title: Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy.
abstract: BACKGROUND
  Onboard magnetic resonance imaging (OB-MRI) for daily localization and adaptive radiotherapy has been under development by several groups. However, no clinical studies have evaluated whether OB-MRI improves visualization of the target and organs at risk (OARs) compared to standard onboard computed tomography (OB-CT). This study compared visualization of patient anatomy on images acquired on the MRI-(60)Co ViewRay system to those acquired with OB-CT.
  
  
  METHODS
  Fourteen patients enrolled on a protocol approved by the Institutional Review Board (IRB) and undergoing image-guided radiotherapy for cancer in the thorax (n = 2), pelvis (n = 6), abdomen (n = 3) or head and neck (n = 3) were imaged with OB-MRI and OB-CT. For each of the 14 patients, the OB-MRI and OB-CT datasets were displayed side-by-side and independently reviewed by three radiation oncologists. Each physician was asked to evaluate which dataset offered better visualization of the target and OARs. A quantitative contouring study was performed on two abdominal patients to assess if OB-MRI could offer improved inter-observer segmentation agreement for adaptive planning.
  
  
  RESULTS
  In total 221 OARs and 10 targets were compared for visualization on OB-MRI and OB-CT by each of the three physicians. The majority of physicians (two or more) evaluated visualization on MRI as better for 71% of structures, worse for 10% of structures, and equivalent for 14% of structures. 5% of structures were not visible on either. Physicians agreed unanimously for 74% and in majority for > 99% of structures. Targets were better visualized on MRI in 4/10 cases, and never on OB-CT.
  
  
  CONCLUSIONS
  Low-field MR provides better anatomic visualization of many radiotherapy targets and most OARs as compared to OB-CT. Further studies with OB-MRI should be pursued.
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Noel
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Parag J
authors.initials: PJ
authors.lastname: Parikh
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Spencer
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Olga L
authors.initials: OL
authors.lastname: Green
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Yanle
authors.initials: Y
authors.lastname: Hu
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
authors.affiliation: a Department of Radiation Oncology , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Olsen
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology / Q000532:radiotherapy; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D010386:Pelvic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D013899:Thoracic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D014057:Tomography, X-Ray Computed