Michael C. Steckner

Open low-field magnetic resonance imaging in radiation therapy treatment planning

PURPOSE To evaluate the possibilities of an open low-field magnetic resonance imaging (MRI) scanner in external beam radiotherapy treatment (RT) planning. METHODS AND MATERIALS A custom-made flat tabletop was constructed for the open MR, which was compatible with standard therapy positioning devices. To assess and correct image distortion in low-field MRI, a custom-made phantom was constructed and a software algorithm was developed. A total of 243 patients (43 patients with non-small-cell lung cancer, 155 patients with prostate cancer, and 45 patients with brain tumors) received low-field MR imaging in addition to computed tomographic (CT) planning imaging between January 1998 and September 2001 before the start of the irradiation. RESULTS Open low-field MRI provided adequate images for RT planning in nearly 95% of the examined patients. The mean and the maximal distortions 15 cm around the isocenter were reduced from 2.5 mm to 0.9 mm and from 6.1 mm to 2.1 mm respectively. The MRI-assisted planning led to better discrimination of tumor extent in two-thirds of the patients and to an optimization in lung cancer RT planning in one-third of the patients. In prostate cancer planning, low-field MRI resulted in significant reduction (40%) of organ volume and clinical target volume (CTV) compared with CT and to a reduction of the mean percentage of rectal dose of 15%. In brain tumors, low-field MR image quality was superior compared with CT in 39/45 patients for planning purposes. CONCLUSIONS The data presented here show that low-field MRI is feasible in RT treatment planning when image correction regarding system-induced distortions is performed and by selecting MR imaging protocol parameters with the emphasis on adequate images for RT planning.

Characteristics and quality assurance of a dedicated open 0.23 T MRI for radiation therapy simulation.

A commercially available open MRI unit is under routine use for radiation therapy simulation. The effects of a gradient distortion correction (GDC) program used to post process the images were assessed by comparison with the known geometry of a phantom. The GDC reduced the magnitude of the distortions at the periphery of the axial images from 12 mm to 2 mm horizontally along the central axis and distortions exceeding 20 mm were reduced to as little as 2 mm at the image periphery. Coronal and sagittal scans produced similar results. Coalescing these data into distortion as a function of radial distance, we found that for radial distances of <10 cm, the distortion after GDC was <2 mm and for radial distances up to 20 cm, the distortion was <5 mm. The dosimetric errors resulting from homogeneous dose calculations with this level of distortion of the external contour is <2%. A set of triangulation lasers has been added to establish a virtual isocenter for convenient setup and marking of patients and phantoms. Repeated measurements of geometric phantoms over several months showed variations in position between the virtual isocenter and the magnetic isocenter were constrained to <2 mm. Additionally, the interscan variations of 12 randomly selected points in space defined by a rectangular grid phantom was found to be within the intraobserver error of approximately 1 mm in the coronal, sagittal, and transverse planes. Thus, the open MRI has sufficient geometric accuracy for most radiation therapy planning and is temporally stable.

MRI simulation: effect of gradient distortions on three-dimensional prostate cancer plans

PURPOSE To quantify the dosimetric consequences of external patient contour distortions produced on low-field and high-field MRIs for external beam radiation of prostate cancer. METHODS AND MATERIALS A linearity phantom consisting of a grid filled with contrast material was scanned on a spiral CT, a 0.23 T open MRI, and a 1.5 T closed bore system. Subsequently, 12 patients with prostate cancer were scanned on CT and the open MRI. A gradient distortion correction (GDC) program was used to postprocess the MRI images. Eight of the patients were also scanned on the 1.5 T MRI with integrated GDC correction. All data sets were fused according to their bony landmarks using a chamfer-matching algorithm. The prostate volume was contoured on an MRI image, irrespective of the apparent prostate location in those sets. Thus, the same target volume was planned and used for calculating the anterior-posterior (AP) and lateral separations. The number of monitor units required for treatment using a four-field conformal technique was compared. Because there are also setup variations in patient outer contours, two different CT scans from 20 different patients were fused, and the differences in AP and lateral separations were measured to obtain an estimate of the mean interfractional separation variation. RESULTS All AP separations measured on MRI were statistically indistinguishable from those on CT within the interfractional separation variations. The mean differences between CT and low-field MRI and CT and high-field MRI lateral separations were 1.6 cm and 0.7 cm, respectively, and were statistically significantly different from zero. However, after the GDC was applied to the low-field images, the difference became 0.4 +/- 0.4 mm (mean +/- standard deviation), which was statistically insignificant from the CT-to-CT variations. The mean variations in the lateral separations from the low-field images with GDC would result in a dosimetric difference of <1%, assuming an equally weighted four-field 18-MV technique for patient separations up to approximately 40 cm. CONCLUSIONS For patients with lateral separations <40 cm, a homogeneous calculation simulated using a 1.5 T MRI or a 0.23 T MRI with a gradient distortion correction will yield a monitor unit calculation indistinguishable from that generated using CT simulation.

Measuring magnetic fields generated by DC currents in receive-only coils

DC decoupling currents applied to receive-only coils during radiofrequency transmission can create stray magnetic fields capable of changing the resonant frequency of nearby nuclei. It is difficult to measure these fields with conventional field-mapping techniques because the fields are not present when the signal is acquired. The stray fields can be measured empirically with cardiac tags.