A Multi-center Prospective Study for Implementation of an MRI-Only Prostate Treatment Planning Workflow

Peter Greer; Peter Greer; Jarad Martin; Jarad Martin; Mark Sidhom; Mark Sidhom; Perry Hunter; Peter Pichler; Jae Hyuk Choi; Leah Best; Joanne Smart; Tony Young; Tony Young; Michael Jameson; Michael Jameson; Michael Jameson; Michael Jameson; Tess Afinidad; Chris Wratten; Chris Wratten; James Denham; James Denham; Lois Holloway; Lois Holloway; Lois Holloway; Swetha Sridharan; Robba Rai; Robba Rai; Robba Rai; Gary Liney; Gary Liney; Gary Liney; Parnesh Raniga; Jason Dowling; Jason Dowling; Jason Dowling

doi:10.3389/fonc.2019.00826

Frontiers in Oncology (Aug 2019)

A Multi-center Prospective Study for Implementation of an MRI-Only Prostate Treatment Planning Workflow

Peter Greer,
Peter Greer,
Jarad Martin,
Jarad Martin,
Mark Sidhom,
Mark Sidhom,
Perry Hunter,
Peter Pichler,
Jae Hyuk Choi,
Leah Best,
Joanne Smart,
Tony Young,
Tony Young,
Michael Jameson,
Michael Jameson,
Michael Jameson,
Michael Jameson,
Tess Afinidad,
Chris Wratten,
Chris Wratten,
James Denham,
James Denham,
Lois Holloway,
Lois Holloway,
Lois Holloway,
Swetha Sridharan,
Robba Rai,
Robba Rai,
Robba Rai,
Gary Liney,
Gary Liney,
Gary Liney,
Parnesh Raniga,
Jason Dowling,
Jason Dowling,
Jason Dowling

Affiliations

Peter Greer: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Peter Greer: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
Jarad Martin: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Jarad Martin: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
Mark Sidhom: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Mark Sidhom: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Perry Hunter: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Peter Pichler: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Jae Hyuk Choi: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
Leah Best: Hunter New England Imaging, HNE Health Service, Newcastle, NSW, Australia
Joanne Smart: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Tony Young: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Tony Young: School of Physics, University of Sydney, Sydney, NSW, Australia
Michael Jameson: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Michael Jameson: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Michael Jameson: Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
Michael Jameson: Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
Tess Afinidad: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Chris Wratten: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Chris Wratten: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
James Denham: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
James Denham: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
Lois Holloway: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Lois Holloway: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Lois Holloway: Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
Swetha Sridharan: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
Robba Rai: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Robba Rai: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Robba Rai: Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
Gary Liney: Liverpool Hospital Cancer Therapy Centre, South West Sydney Local Health District, Sydney, NSW, Australia
Gary Liney: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Gary Liney: Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
Parnesh Raniga: The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
Jason Dowling: School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
Jason Dowling: South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Jason Dowling: The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia

DOI: https://doi.org/10.3389/fonc.2019.00826
Journal volume & issue: Vol. 9

Abstract

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Purpose: This project investigates the feasibility of implementation of MRI-only prostate planning in a prospective multi-center study.Method and Materials: A two-phase implementation model was utilized where centers performed retrospective analysis of MRI-only plans for five patients followed by prospective MRI-only planning for subsequent patients. Feasibility was assessed if at least 23/25 patients recruited to phase 2 received MRI-only treatment workflow. Whole-pelvic MRI scans (T2 weighted, isotropic 1.6 mm voxel 3D sequence) were converted to pseudo-CT using an established atlas-based method. Dose plans were generated using MRI contoured anatomy with pseudo-CT for dose calculation. A conventional CT scan was acquired subsequent to MRI-only plan approval for quality assurance purposes (QA-CT). 3D Gamma evaluation was performed between pseudo-CT calculated plan dose and recalculation on QA-CT. Criteria was 2%, 2 mm criteria with 20% low dose threshold. Gold fiducial marker positions for image guidance were compared between pseudo-CT and QA-CT scan prior to treatment.Results: All 25 patients recruited to phase 2 were treated using the MRI-only workflow. Isocenter dose differences between pseudo-CT and QA-CT were −0.04 ± 0.93% (mean ± SD). 3D Gamma dose comparison pass-rates were 99.7% ± 0.5% with mean gamma 0.22 ± 0.07. Results were similar for the two centers using two different scanners. All gamma comparisons exceeded the 90% pass-rate tolerance with a minimum gamma pass-rate of 98.0%. In all cases the gold fiducial markers were correctly identified on MRI and the distances of all seeds to centroid were within the tolerance of 1.0 mm of the distances on QA-CT (0.07 ± 0.41 mm), with a root-mean-square difference of 0.42 mm.Conclusion: The results support the hypothesis that an MRI-only prostate workflow can be implemented safely and accurately with appropriate quality assurance methods.

Published in Frontiers in Oncology

ISSN: 2234-943X (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.frontiersin.org/journals/oncology/

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