title: Image fusion for stereotactic radiotherapy and radiosurgery treatment planning.
abstract: OBJECTIVE
  We describe an image fusion application that addresses two basic problems that previously limited the use of magnetic resonance imaging (MRI) for geometric localization in stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). The first limitation is imposed by the use of a relocatable, MRI-incompatible, stereotactic frame for stereotactic radiotherapy. The second limitation is an inherent lack of geometric fidelity in current MRI scanners that invalidates the use of MRI for stereotactic localization.
  
  
  METHODS
  We recently developed and implemented a novel automated method for fusing computerized tomography (CT) and MRI volumetric image studies. The method is based on a chamfer matching algorithm, and provides a quality assurance procedure to verify the accuracy of the fused image set. The image fusion protocol removes the need for stereotactic fixation of the patient for the MRI study.
  
  
  RESULTS
  The image fusion protocol significantly improves on the spatial accuracy of the MRI study. We demonstrate the effect of distortion and the effectiveness of the fusion with a phantom study. We present two case studies, an acoustic neurinoma treated with SRS, and a pilocytic astrocytoma treated with SRT.
  
  
  CONCLUSIONS
  The image fusion protocol significantly improves our logistical management of treating patients with radiosurgery and makes conformal therapy practical for treating patients with SRT. The image fusion protocol demonstrates both the superior diagnostic quality and the poor geometric fidelity of MRI. MRI is a required imaging modality in stereotactic therapy. Image fusion combines the superior MRI diagnostic quality with the superior CT geometric definition, and makes the use of MRI in stereotactic therapy possible and practical.
authors.affiliation: Joint Center for Radiation Therapy, Boston MA 02115.
authors.forename: H M
authors.initials: HM
authors.lastname: Kooy
authors.forename: M
authors.initials: M
authors.lastname: van Herk
authors.forename: P D
authors.initials: PD
authors.lastname: Barnes
authors.forename: E
authors.initials: E
authors.lastname: Alexander
authors.forename: S F
authors.initials: SF
authors.lastname: Dunbar
authors.forename: N J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: R V
authors.initials: RV
authors.lastname: Mulkern
authors.forename: E J
authors.initials: EJ
authors.lastname: Holupka
authors.forename: J S
authors.initials: JS
authors.lastname: Loeffler
mesh_terms: D001254:Astrocytoma / Q000175:diagnosis* / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000601:surgery; D016634:Radiosurgery; D014057:Tomography, X-Ray Computed