Development of a magnetic resonance imaging and image-analysis framework for high-precision gamma knife-based stereotactic radiosurgery of brain tumours

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Brain metastasis is a common complication of cancer, occurring in 20-40% of all cancer patients. The standard of care for patients presenting with a limited number of brain metastases is stereotactic radiosurgery (SRS). SRS delivers a high, precisely-focused, single dose of radiation to a target region. Sunnybrook has recently installed a new image-guided dedicated device for SRS of brain tumours (Gamma Knife Perfexion; Elekta, Montreal, Canada).Despite advancements in our ability to precisely deliver high radiation doses to target regions, there is still an urgent need to improve upon our current methods to guide radiation, to determine which patients would benefit from SRS, and to assess response of tumours to radiation early after treatment. To address these shortcomings, this project aims to develop and optimize a novel magnetic resonance (MR) imaging and image-processing framework for high-precision personalized SRS of metastatic brain tumours with Gamma Knife technology.In SRS treatment, MRI is used to delineate the tumour target. However, these images are commonly distorted, which can result in a "geometric miss" and ineffective treatment, especially in the case of small metastatic targets. Geometrically accurate MRI solutions will be developed for radiotherapy planning. These will be complemented by new MRI scans of tumour metabolism, to more accurately delineate treatment targets. In combination with these imaging methods, new image-processing techniques (referred to as "radiomics") will be used to develop and optimize models to predict response prior to or early after a treatment. Such prediction can help clinicians deliver effective adjuvant therapies, or change ineffective treatments before it is potentially too late.In collaboration with industrial partner Elekta, the MRI and radiomics platform developed in this project can be incorporated into the commercial SRS treatment planning system. The novel technologies will assist clinical decision making and improve marketability of the products.