title: MRI-based treatment planning for radiotherapy: dosimetric verification for prostate IMRT.
abstract: OBJECTIVE
  Magnetic resonance (MR) and computed tomography (CT) image fusion with CT-based dose calculation is the gold standard for prostate treatment planning. MR and CT fusion with CT-based dose calculation has become a routine procedure for intensity-modulated radiation therapy (IMRT) treatment planning at Fox Chase Cancer Center. The use of MRI alone for treatment planning (or MRI simulation) will remove any errors associated with image fusion. Furthermore, it will reduce treatment cost by avoiding redundant CT scans and save patient, staff, and machine time. The purpose of this study is to investigate the dosimetric accuracy of MRI-based treatment planning for prostate IMRT.
  
  
  METHODS
  A total of 30 IMRT plans for 15 patients were generated using both MRI and CT data. The MRI distortion was corrected using gradient distortion correction (GDC) software provided by the vendor (Philips Medical System, Cleveland, OH). The same internal contours were used for the paired plans. The external contours were drawn separately between CT-based and MR imaging-based plans to evaluate the effect of any residual distortions on dosimetric accuracy. The same energy, beam angles, dose constrains, and optimization parameters were used for dose calculations for each paired plans using a treatment optimization system. The resulting plans were compared in terms of isodose distributions and dose-volume histograms (DVHs). Hybrid phantom plans were generated for both the CT-based plans and the MR-based plans using the same leaf sequences and associated monitor units (MU). The physical phantom was then irradiated using the same leaf sequences to verify the dosimetry accuracy of the treatment plans.
  
  
  RESULTS
  Our results show that dose distributions between CT-based and MRI-based plans were equally acceptable based on our clinical criteria. The absolute dose agreement for the planning target volume was within 2% between CT-based and MR-based plans and 3% between measured dose and dose predicted by the planning system in the physical phantom.
  
  
  CONCLUSIONS
  Magnetic resonance imaging is a useful tool for radiotherapy simulation. Compared with CT-based treatment planning, MR imaging-based treatment planning meets the accuracy for dose calculation and provides consistent treatment plans for prostate IMRT. Because MR imaging-based digitally reconstructed radiographs do not provide adequate bony structure information, a technique is suggested for producing a wire-frame image that is intended to replace the traditional digitally reconstructed radiographs that are made from CT information.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Price
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Li
authors.forename: Lihong
authors.initials: L
authors.lastname: Qin
authors.forename: Shawn
authors.initials: S
authors.lastname: McNeeley
authors.forename: C-M Charlie
authors.initials: CM
authors.lastname: Ma
authors.forename: Gary M
authors.initials: GM
authors.lastname: Freedman
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019047:Phantoms, Imaging; D011467:Prostate; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder