B W Raaymakers

Integrating a 1.5 T MRI scanner with a 6 MV accelerator: proof of concept

At the UMC Utrecht, The Netherlands, we have constructed a prototype MRI accelerator. The prototype is a modified 6 MV Elekta (Crawley, UK) accelerator next to a modified 1.5 T Philips Achieva (Best, The Netherlands) MRI system. From the initial design onwards, modifications to both systems were aimed to yield simultaneous and unhampered operation of the MRI and the accelerator. Indeed, the simultaneous operation is shown by performing diagnostic quality 1.5 T MRI with the radiation beam on. No degradation of the performance of either system was found. The integrated 1.5 T MRI system and radiotherapy accelerator allow simultaneous irradiation and MR imaging. The full diagnostic imaging capacities of the MRI can be used; dedicated sequences for MRI-guided radiotherapy treatments will be developed. This proof of concept opens the door towards a clinical prototype to start testing MRI-guided radiation therapy (MRIgRT) in the clinic.

Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose increase at tissue-air interfaces in a lateral magnetic field due to returning electrons

In the framework of the development of the integration of a MRI-scanner with a linear accelerator, the influence of a lateral, magnetic field on the dose distribution has to be determined. Dose increase is expected at tissue-air boundaries, due to the electron return effect (ERE): electrons entering air will describe a circular path and return into the phantom causing extra dose deposition. Using IMRT with many beam directions, this exit dose will not constitute a problem. Dose levels behind air cavities will decrease because of the absence of electrons crossing the cavity. The ERE has been demonstrated both by simulation and experiment. Monte Carlo simulations are performed with GEANT4, irradiating a water-air-water phantom in a lateral magnetic field. Also an air tube in water has been simulated, resulting in slightly twisted regions of dose increase and decrease. Experimental demonstration is achieved by film measurement in a perspex-air-perspex phantom in an electromagnet. Although the ERE causes dose increase before air cavities, relatively flat dose profiles can be obtained for the investigated cases using opposite beam configurations. More research will be necessary whether this holds for more realistic geometries with the use of IMRT and whether the ERE can be turned to our advantage when treating small tumour sites at air cavities.

Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose deposition in a transverse magnetic field

Integrating magnetic resonance imaging (MRI) functionality with a radiotherapy accelerator can facilitate on-line, soft-tissue based, position verification. A technical feasibility study, in collaboration with Elekta Oncology Systems and Philips Medical Systems, led to the preliminary design specifications of a MRI accelerator. Basically the design is a 6 MV accelerator rotating around a 1.5 T MRI system. Several technical issues and the clinical rational are currently under investigation. The aim of this paper is to determine the impact of the transverse 1.5 T magnetic field on the dose deposition. Monte Carlo simulations were used to calculate the dose deposition kernel in the presence of 1.5 T. This kernel in turn was used to determine the dose deposition for larger fields. Also simulations and measurements were done in the presence of 1.1 T. The pencil beam dose deposition is asymmetric. For larger fields the asymmetry persists but decreases. For the latter the distance to dose maximum is reduced by approximately 5 mm, the penumbra is increased by approximately 1 mm, and the 50% isodose line is shifted approximately 1 mm. The dose deposition in the presence of 1.5 T is affected, but the effect can be taken into account in a conventional treatment planning procedure. The impact of the altered dose deposition for clinical IMRT treatments is the topic of further research.

The Magnetic Resonance Imaging–Linac System

The current image-guided radiotherapy systems are suboptimal in the esophagus, pancreas, kidney, rectum, lymph node, etc. These locations in the body are not easily accessible for fiducials and cannot be visualized sufficiently on cone-beam computed tomographies, making daily patient set-up prone to geometrical uncertainties and hinder dose optimization. Additional interfraction and intrafraction uncertainties for those locations arise from motion with breathing and organ filling. To allow real-time imaging of all patient tumor locations at the actual treatment position a fully integrated 1.5-T, diagnostic quality, magnetic resonance imaging with a 6-MV linear accelerator is presented. This system must enable detailed dose painting at all body locations.

