Purpose: Real-time high soft-tissue contrast magnetic resonance imaging (MRI) from the MR-Linac offers the best opportunity for accurate motion tracking during radiation therapy delivery via highfrequency two-dimensional (2D) cine imaging. This work investigates the efficacy of real-time organ motion tracking based on the registration of MRI acquired on MR-Linac. Methods: Algorithms based on image intensity were developed to determine the three-dimensional (3D) translation of abdominal targets. 2D and 3D abdominal MRIs were acquired for 10 healthy volunteers using a high-field MR-Linac. For each volunteer, 3D respiration-gated T2 and 2D T2/T1weighted cine in sagittal, coronal, and axial planes with a planar temporal resolution of 0.6 for 60 s was captured. Datasets were also collected on MR-compatible physical and virtual four-dimensional (4D) motion phantoms. Target contours for the liver and pancreas from the 3D T2 were populated to the cine and assumed as the ground-truth motion. We performed image registration using a research software to track the target 3D motion. Standard deviations of the error (SDE) between the groundtruth and tracking were analyzed. Results: Algorithms using a research software were demonstrated to be capable of tracking arbitrary targets in the abdomen at 5 Hz with an overall accuracy of 0.6 mm in phantom studies and 2.1 mm in volunteers. However, this value is subject to patient-specific considerations, namely motion amplitude. Calculation times of < 50 ms provide a pathway of real-time motion tracking integration. A major challenge in using 2D cine MRI to track the target is handling the full 3D motion of the target. Conclusions: Feasibility to track organ motion using intensity-based registration of MRIs was demonstrated for abdominal targets. Tracking accuracy of about 2 mm was achieved for the motion of the liver and pancreatic head for typical patient motion. Further development is ongoing to improve the tracking algorithm for large and complex motions.
The use of an amorphous selenium (a-Se) based direct-detection active matrix flat-panel imager (AMFPI) is studied for megavoltage imaging. The detector consists of a 1.2 mm copper front plate and 200 microm a-Se layer, and has a 85 microm pixel pitch. The Modulation Transfer Function (MTF), Noise Power Spectrum (NPS), and Detective Quantum Efficiency (DQE) are measured for 6 and 15 MV photon beams. A theoretical expression for the DQE is derived using a recently developed formalism for nonelementary cascade stages. A comparison of theory with experiment is good for the 6 and 15 MV beams. The model is used to explore the DQE for more typical pixel sizes. The results indicate that with proper modifications, such as a larger a-Se thickness, a direct flat-panel AMFPI is a very promising detector for megavoltage imaging.
3DUS imaging for IGRT of liver lesions is feasible, although using anatomic surrogates in the close vicinity of the lesion may be needed. ABC-based breath-hold in midventilation during 3DUS imaging can reduce the uncertainty of US-based 3D table shift correction.
Large intrafractional organ motion due to respiratory and/or bowel motion is a limiting factor in administering curative radiation doses to pancreatic tumors. The authors investigate the use of real-time ultrasound to track pancreas motion. Due to the poor visibility of the pancreas head on an ultrasound image, the portal vein is identified as a surrogate. The authors have demonstrated the feasibility of tracking HP motion through the localization of the PV using TAUS. This will potentially allow real-time tracking of intrafractional motion to justify small PTV-margins and to account for unusual motions, thus, improving normal tissue sparing.
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