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Respiratory motion during radiotherapy causes uncertainty in the tumor's location, which is typically addressed by an increased radiation area and a decreased dose. As a result, the treatments' efficacy is reduced. The recently proposed hybrid MR-linac scanner holds the promise to efficiently deal with such respiratory motion through real-time adaptive MR-guided radiotherapy (MRgRT). For MRgRT, motion-fields should be estimated from MR-data and the radiotherapy plan should be adapted in real-time according to the estimated motion-fields. All of this should be performed with a total latency of maximally 200 ms, including data acquisition and reconstruction. A measure of confidence in such estimated motion-fields is highly desirable, for instance to ensure the patient's safety in case of unexpected and undesirable motion. In this work, we propose a framework based on Gaussian Processes to infer 3D motion-fields and uncertainty maps in real-time from only three readouts of MR-data. We demonstrated an inference frame rate up to 69 Hz including data acquisition and reconstruction, thereby exploiting the limited amount of required MR-data. Additionally, we designed a rejection criterion based on the motion-field uncertainty maps to demonstrate the framework's potential for quality assurance. The framework was validated in silico and in vivo on healthy volunteer data (n=5) acquired using an MR-linac, thereby taking into account different breathing patterns and controlled bulk motion. Results indicate end-point-errors with a 75th percentile below 1mm in silico, and a correct detection of erroneous motion estimates with the rejection criterion. Altogether, the results show the potential of the framework for application in real-time MR-guided radiotherapy with an MR-linac., Comment: This manuscript has supplementary files which can be downloaded at https://surfdrive.surf. nl/files/index.php/s/scLts9nJYXfbLMx. The files include videos that show reconstructed motion-fields and spatial uncertainty maps. See the Appendix for a description of all individual files

The MR-Linac is a combination of an MR-scanner and radiotherapy linear accelerator (Linac) which holds the promise to increase the precision of radiotherapy treatments with MR-guided radiotherapy by monitoring motion during radiotherapy with MRI, and adjusting the radiotherapy plan accordingly. Optimal MR-guidance for respiratory motion during radiotherapy requires MR-based 3D motion estimation with a latency of 200-500 ms. Currently this is still challenging since typical methods rely on MR-images, and are therefore limited by the 3D MR-imaging latency. In this work, we present a method to perform non-rigid 3D respiratory motion estimation with 170 ms latency, including both acquisition and reconstruction. The proposed method called real-time low-rank MR-MOTUS reconstructs motion-fields directly from k-space data, and leverages an explicit low-rank decomposition of motion-fields to split the large scale 3D+t motion-field reconstruction problem posed in our previous work into two parts: (I) a medium-scale offline preparation phase and (II) a small-scale online inference phase which exploits the results of the offline phase for real-time computations. The method was validated on free-breathing data of five volunteers, acquired with a 1.5T Elekta Unity MR-Linac. Results show that the reconstructed 3D motion-field are anatomically plausible, highly correlated with a self-navigation motion surrogate (R = 0.975 +/- 0.0110), and can be reconstructed with a total latency of 170 ms that is sufficient for real-time MR-guided abdominal radiotherapy., Comment: This manuscript has supplementary files which can be downloaded at https://surfdrive.surf.nl/files/index.php/s/vz2xmwliglRmcjo. The files include six videos that show reconstructed motion-fields and a document with supporting figures. See Appendix I for a description of all individual files

With the recent introduction of the MR-LINAC, an MR-scanner combined with a radiotherapy LINAC, MR-based motion estimation has become of increasing interest to (retrospectively) characterize tumor and organs-at-risk motion during radiotherapy. To this extent, we introduce low-rank MR-MOTUS, a framework to retrospectively reconstruct time-resolved non-rigid 3D+t motion-fields from a single low-resolution reference image and prospectively undersampled k-space data acquired during motion. Low-rank MR-MOTUS exploits spatio-temporal correlations in internal body motion with a low-rank motion model, and inverts a signal model that relates motion-fields directly to a reference image and k-space data. The low-rank model reduces the degrees-of-freedom, memory consumption and reconstruction times by assuming a factorization of space-time motion-fields in spatial and temporal components. Low-rank MR-MOTUS was employed to estimate motion in 2D/3D abdominothoracic scans and 3D head scans. Data were acquired using golden-ratio radial readouts. Reconstructed 2D and 3D respiratory motion-fields were respectively validated against time-resolved and respiratory-resolved image reconstructions, and the head motion against static image reconstructions from fully-sampled data acquired right before and right after the motion. Results show that 2D+t respiratory motion can be estimated retrospectively at 40.8 motion-fields-per-second, 3D+t respiratory motion at 7.6 motion-fields-per-second and 3D+t head-neck motion at 9.3 motion-fields-per-second. The validations show good consistency with image reconstructions. The proposed framework can estimate time-resolved non-rigid 3D motion-fields, which allows to characterize drifts and intra and inter-cycle patterns in breathing motion during radiotherapy, and could form the basis for real-time MR-guided radiotherapy., Comment: 18 pages main text, 8 main figures, 1 main table, 12 supporting videos, 2 supporting figures, 1 supporting information PDF. Submitted to Magnetic Resonance in Medicine as Full Paper

Magnetic resonance fingerprinting (MRF) can successfully recover quantitative multi-parametric maps of human tissue in a very short acquisition time. Due to their pseudo-random nature, the large spatial undersampling artifacts can be filtered out by an exhaustive search over a pre-computed dictionary of signal fingerprints. This reconstruction approach is robust to large data-model discrepancies and is easy to implement. The curse of dimensionality and the intrinsic rigidity of such a precomputed dictionary approach can however limit its practical applicability. In this work, a method is presented to reconstruct balanced gradient-echo (GRE) acquisitions with established iterative algorithms for nonlinear least-squares, thus bypassing the dictionary computation and the exhaustive search. The global convergence of the iterative approach is investigated by studying the transient dynamic response of balanced GRE sequences and its effect on the minimization landscape. Experimental design criteria are derived which enforce sensitivity to the parameters of interest and successful convergence. The method is validated on simulated and experimentally acquired MRI data. Keywords: MR Fingerprinting, quantitative MRI, Bloch equation, nonlinear least squares, sequence design., Comment: This manuscript was submitted to IEEE Transactions on Medical Imaging on the 4th of July 2017