Abstract
From its inception in the early 1970's up to the present, magnetic resonance imaging (MRI) has evolved into a sophisticated technique, which has aroused considerable interest in var-
ious subelds of medicine including radiotherapy. MRI is capable of imaging in any plane
and does not use ionizing radiation by virtue of which
... read more
MRI lends itself admirably to the
purpose of prolonged time course studies. MRI is capable of excellent spatial resolution and
it presents information over large areas of the body. The MRI signal depends on multiple
parameters resulting in excellent contrast resolution of the soft tissues. Within the realm
of radiotherapy, MRI oers prospects with regards to identication of tissues and tissue ab-
normalities (tumour, oedema, necrosis, brosis, cysts), determination of tumour extent in
relation to surrounding tissues and organs and assessment of response to treatment. The
goal of radiotherapy is to administer a high dose to the tumour while sparing healthy sur-
rounding tissues as much as possible. Since tight margins around the target are applied,
accurate information on tumour extent is of great value in radiotherapy treatment planning
(RTP). Also information on motion of the tumour and surrounding organs, e.g. caused
by respiration, is of importance for dening the margins and can be acquired by fast MR
imaging techniques. However, the introduction of MRI into RTP is seriously hampered by
geometry and intensity distortions which are known to be present in MRI. These distortions
are caused by non-idealities of the equipment (non-uniformity of the static magnetic eld
and non-linearities of the gradient magnetic elds of the MRI scanner) and by magnetic eld
perturbations induced by the object to be imaged, in this case the patient. These magnetic
eld inhomogeneities and gradient eld non-linearities lead to image distortions, the severity
of which depends on the type of pulse sequence and its parameters. The aim of this thesis
is to investigate the capabilities of MRI in radiotherapy treatment planning and to explore
the MR image distortions and how distortions can be reduced or, if necessary, corrected in
order to integrate MRI into RTP in a reliable manner. Image distortions and the ecacy of
correction methods were evaluated in phantom, volunteer, and patient studies. Furthermore,
the potential of MRI in organ motion studies was investigated and it was explored whether
the image artifacts induced by I-125 seeds could be used to evaluate permanent prostate
implants in brachytherapy.
Chapter 1 introduces the potentials and problems with regard to the use of MRI for ra-
diotherapy treatment planning and gives a review of the literature concerning MR image
distortions, integration of MRI into RTP, MRI organ motion studies for RTP, and MRI-
based brachytherapy evaluation.
Chapter 2 brie y reviews the basic principles of nuclear magnetic resonance (NMR), spatial
encoding in MRI, and the sources of geometry and intensity distortions in MRI, viz. machine-
related magnetic eld inhomogeneity and gradient non-linearity and patient-related magnetic
eld inhomogeneity due to chemical shift and susceptibility.
Chapter 3 describes the measurement, analysis, and correction of machine dependent geo-
metric distortions in MRI with special attention for phantom design and eld error stability
in time and for dierent pulse sequence parameters. Inhomogeneity of the static eld and
non-linearity of the gradients was established by phantom experiments. A grid phantom
of equally spaced tubes appeared to be very suitable for this purpose. Interchanging the
directions of the read-out and the phase-encoding gradients enabled decomposition of the
image distortions into contributions from static eld inhomogeneity and the non-linearity of
the three gradients. A 3D map of static eld inhomogeneity and non-linearity of the gra-
112?dients was thus obtained from sagittal, coronal, and transversal multiple slice images with
for each acquisition the phantom positioned such that the tubes were perpendicular to the
image plane. Time series of measurements on the Gyroscan S15 showed eld error stability
within the experimental errors of 1 ppm for static eld inhomogeneity and 1 mm for
the gradient elds. Measurements on the Gyroscan ACS-NT, equipped with active shielding
technology, showed eld error stability under dierent imaging conditions. These observa-
tions imply that the measured error maps can be used for correction of patient images which
may have been acquired with a pulse sequence that is not necessarily identical to the pulse
sequence applied for phantom imaging. The correction procedure reduced distortions up to
13 mm within a volume of interest (VOI) with dimensions 336 x 336 x 210 mm 3 to smaller
than 2 mm. In a study on the Leksell frame, distortions up to 6.4 mm were reduced to
smaller than 1.5 mm. We conclude that MR image corrections are necessary in applications
which require mm accuracy and that correction methods, based on 3D maps of static eld
inhomogeneity and gradient non-linearity, are feasible in clinical practice.
