Respiration-based sorting of dynamic MRI to derive representative 4D-MRI for radiotherapy planning

Erik Tryggestad, Aaron Flammang, Sarah Han-Oh, Russell Hales, Joseph Herman, Todd McNutt, Teboh Roland, Steven M. Shea, John Wong

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Purpose: Current pretreatment, 4D imaging techniques are suboptimal in that they sample breathing motion over a very limited "snap-shot" in time. To potentially address this, the authors have developed a longer-duration MRI and postprocessing technique to derive the average or most-probable state of mobile anatomy and meanwhile capture and convey the observed motion variability. Methods: Sagittal and coronal multislice, 2D dynamic MRI was acquired in a sequential fashion over extended durations in two abdominal and four lung studies involving healthy volunteers. Two sequences, readily available on a commercial system, were employed. Respiratory interval-correlated, or 4D-MRI, volumes were retrospectively derived using a two-pass approach. In a first pass, a respiratory trace acquired simultaneous with imaging was processed and slice stacking was used to derive a set of MRI volumes, each representing an equal time or proportion of respiration. Herein, all raw 2D frames mapping to the given respiratory interval, per slice location, were averaged. In a second-pass, this prior reconstruction provided a set of template images and a similarity metric was employed to discern the subset of best-matching raw 2D frames for secondary averaging (per slice location and respiratory interval). Breathing variability (per respiratory interval and slice location) was depicted by computing both a maximum intensity projection as well as a pixelwise standard deviation image. Results: These methods were successfully demonstrated in both the lung and abdomen for both applicable sequences, performing reconstructions with ten respiratory intervals. The first-pass (average) resulted in motion-induced blurring, especially for irregular breathing. The authors have demonstrated qualitatively that the second-pass result can mitigate this blurring. Conclusions: They have presented a novel methodology employing dMRI to derive representative 4D-MRI. This set of techniques are practical in that (1) they employ MRI sequences that are standard across commercial vendors; (2) the 2D imaging planes can be oriented onto an arbitrary axis (e.g., sagittal, coronal, axial⋯); (3) the image processing techniques are relatively simple. Systematically applying this and similar dMRI-based techniques in patients is a crucial next step to demonstrate efficacy beyond CT-only based practice.

Original languageEnglish (US)
Article number051909
JournalMedical physics
Issue number5
StatePublished - May 2013


  • 4D-MRI
  • retrospective slice stacking

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging


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