An MRI-based mid-ventilation approach for radiotherapy of the liver

MRI is increasingly being used in radiotherapy of the liver. The purpose of this study was to develop and validate a strategy to acquire MR images for treatment planning and image guidance in the presence of respiratory motion. By interleaving two navigator triggered MRI sequences, a fast but low-resolution image in mid ventilation (midV) and a high-resolution image in exhale were acquired efficiently. Deformable registration was applied to map the exhale image to the midV anatomy. Cine-MRI scans were acquired for motion quantification. The method was validated with a motion phantom, 10 volunteers and 1 patient with a liver tumor. The time-weighted mean position of a local structure in a cine-scan was defined as the midV-position ground truth and used to determine the accuracy of the midV-triggering method. Deformable registration accuracy was validated using the SIFT algorithm. Acquisition time of the midV/exhale-scan was 3-5 min. The accuracy of the midV-position was <= 0.5 +/- 0.5 mm for phantom motion and <= 0.9 +/- 1.2 mm for the volunteers. Mean residuals after deform able registration were <= 0.2 +/- 1.8 mm. The accuracy and reproducibility of the method are within inter and intra-fraction liver position variability (Case et al., 2009) and could in the future be incorporated in a conventional liver radiotherapy or MR-linac workflow. (C) 2016 Elsevier Ireland Ltd. All rights reserved.