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Review
. 2019 Nov:122:42-52.
doi: 10.1016/j.ejca.2019.07.021. Epub 2019 Oct 12.

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

William A Hall  1 , Eric S Paulson  2 , Uulke A van der Heide  3 , Clifton D Fuller  4 , B W Raaymakers  5 , Jan J W Lagendijk  5 , X Allen Li  2 , David A Jaffray  6 , Laura A Dawson  6 , Beth Erickson  2 , Marcel Verheij  7 , Kevin J Harrington  8 , Arjun Sahgal  9 , Percy Lee  10 , Parag J Parikh  11 , Michael F Bassetti  12 , Clifford G Robinson  13 , Bruce D Minsky  14 , Ananya Choudhury  15 , Robert J H A Tersteeg  5 , Christopher J Schultz  2 ; MR Linac Atlantic Consortium and the ViewRay C2T2 Research Consortium
Affiliations
Review

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

William A Hall et al. Eur J Cancer. 2019 Nov.

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 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.

Keywords: Biologically guided radiation therapy; Elekta Unity; Image guidance; MR-guided radiation therapy; MRI and radiation therapy; Novel radiation technology; View ray.

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Figures

Fig. 1.
Fig. 1.
Differences between CT and MR-based RT. RT, radiation therapy; CT, computed tomography; MR, magnetic resonance.
Fig. 2.
Fig. 2.
Examples of differences in expansions potentially enabled with real-time MR guidance. MRI, magnetic resonance imaging; PTV, planning target volume.
Fig. 3.
Fig. 3.
Hypothesised novel method of radiation dosing with routine MR guidance. RT, RT; MR, magnetic resonance.
See this image and copyright information in PMC

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