ArticlePloS one2024
Investigation of intrafractional spinal cord and spinal canal movement during stereotactic MR-guided online adaptive radiotherapy for kidney cancer.
Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- CBCT-based adaptive radiotherapy and automated radiotherapy decision-making systems: development and current status.Frontiers in oncology · 2026Review
- Development and evaluation of deep learning models for estimating the organ at-risk dose constraint from two-dimensional cine magnetic resonance imaging scans during irradiation.Journal of applied clinical medical physics · 2025Article
- Prescription dose and optimisation strategies in MR-guided online adaptive radiotherapy for kidney tumours: a two-step planning analysis.Radiation oncology (London, England) · 2025Article
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13 authors.
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No grant is acknowledged in the PubMed record.
Abstract
background and purposeThis study aimed to investigate the intrafractional movement of the spinal cord and spinal canal during MR-guided online adaptive radiotherapy (MRgART) for kidney cancer. MATERIALS AND
methodsAll patients who received stereotactic MRgART for kidney cancer between February 2022 and February 2024 were included in this study. Patients received 30-42 Gy in 3-fraction MRgART for kidney cancer using the Elekta Unity, which is equipped with a linear accelerator and a 1.5 Tesla MRI. MRI scans were performed at three points during each fraction: for online planning, position verification, and posttreatment assessment. The spinal cord was contoured from the upper edge of Th12 to the medullary cone, and the spinal canal was contoured from Th12 to L3, using the first MRI. These contours were adjusted to the second and third MR images via deformable image registration, and movements were measured. Margins were determined via the formula "1.3×Σ+0.5×σ" and 95% prediction intervals.
resultsA total of 22 patients (66 fractions) were analyzed. The median interval between the first and third MRI scans were 38 minutes. The mean ± standard deviation of the spinal cord movements after this interval were -0.01 ± 0.06 for the x-axis (right-left), 0.01 ± 0.14 for the y-axis (caudal-cranial), 0.07 ± 0.05 for the z-axis (posterior-anterior), and 0.15 ± 0.08 for the 3D distance, respectively. The correlation coefficients of the 3D distance between the spinal cord and the spinal canal was high (0.92). The calculated planning organ at risk volume margin for all directions was 0.11 cm for spinal cord. The 95% prediction intervals for the x-axis, y-axis, and z-axis were -0.11-0.09 cm, -0.23-0.25 cm and -0.14-0.03 cm, respectively.
conclusionsMargins are necessary in MRgART to compensate for intrafractional movement and ensure safe treatment delivery.
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