Simultaneous motion monitoring and truth-in-delivery analysis imaging framework for MR-guided radiotherapy

Intrafraction motion can play a pivotal role in the success of abdominal and thoracic radiation therapy. Hybrid magnetic resonance-guided radiotherapy systems have the potential to control for intrafraction motion. Recently, we introduced an MRI sequence capable of acquiring real-time cine imaging in two orthogonal planes (SOPI). We extend SOPI here to permit dynamic updating of slice positions in one plane while keeping the other plane position fixed. In this implementation, cine images from the static plane are used for motion monitoring and as image navigators to sort stepped images in the other plane, producing dynamic 4D image volumes for use in dose reconstruction. A custom 3D-printed target filled with radiochromic FXG gel was interfaced to a dynamic motion phantom. 4D-SOPI was acquired in a dynamic motion phantom driven by an actual patient respiratory waveform displaying amplitude/frequency variations and drifting and in a healthy volunteer. Unique 4D-MRI epochs were reconstructed from a time series of phantom motion. Dose from a static 4cmx15cm field was calculated on each 4D respiratory phase bin and epoch image, scaled by the time spent in each bin, and then rigidly accumulated. The phantom was then positioned on an Elekta MR Linac and irradiated while moving. Following irradiation, actual dose deposited to the FXG gel was determined by applying a R1 versus dose calibration curve to R1 maps of the phantom. The 4D-SOPI cine images produced a respiratory motion navigator that was highly correlated with the actual phantom motion (CC=0.9981). The mean difference between the accumulated and measured dose inside the target was 4.4% of the maximum prescribed dose. These results provide early validation that 4D-SOPI simultaneously enables real-time motion monitoring and truth-in-delivery analysis for integrated MR-guided radiation therapy (MR-gRT) systems.