Real-Time Motion Tracking Based on Orthogonal Cine MRI During MR-Guided Radiation Therapy for Prostate Cancer

Abstract

In contrast to radiographic imaging with implanted radio-opaque fiducials, the high soft tissue contrast and noninvasive nature of MRI are advantageous for real-time motion tracking of prostate motion. The purpose of this study is to investigate the feasibility of tracking the intrafraction prostate motion using an intensity-based template registration technique between real-time 2D cine and 3D MRI acquired during MR-guided Adaptative Radiation Therapy (MRgART).The motion tracking algorithm includes two steps: (1) creating a template by rigidly registering a set of cine images with a 3D reference MRI, and (2) tracking the target motion by registering incoming (i.e., real-time) cine with the template with a known relationship to the 3D volume. The daily 3D T2 MRI and 2D T2/T1 bFFE real-time cine MRI acquired on a 1.5T MR-Linac during MRgART for 6 prostate cancer patients were selected to test the algorithm limits. The cine images were acquired with a temporal resolution of 0.2 s for a total duration of 9-11 minutes interleaved between coronal and sagittal orientations. A 2D template image set was generated in the coronal and sagittal planes using the cine data acquired during the first 20 s registered to the 3D volume using in-plane rigid-body image registration based on a region of interest defined by the prostate contour on 3D T2 MRI. Motion tracking of the prostate was performed by registering the rest of the 2D cine series with the corresponding template. Manually delineated contours on sampled cine frames were used as the ground truth. Tracking accuracy was defined as the standard deviation of the error (SDE) between the center of mass (CM) of the ground-truth and tracked motions in 1 min. Prostate drift was evaluated by tracking the CM shift with the algorithm every 8-9 s for 9-11 min.The prostate tracking algorithm was qualitatively validated by visual assessment of 6 prostate cases. Overall, the tracking was found robust to implant-induced image artefacts in two cases, large change in bladder size in one case, and body motion in one other case. The tracking algorithm was also validated quantitatively on 2 cases for which ground truth contours were available and reliable. Mean SDE for the two cases was 0.45, 0.32, and 0.31 mm in superior-inferior, left-right, and anterior-posterior directions, respectively. A continuous motion drift of the prostate was observed over a 600 s period for one of these two cases and was accurately tracked by the technique.We have demonstrated the feasibility to track prostate motion based on real-time orthogonal cine MRI without implanting fiducials. With further investigation on more patients and following careful workflow, the real-time motion tracking technique may be implemented in MRgART to manage intrafraction motion.H. Jassar: None. A. Tai: None. X. Chen: None. T. Keiper: None. E.S. Paulson: Research Grant; Siemens Healthineers, Elekta Instruments AB.F. Lathuiliere: None. S. Bériault: None. D. Cooper: None. F. Hebert: None. L. Savard: None. S. Cloake: None. W.A. Hall: Research Grant; Elekta, National Cancer Institute, American Cancer Society. C.A. Lawton: None. A. Li: Research Grant; Elekta AB, Accuray Inc, Siemens Healthineers, Manteia Med. Honoraria; Elekta AB, Accuray Inc. Patent/License Fees/Copyright; Manteia Med.