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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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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 |
_version_ | 1783602503191887872 |
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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. |
format | Online Article Text |
id | pubmed-7598055 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
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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