Dosimetric Feasibility of Utilizing the ViewRay Magnetic Resonance Guided Linac System for Image-guided Spine Stereotactic Body Radiation Therapy
Bibliographic record
Abstract
Introduction: Spine stereotactic body radiation therapy (SBRT) achieves favorable outcomes compared to conventional radiotherapy doses/fractionation. The spinal cord is the principal dose-limiting organ-at-risk (OAR), and safe treatment requires precise immobilization/localization. Therefore, image guidance is paramount to successful spine SBRT. Conventional X-ray imaging and alignment to surrogate bony anatomy may be inadequate, whereas magnetic resonance imaging (MRI) directly visualizes the dose-limiting cord. This work assessed the dosimetric capability of the ViewRay (ViewRay Inc. Oakwood Village, OH) magnetic resonance (MR) guided linac (MR-Linac) for spine SBRT. Methods: Eight spine SBRT patients without orthopedic hardware who were previously treated on a TrueBeam using volumetric modulated arc therapy (VMAT) were re-planned using MR-Linac fixed-field intensity-modulated radiation therapy (IMRT). Phantom measurements using film, ionization chamber, and a commercial diode-array assessed feasibility. Plans included a variety of prescriptions (30-50 Gy in 3-10 fractions). Results: MR-Linac plans satisfied all clinical goals. Compared to VMAT plans, both entrance dose and heterogeneity increased (Dmax: 134±3% vs. 120±2%, p=0.0270), while conformality decreased (conformity index: 1.28±0.06 vs. 1.06±0.06, p=0.0005), and heterogeneity increased. However, while not statistically significant, MR-linac cord sparing improved (cord Dmax: 16.1±2.7Gy vs. 19.5±1.6Gy, p=0.2066; cord planning organ at risk volume (cord PRV) Dmax: 20.0±2.6Gy vs. 24.5±2.0Gy, p=0.0996). Delivery time increased but was acceptable (14.39±1.26min vs. 9.57±1.19min). Ionization chamber measurements agreed with planned dose to within 2.5%. Film and diode measurements demonstrated accurate/precise delivery of dose gradients between the target and the cord. Conclusion: Spine SBRT with the MR-Linac is feasible as verified via re-planning eight clinical cases followed by delivery verification in phantoms using film, diodes, and an ionization chamber. Real-time visualization of the dose-limiting cord during spine SBRT may enable cord-based gating, reduced margins, alternate dose schemas, and/or adaptive therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".