The MRI-Linear Accelerator Consortium: Evidence-Based Clinical Introduction of an Innovation in Radiation Oncology Connecting Researchers, Methodology, Data Collection, Quality Assurance, and Technical Development

Kerkmeijer, Linda G.W.; Fuller, C.D.; Verkooijen, Helena M.; Verheij, Marcel; Choudhury, Ananya; Harrington, Kevin J.; Schultz, Chris; Sahgal, Arjun; Frank, Steven J.; Goldwein, Joel W.; Brown, Kevin; Minsky, Bruce D.; Vulpen, Marco van

doi:10.3389/fonc.2016.00215

Cited by 107 publications

(92 citation statements)

References 5 publications

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“…26 Also with the introduction of novel treatment devices like MR-Linear accelerators, we will have further opportunities to interrogate both tumor growth as well as tumor response kinetics in more granular and accurate manner. 27 Despite this, at the moment, many patients still receive multiple pretreatment CT scans and the results of this study suggest that TGV calculated from serial pretreatment CT scans, represent a promising tool for risk stratification and outcomes prediction.…”

Section: Discussionmentioning

confidence: 88%

CT-based volumetric tumor growth velocity: A novel imaging prognostic indicator in oropharyngeal cancer patients receiving radiotherapy

et al. 2016

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Section: Discussionmentioning

confidence: 88%

CT-based volumetric tumor growth velocity: A novel imaging prognostic indicator in oropharyngeal cancer patients receiving radiotherapy

et al. 2016

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“…Also, unlike surgery, effects of radiotherapy can be accurately modeled (13). R-IDEAL has been adopted by an international consortium to work toward coordinated and evidence-based introduction of the MR-Linac (14). The MR-Linac consortium was set up in 2012 and consists of collaborators of seven large cancer institutions in Europe and North America and two companies (Elekta and Philips).…”

Section: Mri-guided Linear Accelaratormentioning

confidence: 99%

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

et al. 2017

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The pace of innovation in radiation oncology is high and the window of opportunity for evaluation narrow. Financial incentives, industry pressure, and patients’ demand for high-tech treatments have led to widespread implementation of innovations before, or even without, robust evidence of improved outcomes has been generated. The standard phase I–IV framework for drug evaluation is not the most efficient and desirable framework for assessment of technological innovations. In order to provide a standard assessment methodology for clinical evaluation of innovations in radiotherapy, we adapted the surgical IDEAL framework to fit the radiation oncology setting. Like surgery, clinical evaluation of innovations in radiation oncology is complicated by continuous technical development, team and operator dependence, and differences in quality control. Contrary to surgery, radiotherapy innovations may be used in various ways, e.g., at different tumor sites and with different aims, such as radiation volume reduction and dose escalation. Also, the effect of radiation treatment can be modeled, allowing better prediction of potential benefits and improved patient selection. Key distinctive features of R-IDEAL include the important role of predicate and modeling studies (Stage 0), randomization at an early stage in the development of the technology, and long-term follow-up for late toxicity. We implemented R-IDEAL for clinical evaluation of a recent innovation in radiation oncology, the MRI-guided linear accelerator (MR-Linac). MR-Linac combines a radiotherapy linear accelerator with a 1.5-T MRI, aiming for improved targeting, dose escalation, and margin reduction, and is expected to increase the use of hypofractionation, improve tumor control, leading to higher cure rates and less toxicity. An international consortium, with participants from seven large cancer institutes from Europe and North America, has adopted the R-IDEAL framework to work toward coordinated, evidence-based introduction of the MR-Linac. R-IDEAL holds the promise for timely, evidence-based introduction of radiotherapy innovations with proven superior effectiveness, while preventing unnecessary exposure of patients to potentially harmful interventions.

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“…Tracking soft tissue motion has recently proven possible using integrated magnetic resonance image guided radiotherapy (MR‐IGRT) systems, and online adaptive planning on these systems has become clinically feasible . Early approaches combined magnetic resonance imaging (MRI) with Co‐60 radioactive sources, while more recent and complex systems incorporate MRI with medical linear accelerators (MR‐linacs) …”

Section: Introductionmentioning

confidence: 99%

Optical imaging method to quantify spatial dose variation due to the electron return effect in an MR‐linac

et al. 2019

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Purpose Treatment planning systems (TPSs) for MR‐linacs must employ Monte Carlo‐based simulations of dose deposition to model the effects of the primary magnetic field on dose. However, the accuracy of these simulations, especially for areas of tissue‐air interfaces where the electron return effect (ERE) is expected, is difficult to validate due to physical constraints and magnetic field compatibility of available detectors. This study employs a novel dosimetric method based on remotely captured, real‐time optical Cherenkov and scintillation imaging to visualize and quantify the ERE. Methods An intensified CMOS camera was used to image two phantoms with designed ERE cavities. Phantom A was a 40 cm × 10 cm × 10 cm clear acrylic block drilled with five holes of increasing diameters (0.5, 1, 2, 3, 4 cm). Phantom B was a clear acrylic block (25 cm × 20 cm × 5 cm) with three cavities of increasing diameter (3, 2, 1 cm) split into two halves in the transverse plane to accommodate radiochromic film. Both phantoms were imaged while being irradiated by 6 MV flattening filter free (FFF) beams within a MRIdian Viewray (Viewray, Cleveland, OH) MR‐linac (0.34 T primary field). Phantom A was imaged while being irradiated by 6 MV FFF beams on a conventional linac (TrueBeam, Varian Medical Systems, San Jose, CA) to serve as a control. Images were post processed in Matlab (Mathworks Inc., Natick, MA) and compared to TPS dose volumes. Results Control imaging of Phantom A without the presence of a magnetic field supports the validity of the optical image data to a depth of 6 cm. In the presence of the magnetic field, the optical data shows deviations from the commissioned TPS dose in both intensity and localization. The largest air cavity examined (3 cm) indicated the largest dose differences, which were above 20% at some locations. Experiments with Phantom B illustrated similar agreement between optical and film dosimetry comparisons with TPS data in areas not affected by ERE. Conclusion There are some appreciable differences in dose intensity and spatial dose distribution observed between the novel experimental data set and the dose models produced by the current clinically implemented MR‐IGRT TPS.

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The MRI-Linear Accelerator Consortium: Evidence-Based Clinical Introduction of an Innovation in Radiation Oncology Connecting Researchers, Methodology, Data Collection, Quality Assurance, and Technical Development

Cited by 107 publications

References 5 publications

CT-based volumetric tumor growth velocity: A novel imaging prognostic indicator in oropharyngeal cancer patients receiving radiotherapy

CT-based volumetric tumor growth velocity: A novel imaging prognostic indicator in oropharyngeal cancer patients receiving radiotherapy

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

Optical imaging method to quantify spatial dose variation due to the electron return effect in an MR‐linac

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