Abstract:PurposeMagnetic resonance imaging-guided radiation therapy (MRgRT) requires patient positioning within the MR bore and prolonged MR imaging during delivery, both of which are new in radiation oncology. Patient tolerance of MRgRT was prospectively evaluated using patient-reported outcome questionnaires (PRO-Q).MethodsOur MRgRT procedure involves daily high-resolution MR scanning, limited re-contouring, daily plan re-optimization, quality assurance (QA), and gated delivery. Patients with claustrophobia are exclu… Show more
“…In our cohort, all fractions could be administered safely, without patient-induced early terminations, and, as expected, without any treatment-related severe toxicities. The PRO-Q results shown in this manuscript confirm that treatment at the MR-Linac is generally well tolerated by patients, which is in accordance with results previously published by Tetar et al [26]. Compared to their rate of MR-related patient complaints of 29%, the value of 65% in our study is considerably higher, while, on the other hand, none of our patients reported considerable anxiety.…”
Section: Discussionsupporting
confidence: 93%
“…We have shown that MR-guided respiratory gating in breath-hold is feasible and, combined with a real-time au-diovisual feedback system, was very well tolerated and appreciated by patients. This confirms the positive results of Tetar et al [26]. Cine-MR-enabled gating in breath-hold is also effective; we observed a mean gating duty cycle of 72%, similar to the range of 67% to 87% published by van Sörnsen de Koste et al [17] using a predecessor of the MRIdian Linac system [12].…”
Purpose Magnetic resonance-guided radiotherapy (MRgRT) has recently been introduced in our institution. As MRgRT requires high patient compliance compared to conventional techniques and can be associated with prolonged treatment times, feasibility and patient tolerance were prospectively assessed using patient-reported outcome questionnaires (PRO-Q). Materials and methods Forty-three patients were enrolled in a prospective observational study and treated with MRgRT on a low-field hybrid Magnetic Resonance Linear Accelerator system (MR-Linac) between April 2018 and April 2019. For assistance in gated breath-hold delivery using cine-MRI, a video feedback system was installed. PRO-Qs consisted of questions on MR-related complaints and also assessed aspects of active patient participation. Results The most commonly treated anatomic sites were nodal metastases and liver lesions. The mean treatment time was 34 min with a mean beam-on time of 2:17 min. Gated stereotactic body radiotherapy (SBRT) was applied in 47% of all patients. Overall, patients scored MRgRT as positive or at least tolerable in the PRO-Q. Almost two thirds of patients (65%) complained about at least one item of the PRO-Q (score ≥4), mainly concerning coldness, paresthesia, and uncomfortable positioning. All patients reported high levels of satisfaction with their active role using the video feedback system in breath-hold delivery. Conclusion MRgRT was successfully implemented in our clinic and well tolerated by all patients, despite MR-related complaints and complaints about uncomfortable immobilization. Prospective clinical studies are in development for further evaluation of MRgRT and for quantification of the benefit of MR-guided on-table adaptive radiotherapy.
“…In our cohort, all fractions could be administered safely, without patient-induced early terminations, and, as expected, without any treatment-related severe toxicities. The PRO-Q results shown in this manuscript confirm that treatment at the MR-Linac is generally well tolerated by patients, which is in accordance with results previously published by Tetar et al [26]. Compared to their rate of MR-related patient complaints of 29%, the value of 65% in our study is considerably higher, while, on the other hand, none of our patients reported considerable anxiety.…”
Section: Discussionsupporting
confidence: 93%
“…We have shown that MR-guided respiratory gating in breath-hold is feasible and, combined with a real-time au-diovisual feedback system, was very well tolerated and appreciated by patients. This confirms the positive results of Tetar et al [26]. Cine-MR-enabled gating in breath-hold is also effective; we observed a mean gating duty cycle of 72%, similar to the range of 67% to 87% published by van Sörnsen de Koste et al [17] using a predecessor of the MRIdian Linac system [12].…”
Purpose Magnetic resonance-guided radiotherapy (MRgRT) has recently been introduced in our institution. As MRgRT requires high patient compliance compared to conventional techniques and can be associated with prolonged treatment times, feasibility and patient tolerance were prospectively assessed using patient-reported outcome questionnaires (PRO-Q). Materials and methods Forty-three patients were enrolled in a prospective observational study and treated with MRgRT on a low-field hybrid Magnetic Resonance Linear Accelerator system (MR-Linac) between April 2018 and April 2019. For assistance in gated breath-hold delivery using cine-MRI, a video feedback system was installed. PRO-Qs consisted of questions on MR-related complaints and also assessed aspects of active patient participation. Results The most commonly treated anatomic sites were nodal metastases and liver lesions. The mean treatment time was 34 min with a mean beam-on time of 2:17 min. Gated stereotactic body radiotherapy (SBRT) was applied in 47% of all patients. Overall, patients scored MRgRT as positive or at least tolerable in the PRO-Q. Almost two thirds of patients (65%) complained about at least one item of the PRO-Q (score ≥4), mainly concerning coldness, paresthesia, and uncomfortable positioning. All patients reported high levels of satisfaction with their active role using the video feedback system in breath-hold delivery. Conclusion MRgRT was successfully implemented in our clinic and well tolerated by all patients, despite MR-related complaints and complaints about uncomfortable immobilization. Prospective clinical studies are in development for further evaluation of MRgRT and for quantification of the benefit of MR-guided on-table adaptive radiotherapy.
“…Video feedback for breath-hold delivery has been positively viewed by patients treated on the MR-linac. 9 Commonly no immobilization is necessary, with the patient arranged comfortably on the couch. No implanted fiducials are required either, making for a safer and noninvasive treatment.…”
“…There is limited literature available to describe patients’ experience of BH. A recent study evaluated 150 patients’ experiences of voluntary BH using MR-guided RT using an un-validated questionnaire [ 11 ]. Considerable difficulty controlling their tumor position in voluntary BH was reported by 12.5% of patients [ 11 ].…”
Section: Introductionmentioning
confidence: 99%
“…A recent study evaluated 150 patients’ experiences of voluntary BH using MR-guided RT using an un-validated questionnaire [ 11 ]. Considerable difficulty controlling their tumor position in voluntary BH was reported by 12.5% of patients [ 11 ]. Another study investigated the patient experience of DIBH, in 41 patients receiving breast RT [ 12 ].…”
Background
Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. Breath-hold, using an Active Breathing Coordinator is one strategy used to reduce motion in these tumor sites. Though widely used, no studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort.
Methods
Patients planned for radiation therapy to upper abdominal tumors are invited to participate in this prospective study. Participants attempt three breath hold techniques: inspiration, deep-inspiration and expiration breath-hold, in random order. kV fluoroscopy images of the dome of diaphragm are taken of five consecutive breath-holds in each technique. Reproducibility and stability of tumour position are measured, and used to select the technique with which to proceed to planning and treatment. Reproducibility at planning and each treatment fraction is measured, along with breath hold time, treatment efficiency and patient experience.
Discussion
The screening method was validated after the first three participants. This screening process may be able to select the best breath-hold technique for an individual, which may lead to improved reproducibility. The screening process is being piloted as a prospective clinical trial.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR): 12618001691235. Registered 12th October 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376109&isReview=true.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.