Motion compensation strategies in magnetic resonance imaging

Image quality in magnetic resonance imaging (MRI) is considerably affected by motion. Therefore, motion is one of the most common sources of artifacts in contemporary cardiovascular MRI. Such artifacts in turn may easily lead to misinterpretations in the images and a subsequent loss in diagnostic quality. Hence, there is considerable research interest in strategies that help to overcome these limitations at minimal cost in time, spatial resolution, temporal resolution, and signal-to-noise ratio. This review summarizes and discusses the three principal sources of motion: the beating heart, the breathing lungs, and bulk patient movement. This is followed by a comprehensive overview of commonly used compensation strategies for these different types of motion. Finally, a summary and an outlook are provided.     

Motion in radiotherapy: particle therapy

Charged particle beam radiotherapy requires dedicated measures to compensate for the dosimetric influence of inter- and intra-fractional target motion. Independent of the delivery technique, these measures have to incorporate the strong influence of the radiological depth on the delivered dose. For scanned beam delivery, interference effects of target motion and scanned beam can further cause under-dosage of the clinical target volume despite using margins. Within the scope of this review, published data with respect to motion management in scattered as well as scanned beam treatment delivery will be summarized. Based on a section covering the dosimetric impact of organ motion, motion management during treatment planning, patient positioning, treatment delivery and treatment validation will be summarized. For scattered beam delivery, the concepts and data are often based on clinical usage since treatment of moving tumors has been performed for several years. In the field of scanned beam delivery, the report focuses on the results of research on countermeasures of the interference effect. Clinical application of these techniques can be expected in the near future.     

Adaptive prediction of respiratory motion for motion compensation radiotherapy

One potential application of image-guided radiotherapy is to track the target motion in real time, then deliver adaptive treatment to a dynamic target by dMLC tracking or respiratory gating. However, the existence of a finite time delay (or a system latency) between the image acquisition and the response of the treatment system to a change in tumour position implies that some kind of predictive ability should be included in the real-time dynamic target treatment. If diagnostic x-ray imaging is used for the tracking, the dose given over a whole image-guided radiotherapy course can be significant. Therefore, the x-ray beam used for motion tracking should be triggered at a relatively slow pulse frequency, and an interpolation between predictions can be used to provide a fast tracking rate. This study evaluates the performance of an autoregressive-moving average (ARMA) model based prediction algorithm for reducing tumour localization error due to system latency and slow imaging rate. For this study, we use 3D motion data from ten lung tumour cases where the peak-to-peak motion is greater than 8 mm. Some strongly irregular traces with variation in amplitude and phase were included. To evaluate the prediction accuracy, the standard deviations between predicted and actual motion position are computed for three system latencies (0.1, 0.2 and 0.4 s) at several imaging rates (1.25-10 Hz), and compared against the situation of no prediction. The simulation results indicate that the implementation of the prediction algorithm in real-time target tracking can improve the localization precision for all latencies and imaging rates evaluated. From a common initial setting of model parameters, the predictor can quickly provide an accurate prediction of the position after collecting 20 initial data points. In this retrospective analysis, we calculate the standard deviation of the predicted position from the twentieth position data to the end of the session at 0.1 s interval. For both regular and irregular lung tumour motions, with prediction the range of average errors is 0.4-2.5 mm in the SI direction from shorter to longer latency, corresponding to a range of 0.8-4.3 mm without prediction; for the AP direction a range of 0.3-1.6 mm is obtained with prediction, corresponding to a range of 0.6-3.0 mm without prediction. For 0.2 s and 0.4 s system latency, with prediction the localization based on a relatively slow imaging rate (2.5 Hz) can achieve a better or similar precision compared with no prediction but on a fast imaging rate (10 Hz). This means that precise localization can be realized at a slow imaging rate. This is important for the application of kV x-ray imaging systems and EPID-based systems in image-guided radiotherapy. In conclusion, the adaptive predictor can successfully predict irregular respiratory motion, and the adaptive prediction of respiration motion can effectively improve the delivery precision of real-time motion compensation radiotherapy.     

