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Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer

BACKGROUND AND PURPOSE: Magnetic Resonance (MR)-only planning has been implemented clinically for radiotherapy of prostate cancer. However, fewer studies exist regarding the overall success rate of MR-only workflows. We report on successes and challenges of implementing MR-only workflows for prostat...

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Autores principales: Tyagi, Neelam, Zelefsky, Michael J., Wibmer, Andreas, Zakian, Kristen, Burleson, Sarah, Happersett, Laura, Halkola, Aleksi, Kadbi, Mo, Hunt, Margie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598055/
https://www.ncbi.nlm.nih.gov/pubmed/33134566
http://dx.doi.org/10.1016/j.phro.2020.09.009
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author Tyagi, Neelam
Zelefsky, Michael J.
Wibmer, Andreas
Zakian, Kristen
Burleson, Sarah
Happersett, Laura
Halkola, Aleksi
Kadbi, Mo
Hunt, Margie
author_facet Tyagi, Neelam
Zelefsky, Michael J.
Wibmer, Andreas
Zakian, Kristen
Burleson, Sarah
Happersett, Laura
Halkola, Aleksi
Kadbi, Mo
Hunt, Margie
author_sort Tyagi, Neelam
collection PubMed
description BACKGROUND AND PURPOSE: Magnetic Resonance (MR)-only planning has been implemented clinically for radiotherapy of prostate cancer. However, fewer studies exist regarding the overall success rate of MR-only workflows. We report on successes and challenges of implementing MR-only workflows for prostate. MATERIALS AND METHODS: A total of 585 patients with prostate cancer underwent an MR-only simulation and planning between 06/2016 – 06/2018. MR simulation included images for contouring, synthetic-CT generation and fiducial identification. Workflow interruptions occurred that required a backup CT, a re-simulation or an update to our current quality assurance (QA) process. The challenges were prospectively evaluated and classified into synthetic-CT generation, motion/artifacts in the MRs, fiducial QA and bowel preparation guidelines. RESULTS: MR-only simulation was successful in 544 (93.2%) patients. In seventeen patients (2.9%), reconstruction of synthetic-CT failed due to patient size, femur angulation, or failure to determine the body contour. Twenty-four patients (4.1%) underwent a repeat/backup CT scan because of artifacts on the MR such as image blur due to patient motion or biopsy/surgical artifacts that hampered identification of the implanted fiducial markers. In patients requiring large coverage due to nodal involvement, inhomogeneity artifacts were resolved by using a two-stack acquisition and adaptive inhomogeneity correction. Bowel preparation guidelines were modified to address frequent rectum/gas issues due to longer MR scan time. CONCLUSIONS: MR-only simulation has been successfully implemented for a majority of patients in the clinic. However, MR-CT or CT-only pathway may still be needed for patients where MR-only solution fails or patients with MR contraindications.
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spelling pubmed-75980552020-10-30 Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer Tyagi, Neelam Zelefsky, Michael J. Wibmer, Andreas Zakian, Kristen Burleson, Sarah Happersett, Laura Halkola, Aleksi Kadbi, Mo Hunt, Margie Phys Imaging Radiat Oncol Original Research Article BACKGROUND AND PURPOSE: Magnetic Resonance (MR)-only planning has been implemented clinically for radiotherapy of prostate cancer. However, fewer studies exist regarding the overall success rate of MR-only workflows. We report on successes and challenges of implementing MR-only workflows for prostate. MATERIALS AND METHODS: A total of 585 patients with prostate cancer underwent an MR-only simulation and planning between 06/2016 – 06/2018. MR simulation included images for contouring, synthetic-CT generation and fiducial identification. Workflow interruptions occurred that required a backup CT, a re-simulation or an update to our current quality assurance (QA) process. The challenges were prospectively evaluated and classified into synthetic-CT generation, motion/artifacts in the MRs, fiducial QA and bowel preparation guidelines. RESULTS: MR-only simulation was successful in 544 (93.2%) patients. In seventeen patients (2.9%), reconstruction of synthetic-CT failed due to patient size, femur angulation, or failure to determine the body contour. Twenty-four patients (4.1%) underwent a repeat/backup CT scan because of artifacts on the MR such as image blur due to patient motion or biopsy/surgical artifacts that hampered identification of the implanted fiducial markers. In patients requiring large coverage due to nodal involvement, inhomogeneity artifacts were resolved by using a two-stack acquisition and adaptive inhomogeneity correction. Bowel preparation guidelines were modified to address frequent rectum/gas issues due to longer MR scan time. CONCLUSIONS: MR-only simulation has been successfully implemented for a majority of patients in the clinic. However, MR-CT or CT-only pathway may still be needed for patients where MR-only solution fails or patients with MR contraindications. Elsevier 2020-10-13 /pmc/articles/PMC7598055/ /pubmed/33134566 http://dx.doi.org/10.1016/j.phro.2020.09.009 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Tyagi, Neelam
Zelefsky, Michael J.
Wibmer, Andreas
Zakian, Kristen
Burleson, Sarah
Happersett, Laura
Halkola, Aleksi
Kadbi, Mo
Hunt, Margie
Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title_full Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title_fullStr Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title_full_unstemmed Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title_short Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
title_sort clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598055/
https://www.ncbi.nlm.nih.gov/pubmed/33134566
http://dx.doi.org/10.1016/j.phro.2020.09.009
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