Dose accumulation for MR-guided adaptive radiotherapy: From practical considerations to state-of-the-art clinical implementation
McDonald, Brigid A; Zachiu, Cornel; Christodouleas, John; Naser, Mohamed A; Ruschin, Mark; Sonke, Jan-Jakob; Thorwarth, Daniela; Létourneau, Daniel; Tyagi, Neelam; Tadic, Tony; Yang, Jinzhong; Li, X Allen; Bernchou, Uffe; Hyer, Daniel E; Snyder, Jeffrey E; Bubula-Rehm, Edyta; Fuller, Clifton D; Brock, Kristy K
(2023) Frontiers in oncology, volume 12
(Article)
Abstract
MRI-linear accelerator (MR-linac) devices have been introduced into clinical practice in recent years and have enabled MR-guided adaptive radiation therapy (MRgART). However, by accounting for anatomical changes throughout radiation therapy (RT) and delivering different treatment plans at each fraction, adaptive radiation therapy (ART) highlights several challenges in terms of calculating
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the total delivered dose. Dose accumulation strategies-which typically involve deformable image registration between planning images, deformable dose mapping, and voxel-wise dose summation-can be employed for ART to estimate the delivered dose. In MRgART, plan adaptation on MRI instead of CT necessitates additional considerations in the dose accumulation process because MRI pixel values do not contain the quantitative information used for dose calculation. In this review, we discuss considerations for dose accumulation specific to MRgART and in relation to current MR-linac clinical workflows. We present a general dose accumulation framework for MRgART and discuss relevant quality assurance criteria. Finally, we highlight the clinical importance of dose accumulation in the ART era as well as the possible ways in which dose accumulation can transform clinical practice and improve our ability to deliver personalized RT.
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Keywords: MR-guided radiation therapy, MR-linac, adaptive radiation therapy, deformable image registration, dose accumulation, Journal Article, Review
ISSN: 2234-943X
Publisher: Frontiers Media S. A.
Note: Funding Information: MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Centers both have master research agreements with Elekta AB and Philips Healthcare. CF has received direct industry grant support, speaking honoraria, and travel funding from Elekta AB. KB received funding from RaySearch Laboratories AB through a Co-Development and Collaboration Agreement. KB has a licensing agreement with RaySearch Laboratories AB. NT has received travel funding and speaking honoraria from Elekta and Philips. DT reports institutional collaborations including financial and non-financial support by Elekta, Philips, Kaiku, Therapanacea and PTW Freiburg. JC and EB-R are employees of Elekta AB. Funding Information: BM has received research and training support through a Ruth L. Kirschstein National Research Service Award Fellowship from the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR) (F31DE029093), a Dr. John J. Kopchick Fellowship from the University of Texas MD Anderson Cancer UTHealth Graduate School of Biomedical Sciences, and an Image-Guided Cancer Therapy T32 Fellowship from MD Anderson Cancer Center and NIH/National Cancer Institute (NCI). CF received funding from the NIH/NIDCR (1R01DE025248–01/R56DE025248); an NIH/NIDCR Academic-Industrial Partnership Award (R01DE028290); the National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the NCI Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825); the NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148); an NIH/NCI Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672); an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50CA097007); and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program (R25EB025787). KB received funding from RaySearch Laboratories AB through a Co-Development and Collaboration Agreement. KB has a licensing agreement with RaySearch Laboratories AB. DT reports institutional collaborations including financial and non-financial support by Elekta, Philips, Kaiku, Therapanacea and PTW Freiburg. JC and EB-R are employees of Elekta AB. Acknowledgments Publisher Copyright: Copyright © 2023 McDonald, Zachiu, Christodouleas, Naser, Ruschin, Sonke, Thorwarth, Létourneau, Tyagi, Tadic, Yang, Li, Bernchou, Hyer, Snyder, Bubula-Rehm, Fuller and Brock.
(Peer reviewed)