基部计划剂量补偿优化方法在肺癌调强放疗计划中的应用

【摘要】目的:比较基部计划剂量补偿（BDPC组）和冷热点控制（HCSC组）两种计划优化方法得到的肺癌调强放疗计划的剂量学差异。方法:选取13例肺癌患者,采用相同优化条件分别设计BDPC和HCSC两组放疗计划。计划处方:PGTV为60 Gy/26 f、PCTV为50 Gy/26 f。比较两组肿瘤靶区和危及器官的各项剂量评价参数、计划时间和机器跳数（MU）。采用配对t检验或非参数检验进行统计学分析。结果:BDPC组相对于HCSC组有较好的靶区CI（PGTV:0.66±0.14 vs 0.58±0.15, P<0.05;PCTV:0.61±0.28 vs 0.57±0.27, P=0.066）和HI （PGTV:0.08±0.02 vs 0.11±0.05, P<0.05;PCTV:0.23±0.03 vs 0.27±0.03, P<0.05）;前者较后者重要危及器官的剂量低,食管的Dmax、双肺的V5 Gy和V20 Gy分别为（59.92±2.87） Gy vs （62.09±3.34） Gy、49%±18% vs 51%±11%和22%±9 % vs 24%±7%,P值均小于0.05。结论:对于肺癌调强放疗计划,BDPC优化方法得到的计划剂量分布较HCSC优化方法更优,能保证靶区覆盖的同时降低重要危及器官的受照剂量,可在临床上推广应用。     

Tumour shapes and fully automated range compensation for heavy charged particle radiotherapy

The idea of a computer-controlled range-compensating system for heavy charged particle radiotherapy, the multibar compensator, is proposed. By stacking multiple energy-absorbing layers along the beam, each of which has structure and behaviour similar to those of a multileaf collimator, variable range compensation will be achieved. The analysis of the conventional range compensators actually used for treatment concluded that the proposed system would not seriously degrade the treatment quality for the most cases, except for tumours in the head and neck region where 1 mm precision may be required. The system will even be able to coexist with the conventional range compensators to provide either method depending on clinical situations.     

Inferential modeling and predictive feedback control in real-time motion compensation using the treatment couch during radiotherapy

Tumor motion induced by respiration presents a challenge to the reliable delivery of conformal radiation treatments. Real-time motion compensation represents the technologically most challenging clinical solution but has the potential to overcome the limitations of existing methods. The performance of a real-time couch-based motion compensation system is mainly dependent on two aspects: the ability to infer the internal anatomical position and the performance of the feedback control system. In this paper, we propose two novel methods for the two aspects respectively, and then combine the proposed methods into one system. To accurately estimate the internal tumor position, we present partial-least squares (PLS) regression to predict the position of the diaphragm using skin-based motion surrogates. Four radio-opaque markers were placed on the abdomen of patients who underwent fluoroscopic imaging of the diaphragm. The coordinates of the markers served as input variables and the position of the diaphragm served as the output variable. PLS resulted in lower prediction errors compared with standard multiple linear regression (MLR). The performance of the feedback control system depends on the system dynamics and dead time (delay between the initiation and execution of the control action). While the dynamics of the system can be inverted in a feedback control system, the dead time cannot be inverted. To overcome the dead time of the system, we propose a predictive feedback control system by incorporating forward prediction using least-mean-square (LMS) and recursive least square (RLS) filtering into the couch-based control system. Motion data were obtained using a skin-based marker. The proposed predictive feedback control system was benchmarked against pure feedback control (no forward prediction) and resulted in a significant performance gain. Finally, we combined the PLS inference model and the predictive feedback control to evaluate the overall performance of the feedback control system. Our results show that, with the tumor motion unknown but inferred by skin-based markers through the PLS model, the predictive feedback control system was able to effectively compensate intra-fraction motion.     

Motion compensation for interventional navigation on 3D static roadmaps based on an affine model and gating

Current cardiac interventions are performed under 2D fluoroscopy, which comes along with well-known burdens to patients and physicians, such as x-ray exposure and the use of contrast agent. Furthermore, the navigation on complex structures such as the coronaries is complicated by the use of 2D images in which the catheter position is only visible while the contrast agent is introduced. In this work, a new method is presented, which circumvents these drawbacks and enables the cardiac interventional navigation on motion-compensated 3D static roadmaps. For this, the catheter position is continuously reconstructed within a previously acquired 3D roadmap of the coronaries. The motion compensation makes use of an affine motion model for compensating the respiratory motion and compensates the motion due to cardiac contraction by gating the catheter position. In this process, only those positions which have been acquired during the rest phase of the heart are used for the reconstruction. The method necessitates the measurement of the catheter position, which is done by using a magnetic tracking system. Nevertheless, other techniques, such as image-based catheter tracking, can be applied. This motion compensation has been tested on a dynamic heart phantom. The evaluation shows that the algorithm can reconstruct the catheter position on the 3D static roadmap precisely with a residual motion of 1.0 mm and less.     

