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.

LETTER • OPEN ACCESSFirst patients treated with a 1.5 T MRI-Linac: clinical proof of concept of a high-precision, highfield MRI guided radiotherapy treatment AbstractThe integration of 1.5 T MRI functionality with a radiotherapy linear accelerator (linac) has been pursued since 1999 by the UMC Utrecht in close collaboration with Elekta and Philips. The idea behind this integrated device is to offer unrivalled, online and real-time, soft-tissue visualization of the tumour and the surroundings for more precise radiation delivery. The proof of concept of this device was given in 2009 by demonstrating simultaneous irradiation and MR imaging on phantoms, since then the device has been further developed and commercialized by Elekta. The aim of this work is to demonstrate the clinical feasibility of online, high-precision, high-field MRI guidance of radiotherapy using the first clinical prototype MRI-Linac.Four patients with lumbar spine bone metastases were treated with a 3 or 5 beam step-and-shoot IMRT plan. The IMRT plan was created while Letter Institute of Physics and Engineering in MedicineOriginal content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. 3 Author to whom any correspondence should be addressed. the patient was on the treatment table and based on the online 1.5 T MR images; pre-treatment CT was deformably registered to the online MRI to obtain Hounsfield values. Bone metastases were chosen as the first site as these tumors can be clearly visualized on MRI and the surrounding spine bone can be detected on the integrated portal imager. This way the portal images served as an independent verification of the MRI based guidance to quantify the geometric precision of radiation delivery. Dosimetric accuracy was assessed post-treatment from phantom measurements with an ionization chamber and film. Absolute doses were found to be highly accurate, with deviations ranging from 0.0% to 1.7% in the isocenter. The geometrical, MRI based targeting as confirmed using portal images was better than 0.5 mm, ranging from 0.2 mm to 0.4 mm.In conclusion, high precision, high-field, 1.5 T MRI guided radiotherapy is clinically feasible.

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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.

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Ultra high field MR imaging (≥7 T) of deeply located targets in the body is facing some radiofrequency‐field related challenges: interference patterns, reduced penetration depth, and higher Specific Absorbtion Ratio (SAR) levels. These can be alleviated by redesigning the elements of the transmit or transceive array. This is because at these high excitation field (B1) frequencies, conventional array element designs may have become suboptimal. In this work, an alternative design approach is presented, regarding coil array elements as antennas. Following this approach, the Poynting vector of the element should be oriented towards the imaging target region. The single‐side adapted dipole antenna is a novel design that fulfills this requirement. The performance of this design as a transmit coil array element has been characterized by comparison with three other, more conventional designs using finite difference time domain (FDTD) simulations and B +1 measurements on a phantom. Results show that the B +1 level at the deeper regions is higher while maintaining relatively low SAR levels. Also, the B +1 field distribution is more symmetrical and more uniform, promising better image homogeneity. Eight radiative antennas have been combined into a belt‐like surface array for prostate imaging. T1‐weighted (T1W) and T2‐weighted (T2W) volunteer images are presented along with B +1 measurements to demonstrate the improved efficiency. Magn Reson Med, 2011. © 2011 Wiley Periodicals, Inc.

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.

In this study, a new approach to measure local electrical conductivity in tissue is presented, which is based on the propagating B In recent years, the used frequency of radio frequency (RF) pulses in MRI has increased considerably as a consequence of the increase in magnetic field strengths. As an increased frequency leads to a shorter wavelength, the electromagnetic fields (EM-fields) induced by the RF pulse should more and more be regarded as waves (1,2) impinging onto a very dielectrically heterogeneous object: the human body. As a wave propagates in the human body, it is being affected by the local dielectric properties which are tissue dependent. The interaction between the applied EM-fields and the body leads to a variation of the EM-fields in amplitude (3,4) as well as in phase (5); this is the origin of B 1 field inhomogeneities. The variations in the B + 1 field can be separated in two categories: body-scale effects and local effects. A recent simulation study has shown that the B + 1 field variations depend predominantly on the global dielectric properties and the contour of the body (6). Small deviations were found; these were attributed to local variations in dielectric properties. Furthermore, it was found that these local B + 1 variations can amount up to 10-20% in magnitude of the average B + 1 field at 3 T (7). These findings indicate that the local B + 1 field variations contain information about the local dielectric environment; in this study we aim to exploit this information. As the B