Novel MR-Guided Radiotherapy Elective Rotation for Radiation Oncology Trainees.

Austin J Sim,Evan Wuthrick,Thomas J Dilling,Stephen Rosenberg,Jessica M Frakes,Sarah E Hoffe

doi:10.7759/cureus.10706

Abstract

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively nascent technology and only a few institutions and programs have access to this technology for clinical use and trainee education. To increase the diversity of elective offerings and improve the understanding of an MR-guided radiotherapy program, we initiated a unique MR-guided radiotherapy elective rotation for radiation oncology residents. During a representative four-week rotation, 21 simulations were completed by the resident on service. A plurality of simulations were for pancreas stereotactic body radiation therapy (SBRT; 48%) and a majority (71%) of simulations were for adaptive treatments. Additionally, 74 adaptive fractions were completed during this month, of which a significant majority (74%) were for pancreas SBRT. Of the non-adaptive fractions, the majority were for prostate SBRT and intensity-modulated radiation therapy (IMRT). Although many programs may offer training in some aspects of MR-guided radiotherapy as trainees rotate through certain disease sites, we hope this may serve as a blueprint to encourage programs with this technology to fully embrace training in essential competencies related to MR-guided radiotherapy. MR-guided radiotherapy has unique challenges that trainees need to understand to deliver treatment safely: geometric uncertainty, MRI to RT isocenter, and uncertainties with voxel size/tracking.

Highlights

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization
During a representative four-week rotation, all simulations not covered by another resident were completed by the resident on service (n=21, an additional seven MR-guided prostate stereotactic body radiation therapy (SBRT) simulations were completed by the resident on the genitourinary service)
A plurality of simulations were for pancreas SBRT (48%) and 71% of simulations were for adaptive treatments (Figures 1a, 1b)

Summary

Introduction

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. Two commercial systems are FDA approved and are in routine clinical use in the United States, with many more systems under development across the globe [3]. This is still a relatively nascent technology and only a few institutions and programs have access to this technology for clinical use and trainee education. In the United States, residency in radiation oncology lasts for four years after completion of an intern year. To increase the diversity of elective offerings and improve the understanding of MR-guided radiotherapy program, we initiated a unique MRguided radiotherapy elective rotation for radiation oncology residents

Materials And Methods

Results

Discussion

Conclusions

Disclosures