Synthetic digital reconstructed radiographs for MR-only robotic stereotactic radiation therapy: A proof of concept

Szalkowski, Gregory; Nie, Dong; Zhu, Tong; Yap, Pew-Thian; Lian, Jun

doi:10.1016/j.compbiomed.2021.104917

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…The goal of many of these studies was to identify fiducial markers for identification at simulation with the eventual goal of voxel burning the fiducial locations in DRR images for pretreatment positioning and alignment using C‐arm linacs. The findings of these studies, such as the selection of gradient echo sequences and iron doped fiducial markers for MRI‐only simulation, are still relevant when integrating MRI‐only simulation with IGRT robotic radiosurgery 20 . The main difference will involve the insertion of a fiducial marker template in sCT images that is compatible with robotic radiosurgery fiducial marker tracking systems.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of these studies, such as the selection of gradient echo sequences and iron doped fiducial markers for MRI-only simulation, are still relevant when integrating MRI-only simulation with IGRT robotic radiosurgery. 20 The main difference will involve the insertion of a fiducial marker template in sCT images that is compatible with robotic radiosurgery fiducial marker tracking systems.…”

Section: Discussionmentioning

confidence: 99%

“…Robotic radiosurgery platforms use fiducial tracking algorithms to detect fiducial markers for tumor localization on orthogonal X‐ray images for IGRT‐based tracking 14,17 . Fiducial markers appear as small dark signal voids on MRI and cannot be directly used with robotic radiosurgery fiducial marker tracking software 18–20 . For the clinical use of MRI‐only simulation with standard C‐arm linear accelerator (linac)‐based treatments, fiducials identified on MRI are voxel burned at the same location in their corresponding sCT images 21,22 .…”

Section: Introductionmentioning

confidence: 99%

“…14,17 Fiducial markers appear as small dark signal voids on MRI and cannot be directly used with robotic radiosurgery fiducial marker tracking software. [18][19][20] For the clinical use of MRI-only simulation with standard C-arm linear accelerator (linac)based treatments, fiducials identified on MRI are voxel burned at the same location in their corresponding sCT images. 21,22 In treatments using C-arm linacs, radiation therapists typically manually identify fiducial locations, which is why a voxel-burned fiducial suffices.…”

Section: Introductionmentioning

confidence: 99%

“…Szalkowski et al developed a proof -of -concept deep learning-based approach to create synthetic CTs and digital reconstructed radiographs (DRRs) from MRI allowing for compatibility of MRI-only simulation workflows with the tracking system of robotic radiosurgery methods. 20 Their methodology consisted of training a generative adversarial model to mimic hyperintense fiducial markers from CT in sCT images. Model evaluation involved a quantitative image assessment of the generated fiducials and a subjective human observer image assessment.…”

Section: Introductionmentioning

confidence: 99%

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End‐to‐end validation of fiducial tracking accuracy in robotic radiosurgery using MRI‐only simulation imaging

