Ultra-low field magnetic resonance breast imaging in prone and seated positions for radiation therapy

Background & purpose: The aim of this first-in-human study was to investigate the potential of ultra-low field (ULF) magnetic resonance imaging (MRI) at 6.5 mT for breast imaging in healthy female participants in prone and seated positions for radiation therapy, especially compact proton therapy systems. Materials & methods: An experimental setup for breast imaging in prone and seated positions utilizing an ULF MRI scanner and a conical RF coil was developed. ULF MR images of the left breast of ten healthy women were acquired in prone and seated positions using a 3D balanced steady-state free precession sequence without the use of contrast agents. The visibility of the breast outline, chest wall, and cardiac silhouette in prone and seated position ULF breast MR images was evaluated by two radiation oncologists (ROs) and two radiation therapists (RTTs), respectively. Results: ULF breast MRI obtained at 6.5 mT can show breast outline, chest wall, and cardiac silhouette in prone and seated positions. ULF prone/seated images were found to be acceptable by the ROs (RTTs) for treatment planning (setup) purposes in 100%/95% (95%/85%) of cases for breast outline visibility, in 70%/50% (75%/70%) of cases for chest wall visibility, and in 65%/65% (0%/10%) of cases for cardiac silhouette visibility. Conclusions: This proof-of-concept study demonstrated that breast imaging is feasible in prone and seated positions utilizing ULF MRI and partially suitable for treatment planning and setup in proton therapy. Yet an increased spatio-temporal resolution is required for applications to MRI-guided proton therapy. ULF MRI may enable position monitoring and adaptive treatment procedures in radiation therapy.