Magnetic Resonance Imaging (MR) is increasingly used in treatment planning (TP) owing to superior soft tissue contrast versus computed tomography (CT). Organ deformation in patient positioning on a curved MR couch versus a flat CT couch causes registration difficulties. This may lead to contour errors and tumor volume misjudgment, particularly in organs poorly visualized on CT (i.e. liver). MR-based simulation systems (MR-BSS) address this issue but are not widely available. In this study, we fabricated a 3D-printed platform (3D-PP) adapted to the MR couch and body array to enable scans in the TP position and optimize MR-guided TP in the absence of a dedicated MR-BSS. We demonstrate that a 3D-PP is low cost, does not interfere with image quality, and is easily implemented by radiology staff. The 3D-PP was drafted with computer-aided design to fit the table arc and 12 channel body array coil of a 1.5 T, 70 cm wide bore, MR scanner. The 3D-PP creates a flat surface to position an immobilization vacuum bag typically used in treatment. The 3D-PP consists of ¼” thick deck and 3/32” thick alignment wings mounted on ten risers. The deck and alignment wings are polyoxymethylene homopolymer laser-cut with a contact-free CO2 beam. Risers are fabricated from polylactide in a thermoplastic 3D printer. A urethane immobilization vacuum cushion (88 x 55 cm, 15 L fill) was fabricated for an 8-channel upper annular MR phantom. CT was acquired in an 85 cm bore simulation CT (120kVp, 512x512 in-plane dimensions, 0.11cm x 0.11cm pixel size, 2mm thickness). Standard body MR sequences were done including single shot fast spin echo (SS-FSE), 3D fast spoiled gradient echo with fat suppression(FSPGR FS), T2 fat suppression(T2 FS), balanced steady-state free precession (BSSFP), dual echo fast spin echo(DE FSE), and diffusion weight imaging (DWI). MR and CT scans were exported to a treatment planning system and fused using a local correlation algorithm capable of both rigid and deformable registration. An anthropomorphic phantom and quality control devices were employed for MR scans. SS-FSE, FSPGR, FSPGR FS, T2 FS, BSSFP, DEFSE, and DWI were analyzed to determine the effect of any artifacts contributed by the 3D-PP. Neither appreciable signal loss nor artifact were observed on any scan. Each MR-CT fusion required negligible computation time (< 2 seconds). In-plane registration was within sub-pixel accuracy for every slice in each sequence. We report a new, low cost approach to optimize MR-guided TP. A 3D-PP enables MR scans in the simulated TP position without appreciable loss of image quality or interruption of radiology workflow. A 3D-PP in a 70 cm wide bore MR system accommodates most treatment positions, including wing board. We are implementing this process into our abdominal SBRT workflow. The 3D-PP design and fabrication can be modified for the workflow of most clinics.
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