Feasibility of image registration and intensity-modulated radiotherapy planning with hyperpolarized helium-3 magnetic resonance imaging for non-small-cell lung cancer

Rob H Ireland, Chris M Bragg, Mark McJury, Neil Woodhouse, Stan Fichele, Edwin J R van Beek, Jim M Wild, Matthew Q Hatton, Rob H Ireland, Chris M Bragg, Mark McJury, Neil Woodhouse, Stan Fichele, Edwin J R van Beek, Jim M Wild, Matthew Q Hatton

Abstract

Purpose: To demonstrate the feasibility of registering hyperpolarized helium-3 magnetic resonance images ((3)He-MRI) to X-ray computed tomography (CT) for functionally weighted intensity-modulated radiotherapy (IMRT) planning.

Methods and materials: Six patients with non-small-cell lung cancer underwent (3)He ventilation MRI, which was fused with radiotherapy planning CT using rigid registration. Registration accuracy was assessed using an overlap coefficient, calculated as the proportion of the segmented (3)He-MR volume (V(MRI)) that intersects the segmented CT lung volume expressed as a percentage of V(MRI). For each patient, an IMRT plan that minimized the volume of total lung receiving a dose > or = 20 Gy (V(20)) was compared with a plan that minimized the V(20) to well-ventilated lung defined by the registered (3)He-MRI.

Results: The (3)He-MRI and CT were registered with sufficient accuracy to enable functionally guided IMRT planning (median overlap, 89%; range, 72-97%). In comparison with the total lung IMRT plans, IMRT constrained with (3)He-MRI reduced the V(20) not only for the well-ventilated lung (median reduction, 3.1%; range, 0.4-5.1%; p = 0.028) but also for the total lung volume (median reduction, 1.6%; range, 0.2-3.7%; p = 0.028).

Conclusions: Statistically significant improvements to IMRT plans are possible using functional information provided by (3)He-MRI that has been registered to radiotherapy planning CT.

Figures

Fig. 1
Fig. 1
(a) Hyperpolarized 3He magnetic resonance image exhibiting a complete ventilation obstruction for a patient with a tumor in the upper right lobe. (b) Corresponding 1H magnetic resonance image.
Fig. 2
Fig. 2
Sample registered hyperpolarized 3He magnetic resonance image (right) displayed with the external contour, left and right lung and, for Patient 4, the gross tumor volume (GTV) from the transaxial radiotherapy treatment-planning computed tomography (CT) (left).
Fig. 3
Fig. 3
The overlap coefficient (Ω) to evaluate image registration for all 6 patients displayed with a sample coronal computed tomography slice.

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