ArticlePhysics and imaging in radiation oncology2026
Motion mitigation in positron-emission tomography guided radiotherapy delivered on a magnetic resonance imaging-linear accelerator.
Article in Physics and imaging in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Purpose: The precision of Positron Emission Tomography (PET)-guided radiotherapy may be compromised by motion. To address this, we demonstrated the feasibility of a motion-robust PET-to-magnetic resonance linear accelerator (MR-linac) pipeline. Materials and Methods: For comparison, PET images of a phantom with a target in a movable insert were acquired under a patient-derived breathing waveform and static conditions. Motion correction using the PET Maximum-Likelihood Motion and Activity (MLMA) reconstruction was compared with static reference and motion-blurred images. Targets were delineated using thresholding based on maximum standardized uptake value, and Intensity-Modulated Radiation Therapy (IMRT) plans were generated. Plans were delivered on an MR-linac with and without gating or Multi Leaf Collimator (MLC) tracking. Dosimetry was assessed using film measurements, evaluating dose differences and 3%/3 mm gamma pass rates. The pipeline was further evaluated using clinical PET data, delivered with and without gating and tracking after motion correction. Dosimetric evaluation was performed using a cylindrical multi-diode phantom. Results: Motion-blurred PET produced larger gross target volumes (GTV) (GTV: 58 cm Conclusions: A motion-robust PET-to-MR-linac pipeline using motion-corrected PET imaging and MR-guided motion mitigation is technically feasible and enhances dose precision.
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