Magnetic-field-induced dose effects in MR-guided radiotherapy systems: dependence on the magnetic field strength

Several institutes are currently working on the development of a radiotherapy treatment system with online MR imaging (MRI) modality. The main difference between their designs is the magnetic field strength of the MRI system. While we have chosen a 1.5 Tesla (T) magnetic field strength, the Cross Cancer Institute in Edmonton will be using a 0.2 T MRI scanner and the company Viewray aims to use 0.3 T. The magnetic field strength will affect the severity of magnetic field dose effects, such as the electron return effect (ERE): considerable dose increase at tissue air boundaries due to returning electrons. This paper has investigated how the ERE dose increase depends on the magnetic field strength. Therefore, four situations where the ERE occurs have been simulated: ERE at the distal side of the beam, the lateral ERE, ERE in cylindrical air cavities and ERE in the lungs. The magnetic field comparison values were 0.2, 0.75, 1.5 and 3 T. Results show that, in general, magnetic field dose effects are reduced at lower magnetic field strengths. At the distal side, the ERE dose increase is largest for B = 0.75 T and depends on the irradiation field size for B = 0.2 T. The lateral ERE is strongest for B = 3 T but shows no effect for B = 0.2 T. Around cylindrical air cavities, dose inhomogeneities disappear if the radius of the cavity becomes small relative to the in-air radius of the secondary electron trajectories. At larger cavities (r > 1 cm), dose inhomogeneities exist for all magnetic field strengths. In water-lung-water phantoms, the ERE dose increase takes place at the water-lung transition and the dose decreases at the lung-water transition, but these effects are minimal for B = 0.2 T. These results will contribute to evaluating the trade-off between magnetic field dose effects and image quality of MR-guided radiotherapy systems.

Simultaneous B 1+ homogenization and specific absorption rate hotspot suppression using a magnetic resonance phased array transmit coil

In high‐field MRI severe problems with respect to B  1+ uniformity and specific absorption rate (SAR) deposition pose a great challenge to whole‐body imaging. In this study the potential of a phased array transmit coil is investigated to simultaneously reduce B  1+ nonuniformity and SAR deposition. This was tested by performing electromagnetic simulations of a phased array TEM coil operating at 128 MHz loaded with two different homogeneous elliptical phantoms and four dielectric patient models. It was shown that the wave interference of a circularly polarized RF field with an ellipse and a pelvis produces largely identical B  1+ and electric field patterns. Especially for obese patients, this results in large B  1+ nonuniformity and global areas with elevated SAR deposition. It is demonstrated that a phased array transmit coil can reduce these phenomena. The technique was especially successful in suppressing SAR hotspots with a decrease up to 50%. The application of optimized settings for an ellipse to the patient models leads to comparable results as obtained with the patient‐specific optimizations. This suggests that generic phase/amplitude port settings are possible, requiring no preinformation about patient‐specific RF fields. Such a scheme would, due to its simultaneous B  1+ homogenization and extra SAR margin, have many benefits for whole‐body imaging at 3 T. Magn Reson Med 57:577–586, 2007.

Integrating a MRI scanner with a 6 MV radiotherapy accelerator: impact of the surface orientation on the entrance and exit dose due to the transverse magnetic field

At the UMC Utrecht, in collaboration with Elekta and Philips Research Hamburg, we are developing a radiotherapy accelerator with integrated MRI functionality. The radiation dose will be delivered in the presence of a lateral 1.5 T field. Although the photon beam is not affected by the magnetic field, the actual dose deposition is done by a cascade of secondary electrons and these electrons are affected by the Lorentz force. The magnetic field causes a reduced build-up distance: because the trajectory of the electrons between collisions is curved, the entrance depth in tissue decreases. Also, at tissue-air interfaces an increased dose occurs due to the so-called electron return effect (ERE): electrons leaving tissue will describe a circular path in air and re-enter the tissue yielding a local dose increase. In this paper the impact of a 1.5 T magnetic field on both the build-up distance and the dose increase due to the ERE will be investigated as a function of the angle between the surface and the incident beam. Monte Carlo simulations demonstrate that in the presence of a 1.5 T magnetic field, the surface dose, the build-up distance and the exit dose depend more heavily on the surface orientation than in the case without magnetic field. This is caused by the asymmetrical pointspread kernel in the presence of 1.5 T and the directional behaviour of the re-entering electrons. Simulations on geometrical phantoms show that ERE dose increase at air cavities can be avoided using opposing beams, also when the air-tissue boundary is not perpendicular to the beam. For the more general case in patient anatomies, more problems may arise. Future work will address the possibilities and limitations of opposing beams in combination with IMRT in a magnetic field.

