The transformation of radiation oncology using real-time magnetic resonance guidance: A review
MR Linac Atlantic Consortium and the ViewRay C2T2 Research Consortium
(2019) European Journal of Cancer, volume 122, pp. 42 - 52
(Article)
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 imaging (MRI) with linear accelerators represents an exciting development
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with the potential to dramatically 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 introduction to this topic targeted towards oncologists without a speciality focus in RT. Speciality implications, areas for physician education and research opportunities are identified as they are associated with MRI-guided RT. The uniquely disruptive implications of MRI-guided RT are discussed and placed in context. We further aim to describe and outline important future changes to the speciality of radiation oncology that will occur with MRI-guided RT. The impacts on RT caused by MRI guidance include target identification, RT planning, quality assurance, treatment delivery, training, clinical workflow, tumour response assessment and treatment scheduling. In addition, entirely novel research areas that may be enabled by MRI guidance are identified for future investigation.
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Keywords: Biologically guided radiation therapy, Elekta Unity, Image guidance, MR-guided radiation therapy, MRI and radiation therapy, Novel radiation technology, View ray, Oncology, Cancer Research, Review, Journal Article
ISSN: 0959-8049
Publisher: Elsevier Limited
Note: Funding Information: David A. Jaffray receives royalties for image-guidance technologies from Elekta. He has held multiple research and educational grants from Elekta, Varian, Philips, and Raysearch over the past 10 years. He holds patents in the domain of image-guided radiotherapy. B.W. Raaymakers reports receiving institutional research support from Elekta AB , Stockholm, Sweden and an honorarium for educational presentations at Elekta AB meetings. J.J.W. Lagendijk reports receiving institutional research support from Elekta AB , Stockholm, Sweden, and an honorarium for educational presentations at Elekta AB meetings. Kevin J. Harrington acknowledges research funding from ICR/RM NIHR Biomedical Research Centre and CRUK ART-NET Network Accelerator Award. Arjun Sahgal has been an advisor/consultant with Abbvie, Merck, Roche , Varian (Medical Advisory Group) and Elekta (Gamma Knife Icon); has been an ex officio Board Member to International Stereotactic Radiosurgery Society (ISRS); received an honorarium for past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB and Medtronic Kyphon; received research grant with Elekta AB and received travel accommodations/expenses from Elekta, Varian and BrainLAB. Dr. Sahgal also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases and Linac Based SRS Consortia. Parag Parikh received research funding from Varian and Viewray and has stock ownership of Nuvaira Inc. Cliff Robinson receieved grant funding from Varian , Elekta and Merck; was a consultant in Varian; was a principal investigator of PACIFIC-4 and a consultant in AstraZeneca; was a consultant in EMD Serono; was a speaker of ViewRay, received travel expenses from Siemens; was a consultant and had stock ownership in Radialogica. Chris Schultz receieved institutional research support from Elekta AB , Siemens Healthineers , Philips Healthcare and Accuray. William A. Hall received institutional research support from Elekta AB , Siemens Healthineers , Philips Healthcare and Accuray. Percy Lee has been an advisor/consultant with Viewray, AstraZeneca, BrainLab and Varian Inc. He has received an honorarium for past educational seminars with Viewray, AstraZeneca, BrainLab and Varian Inc. He has received research grants from Viewray; clinical trials supporting grants from AstraZeneca Inc. and educational meeting unrestricted supporting grants from BrainLab, Elekta , Varian and Viewray, Inc . His travel accommodations/expenses have been paid by Viewray, AstraZeneca and Varian Inc. Dr. Lee also belongs to the Viewray MR Linac Research Consortium (C2T2). X. Allen Li received research funding from Elekta AB , Siemens Healthineers and Accuray and an honorarium for past educational seminars with Elekta and Accuray. Laura Dawson received licencing agreement for deformable image registration software from Raysearch. Funds are paid to his institution then distributed. Michael Bassetti received travel funding from Viewray Inc and research funding from Merck and AstraZeneca and clinical trials supporting grants EMD Serono. Dr Bassetti is also a participant in the Viewray MR Linac Research Consortium (C2T2). Beth Erickson received institutional