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MR-PROTECT : Clinical feasibility of a prostate MRI-only radiotherapy treatment workflow and investigation of acceptance criteria

Persson, Emilia LU ; Jamtheim Gustafsson, Christian LU ; Ambolt, Petra ; Engelholm, Silke ; Ceberg, Sofie LU ; Bäck, Sven LU ; Olsson, Lars E. LU orcid and Gunnlaugsson, Adalsteinn LU (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.

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author
; ; ; ; ; ; and
organization
publishing date
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
  • scopus:85083222746
  • pmid:32272943
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
2024-04-17 07:50:57
@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}},
}