# Magnetic resonance-only rapid on-table planning and immediate treatment for spine metastases

## TL;DR

This study shows that spine metastases can be quickly and safely treated in under 30 minutes using MR-only planning and immediate treatment.

## Contribution

A new MR-only workflow for rapid on-table planning and immediate treatment of spine metastases is developed and validated.

## Key findings

- All MR-SIM plans produced acceptable dose distributions, approved by two physicians.
- Dose accuracy was within 3.2% for maximum point dose and 2.8% for 90% target volume dose.
- The workflow was completed in 23.6–25.4 minutes for different treatment plans.

## Abstract

This work aims to develop a magnetic resonance (MR)-only treatment planning protocol for integration into magnetic resonance simulation (MR-SIM), on-table treatment planning, and immediate treatment workflow for rapid palliation of painful spine metastases.

Thirty-five treatment plans from healthy volunteers were generated on MR-SIM scans using a protocol including: (1) a library of 4 planning target volume (PTV) structures based on vertebral level, (2) default beam templates covering the PTVs while avoiding organs at risk (OAR), (3) bulk density assignments for dose calculations, and (4) a single set of dose optimization parameters. We transferred each plan to the patient’s prior computed tomography simulation (CT-SIM) images and compared dosimetric parameters. A time study was performed on the MR-SIM, on-table planning, and immediate treatment workflow for all 35 cases using healthy volunteers.

All bulk density MR-SIM plans resulted in acceptable dose distributions, with 100 % deemed appropriate for treatment by two physicians. The maximum point dose was within 3.2 %, and the minimum dose to 90 % of the target volume was within 2.8 % of the prescription dose. The time study demonstrated that the proposed workflow could be completed in a mean time of 23.6 min for the 3 Gy (10 fractions) plan and 25.4 min for the 8 Gy (single fraction) plan, from patient placement to treatment completion.

These results demonstrate that safe, fast palliation of spine metastases can be achieved in under 30 min using MR-SIM, bulk density on-table planning, and immediate treatment delivery.