Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy

• Published in: Acta oncologica Vol. 54; no. 9; pp. 1474 - 1482
• Main Authors: Noel, Camille E, Parikh, Parag J, Spencer, Christopher R, Green, Olga L, Hu, Yanle, Mutic, Sasa, Olsen, Jeffrey R
• Format: Journal Article
• Language: English
• Published: England 21.10.2015
• Subjects: Abdominal Neoplasms - pathology; Abdominal Neoplasms - radiotherapy; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Magnetic Resonance Imaging; Observer Variation; Pelvic Neoplasms - pathology; Pelvic Neoplasms - radiotherapy; Radiotherapy, Image-Guided - methods; Thoracic Neoplasms - pathology; Thoracic Neoplasms - radiotherapy; Tomography, X-Ray Computed
• ISSN: 0284-186X; 1651-226X
• DOI: 10.3109/0284186X.2015.1062541

Onboard magnetic resonance imaging (OB-MRI) for daily localization and adaptive radiotherapy has been under development by several groups. However, no clinical studies have evaluated whether OB-MRI improves visualization of the target and organs at risk (OARs) compared to standard onboard computed tomography (OB-CT). This study compared visualization of patient anatomy on images acquired on the MRI-(60)Co ViewRay system to those acquired with OB-CT. Fourteen patients enrolled on a protocol approved by the Institutional Review Board (IRB) and undergoing image-guided radiotherapy for cancer in the thorax (n = 2), pelvis (n = 6), abdomen (n = 3) or head and neck (n = 3) were imaged with OB-MRI and OB-CT. For each of the 14 patients, the OB-MRI and OB-CT datasets were displayed side-by-side and independently reviewed by three radiation oncologists. Each physician was asked to evaluate which dataset offered better visualization of the target and OARs. A quantitative contouring study was performed on two abdominal patients to assess if OB-MRI could offer improved inter-observer segmentation agreement for adaptive planning. In total 221 OARs and 10 targets were compared for visualization on OB-MRI and OB-CT by each of the three physicians. The majority of physicians (two or more) evaluated visualization on MRI as better for 71% of structures, worse for 10% of structures, and equivalent for 14% of structures. 5% of structures were not visible on either. Physicians agreed unanimously for 74% and in majority for > 99% of structures. Targets were better visualized on MRI in 4/10 cases, and never on OB-CT. Low-field MR provides better anatomic visualization of many radiotherapy targets and most OARs as compared to OB-CT. Further studies with OB-MRI should be pursued.