Phantom-based quality assurance for multicenter quantitative MRI in locally advanced cervical cancer

Petra J. van Houdt*, Jesper F. Kallehauge, Kari Tanderup, Remi Nout, Marko Zaletelj, Tony Tadic, Zdenko J. van Kesteren, Cornelius A.T. van den Berg, Dietmar Georg, Jean Charles Côté, Ives R. Levesque, Jamema Swamidas, Eirik Malinen, Sven Telliskivi, Patrik Brynolfsson, Faisal Mahmood, Uulke A. van der Heide, EMBRACE Collaborative Group

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Background and purpose: A wide variation of MRI systems is a challenge in multicenter imaging biomarker studies as it adds variation in quantitative MRI values. The aim of this study was to design and test a quality assurance (QA) framework based on phantom measurements, for the quantitative MRI protocols of a multicenter imaging biomarker trial of locally advanced cervical cancer. Materials and methods: Fifteen institutes participated (five 1.5 T and ten 3 T scanners). Each institute optimized protocols for T2, diffusion-weighted imaging, T1, and dynamic contrast-enhanced (DCE–)MRI according to system possibilities, institutional preferences and study-specific constraints. Calibration phantoms with known values were used for validation. Benchmark protocols, similar on all systems, were used to investigate whether differences resulted from variations in institutional protocols or from system variations. Bias, repeatability (%RC), and reproducibility (%RDC) were determined. Ratios were used for T2 and T1 values. Results: The institutional protocols showed a range in bias of 0.88–0.98 for T2 (median %RC = 1%; %RDC = 12%), −0.007 to 0.029 × 10−3 mm2/s for the apparent diffusion coefficient (median %RC = 3%; %RDC = 18%), and 0.39–1.29 for T1 (median %RC = 1%; %RDC = 33%). For DCE a nonlinear vendor-specific relation was observed between measured and true concentrations with magnitude data, whereas the relation was linear when phase data was used. Conclusion: We designed a QA framework for quantitative MRI protocols and demonstrated for a multicenter trial for cervical cancer that measurement of consistent T2 and apparent diffusion coefficient values is feasible despite protocol differences. For DCE–MRI and T1 mapping with the variable flip angle method, this was more challenging.

Original languageEnglish
JournalRadiotherapy & Oncology
Pages (from-to)114-121
Publication statusPublished - Dec 2020


  • Magnetic resonance imaging
  • Radiotherapy
  • Uterine cervical neoplasms


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