Dose Accumulation for Mr-Guided Adaptive Radiotherapy: From Practical Considerations to State-of-the-Art Clinical Implementation

Authors

Brigid A McDonald
Cornel Zachiu
John Christodouleas
Mohamed A Naser
Mark Ruschin
Jan-Jakob Sonke
Daniela Thorwarth
Daniel Létourneau
Neelam Tyagi
Tony Tadic
Jinzhong Yang
X Allen Li
Uffe Bernchou
Daniel E Hyer
Jeffrey E Snyder
Edyta Bubula-Rehm
Clifton D Fuller
Kristy K Brock

Publication Date

1-1-2022

Journal

Frontiers in Oncology

Abstract

MRI-linear accelerator (MR-linac) devices have been introduced into clinical practice in recent years and have enabled MR-guided adaptive radiation therapy (MRgART). However, by accounting for anatomical changes throughout radiation therapy (RT) and delivering different treatment plans at each fraction, adaptive radiation therapy (ART) highlights several challenges in terms of calculating the total delivered dose. Dose accumulation strategies-which typically involve deformable image registration between planning images, deformable dose mapping, and voxel-wise dose summation-can be employed for ART to estimate the delivered dose. In MRgART, plan adaptation on MRI instead of CT necessitates additional considerations in the dose accumulation process because MRI pixel values do not contain the quantitative information used for dose calculation. In this review, we discuss considerations for dose accumulation specific to MRgART and in relation to current MR-linac clinical workflows. We present a general dose accumulation framework for MRgART and discuss relevant quality assurance criteria. Finally, we highlight the clinical importance of dose accumulation in the ART era as well as the possible ways in which dose accumulation can transform clinical practice and improve our ability to deliver personalized RT.

Keywords

dose accumulation, MR-guided radiation therapy, adaptive radiation therapy, deformable image registration, MR-linac

Comments

PMID: 36776378