The authors report the first magnetic resonance (MR) images produced by their prototype MR system integrated with a radiation therapy source. The prototype consists of a 6 MV linac mounted onto the open end of a biplanar 0.2 T permanent MR system which has 27.9 cm pole-to-pole opening with flat gradients (40 mT/m) running under a TMX NRC console. The distance from the magnet isocenter to the linac target is 80 cm. The authors' design has resolved the mutual interferences between the two devices such that the MR magnetic field does not interfere with the trajectory of the electron in the linac waveguide, and the radiofrequency (RF) signals from each system do not interfere with the operation of the other system. Magnetic and RF shielding calculations were performed and confirmed with appropriate measurements. The prototype is currently on a fixed gantry; however, in the very near future, the linac and MR magnet will rotate in unison such that the linac is always aimed through the opening in the biplanar magnet. MR imaging was found to be fully operational during linac irradiation and proven by imaging a phantom with conventional gradient echo sequences. Except for small changes in SNR, MR images produced during irradiation were visually and quantitatively very similar to those taken with the linac turned off. This prototype system provides proof of concept that the design has decreased the mutual interferences sufficiently to allow the development of real-time MR-guided radiotherapy. Low field-strength systems (0.2-0.5 T) have been used clinically as diagnostic tools. The task of the linac-MR system is, however, to provide MR guidance to the radiotherapy beam. Therefore, the 0.2 T field strength would provide adequate image quality for this purpose and, with the addition of fast imaging techniques, has the potential to provide 4D soft-tissue visualization not presently available in image-guided radiotherapy systems. The authors' initial design incorporates a permanent magnet; however, other types of magnets and field strengths could also be incorporated. Usable MR images were obtained during linac irradiation from the linac-MR prototype. The authors' prototype design can be used as the functional starting point in developing real-time MR guidance offering soft-tissue contrast that can be coupled with tumor tracking for real-time adaptive radiotherapy.

The work presented herein describes our methods and results for predicting, measuring and correcting geometric distortions in a 3 T clinical magnetic resonance (MR) scanner for the purpose of image guidance in radiation treatment planning. Geometric inaccuracies due to both inhomogeneities in the background field and nonlinearities in the applied gradients were easily visualized on the MR images of a regularly structured three-dimensional (3D) grid phantom. From a computed tomography scan, the locations of just under 10 000 control points within the phantom were accurately determined in three dimensions using a MATLAB-based computer program. MR distortion was then determined by measuring the corresponding locations of the control points when the phantom was imaged using the MR scanner. Using a reversed gradient method, distortions due to gradient nonlinearities were separated from distortions due to inhomogeneities in the background B0 field. Because the various sources of machine-related distortions can be individually characterized, distortions present in other imaging sequences (for which 3D distortion cannot accurately be measured using phantom methods) can be predicted negating the need for individual distortion calculation for a variety of other imaging sequences. Distortions were found to be primarily caused by gradient nonlinearities and maximum image distortions were reported to be less than those previously found by other researchers at 1.5 T. Finally, the image slices were corrected for distortion in order to provide geometrically accurate phantom images.

The aim of this work is to demonstrate a complete, robust, and time-efficient method for distortion correction of magnetic resonance (MR) images. It is well known that MR images suffer from both machine-related spatial distortions [gradient nonlinearity and main field (B0) inhomogeneity] and patient-related spatial distortions (susceptibility and chemical shift artifacts), and growing interest in the area of MR-based radiotherapy treatment planning has put new requirements on the geometric accuracy of such images. The authors present a two-step method that combines a phantom-based reverse gradient technique for measurement of gradient nonlinearities and a patient-based phase difference mapping technique for measurement of B0 inhomogeneities, susceptibility, and chemical shift distortions. The phase difference mapping technique adds only minutes to the total patient scan time and can be used to correct a variety of images of the same patient and anatomy. The technique was tested on several different phantoms, each designed to isolate one type of distortion. The mean distortion was reduced to 0.2 +/- 0.1 mm in both gradient echo and spin echo images of a grid phantom. For the more difficult case of a highly distorted echo planar image, residual distortion was reduced to subvoxel dimensions. As a final step, the technique was implemented on patient images. The current technique is effective, time efficient, and robust and provides promise for preparing distortion-rectified MR images for use in MR-based treatment planning.

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Care must be taken when making ion chamber measurements in a transverse magnetic field. Ion chamber responses vary not only with transverse field strength, but with chamber orientation and type, and can be considerable. Longitudinal magnetic fields influence ion chamber responses relatively little (2% at 1.5 T), and only at field strengths in excess of 1.0 T.