Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects.

Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
PMID: 37898437

Abstract

MRI-guided radiotherapy (MRIgRT) is a highly complex treatment modality, allowing adaptation to anatomical changes occurring from one treatment day to the other (inter-fractional), but also to motion occurring during a treatment fraction (intra-fractional). In this vision paper, we describe the different steps of intra-fractional motion management during MRIgRT, from imaging to beam adaptation, and the solutions currently available both clinically and at a research level. Furthermore, considering the latest developments in the literature, a workflow is foreseen in which motion-induced over- and/or under-dosage is compensated in 3D, with minimal impact to the radiotherapy treatment time. Considering the time constraints of real-time adaptation, a particular focus is put on artificial intelligence (AI) solutions as a fast and accurate alternative to conventional algorithms.

Authors

  • Elia Lombardo
    Department of Radiation Oncology, University Hospital, LMU Munich, Munich, 81377, Germany.
  • Jennifer Dhont
    Maastro Clinic, Maastrict, the Netherlands.
  • Denis Page
    University of Manchester, Division of Cancer Sciences, Manchester, United Kingdom.
  • Cristina Garibaldi
    Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milano, Italy. Electronic address: cristina.garibaldi@ieo.it.
  • Luise A Künzel
    National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.
  • Coen Hurkmans
    Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands. coen.hurkmans@catharinaziekenhuis.nl.
  • Rob H N Tijssen
  • Chiara Paganelli
    Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
  • Paul Z Y Liu
    ACRF Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Paul J Keall
    Image X Institute, University of Sydney, Sydney, Australia. Electronic address: paul.keall@sydney.edu.au.
  • Marco Riboldi
    Department of Medical Physics, Ludwig-Maximilians-Universität München, Germany.
  • Christopher Kurz
    Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), Garching bei München, 85748, Germany.
  • Guillaume Landry
    Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), Garching bei München, 85748, Germany.
  • Davide Cusumano
    Polo Scienze Oncologiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 8, 00168 Rome, Italy.
  • Marco Fusella
    Department of Radiation Oncology, Abano Terme Hospital, Italy. Electronic address: mfusella@casacura.it.
  • Lorenzo Placidi
    Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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