SU‐E‐J‐90: MRI‐Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR‐based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra‐short T2 and T1, which presents difficulty for both dose calculation and patient setup in terms of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in‐house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on‐board images were used to evaluate 2D patient setup with MRI‐DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI‐DRR is comparable to CT‐based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post‐processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.