MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy.

Via, Riccardo; Pica, Alessia; Antonioli, Luca; Paganelli, Chiara; Fattori, Giovanni; Spaccapaniccia, Chiara; Lomax, Antony; Weber, Damien Charles; Schalenbourg, Ann; Baroni, Guido; Hrbacek, Jan (2022). MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 174, pp. 16-22. Elsevier Scientific Publ. Ireland 10.1016/j.radonc.2022.06.021

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INTRODUCTION

Ocular biometry in Ocular Proton Therapy (OPT) currently relies on a generic geometrical eye model built by referencing surgically implanted markers. An alternative approach based on image fusion of volumetric Magnetic Resonance Imaging (MRI) and panoramic fundus photography was investigated.

MATERIALS AND METHODS

Eighteen non-consecutive uveal melanoma (UM) patients, who consented for an MRI and had their tumour base visible on panoramic fundus photography, were included in this comparative analysis. Through generating digitally-reconstructed projections from MRI images using the Lambert azimuthal equal-area projection, 2D-3D image fusion between fundus photography and an eye model delineated on MRI scans was achieved and allowed for a novel definition of the target base (MRI + FCTV). MRI + FCTV was compared with MRI-only delineation (MRIGTV) and the conventional (EyePlan) target definition (EPCTV).

RESULTS

The combined use of fundus photography and MRI to define tumour volumes reduced the average discrepancies by almost 65% with respect to the MRI only tumour definitions when comparing with the conventionally planned EPCTV. With the proposed method, shallow sub-retinal tumour infiltration, otherwise invisible on MRI, can be included in the target volume definition. Moreover, a novel definition of the fovea location improves the accuracy and personalisation of the 3D eye model.

CONCLUSION

MRI and fundus image fusion overcomes some of the limitations of ophthalmological MRI for tumour volume definition in OPT. This novel eye tumour modelling method might improve treatment planning personalisation, allowing to better anticipate which patients could benefit from prophylactic treatment protocols for radiation induced maculopathy.

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