
- publishing date
- 2020-04-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Acceptance criteria, Clinical implementation, MRI only, Prospective, Prostate, Synthetic CT
- in
- Radiation Oncology
- volume
- 15
- issue
- 1
- article number
- 77
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:32272943
- scopus:85083222746
- ISSN
- 1748-717X
- DOI
- 10.1186/s13014-020-01513-7
- language
- English
- LU publication?
- yes
- id
- 06dd6934-4b92-43e9-8332-6332d3f21f47
- date added to LUP
- 2020-05-04 10:45:03
- date last changed
- 2024-09-04 21:03:41
@article{06dd6934-4b92-43e9-8332-6332d3f21f47, abstract = {{<p>Background: Retrospective studies on MRI-only radiotherapy have been presented. Widespread clinical implementations of MRI-only workflows are however limited by the absence of guidelines. The MR-PROTECT trial presents an MRI-only radiotherapy workflow for prostate cancer using a new single sequence strategy. The workflow incorporated the commercial synthetic CT (sCT) generation software MriPlanner™ (Spectronic Medical, Helsingborg, Sweden). Feasibility of the workflow and limits for acceptance criteria were investigated for the suggested workflow with the aim to facilitate future clinical implementations. Methods: An MRI-only workflow including imaging, post imaging tasks, treatment plan creation, quality assurance and treatment delivery was created with questionnaires. All tasks were performed in a single MR-sequence geometry, eliminating image registrations. Prospective CT-quality assurance (QA) was performed prior treatment comparing the PTV mean dose between sCT and CT dose-distributions. Retrospective analysis of the MRI-only gold fiducial marker (GFM) identification, DVH- analysis, gamma evaluation and patient set-up verification using GFMs and cone beam CT were performed. Results: An MRI-only treatment was delivered to 39 out of 40 patients. The excluded patient was too large for the predefined imaging field-of-view. All tasks could successfully be performed for the treated patients. There was a maximum deviation of 1.2% in PTV mean dose was seen in the prospective CT-QA. Retrospective analysis showed a maximum deviation below 2% in the DVH-analysis after correction for rectal gas and gamma pass-rates above 98%. MRI-only patient set-up deviation was below 2 mm for all but one investigated case and a maximum of 2.2 mm deviation in the GFM-identification compared to CT. Conclusions: The MR-PROTECT trial shows the feasibility of an MRI-only prostate radiotherapy workflow. A major advantage with the presented workflow is the incorporation of a sCT-generation method with multi-vendor capability. The presented single sequence approach are easily adapted by other clinics and the general implementation procedure can be replicated. The dose deviation and the gamma pass-rate acceptance criteria earlier suggested was achievable, and these limits can thereby be confirmed. GFM-identification acceptance criteria are depending on the choice of identification method and slice thickness. Patient positioning strategies needs further investigations to establish acceptance criteria.</p>}}, author = {{Persson, Emilia and Jamtheim Gustafsson, Christian and Ambolt, Petra and Engelholm, Silke and Ceberg, Sofie and Bäck, Sven and Olsson, Lars E. and Gunnlaugsson, Adalsteinn}}, issn = {{1748-717X}}, keywords = {{Acceptance criteria; Clinical implementation; MRI only; Prospective; Prostate; Synthetic CT}}, language = {{eng}}, month = {{04}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{Radiation Oncology}}, title = {{MR-PROTECT : Clinical feasibility of a prostate MRI-only radiotherapy treatment workflow and investigation of acceptance criteria}}, url = {{http://dx.doi.org/10.1186/s13014-020-01513-7}}, doi = {{10.1186/s13014-020-01513-7}}, volume = {{15}}, year = {{2020}}, }