Proof of concept of MRI-guided tracked radiation delivery: tracking one-dimensional motion

In radiotherapy one aims to deliver a radiation dose to a tumour with high geometrical accuracy while sparing organs at risk (OARs). Although image guidance decreases geometrical uncertainties, treatment of cancer of abdominal organs is further complicated by respiratory motion, requiring intra-fraction motion compensation to fulfil the treatment intent. With an ideal delivery system, the optimal method of intra-fraction motion compensation is to adapt the beam collimation to the moving target using a dynamic multi-leaf collimator (MLC) aperture. The many guidance strategies for such tracked radiation delivery tested up to now mainly use markers and are therefore invasive and cannot deal with target deformations or adaptations for OAR positions. We propose to address these shortcomings using the online MRI guidance provided by an MRI accelerator and present a first step towards demonstration of the technical feasibility of this proposal. The position of a phantom subjected to one-dimensional (1D) periodic translation was tracked using a fast 1D MR sequence. Real-time communication with the MR scanner and control of the MLC aperture were established. Based on the time-resolved position of the phantom, tracked radiation delivery to the phantom was realized. Dose distributions for various delivery conditions were recorded on a gafchromic film. Without motion a sharply defined dose distribution is obtained, whereas considerable blur occurs for delivery to a moving phantom. With compensation for motion, the sharpness of the dose distribution is nearly restored. The total latency in our motion management architecture is approximately 200 ms. Combination of the recorded phantom and aperture positions with the planned dose distribution enabled the reconstruction of the delivered dose in all cases, which illustrates the promise of online dose accumulation and confirms that latency compensation could further enhance our results. For a simple 1D tracked delivery scenario, the technical feasibility of MRI-guided tracked radiation delivery is confirmed. More generic tracking scenarios require advanced MRI, leading to increased acquisition time and more challenging image processing problems. Latency compensation is therefore an important subject of future investigations.

Dosimetry for the MRI accelerator:the impact of a magnetic field on the response of a Farmer NE2571 ionization chamber

The UMC Utrecht is constructing a 1.5 T MRI scanner integrated with a linear accelerator (Lagendijk et al 2008 Radiother. Oncol. 86 25-9). The goal of this device is to facilitate soft-tissue contrast based image-guided radiotherapy, in order to escalate the dose to the tumour while sparing surrounding normal tissues. Dosimetry for the MRI accelerator has to be performed in the presence of a magnetic field. This paper investigates the feasibility of using a Farmer NE2571 ionization chamber for absolute dosimetry. The impact of the mcagnetic field on the response of this ionization chamber has been measured and simulated using GEANT4 Monte Carlo simulations. Two orientations of the ionization chamber with respect to the incident beam and the magnetic field which are feasible in the MRI accelerator configuration are taken into account. Measurements are performed using a laboratory magnet ranging from 0 to 1.2 T. In the simulations a range from 0 to 2 T is used. For both orientations, the measurements and simulations agreed within the uncertainty of the measurements and simulations. In conclusion, the response of the ionization chamber as a function of the magnetic field is understood and can be simulated using GEANT4 Monte Carlo simulations.

Experimental verification of magnetic field dose effects for the MRI-accelerator

The MRI-linear accelerator system, currently being developed, is designed such that the patient is irradiated in the presence of a magnetic field. This influences the dose distribution due to the Lorentz force working on the secondary electrons. Simulations have shown that the following dose effects occur: the build-up distance is reduced, the lateral profile becomes asymmetric in the direction orthogonal to the magnetic field and at tissue-air interfaces the dose increases due to returning electrons. In this work, GafChromic film measurements were performed in the presence of a magnetic field to experimentally quantify these dose effects. Depth-dose curves were measured in a PMMA-air-PMMA phantom and the lateral profiles were measured in a homogeneous PMMA phantom with the photon beam protruding over the edges of the phantom. The measurement results confirmed the magnetic field dose effects that were predicted by simulations. This enabled us to verify Geant4 Monte Carlo simulations of these MRI-linac specific dose effects: the relative agreement for the depth-dose curves between measurements and simulations was within 2.2%/1.8 mm. The relative agreement for the lateral profiles was 2.3%/1.7 mm. Overall, the magnetic field dose effects that are expected for irradiation with the MRI-linac can be modelled using Geant4 Monte Carlo simulations within measurement accuracy.