Technical note: Minimizing CIED artifacts on a 0.35 T MRI-Linac using deep learning.

BACKGROUND: Artifacts from implantable cardioverter defibrillators (ICDs) are a challenge to magnetic resonance imaging (MRI)-guided radiotherapy (MRgRT). PURPOSE: This study tested an unsupervised generative adversarial network to mitigate ICD artifacts in balanced steady-state free precession (bSSFP) cine MRIs and improve image quality and tracking performance for MRgRT. METHODS: Fourteen healthy volunteers (Group A) were scanned on a 0.35 T MRI-Linac with and without an MR conditional ICD taped to their left pectoral to simulate an implanted ICD. bSSFP MRI data from 12 of the volunteers were used to train a CycleGAN model to reduce ICD artifacts. The data from the remaining two volunteers were used for testing. In addition, the dataset was reorganized three times using a Leave-One-Out scheme. Tracking metrics [Dice similarity coefficient (DSC), target registration error (TRE), and 95 percentile Hausdorff distance (95% HD)] were evaluated for whole-heart contours. Image quality metrics [normalized root mean square error (nRMSE), peak signal-to-noise ratio (PSNR), and multiscale structural similarity (MS-SSIM) scores] were evaluated. The technique was also tested qualitatively on three additional ICD datasets (Group B) including a patient with an implanted ICD. RESULTS: For the whole-heart contour with CycleGAN reconstruction: 1) Mean DSC rose from 0.910 to 0.935; 2) Mean TRE dropped from 4.488 to 2.877 mm; and 3) Mean 95% HD dropped from 10.236 to 7.700 mm. For the whole-body slice with CycleGAN reconstruction: 1) Mean nRMSE dropped from 0.644 to 0.420; 2) Mean MS-SSIM rose from 0.779 to 0.819; and 3) Mean PSNR rose from 18.744 to 22.368. The three Group B datasets evaluated qualitatively displayed a reduction in ICD artifacts in the heart. CONCLUSION: CycleGAN-generated reconstructions significantly improved both tracking and image quality metrics when used to mitigate artifacts from ICDs.

Real-time B0 compensation during gantry rotation in a 0.35-T MRI-Linac.

BACKGROUND: Rotation of the ferromagnetic gantry of a low magnetic field MRI-Linac was previously demonstrated to cause large center frequency offsets of ±400 Hz. The B0 off-resonances cause image artifacts and imaging isocenter shifts that would preclude MRI-guided arc therapy. PURPOSE: The purpose of this study was to measure and compensate for center frequency offsets in real time during gantry rotation on a 0.35-T MRI-Linac using a free induction decay (FID) navigator. METHODS: A nonselective FID navigator was added before each 2D balanced steady-state free precession cine image acquisition on a 0.35-T MRI-Linac. Images were acquired at 7.3 frames per second. Phase data from the initial FID navigator (while the gantry was stationary) was used as a reference. The phase data from each subsequent FID navigator was used to calculate the real-time B0 off-resonance. The transmitter/receiver phase and the phase accrual over the adjacent image acquisition were adjusted to correct for the center frequency offset. Measurements were performed using an MRI-Linac dynamic phantom prior to and while the gantry rotated clockwise and counterclockwise. Image quality and signal-to-noise ratio (SNR) were compared between uncorrected and B0 -corrected MRIs using a reference image acquired while the gantry was stationary. Four targets in the phantom were manually contoured on the first image frame, and an active contouring algorithm was used retrospectively on each subsequent frame to assess image variations and calculate Dice coefficients. Additionally, three healthy volunteers were imaged using the same pulse sequences with and without real-time B0 compensation during gantry rotation. Normalized root mean square errors (nRMSEs) were calculated for the phantom and in vivo to assess the efficacy of the B0 compensation on image quality. The measured center frequency offsets from the volunteer and MRI dynamic phantom navigator data were also compared. The sinusoidal behavior of the center frequency offsets was modeled based on the gantry layout and long-time constant eddy currents resulting from gantry rotation. RESULTS: The duration of the FID navigator and processing was 4.5 ms. The FID navigator resulted in a ≤11% drop in SNR in the phantom and in vivo (liver). Dice coefficients from the MRI-guided radiation therapy (MR-IGRT) phantom contour measurements remained above 0.8 with B0 compensation. Without B0 compensation, the Dice coefficients dropped below 0.8 for up to 21% of the time depending on the contour. Real-time B0 compensation resulted in mean reductions in nRMSE of 51% and 16% for the MR-IGRT phantom and in vivo, respectively. Peak-to-peak center frequency offsets ranged from 757 to 773 Hz in the phantom and 760 to 871 Hz in vivo. CONCLUSION: Dynamic real-time B0 compensation significantly improved image quality and reduced artifacts during gantry rotation in the phantom and in vivo. However, the FID navigator resulted in a small drop in the imaging duty cycle and SNR.

Technical Note: Effects of rotating gantry on magnetic field and eddy currents in 0.35 T MRI-guided radiotherapy (MR-IGRT) system.

