Dosimetric Accuracy of MR-Guided Online Adaptive Planning for Nasopharyngeal Carcinoma Radiotherapy on 1.5 T MR-Linac

Abstract

PurposeThe aim of this study is to evaluate the dose accuracy of bulk relative electron density (rED) approach for application in 1.5 T MR-Linac and assess the reliability of this approach in the case of online adaptive MR-guided radiotherapy for nasopharyngeal carcinoma (NPC) patients.MethodsTen NPC patients formerly treated on conventional linac were included in this study, with their original planning CT and MRI collected. For each patient, structures such as the targets, organs at risk, bone, and air regions were delineated on the original CT in the Monaco system (v5.40.02). To simulate the online adaptive workflow, firstly all contours were transferred to MRI from the original CT using rigid registration in the Monaco system. Based on the structures, three different types of synthetic CT (sCT) were generated from MRI using the bulk rED assignment approach: the sCTICRU uses the rED values recommended by ICRU46, the sCTtailor uses the patient-specific mean rED values, and the sCTHomogeneity uses homogeneous water equivalent values. The same treatment plan was calculated on the three sCTs and the original CT. Dose calculation accuracy was investigated in terms of gamma analysis, point dose comparison, and dose volume histogram (DVH) parameters.ResultsGood agreement of dose distribution was observed between sCTtailor and the original CT, with a gamma passing rate (3%/3 mm) of 97.81% ± 1.06%, higher than that of sCTICRU (94.27% ± 1.48%, p = 0.005) and sCTHomogeneity (96.50% ± 1.02%, p = 0.005). For stricter criteria 1%/1 mm, gamma passing rates for plans on sCTtailor, sCTICRU, and sCTHomogeneity were 86.79% ± 4.31%, 79.81% ± 3.63%, and 77.56% ± 4.64%, respectively. The mean point dose difference in PTVnx between sCTtailor and planning CT was −0.14% ± 1.44%, much lower than that calculated on sCTICRU (−8.77% ± 2.33%) and sCTHomogeneity (1.65% ± 2.57%), all with p < 0.05. The DVH differences for the plan based on sCTtailor were much smaller than sCTICRU and sCTHomogeneity.ConclusionsThe bulk rED-assigned sCT by adopting the patient-specific rED values can achieve a clinically acceptable level of dose calculation accuracy in the presence of a 1.5 T magnetic field, making it suitable for online adaptive MR-guided radiotherapy for NPC patients.

Towards simulation-free MR-linac treatment: utilizing male pelvis PSMA-PET/CT and population-based electron density assignments

“…Key benefits include enhanced daily structure delineation and daily replanning and monitoring intra-fraction organ motion. These enhancements can collectively contribute to improved treatment outcomes (Ding et al 2022, Pham et al 2022, Rammohan et al 2022. Overall findings from this study suggested that the proposed simulation-free workflow is a feasible and accurate alternative compared to current MRL treatments.…”

“…The Unity MRL system is amenable to simulation-free workflows; currently utilizing bulk RED overrides for planning and involving daily re-contouring and re-planning based on the anatomy of the day (Winkel et al 2019, Ding et al 2022. To implement a simulation-free workflow, the RED values of patients' organs are required to be either known or estimated (Choi et al 2019, Pham et al 2022.…”

“…Recent studies have reported on the dosimetric impact of using bulk RED overrides on MRL systems (Ding et al 2022, Green et al 2019, Pham et al 2022, Tang et al 2022. Due to the presence of the magnetic field, investigating these effects in such systems are of particular interest, especially near tissue-air boundaries which are subject to the electron return effect by the Lorentz force (Uilkema et al 2015, Green et al 2019, Pham et al 2022, Rammohan et al 2022.…”

“…Due to the presence of the magnetic field, investigating these effects in such systems are of particular interest, especially near tissue-air boundaries which are subject to the electron return effect by the Lorentz force (Uilkema et al 2015, Green et al 2019, Pham et al 2022, Rammohan et al 2022. An investigation by Ding et al (2022) reported that there was good agreement of the dose distribution between using simulation-CT RED values and bulk RED overrides for 1.5 T MRL nasopharyngeal carcinoma patients (gamma pass rate (3%/3 mm) = 97.81%) (Ding et al 2022); in higher agreement than that using the RED values from the ICRU Report 46 or a homogeneous override.…”