MRI in Radiation Oncology After the COVID-19 Pandemic

Abstract

The COVID-19 pandemic presents new challenges for many aspects of health care delivery, including diagnostic and therapeutic procedures in radiation oncology. Because the date of COVID-19 elimination is not yet known, efforts to take precautions against transmission of COVID-19, and similar viruses, will likely continue. One area that will likely be changed after the pandemic is magnetic resonance imaging (MRI) use in radiation oncology. National guidelines released during the COVID-19 pandemic addressed MRI use in diagnostic radiology, with applications to radiation oncology.1American College of RadiologyACR guidance on COVID-19 and MR use.https://www.acr.org/Clinical-Resources/Radiology-Safety/MR-Safety/COVID-19-and-MR-UseDate accessed: June 30, 2020Google Scholar, 2Mossa-Basha M, Meltzer CC, Kim DC, et al. Radiology department preparedness for COVID-19: Radiology scientific expert panel [e-pub ahead of print]. Radiology. https://doi.org/10.1148/radiol.2020200988. Accessed June 30, 2020.Google Scholar, 3Han Y. Chen T. Bryant J. et al.Society for Cardiovascular Magnetic Resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic.J Cardiovasc Magn Reson. 2020; 22: 26Crossref PubMed Scopus (4) Google Scholar MRI is used in many radiation oncology departments for magnetic resonance linear accelerator (MR-linac) treatments and for MRI simulations. Given the risks imposed by a strong magnetic field, all MRI scans require a careful assessment of devices implanted in, or accompanying the patient; in cases in which MRI presents a risk, a risk–benefit analysis is used.4Greenberg T.D. Hoff M.N. et al.ACR Committee on MR SafetyACR guidance document on MR safe practices: Updates and critical information 2019.J Magn Reson Imaging. 2019; 51: 331-338Crossref Scopus (4) Google Scholar, 5ACR Manual on MR Safety. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf. Accessed April 17, 2020.Google Scholar, 6Kanal E. Barkovich A.J. et al.Expert Panel on MR SafetyACR guidance document on MR safe practices: 2013.J Magn Reson Imaging. 2013; 37: 501-530Crossref PubMed Scopus (384) Google Scholar Postpandemic, the possibility of virus transmission should continue to be included in patient risk assessment, requiring new mitigation strategies. Here, we reassess the benefits and risks of MRI use in post–COVID-19 radiation oncology and present recommendations for a path forward.