Development of patient-controlled respiratory gating system based on visual guidance for magnetic-resonance image-guided radiation therapy.

Abstract

The aim of this study is to develop a visual guidance patient-controlled (VG-PC) respiratory gating system for respiratory-gated magnetic-resonance image-guided radiation therapy (MR-IGRT) and to evaluate the performance of the developed system. The near-real-time cine planar MR image of a patient acquired during treatment was transmitted to a beam projector in the treatment room through an optical fiber cable. The beam projector projected the cine MR images inside the bore of the ViewRay system in order to be visible to a patient during treatment. With this visual information, patients voluntarily controlled their respiration to put the target volume into the gating boundary (gating window). The effect of the presence of the beam projector in the treatment room on the image quality of the MRI was investigated by evaluating the signal-to-noise ratio (SNR), uniformity, low-contrast detectability, high-contrast spatial resolution, and spatial integrity with the VG-PC gating system. To evaluate the performance of the developed system, we applied the VG-PC gating system to a total of seven patients; six patients received stereotactic ablative radiotherapy (SABR) and one patient received conventional fractionated radiation therapy. The projected cine MR images were visible even when the room light was on. No image data loss or additional time delay during delivery of image data were observed. Every indicator representing MRI quality, including SNR, uniformity, low-contrast detectability, high-contrast spatial resolution, and spatial integrity exhibited values higher than the tolerance levels of the manufacturer with the VG-PC gating system; therefore, the presence of the VG-PC gating system in the treatment room did not degrade the MR image quality. The average beam-off times due to respiratory gating with and without the VG-PC gating system were 830.3±278.2s and 1264.2±302.1s respectively (P=0.005). Consequently, the total treatment times excluding the time for patient setup with and without the VG-PC gating system were 1453.3±297.3s and 1887.2±469.6s, respectively, on average (P=0.005). The average number of beam-off events during whole treatment session was reduced from 457±154 times to 195±90 times by using the VG-PC gating system (P<0.001). The developed system could improve treatment efficiency when performing respiratory-gated MR-IGRT. The VG-PC gating system could be applied to any kind of bore-type radiotherapy machine.