research support from Elekta AB , Siemens Healthineers , Philips Healthcare and Accuray. Clifton Dave Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including the National Institute of Dental and Craniofacial Research Award ( 1R01DE025248-01/R56DE025248-01 ); a National Science Foundation (NSF), Division of Mathematical Sciences , Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679 ); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award ( 1R01CA214825-01 ); NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program ( 1R01CA218148-01 ); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialised Programs of Research Excellence (SPORE) Developmental Research Program Award ( P50 CA097007-10 ). Dr. Fuller has received direct industry grant support and travel funding from Elekta AB . Marcel Verheij acknowledges research funding from the Dutch Cancer Society , Elekta AB , Roche and AstraZeneca . All other authors declare no conflicts of interest. Funding Information: David A. Jaffray receives royalties for image-guidance technologies from Elekta. He has held multiple research and educational grants from Elekta, Varian, Philips, and Raysearch over the past 10 years. He holds patents in the domain of image-guided radiotherapy. B.W. Raaymakers reports receiving institutional research support from Elekta AB, Stockholm, Sweden and an honorarium for educational presentations at Elekta AB meetings. J.J.W. Lagendijk reports receiving institutional research support from Elekta AB, Stockholm, Sweden, and an honorarium for educational presentations at Elekta AB meetings. Kevin J. Harrington acknowledges research funding from ICR/RM NIHR Biomedical Research Centre and CRUK ART-NET Network Accelerator Award. Arjun Sahgal has been an advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group) and Elekta (Gamma Knife Icon); has been an ex officio Board Member to International Stereotactic Radiosurgery Society (ISRS); received an honorarium for past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB and Medtronic Kyphon; received research grant with Elekta AB and received travel accommodations/expenses from Elekta, Varian and BrainLAB. Dr. Sahgal also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases and Linac Based SRS Consortia. Parag Parikh received research funding from Varian and Viewray and has stock ownership of Nuvaira Inc. Cliff Robinson receieved grant funding from Varian, Elekta and Merck; was a consultant in Varian; was a principal investigator of PACIFIC-4 and a consultant in AstraZeneca; was a consultant in EMD Serono; was a speaker of ViewRay, received travel expenses from Siemens; was a consultant and had stock ownership in Radialogica. Chris Schultz receieved institutional research support from Elekta AB, Siemens Healthineers, Philips Healthcare and Accuray. William A. Hall received institutional research support from Elekta AB, Siemens Healthineers, Philips Healthcare and Accuray. Percy Lee has been an advisor/consultant with Viewray, AstraZeneca, BrainLab and Varian Inc. He has received an honorarium for past educational seminars with Viewray, AstraZeneca, BrainLab and Varian Inc. He has received research grants from Viewray; clinical trials supporting grants from AstraZeneca Inc. and educational meeting unrestricted supporting grants from BrainLab, Elekta, Varian and Viewray, Inc. His travel accommodations/expenses have been paid by Viewray, AstraZeneca and Varian Inc. Dr. Lee also belongs to the Viewray MR Linac Research Consortium (C2T2). X. Allen Li received research funding from Elekta AB, Siemens Healthineers and Accuray and an honorarium for past educational seminars with Elekta and Accuray. Laura Dawson received licencing agreement for deformable image registration software from Raysearch. Funds are paid to his institution then distributed. Michael Bassetti received travel funding from Viewray Inc and research funding from Merck and AstraZeneca and clinical trials supporting grants EMD Serono. Dr Bassetti is also a participant in the Viewray MR Linac Research Consortium (C2T2). Beth Erickson received institutional research support from Elekta AB, Siemens Healthineers, Philips Healthcare and Accuray. Clifton Dave Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including the National Institute of Dental and Craniofacial Research Award (1R01DE025248-01/R56DE025248-01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialised Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007-10). Dr. Fuller has received direct industry grant support and travel funding from Elekta AB. Marcel Verheij acknowledges research funding from the Dutch Cancer Society, Elekta AB, Roche and AstraZeneca. All other authors declare no conflicts of interest. Publisher Copyright: © 2019
(Peer reviewed)