Chapter 4 describes the analysis of the patient related magnetic eld perturbations and
resulting image distortions in case of MRI of the head and the pelvic region. The magnetic
eld was calculated by numerically solving the Maxwell equations for a magnetostatic eld.
The magnetic eld around the head resembled a dipole eld in the midsagittal plane of
calculation with minimal eld perturbation on the diagonals. The magnetic eld in the
localization frame depended strongly on the orientation of the Perspex plates with respect
to the applied magnetic eld. The maximum spatial distortion of external landmarks in the
localization frame amounted 12.8 mm in a 1.5 T MR head image acquired with a relatively
weak read-out gradient of 0.68 mT/m. Susceptibility-induced distortions in the pelvic region
were smaller than 3 mm in 1.5 T images acquired with a read-out gradient strength of
0.54 mT/m. Since susceptibility induced distortions are proportional to the static magnetic
eld strength and inversely proportional to the gradient strength, we may conclude that
object-related distortions can be reduced to the order of the pixel size by imaging at 0.5 T
and using gradient strengths on the order of 3 mT/m.
Chapter 5 describes qualitatively the in uence of the type of pulse sequence and its param-
eters on geometry and intensity distortions. The strength of the read-out gradient, which is
controlled by the water fat shift parameter, was the main factor aecting the severity of the
susceptibility artifact. The range of water fat shifts, that could be selected, was in uenced
by the eld of view and the acquisition matrix. In echo planar imaging (EPI), the EPI factor
(number of proles acquired after a single excitation) strongly in uenced the water fat shift
(in pixels) in the phase encoding direction. In applications of MRI, which require geometric
accuracy, we should be aware that these parameters indirectly aect the severity of image
distortions. Spatial distortions occurred in the direction of the read-out gradient in spin echo
(SE) and fast eld echo (FFE) imaging, but also and more strongly in the direction of the
phase-encoding gradient in echo planar imaging. The direction of the read-out gradient was
controlled by the fold-over direction parameter which is the direction of the phase-encoding
gradient. Signal loss was most severe in FFE images acquired with relatively long echo
times and/or in case of partial k -space sampling (reduced scan matrix, half matrix or partial
echo). Generally, highest accuracy and least signal loss is achieved in spin echo imaging with
minimal water fat shift and in fast eld echo imaging with minimal water fat shift and short
echo time.
113?Chapter 6 describes the investigation of geometric distortions in 1.5 T MR images for use
in radiotherapy treatment planning of patients with brain tumours. Patients underwent
magnetic resonance imaging in the radiotherapy position with the head xed by a plastic cast
in a Perspex localization frame. For purposes of accuracy assessment, external and internal
landmarks were indicated. Tubes attached to the cast and in the localization frame served
as external landmarks. In the mid-sagittal plane the brain-sinus sphenoidalis interface, the
pituitary gland-sinus sphenoidalis interface, the sphenoid bone and the corpora of the cervical
vertebra served as internal landmarks. Landmark displacements as observed in the reversed
read-out gradient experiments were analyzed with respect to the contributions of machine
related static magnetic eld inhomogeneity and susceptibility and chemical shift artifacts.
In this study at 1.5 T with read-out gradient strength of 3 mT/m, machine related and
susceptibility induced static magnetic eld inhomogeneity were on the same order, resulting
in spatial distortions between
show less