Abstract
The new radiotherapy high field, 1.5 Tesla MRI-guided linear accelerator (MR-Linac) is being clinically introduced. Sensing and evaluating opportunities and barriers at an early stage will facilitate its eventual scale-up. This study investigates the opportunities and barriers to the implementation of MR-Linac into prostate cancer care based on 43 semi-structured interviews with Dutch oncology care professionals, hospital and division directors, patients, payers and industry. The analysis was guided by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework of new medical technologies and services. Opportunities included: the acquirement of (1) advanced MRI-guided radiotherapy technology with (2) the potential for improved patient outcomes and (3) economic benefits, as well as (4) professional development and (5) a higher hospital quality profile. Barriers included: (1) technical complexities, (2) substantial staffing and structural investments, (3) the current lack of empirical evidence of clinical benefits, (4) professional silos, and (5) the presence of patient referral patterns. While our study confirms the expected technical and clinical prospects from the literature, it also reveals economic, organizational, and socio-political challenges.
Highlights
The implementation of medical technology and services usually involves individual, organizational and environmental factors [1,2,3,4]
Whereas this study focuses on prostate cancer, the operational and organizational prospects discussed by respondents are likely to be valid for the implementation of MR-Linac for other tumor indications as well
We raise issues that are known in the field but largely overlooked in the current literature on MR-Linac implementation
Summary
The implementation of medical technology and services usually involves individual, organizational and environmental factors [1,2,3,4]. MR-Linac Implementation in Oncology Care collaboration with Elekta AB (Stockholm, Sweden) and Philips (Best, The Netherlands) This technology integrates a 1.5 Tesla MR-imaging scanner with a radiotherapy linear accelerator [9, 11,12,13,14,15]. This enables online adaptive radiotherapy delivery and diagnostic quality imaging simultaneously that allows the visualization of tumor and surrounding organs before, during and after treatment [9, 12, 16,17,18,19], with potentially higher treatment accuracy, the sparing of healthy tissue and the possibility of hypofractionation (providing the total dose in fewer treatment sessions). Since MRLinac’s CE approval in June 2018 and FDA approval in December 2018, the technology has been installed in institutions worldwide [23, 24]
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