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. 2023 Jul 8:27:100472.
doi: 10.1016/j.phro.2023.100472. eCollection 2023 Jul.

Cone beam computed tomography image guidance within a magnetic resonance imaging-only planning workflow

Laura M O'Connor  1   2 , Alesha Quinn  1 , Samuel Denley  1 , Lucy Leigh  3 , Jarad Martin  1 , Jason A Dowling  4 , Kate Skehan  1 , Helen Warren-Forward  2 , Peter B Greer  1   5
Affiliations

Cone beam computed tomography image guidance within a magnetic resonance imaging-only planning workflow

Laura M O'Connor et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Magnetic Resonance Imaging (MRI)-only planning workflows offer many advantages but raises challenges regarding image guidance. The study aimed to assess the viability of MRI to Cone Beam Computed Tomography (CBCT) based image guidance for MRI-only planning treatment workflows.

Materials and methods: An MRI matching training package was developed. Ten radiation therapists, with a range of clinical image guidance experience and experience with MRI, completed the training package prior to matching assessment. The matching assessment was performed on four match regions: prostate gold seed, prostate soft tissue, rectum/anal canal and gynaecological. Each match region consisted of five patients, with three CBCTs per patient, resulting in fifteen CBCTs for each match region. The ten radiation therapists performed the CBCT image matching to CT and to MRI for all regions and recorded the match values.

Results: The median inter-observer variation for MRI-CBCT matching and CT-CBCT matching for all regions were within 2 mm and 1 degree. There was no statistically significant association in the inter-observer variation in mean match values and radiation therapist image guidance experience levels. There was no statistically significant association in inter-observer variation in mean match values for MRI experience levels for prostate soft tissue and gynaecological match regions, while there was a statistically significant difference for prostate gold seed and rectum match regions.

Conclusion: The results of this study support the concept that with focussed training, an MRI to CBCT image guidance approach can be successfully implemented in a clinical planning workflow.

Keywords: Cone Beam Computed Tomography; Image-guided radiation therapy; MRI guided radiation therapy; MRI-only radiotherapy planning; Magnetic resonance imaging; Radiotherapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Bland-Altman plots of the difference in match for each observer by the mean of all observers (for each CBCT scan that is registered) for prostate soft tissue. Each coloured dot represents a single radiation therapist each. Note that due to ties, it does not always appear as though there are 10 dots for each site. The red line is the overall mean difference, blue line is the 0 difference (for reference) and the green lines are the upper and lower limits of agreement. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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