Singhrao,

Zubair,

Nano

et al. 2023

Medical Physics

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BackgroundImage‐guided radiation‐therapy (IGRT)‐based robotic radiosurgery using magnetic resonance imaging (MRI)‐only simulation could allow for improved target definition with highly conformal radiotherapy treatments. Fiducial marker (FM)‐based alignment is used with robotic radiosurgery treatments of sites such as the prostate because it aids in accurate target localization. Synthetic CT (sCT) images are generated in the MRI‐only workflow but FMs used for IGRT appear as signal voids in MRIs and do not appear in MR‐generated sCTs, hindering the ability to use sCTs for fiducial‐based IGRT.PurposeIn this study we evaluate the fiducial tracking accuracy for a novel artificial fiducial insertion method in sCT images that allows for fiducial marker tracking in robotic radiosurgery, using MRI‐only simulation imaging (MRI‐only workflow).MethodsArtificial fiducial markers were inserted into sCT images at the site of the real marker implantation as visible in MRI. Two phantoms were used in this study. A custom anthropomorphic pelvis phantom was designed to validate the tracking accuracy for a variety of artificial fiducials in an MRI‐only workflow. A head phantom containing a hidden target and orthogonal film pair inserts was used to perform end‐to‐end tests of artificial fiducial configurations inserted in sCT images. The setup and end‐to‐end targeting accuracy of the MRI‐only workflow were compared to the computed tomography (CT)‐based standard. Each phantom had six FMs implanted with a minimum spacing of 2 cm. For each phantom a bulk‐density sCT was generated, and artificial FMs were inserted at the implantation location. Several methods of FM insertion were tested including: (1) replacing HU with a fixed value (10000HU) (voxel‐burned); (2) using a representative fiducial image derived from a linear combination of fiducial templates (composite‐fiducial); (3) computationally simulating FM signal voids using a digital phantom containing FMs and inserting the corresponding signal void into sCT images (simulated‐fiducial). All tests were performed on a CyberKnife system (Accuray, Sunnyvale, CA). Treatment plans and digital‐reconstructed‐radiographs were generated from the original CT and sCTs with embedded fiducials and used to align the phantom on the treatment couch. Differences in the initial phantom alignment (3D translations/rotations) and tracking parameters between CT‐based plans and sCT‐based plans were analyzed. End‐to‐end plans for both scenarios were generated and analyzed following our clinical protocol.ResultsFor all plans, the fiducial tracking algorithm was able to identify the fiducial locations. The mean FM‐extraction uncertainty for the composite and simulated FMs was below 48% for fiducials in both the anthropomorphic pelvis and end‐to‐end phantoms, which is below the 70% treatment uncertainty threshold. The total targeting error was within tolerance (<0.95 mm) for end‐to‐end tests of sCT images with the composite and head‐on simulated FMs (0.26, 0.44, and 0.35 mm for the composite fiducial in sCT, head‐on simulated fiducial in sCT, and fiducials in original CT, respectively.ConclusionsMRI‐only simulation for robotic radiosurgery could potentially improve treatment accuracy and reduce planning margins. Our study has shown that using a composite‐derived or simulated FM in conjunction with sCT images, MRI‐only workflow can provide clinically acceptable setup accuracy in line with CT‐based standards for FM‐based robotic radiosurgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

End‐to‐end validation of fiducial tracking accuracy in robotic radiosurgery using MRI‐only simulation imaging

Singhrao,

Zubair,

Nano

et al. 2023

Medical Physics

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Fine-Grained Medical Image Synthesis with Dual-Attention Adversarial Learning

Xiao,

Nie

2024

Medical Image Understanding and Analysis

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A systematic literature review: deep learning techniques for synthetic medical image generation and their applications in radiotherapy

Sherwani,

Gopalakrishnan

2024

Front. Radiol.

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The aim of this systematic review is to determine whether Deep Learning (DL) algorithms can provide a clinically feasible alternative to classic algorithms for synthetic Computer Tomography (sCT). The following categories are presented in this study: ∙ MR-based treatment planning and synthetic CT generation techniques. ∙ Generation of synthetic CT images based on Cone Beam CT images. ∙ Low-dose CT to High-dose CT generation. ∙ Attenuation correction for PET images. To perform appropriate database searches, we reviewed journal articles published between January 2018 and June 2023. Current methodology, study strategies, and results with relevant clinical applications were analyzed as we outlined the state-of-the-art of deep learning based approaches to inter-modality and intra-modality image synthesis. This was accomplished by contrasting the provided methodologies with traditional research approaches. The key contributions of each category were highlighted, specific challenges were identified, and accomplishments were summarized. As a final step, the statistics of all the cited works from various aspects were analyzed, which revealed that DL-based sCTs have achieved considerable popularity, while also showing the potential of this technology. In order to assess the clinical readiness of the presented methods, we examined the current status of DL-based sCT generation.

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Synthetic digital reconstructed radiographs for MR-only robotic stereotactic radiation therapy: A proof of concept

Cited by 3 publications

References 27 publications

End‐to‐end validation of fiducial tracking accuracy in robotic radiosurgery using MRI‐only simulation imaging

End‐to‐end validation of fiducial tracking accuracy in robotic radiosurgery using MRI‐only simulation imaging

Fine-Grained Medical Image Synthesis with Dual-Attention Adversarial Learning

A systematic literature review: deep learning techniques for synthetic medical image generation and their applications in radiotherapy

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