PURPOSE: The purpose of this study was to identify the cause of severe image artifacts that occurred during gantry rotation in a 0.35 T MRI-Linac by comparing measurements of eddy currents, center frequency, and field inhomogeneities made with the gantry in motion and stationary. METHODS: Gradient and B0 eddy currents were calculated from the free induction decays (FIDs) resulting from selective excitation at a temporal resolution of 200 ms/measurement. B0 eddy currents were also calculated from FIDs acquired with nonselective excitation at a temporal resolution of 100 ms/measurement. Center frequencies and B0 inhomogeneities were measured by acquiring FIDs with a repetition time (TR) of 290 ms. Cartesian and radial 2D true fast imaging with steady-state precession (TrueFISP) pulse sequences used in real-time MRI-guided radiation therapy (MR-IGRT) were acquired. To assess artifact severity, the normalized root mean square error (nRMSE) was calculated between a reference MRI (static gantry) and MRIs acquired during gantry rotation for each serial acquisition. Image artifacts were qualitatively graded as nominal, minor, or severe. Measurements were conducted while the gantry was rotated through its entire range for both clockwise and counterclockwise. Measurements during gantry rotation were compared to measurements with a stationary gantry (every 30°). RESULTS: Severe image artifacts were observed 22-35% of the time while the gantry was rotating. Short time constant eddy currents were not affected by gantry rotation. The peak to peak center frequency and FWHM rose by factors of 13.2-14.5 and 1.1-1.6, respectively, for the rotating versus stationary gantry. The magnitude of the center frequency offset and field inhomogeneities depended on the direction of the gantry rotation. CONCLUSIONS: Image artifacts during gantry rotation were primarily caused by center frequency variations and field inhomogeneities. Therefore, dynamic B0 compensation techniques should be able to reduce artifacts during gantry rotation.

Effects of B0 eddy currents on imaging isocenter shifts in 0.35-T MRI-guided radiotherapy (MR-IGRT) system.

PURPOSE: The purpose of this study was to measure gantry angle-related eddy currents in a 0.35-T MRI-Linac and determine if B0 (zeroth order) eddy currents are the primary cause of gantry angle-dependent imaging isocenter shifts vs other potential causes like B0 inhomogeneities and gradient (first order) eddy currents. For conventional Cartesian acquisitions, B0 eddy currents can cause imaging isocenter shifts along both phase encode and readout directions. Gradient eddy currents can cause spatial distortion along both the phase encode and readout directions. Center frequency offsets can cause imaging isocenter shifts along the readout direction that vary with readout gradient polarity. METHODS: MRI-related eddy currents and imaging isocenter shifts were measured on a 0.35-T MRI-Linac at gantry angles from 0° to 330° in increments of 30° . All measurements were made after gradient shimming and center frequency tuning at each planned gantry angle. Eddy current and field homogeneity measurements were conducted using a 24-cm diameter spherical phantom. Gradient and B0 eddy currents were calculated from the free induction decays (FIDs) resulting from selective excitation of slices located ±5 cm from isocenter. B0 eddy currents were also calculated from FIDs acquired with nonselective excitation and compared with B0 eddy current values derived using selective excitation. B0 inhomogeneities and center frequency offsets were measured by acquiring FIDs with nonselective excitation. Imaging isocenter shifts were measured using a 33x33x10.5 cm3 uniformity linearity (grid) phantom and a 3D true fast imaging with steady-state precession (TrueFISP) sequence used in MRI-guided radiation therapy. Eddy currents were compared to vendor specifications and correlated with the imaging isocenter shifts. Measurements were conducted before and after the MRI-Linac's waveguide was replaced with an updated design to reduce eddy currents. RESULTS: B0 eddy currents were highly correlated (r = 0.986, P << 0.001) for measurements made with vs without selective excitation. Transverse (X and Y) axis B0 eddy currents before and after the waveguide upgrade were out of specification (specification: ≤0.1 µT m/mT for delays < 10 ms) for most of the measured gantry angles. Gradient eddy currents before and after the upgrade were within specifications for the measured gantry angles (≤0.1% for delays < 10 ms). B0 eddy currents and imaging isocenter shifts were highly correlated (r = 0.965, P << 0.001). After the Linac waveguide upgrade, root mean square (RMS) peak B0 and gradient eddy currents dropped 45% and 11%, respectively, for delays <10 ms, while imaging isocenter shifts dropped 53%. Isocenter shifts were observed in both phase encode and readout directions. Center frequency offsets were <26 Hz while B0 inhomogeneities were <33 Hz full width at half maximum (FWHM). CONCLUSIONS: Imaging isocenter shifts measured in a 0.35-T MRI-Linac were highly correlated with B0 eddy currents. The eddy currents and imaging isocenter shifts decreased after the MRI-Linac's waveguide was replaced.

B0 field homogeneity recommendations, specifications, and measurement units for MRI in radiation therapy.

