Determination of internal target volume with Cine-MRI sequence for prostate MRI-Guided radiotherapy.

Abstract

In prostate radiotherapy, the intrafractional target motion negatively affects treatment accuracy. Generating internal target volume (ITV) using four-dimensional (4D) images may resolve the issue of intrafractional target motion induced by bladder filling and bowel movement. However, no 4D imaging techniques suitable for the prostate are currently available in clinical practice. This study aimed to determine the ITV based on cine magnetic resonance imaging (MRI) sequence for intrafractional target motion management in prostate MRI-guided radiotherapy. A reference ITV was generated in simulation process. Then, the reference ITV was adapted with cine MRI sequence before online planning in each fraction. Finally, the reference ITV was updated with the cine MRI sequence acquired during beam delivery after each fraction. Cine MRI sequences and positioning three-dimensional (3D) MRI from 35 patients were retrospectively collected. Clinical target volume (CTV) coverage was computed according to the two-dimensional contour of CTV and ITV on cine MRI images. Relative target size was calculated as the ratio of the volume of ITV and CTV. Isotropic planning target volume (PTV; 5mm margin) and anisotropic PTV (3mm margin in the posterior direction and 5mm margin in other directions) were generated for comparison. The CTV coverage rate of the proposed ITV had a mean value of 98.61%±0.51%, whereas the CTV coverage rates of the isotropic and anisotropic PTVs were 97.43%±0.41% and 96.58%±0.73%, respectively. The proposed ITV had a relative target size of 1.79±0.17, whereas the anisotropic and isotropic PTVs had relative target sizes of 1.92±0.12 and 2.21±0.19, respectively. For both the CTV coverage rate and target relative size, significant differences were observed between the proposed ITV and the other two PTVs (p<0.05). The ITV achieved higher CTV coverage with smaller size than conventional isotropic and anisotropic PTVs, indicating that it can effectively deal with the intrafractional movement of the prostate.