Practical Implications of Ferromagnetic Artifacts in Low-field MRI-guided Radiotherapy

Fractionated radiotherapy presents a new challenge in the screening of patients undergoing magnetic resonance imaging-guided radiotherapy (MR-IGRT). In our institution, patients are evaluated at the time of consult, simulation, and first fraction using a thorough MRI questionnaire identical to the one used for diagnostic radiology patients. For each subsequent fraction, the therapists are trained to inquire about any procedures the patient may have had between the last and current fractions. Patients are also advised to avoid food and fluid intake at least two but not beyond four hours prior to treatment. Despite these screening efforts, we have observed several non-permanent imaging artifacts that, while not harmful to the patient, prevent the accurate delivery of MR-IGRT when using online adaptive radiotherapy due to interference with the identification of relevant anatomy. Two such cases are presented here: (1) an imaging artifact due to iron-enriched breakfast cereal that precluded treatment for that day, and (2) an imaging artifact due to an iron-containing multivitamin that necessitated a creative solution to enable the accurate visualization of the area to be treated.