The transformation of radiation oncology using real-time magnetic resonance guidance: A review

Abstract

Radiation therapy (RT) is an essential component of effective cancer care and is used across nearly all cancer types. The delivery of RT is becoming more precise through rapid advances in both computing and imaging. The direct integration of magnetic resonance imag-ing (MRI) with linear accelerators represents an exciting development with the potential todramatically impact cancer research and treatment. These impacts extend beyond improved imaging and dose deposition. Real-time MRI-guided RT is actively transforming the work flows and capabilities of virtually every aspect of RT. It has the opportunity to change entirely the delivery methods and response assessments of numerous malignancies. This review intends to approach the topic of MRI-based RT guidance from a vendor neutral and international perspective. It also aims to provide an *

Problems and Promises of Introducing the Magnetic Resonance Imaging Linear Accelerator Into Routine Care: The Case of Prostate Cancer

“…Our findings help radiation oncology departments determining focus areas in their strategy for successful MR-Linac implementation into prostate cancer care. Consistent with prior research, MR-Linac users expect to benefit from advanced MRI-guided radiation technology with online adaptive treatment and response assessment that may potentially improve patient outcomes and identify new treatment opportunities ( 7 , 8 , 10 , 19 , 40 ). The possibility of prostate hypofractionation promises improved treatment and economic benefits ( 17 , 20 , 41 – 43 ).…”

“…The possibility of prostate hypofractionation promises improved treatment and economic benefits ( 17 , 20 , 41 – 43 ). Users boost their hospital profile and professional development, irrespective of radiation oncologists, technologists and physicists ( 7 , 8 , 25 , 44 , 45 ). Our study also confirms the need to generate clinical evidence, while dealing with technical complexities and substantial staffing and structural investments ( 7 ).…”

“…All three are relevant to the introduction of MRI-guided linear accelerator (MR-Linac) systems: the 0.35 Tesla ViewRay MRIdian system and the 1.5 Tesla Elekta Unity system ( 5 , 6 ). Yet, their introduction into routine oncology care has mainly been reported from a technical and clinical perspective ( 7 – 10 ). In this study we will focus on the Unity MR-Linac, recently developed by the University Medical Center Utrecht (Utrecht, The Netherlands) in collaboration with Elekta AB (Stockholm, Sweden) and Philips (Best, The Netherlands).…”

“…Despite the promising clinical and technological prospects, challenges remain. The use of MR-Linac requires high capital investments in equipment, logistics, quality assurance and complementary training ( 7 ), and evidence of superior patient outcomes ( 8 ). Implementing technical developments in cancer treatment may disrupt standard treatment practices, which call for financial considerations, collective learning, and organizational renewal ( 25 , 26 ).…”

Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy

“…For instance, soft tissue pelvic tumours are optimally delineated on MRI and while nodal disease are best appreciated on PET. With the recent introduction of MRI-based LINAC treatment systems, there is significant potential for this technology to play a role in GYN SABR [32]. With the challenge of organ motion in GYN tumours, MRI may help address this issue through on-line and real-time imaging.…”