Abstract
BackgroundMain purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive MR-guided radiotherapy (MRgRT), especially new risks in workflow due to the new technique. We herein report the single center experience for the implementation of (MRgRT) and present an overview on our treatment practice.MethodsDescriptive statistics were used to summarize clinical and technical characteristics of treatment and patient characteristics including sites treated between April 2019 and end of March 2020 after ethical approval. A risk analysis was performed to identify risks of the online adaptive workflow.ResultsA summary of the processes on the MR-Linac including workflows, quality assurance and possible pitfalls is presented. 111 patients with 124 courses were treated during the first year of MR-guided radiotherapy. The most commonly treated site was the abdomen (42% of all treatment courses). 73% of the courses were daily online adapted and a high number of treatment courses (75%) were treated with stereotactic body irradiation. Only 4/382 fractions could not be treated due to a failing online adaptive quality assurance. In the risk analysis for errors, the two risks with the highest risk priority number were both in the contouring category, making it the most critical step in the workflow.ConclusionAlthough challenging, establishment of MRgRT as a routinely used technique at our department was successful for all sites and daily o-ART was feasible from the first day on. However, ongoing research and reports will have to inform us on the optimal indications for MRgRT because careful patient selection is necessary as it continues to be a time-consuming treatment technique with restricted availability. After risk analysis, the most critical workflow category was the contouring process, which resembles the need of experienced staff and safety check paths.
Highlights
Main purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive Magnetic resonance (MR)-guided radiotherapy (MRgRT), especially new risks in workflow due to the new tech‐ nique
The major advantages of MR-guided radiotherapy (MRgRT) are the superior soft tissue contrast compared to computed tomography (CT), real-time imaging for accurate tumor tracking and the possibility for on-table target and organ-at-risk (OAR) adaptation with subsequent replanning to adapt to the anatomy-of-the-day
Compliance and treatment aspects The core team had initially defined beneficial indications for MRgRT based on the following criteria: (a) anticipated benefit from enhanced imaging and motion management, (b) anticipated benefit from daily adaptation, ((c) prospective studies to define benefit of online-adaptive radiotherapy (o-ART)
Summary
Main purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive MR-guided radiotherapy (MRgRT), especially new risks in workflow due to the new tech‐ nique. Plan adaptation during the course of radiotherapy has been shown to be advantageous in cases where changes in anatomy of either OAR or tumor are likely, for example in head and neck, lung or prostate cancer [4,5,6,7]. This technical evolution offers a significant potential to improve the therapeutic ratio by better tumor visualization and targeting as well as by novel adaptive dose optimization concepts raising the expectations for paradigm change in radiation oncology [8]
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