The theoretical benefit of beam fringe compensation and field size reduction for iso-normal tissue complication probability dose escalation in radiotherapy of lung cancer

To assess the benefit of beam fringe (50%-90% dose level) sharpening for lung tumors, we performed a numerical simulation in which all geometrical errors (breathing motion, random and systematic errors) are included. A 50 mm diameter lung tumor, located centrally in a lung-equivalent phantom was modeled. Treatment plans were designed with varying number and direction of beams, both with and without the use of intensity modulation to sharpen the beam fringe. Field size and prescribed dose were varied under the constraint of a constant mean lung dose of 20 Gy, which yields a predicted complication probability of about 10%. After numerical simulation of the effect of setup errors and breathing, the resulting dose distribution was evaluated using the minimum dose and the equivalent uniform dose (EUD) in the moving clinical target volume (CTV). When the dose in the CTV was constrained between 95% and 107% of the prescribed dose, the maximum attainable EUD was 71 Gy for a four-field noncoplanar technique with simple conformal beams. When penumbra sharpening was applied using a single beam segment at the edge of the open field, this EUD could be raised to 87 Gy. For a hypothetical infinitely steep penumbra, further escalation to an EUD of 104 Gy was possible. When the dose in the CTV was not constrained, a large escalation of the EUD was possible compared to the constrained case. In this case, the maximum attainable EUD for open fields was 115 Gy, using the four-field noncoplanar technique. The benefit of penumbra sharpening was only modest, with no increase of the EUD for the single-segment technique and a small increase to 125 Gy for the infinitely steep penumbra. From these results we conclude that beam fringe sharpening in combination with field-size reduction leads to a large increase in EUD when a homogeneous target dose is pursued. Further escalation of the EUD is possible when the homogeneity constrained is relaxed, but the relative benefit of beam-fringe sharpening then decreases.     

A phenomenon in vestibular compensation

The role of spinal afferentation from the lower half of the body in compensation of the sequelae of unilateral loss of vestibular function was studied in experiments on guinea pigs. Division of the spinal cord at the thoracic level under local anesthesia had no appreciable effect on the development of compensation after simultaneous or subsequent destruction of the labyrinth and did not disturb compensation in previously labyrinthectomized animals. Division of the spinal cord in labyrinthectomized animals under ether or chloroform anesthesia was accompanied by a sharp disturbance of compensation. These substances evoked a similar picture of decompensation in unilaterally labyrinthectomized animals with an intact spinal cord also. The results indicate that the disturbance of vestibular compensation discribed in the literature after division of the spinal cord under ether anesthesia is not the result of removal of spinal afferentation from the lower half of the body, but is due to the direct effect of inhalational anesthetics on compensation mechanisms.(Presented by Academician of the Academy of Medical Sciences of the USSR O. G. Gazenko.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 88, No. 7, pp. 21–23, July, 1979.     

Recent advances in radiotherapy

Radiation therapy has come a long way from treatment planning based on orthogonal radiographs with large margins around tumours. Advances in imaging and radiation planning software have led to three-dimensional conformal radiotherapy and, further, to intensity modulated radiotherapy (IMRT). IMRT permits sparing of normal tissues and hence dose-escalation to tumours. IMRT is the current standard in treatment of head and prostate cancer and is being investigated in other tumour sites. Exquisitely sculpted dose distributions (increased geographical miss) with IMRT, plus tumour motion and anatomical changes during radiotherapy make image guided radiotherapy an essential part of modern radiation delivery. Various hardware and software tools are under investigation for optimal IGRT.     

Accident prevention in radiotherapy

In order to prevent accidents in radiotherapy, it is important to learn from accidents that have occurred previously. Lessons learned from a number of accidents are summarised and underlying patterns are looked for in this paper. Accidents can be prevented by applying several safety layers of preventive actions. Categories of these preventive actions are discussed together with specific actions belonging to each category of safety layer.