Assessment of Fiducial-based 2D kV Orthogonal Imaging, Fiducial-based CBCT, and Soft-tissue-based CBCT for Prostate Cancer Patients With Implanted Fiducial Markers

Abstract

Purpose/Objective(s): To assess the geometric accuracy and imaging performance of a newly developed phased array coil system optimized for MR imaging of patients immobilized with the type S frame for head and neck radiation therapy. Materials/Methods: Protocol optimization for the novel coil was undertaken using a GE Optima450-GEM 70cm wide bore unit adapted for radiation therapy MR-SIM localization. Pulse sequence parameters for T1FSE, T2 FRFSE and T1 and T2 CUBE (including matrix, slice thickness, bandwidth) were optimized to maximize SNR while minimizing the effect of chemical shift. Phantom measurements were then performed to quantify system related residual geometric distortions after application of a 3D commercial gradient distortion correction algorithm for the effective FOV and the pulse sequences utilized. The optimized protocols were used to image seven volunteers positioned using an MR compatible type S system with neutral head supports. MRI images (from the base of brain to below the clavicles) were acquired using the novel phased array coil combination placed over the head, neck and thoracic region. The volunteers were re-imaged without immobilization in a standard diagnostic head coil, which served as the benchmark for image quality. Signal to noise, image homogeneity and image artifacts were compared between the two image datasets in a blinded study. Visibility of ten anatomical structures was evaluated. For statistical analysis, Cohen’s kappa, Wilcoxon matched pairs and t-testing were utilized. Results: A geometrically accurate, high resolution MR-SIM imaging protocol (T1/T2CUBE. 2D T1/T2 FSE) was developed with 3mm slice thickness/no gap that provides excellent image quality from the base of brain to below the clavicles in the treatment position. From phantom studies, residual distortions were found to be 1.0mm within a 10 cm radius and < 1.5 mm within a 15 cm radius of the scan centre. Using a RBWof 50-62.5 minimized chemical shift (<1mm within a 10cm radius) at 1.5T while providing acceptable SNR. The coil provided higher SNR values in all anatomical structures, but less uniformity than the standard diagnostic head coil (full comparative SNR/CNR/geometric data will be presented). No significant difference for image quality and artifacts were demonstrated between the coils in the blinded study. Conclusions: The novel open architecture purpose built phased coil array provides unparalleled coverage and good image quality of the subject immobilized for head and neck radiation therapy and is a promising solution for MR-SIM in the head and neck region. Author Disclosure: G. Perkins: None. R. Hammoud: None. S. Pienaar: None. S. Paloor: None. N. Al Hammadi: None.