Development and implementation of optimized endogenous contrast sequences for delineation in adaptive radiotherapy on a 1.5T MR-linear-accelerator: a prospective R-IDEAL stage 0-2a quantitative/qualitative evaluation of in vivo site-specific quality-assurance using a 3D T2 fat-suppressed platform fo

Joint Head and Neck Radiotherapy-MRI Development Cooperative; Travis C. Salzillo; M. Alex Dresner; Ashley Way; Kareem A. Wahid; Brigid A. McDonald; Sam Mulder; Mohamed A. Naser; Renjie He; Yao Ding; Alison Yoder; Sara Ahmed; Kelsey L. Corrigan; Gohar S. Manzar; Lauren Andring; Chelsea Pinnix; R. Jason Stafford; Abdallah S. R. Mohamed; John Christodouleas; Jihong Wang; Clifton David Fuller

doi:10.1117/1.JMI.10.6.065501

6 November 2023 Development and implementation of optimized endogenous contrast sequences for delineation in adaptive radiotherapy on a 1.5T MR-linear-accelerator: a prospective R-IDEAL stage 0-2a quantitative/qualitative evaluation of in vivo site-specific quality-assurance using a 3D T2 fat-suppressed platform for head and neck cancer

Joint Head and Neck Radiotherapy-MRI Development Cooperative, Travis C. Salzillo, M. Alex Dresner, Ashley Way, Kareem A. Wahid, Brigid A. McDonald, Sam Mulder, Mohamed A. Naser, Renjie He, Yao Ding, Alison Yoder, Sara Ahmed, Kelsey L. Corrigan, Gohar S. Manzar, Lauren Andring, Chelsea Pinnix, R. Jason Stafford, Abdallah S. R. Mohamed, John Christodouleas, Jihong Wang, Clifton David Fuller

Author Affiliations +

Journal of Medical Imaging, Vol. 10, Issue 6, 065501 (November 2023). https://doi.org/10.1117/1.JMI.10.6.065501

Abstract

Purpose

To improve segmentation accuracy in head and neck cancer (HNC) radiotherapy treatment planning for the 1.5T hybrid magnetic resonance imaging/linear accelerator (MR-Linac), three-dimensional (3D), T2-weighted, fat-suppressed magnetic resonance imaging sequences were developed and optimized.

Approach

After initial testing, spectral attenuated inversion recovery (SPAIR) was chosen as the fat suppression technique. Five candidate SPAIR sequences and a nonsuppressed, T2-weighted sequence were acquired for five HNC patients using a 1.5T MR-Linac. MR physicists identified persistent artifacts in two of the SPAIR sequences, so the remaining three SPAIR sequences were further analyzed. The gross primary tumor volume, metastatic lymph nodes, parotid glands, and pterygoid muscles were delineated using five segmentors. A robust image quality analysis platform was developed to objectively score the SPAIR sequences on the basis of qualitative and quantitative metrics.

Results

Sequences were analyzed for the signal-to-noise ratio and the contrast-to-noise ratio and compared with fat and muscle, conspicuity, pairwise distance metrics, and segmentor assessments. In this analysis, the nonsuppressed sequence was inferior to each of the SPAIR sequences for the primary tumor, lymph nodes, and parotid glands, but it was superior for the pterygoid muscles. The SPAIR sequence that received the highest combined score among the analysis categories was recommended to Unity MR-Linac users for HNC radiotherapy treatment planning.

Conclusions

Our study led to two developments: an optimized, 3D, T2-weighted, fat-suppressed sequence that can be disseminated to Unity MR-Linac users and a robust image quality analysis pathway that can be used to objectively score SPAIR sequences and can be customized and generalized to any image quality optimization protocol. Improved segmentation accuracy with the proposed SPAIR sequence will potentially lead to improved treatment outcomes and reduced toxicity for patients by maximizing the target coverage and minimizing the radiation exposure of organs at risk.

CC BY: © The Authors. Published by SPIE under a Creative Commons Attribution 4.0 International License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Joint Head and Neck Radiotherapy-MRI Development Cooperative, Travis C. Salzillo, M. Alex Dresner, Ashley Way, Kareem A. Wahid, Brigid A. McDonald, Sam Mulder, Mohamed A. Naser, Renjie He, Yao Ding, Alison Yoder, Sara Ahmed, Kelsey L. Corrigan, Gohar S. Manzar, Lauren Andring, Chelsea Pinnix, R. Jason Stafford, Abdallah S. R. Mohamed, John Christodouleas, Jihong Wang, and Clifton David Fuller "Development and implementation of optimized endogenous contrast sequences for delineation in adaptive radiotherapy on a 1.5T MR-linear-accelerator: a prospective R-IDEAL stage 0-2a quantitative/qualitative evaluation of in vivo site-specific quality-assurance using a 3D T2 fat-suppressed platform for head and neck cancer," Journal of Medical Imaging 10(6), 065501 (6 November 2023). https://doi.org/10.1117/1.JMI.10.6.065501

Received: 16 May 2023; Accepted: 16 October 2023; Published: 6 November 2023

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KEYWORDS

Image segmentation

Image quality

Signal to noise ratio

Muscles

Radiotherapy

Lymph nodes

Neck

Purpose

Approach

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