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Review
. 2019 Jun 3;14(1):92.
doi: 10.1186/s13014-019-1308-y.

MR-guidance in clinical reality: current treatment challenges and future perspectives

S Corradini  1 , F Alongi  2   3 , N Andratschke  4 , C Belka  5 , L Boldrini  6   7 , F Cellini  7 , J Debus  8   9   10 , M Guckenberger  4 , J Hörner-Rieber  8   9   10 , F J Lagerwaard  11 , R Mazzola  2   3 , M A Palacios  11 , M E P Philippens  12 , C P J Raaijmakers  12 , C H J Terhaard  12 , V Valentini  6   7 , M Niyazi  5
Affiliations
Review

MR-guidance in clinical reality: current treatment challenges and future perspectives

S Corradini et al. Radiat Oncol. .

Abstract

Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.

Keywords: MR-guided radiotherapy, Image-guided, radiotherapy, MR-IGRT, MR-Linac, adaptive radiotherapy, Inter-fraction variability, Intra-fraction fraction variability, MRI, outcome.

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Conflict of interest statement

FJL and JR have received speaker fees and travel reimbursement from ViewRay Inc. (Mountain View, California USA). LB and FC received speaker fees from ViewRay Inc. (Mountain View, California USA). FA, CB, CHJT and SC have received speaker fees and travel reimbursement from Elekta AB (Uppsala, Sweden). MEPP has received speaker fees and travel reimbursement from Elekta AB (Uppsala, Sweden) and from Philips (Amsterdam, The Netherlands). CB, JD and VV have a research agreement with ViewRay Inc. (Mountain View, California USA). CB and JD have a research agreement with Elekta AB (Uppsala, Sweden).

Figures

Fig. 1
Fig. 1
Cone beam CT images of an oropharyngeal cancer patient (upper row) compared to the 1.5 T MR images (T1 3D 0.7 × 0.7 × 1.2 mm3) of the same patient acquired at the MRL (lower row)
See this image and copyright information in PMC

Comment in

References

    1. van Sörnsen de Koste John R., Palacios Miguel A., Bruynzeel Anna M.E., Slotman Ben J., Senan Suresh, Lagerwaard Frank J. MR-guided Gated Stereotactic Radiation Therapy Delivery for Lung, Adrenal, and Pancreatic Tumors: A Geometric Analysis. International Journal of Radiation Oncology*Biology*Physics. 2018;102(4):858–866. doi: 10.1016/j.ijrobp.2018.05.048. - DOI - PubMed
    1. Cusumano D, Dhont J, Boldrini L, Chiloiro G, Teodoli S, Massaccesi M, et al. Predicting tumour motion during the whole radiotherapy treatment: a systematic approach for thoracic and abdominal lesions based on real time MR. Radiother Oncol. 2018;129:456–462. doi: 10.1016/j.radonc.2018.07.025. - DOI - PubMed
    1. Raaymakers B W, Jürgenliemk-Schulz I M, Bol G H, Glitzner M, Kotte A N T J, van Asselen B, de Boer J C J, Bluemink J J, Hackett S L, Moerland M A, Woodings S J, Wolthaus J W H, van Zijp H M, Philippens M E P, Tijssen R, Kok J G M, de Groot-van Breugel E N, Kiekebosch I, Meijers L T C, Nomden C N, Sikkes G G, Doornaert P A H, Eppinga W S C, Kasperts N, Kerkmeijer L G W, Tersteeg J H A, Brown K J, Pais B, Woodhead P, Lagendijk J J W. First patients treated with a 1.5 T MRI-Linac: clinical proof of concept of a high-precision, high-field MRI guided radiotherapy treatment. Physics in Medicine & Biology. 2017;62(23):L41–L50. doi: 10.1088/1361-6560/aa9517. - DOI - PubMed
    1. Hessen Eline D., van Buuren Laurens D., Nijkamp Jasper A., de Vries Kim C., Kong Mok Wai, Dewit Luc, van Mourik Anke M., Berlin Alejandro, van der Heide Uulke A., Borst Gerben R. Significant tumor shift in patients treated with stereotactic radiosurgery for brain metastasis. Clinical and Translational Radiation Oncology. 2017;2:23–28. doi: 10.1016/j.ctro.2016.12.007. - DOI - PMC - PubMed
    1. Gommlich Andreas, Raschke Felix, Wahl Hannes, Troost Esther G.C. Retrospective assessment of MRI-based volumetric changes of normal tissues in glioma patients following radio(chemo)therapy. Clinical and Translational Radiation Oncology. 2018;8:17–21. doi: 10.1016/j.ctro.2017.11.008. - DOI - PMC - PubMed

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