ACPSEM position paper: the safety of magnetic resonance imaging linear accelerators

Abstract

Magnetic Resonance Imaging linear-accelerator (MRI-linac) equipment has recently been introduced to multiple centres in Australia and New Zealand. MRI equipment creates hazards for staff, patients and others in the MR environment; these hazards must be well understood, and risks managed by a system of environmental controls, written procedures and a trained workforce. While MRI-linac hazards are similar to the diagnostic paradigm, the equipment, workforce and environment are sufficiently different that additional safety guidance is warranted. In 2019 the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) formed the Magnetic Resonance Imaging Linear-Accelerator Working Group (MRILWG) to support the safe clinical introduction and optimal use of MR-guided radiation therapy treatment units. This Position Paper is intended to provide safety guidance and education for Medical Physicists and others planning for and working with MRI-linac technology. This document summarises MRI-linac hazards and describes particular effects which arise from the combination of strong magnetic fields with an external radiation treatment beam. This document also provides guidance on safety governance and training, and recommends a system of hazard management tailored to the MRI-linac environment, ancillary equipment, and workforce.

The current and future role of the MRI radiographer in radiation oncology: A collaborative, experiential reflection on the Australian rollout of dedicated MRI simulators

“…This is further complicated in atypical settings outside of clinical radiology departments, such as radiation oncology, where no specific guidance currently exists. 33 MRI equipment is often retrofitted into pre‐existing radiation bunkers or converted CT scan rooms and many of the personnel have not undergone MR safety education as part of their conventional clinical training. 34 …”

“…35 Although this role is most often filled by a senior radiographer, the description of the role in current guidance documents is ambiguous, for example, suggesting it could be held by professionals of varying educational backgrounds, qualifications, or certifications. 29 , 30 , 33 , 35 , 36 These definitions fail to recognise the core knowledge skills and competence required to hold the MRSO role, particularly the specialist knowledge required for operating imaging in non‐conventional MR environments. Therefore, careful consideration is needed when deciding who to appoint to the MRSO role in the radiation oncology setting, and what supports or training they will require.…”

ACPSEM position paper on ROMP scope of practice and staffing levels for magnetic resonance linear accelerators

“…The ACPSEM position paper on the Safety of Magnetic Resonance Linear Accelerators [6] describes the roles necessary for safety. ROMPs have safety expertise, already routinely fulfilling the role of Radiation Safety Officer (RSO), this should be extended to the unique environment of the MRL with appropriate accreditation.…”

“…From the ROMPs appointed, one could fulfil the role of MRSO, and ideally, one member of the ROMP workforce should be educated to the MRSE level. These roles and responsibilities, are elaborated in the MRILWG safety recommendations [6].…”

“…This will be run frequently; before go live, and throughout the clinical life of the MRI-Linac. A robust incident review system aligned with local clinic practice will heavily involve ROMP responsibility under the remit of the MRSE or MRSO and RSO roles [6].…”