High-speed magnetic resonance imaging for four-dimensional treatment planning of conformal radiotherapy of moving body tumors.

Abstract

High-speed magnetic resonance imaging (MRI) was applied to the determination of the planning target volume (PTV) of moving hepatobiliary tumors. Three moving tumors, including two metastatic hepatic tumors and one bile duct tumor, were examined using high-speed MRI and reference fiducial markers before external radiotherapy. Patients were examined for 30 seconds under conditions of normal breathing during the examination. The coordinates of the center of the tumor contours were shown on sagittal and coronal images displayed on the monitor. The maximum length of movement was 10.6 +/- 7.0 mm in a craniocaudal direction; 5.2 +/- 1.8 mm in a lateral direction; and 4.6 +/- 1.6 mm in a ventrodorsal direction. When the PTV was determined using MRI at exhalation phase with a 10-mm safety margin, clinical target volume (CTV) was not covered in 19% of all images in the 3 patients. With MRI at inhalation phase with a 10-mm safety margin, CTV was not covered in 36% of all images. Four-dimensional treatment planning using high speed MRI, and integrating time and spatial information, has the potential to determine the planning target volume of moving body tumors more precisely than does conventional CT planning.