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Prospective Clinical Feasibility Study for MRI-Only Brain Radiotherapy

Lerner, Minna LU ; Medin, Joakim LU ; Jamtheim Gustafsson, Christian LU ; Alkner, Sara LU and Olsson, Lars E. LU orcid (2022) In Frontiers in Oncology 11.
Abstract

Objectives: MRI-only radiotherapy (RT) provides a workflow to decrease the geometric uncertainty introduced by the image registration process between MRI and CT data and to streamline the RT planning. Despite the recent availability of validated synthetic CT (sCT) methods for the head region, there are no clinical implementations reported for brain tumors. Based on a preceding validation study of sCT, this study aims to investigate MRI-only brain RT through a prospective clinical feasibility study with endpoints for dosimetry and patient setup. Material and Methods: Twenty-one glioma patients were included. MRI Dixon images were used to generate sCT images using a CE-marked deep learning-based software. RT treatment plans were generated... (More)

Objectives: MRI-only radiotherapy (RT) provides a workflow to decrease the geometric uncertainty introduced by the image registration process between MRI and CT data and to streamline the RT planning. Despite the recent availability of validated synthetic CT (sCT) methods for the head region, there are no clinical implementations reported for brain tumors. Based on a preceding validation study of sCT, this study aims to investigate MRI-only brain RT through a prospective clinical feasibility study with endpoints for dosimetry and patient setup. Material and Methods: Twenty-one glioma patients were included. MRI Dixon images were used to generate sCT images using a CE-marked deep learning-based software. RT treatment plans were generated based on MRI delineated anatomical structures and sCT for absorbed dose calculations. CT scans were acquired but strictly used for sCT quality assurance (QA). Prospective QA was performed prior to MRI-only treatment approval, comparing sCT and CT image characteristics and calculated dose distributions. Additional retrospective analysis of patient positioning and dose distribution gamma evaluation was performed. Results: Twenty out of 21 patients were treated using the MRI-only workflow. A single patient was excluded due to an MRI artifact caused by a hemostatic substance injected near the target during surgery preceding radiotherapy. All other patients fulfilled the acceptance criteria. Dose deviations in target were within ±1% for all patients in the prospective analysis. Retrospective analysis yielded gamma pass rates (2%, 2 mm) above 99%. Patient positioning using CBCT images was within ± 1 mm for registrations with sCT compared to CT. Conclusion: We report a successful clinical study of MRI-only brain radiotherapy, conducted using both prospective and retrospective analysis. Synthetic CT images generated using the CE-marked deep learning-based software were clinically robust based on endpoints for dosimetry and patient positioning.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
brain, cancer, glioma, implementation, MRI-only, radiotherapy, sCT
in
Frontiers in Oncology
volume
11
article number
812643
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85123344230
  • pmid:35083159
ISSN
2234-943X
DOI
10.3389/fonc.2021.812643
language
English
LU publication?
yes
id
5f2335fd-057c-4878-baee-39c59520c535
date added to LUP
2022-03-21 10:22:33
date last changed
2025-01-30 09:07:53
@article{5f2335fd-057c-4878-baee-39c59520c535,
  abstract     = {{<p>Objectives: MRI-only radiotherapy (RT) provides a workflow to decrease the geometric uncertainty introduced by the image registration process between MRI and CT data and to streamline the RT planning. Despite the recent availability of validated synthetic CT (sCT) methods for the head region, there are no clinical implementations reported for brain tumors. Based on a preceding validation study of sCT, this study aims to investigate MRI-only brain RT through a prospective clinical feasibility study with endpoints for dosimetry and patient setup. Material and Methods: Twenty-one glioma patients were included. MRI Dixon images were used to generate sCT images using a CE-marked deep learning-based software. RT treatment plans were generated based on MRI delineated anatomical structures and sCT for absorbed dose calculations. CT scans were acquired but strictly used for sCT quality assurance (QA). Prospective QA was performed prior to MRI-only treatment approval, comparing sCT and CT image characteristics and calculated dose distributions. Additional retrospective analysis of patient positioning and dose distribution gamma evaluation was performed. Results: Twenty out of 21 patients were treated using the MRI-only workflow. A single patient was excluded due to an MRI artifact caused by a hemostatic substance injected near the target during surgery preceding radiotherapy. All other patients fulfilled the acceptance criteria. Dose deviations in target were within ±1% for all patients in the prospective analysis. Retrospective analysis yielded gamma pass rates (2%, 2 mm) above 99%. Patient positioning using CBCT images was within ± 1 mm for registrations with sCT compared to CT. Conclusion: We report a successful clinical study of MRI-only brain radiotherapy, conducted using both prospective and retrospective analysis. Synthetic CT images generated using the CE-marked deep learning-based software were clinically robust based on endpoints for dosimetry and patient positioning.</p>}},
  author       = {{Lerner, Minna and Medin, Joakim and Jamtheim Gustafsson, Christian and Alkner, Sara and Olsson, Lars E.}},
  issn         = {{2234-943X}},
  keywords     = {{brain; cancer; glioma; implementation; MRI-only; radiotherapy; sCT}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Oncology}},
  title        = {{Prospective Clinical Feasibility Study for MRI-Only Brain Radiotherapy}},
  url          = {{http://dx.doi.org/10.3389/fonc.2021.812643}},
  doi          = {{10.3389/fonc.2021.812643}},
  volume       = {{11}},
  year         = {{2022}},
}