PURPOSE: The purpose is: (a) Relate magnetic resonance imaging (MRI) quality recommendations for radiation therapy (RT) to B0 field homogeneity; (b) Evaluate manufacturer specifications of B0 homogeneity for 34 commercial whole-body MRI systems based on the MRI quality recommendations and RT application; (c) Measure field homogeneity in five commercial MRI systems and one commercial MRI-Linac used in RT and compare the results with their B0 homogeneity specifications. METHODS: Magnetic resonance imaging quality recommendations for spatial integrity, image blurring, fat saturation, and null banding in RT were developed based on the literature. Guaranteed (maximum) and typical B0 field homogeneity specifications for various diameter spherical volumes (DSVs) were provided by GE, Philips, Siemens, and Canon. For each system, the DSV that conforms to each MRI quality recommendation and anatomical RT application was estimated based on the manufacturer specifications. B0 field homogeneity was measured on six MRI systems including Philips (1.5 T), Siemens (1.5 and 3 T), and ViewRay MRI (0.35 T) systems using 24 and 35 cm DSV spherical phantoms. Two measurement techniques were used: (a) MRI using phase contrast field mapping to measure peak-to-peak (pk-pk), volume root mean square (VRMS), and standard deviation (SD); and (b) Magnetic resonance (MR) spectroscopy by acquiring a volumetric free induction decay (FID) to measure full width at half maximum (FWHM). The measurements were used to assess: (a) conformance with the manufacturer specifications; and (b) the relationship between the various field homogeneity measurement units. Measurements were made with and without gradient shimming (gradshim) or second-order active shimming. Multiple comparisons, analysis of variance (ANOVA), and Pearson correlations were performed to assess the dependence of pk-pk, VRMS, SD, and FWHM measurements of field homogeneity on shim volume, level of shim, and MRI system. RESULTS: For a 40 cm DSV, the B0 homogeneity specifications ranged from 0.35 to 5 ppm (median = 0.75 ppm) VRMS for 1.5 T systems and 0.2 to 1.4 ppm (median = 0.5 ppm) VRMS for 3 T systems. The usable DSVs ranged from 16 to 49 cm (median = 35 cm) based on the image quality recommendations and the manufacturer specifications. There was general compliance between the six measured field homogeneities and manufacturer specifications although signal dephasing was observed in two systems at < 35 cm DSV. The relationships between pk-pk, VRMS, SD, and FWHM varied based on MRI system, shim volume, and quality of shim. However, VRMS and SD measurements were highly correlated. CONCLUSIONS: The delineation of the diseased lesion from organs at risk is the main priority for RT. Therefore, field homogeneity performance for RT must minimize image blurring and image artifacts (null bands and signal dephasing) while optimizing spatial integrity and fat saturation. Based on the specifications and recommendations for field homogeneity, some MRI systems are not well suited to meet the strict demands of RT particularly for the large imaging volumes used in body MRI. VRMS and SD measurements of B0 field homogeneity tend to be more stable and sensitive to field inhomogeneities in RT applications than pk-pk and FWHM.

MRI quality control for low-field MR-IGRT systems: Lessons learned.

PURPOSE: To present lessons learned from magnetic resonance imaging (MRI) quality control (QC) tests for low-field MRI-guided radiation therapy (MR-IGRT) systems. METHODS: MRI QC programs were established for low-field MRI-60 Co and MRI-Linac systems. A retrospective analysis of MRI subsystem performance covered system commissioning, operations, maintenance, and quality control. Performance issues were classified into three groups: (a) Image noise and artifact; (b) Magnetic field homogeneity and linearity; and (c) System reliability and stability. RESULTS: Image noise and artifacts were attributed to room noise sources, unsatisfactory system cabling, and broken RF receiver coils. Gantry angle-dependent magnetic field inhomogeneities were more prominent on the MRI-Linac due to the high volume of steel shielding in the gantry. B0 inhomogeneities measured in a 24-cm spherical phantom were <5 ppm for both MR-IGRT systems after using MRI gradient offset (MRI-GO) compensation on the MRI-Linac. However, significant signal dephasing occurred on the MRI-Linac while the gantry was rotating. Spatial integrity measurements were sensitive to gradient calibration and vulnerable to shimming. The most common causes of MR-IGRT system interruptions were software disconnects between the MRI and radiation therapy delivery subsystems caused by patient table, gantry, and multi-leaf collimator (MLC) faults. The standard deviation (SD) of the receiver coil signal-to-noise ratio was 1.83 for the MRI-60 Co and 1.53 for the MRI-Linac. The SD of the deviation from the mean for the Larmor frequency was 1.41 ppm for the MRI-60 Co and 1.54 ppm for the MRI-Linac. The SD of the deviation from the mean for the transmitter reference amplitude was 0.90% for the MRI-60 Co and 1.68% for the MRI-Linac. High SDs in image stability data corresponded to reports of spike noise. CONCLUSIONS: There are significant technological challenges associated with implementing and maintaining MR-IGRT systems. Most of the performance issues were identified and resolved during commissioning.