MR Linac Radiotherapy

A New Personalized Treatment Approach

1st Edition, Volume 8 - December 1, 2022
Editors: Sara L. Hackett, Cem Onal, Enis Ozyar
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 6 8 9 - 9
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 8 5 4 8 - 2

MR Linac Radiotherapy: A New Personalized Treatment Approach comprises both clinical and physical aspects of this new technology. The book covers treatment planning, workflow… Read more

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MR Linac Radiotherapy: A New Personalized Treatment Approach comprises both clinical and physical aspects of this new technology. The book covers treatment planning, workflow and technical issues about MR-Linac. Specially, the clinical use of MR-Linac according to different cancer types is presented by experienced physicians. This is a unique guide for medical physicists, RTTs, dosimetrists and physicians, as well as radiation oncologists and their teams. The MR Linac combines two technologies - a magnetic resonance imaging scanner and a linear accelerator - to precisely locate tumors, tailor the shape of radiation beams in real-time, and precisely deliver doses of radiation, even to moving tumors.

This highly innovative technology is very new, and the number of newly installed MR-Linac machines will gradually increase worldwide. However, as there is no published book as a guideline, this book will help new MR-Linac users and centers planning to have MR-Linac.

Cover image
Title Page
Table of Contents
Copyright
Contributors
Preface
Chapter 1: Rationale for the MR-linac
Abstract
Optimal radiotherapy
MR-guided radiotherapy
Opportunities of MR-guided radiotherapy
Concluding remarks
References
Chapter 2: Basics of MR imaging for the radiation oncologist
Abstract
Introduction
MR imaging
MR linac (MRL) in radiation oncology
Current trends in MRL
Outlook of MRI in radiation oncology
Concluding remarks
References
Chapter 3: Technical concepts of MRI-Linac (MRL)
Abstract
Introduction: The challenges of a hybrid MRI-Linac system
Perpendicular systems
Inline systems
Concluding remarks
References
Chapter 4: Linac dosimetry in a magnetic field
Abstract
Introduction
Physics
Systems and configurations
Measurements in B-fields
Reference dosimetry
Linac reference conditions
Uncertainty
Additional concepts
Concluding remarks
References
Chapter 5: MR safety considerations for MRI-guided radiotherapy
Abstract
Introduction
Magnetic field-induced hazards
Safety considerations for MR in RT
Device considerations
Concluding remarks
References
Chapter 6: Robust online adaptive planning: Toward a uniform MR-LINAC treatment planning technique
Abstract
Introduction
Initial approach to treatment planning
Chasing further efficiencies and MPT
Principles of a uniform MR-LINAC planning technique
Making the MPT base plan (SBRT for pancreas)
Adapting an MPT plan (SBRT for pancreas)
Incorporating MPT—An evaluation
Concluding remarks
Acknowledgment
References
Chapter 7: Immobilization and patient positioning considerations when using MRI for radiotherapy treatment planning
Abstract
Introduction
Utilizing magnetic resonance imaging (MRI) for radiotherapy treatment planning (RTP)
General principles and equipment
MRI systems
MRI scanning protocols
Workforce and training
Patient communication
Coil bridges
Safe and efficient patient setup
Site-specific considerations
Brain
Head and neck
Thorax and abdomen
Breast
Pelvis
Spine
Limbs
Concluding remarks
References
Chapter 8: Treatment planning and delivery workflow steps in MR-guided adaptive RT
Abstract
Introduction
Reference treatment planning workflow steps
Treatment delivery
Quality assurance of daily replanning
Concluding remarks
References
Chapter 9: QA of MR-linac
Abstract
Geometric machine QA of MR-linac
Dosimetric QA of MR-linac
QA of MR-linac images and center position
Patient-specific QA
Concluding remarks
References
Chapter 10: Changing role of radiation therapy technologists in magnetic resonance-guided radiotherapy
Abstract
Introduction
Implementation
“Business as usual”
Training
Conditions and infrastructure
Concluding remarks
References
Chapter 11: Central nervous system tumors
Abstract
Introduction
Multiparametric MRI for MR Linac neuroimaging
Clinical applications for MR Linac therapy in the CNS
Concluding remarks
References
Chapter 12: Esophageal cancer
Abstract
Introduction
Staging
Evidence-based treatment approaches for locoregional disease
Selection for nonoperative management
Rationale for MR-guided radiotherapy in esophageal cancer
Interfraction tumor shape adaptation
Intrafraction tumor motion
Treatment-related toxicity
Targeted selected dose escalation
Target volume determination and delineation guidelines
Simulation
Treatment planning
Concluding remarks
References
Chapter 13: Lung tumors
Abstract
Concluding remarks
References
Chapter 14: Breast cancer: Role of MR-guided radiation therapy
Abstract
Introduction
External beam radiotherapy
MRI-guided APBI
Published treatment outcomes
Concluding remarks
References
Chapter 15: MR-guided radiotherapy for liver tumors: Hepatocarcinomas, cholangiocarcinomas, and liver metastases
Abstract
Introduction
Stereotactic body radiotherapy for liver tumor before MRI-guided radiotherapy (MRgRT) era
MRI-guided radiotherapy (MRgRT) for primary and secondary hepatic malignancies
Appendix: Supplementary material
Appendix: Supplementary material
Concluding remarks
References
Chapter 16: Pancreatic cancers
Abstract
Introduction
General management
Radiation therapy
Concluding remarks
References
Chapter 17: MR linac radiation therapy: A real-time personalized approach for prostate cancer
Abstract
Introduction
Practical considerations
Definitive radiotherapy
Definitive treatment intro
Patient selection
Planning and treatment delivery
Current clinical evidence
Other considerations
Postoperative radiotherapy
Limitations
Future directions
Concluding remarks
References
Chapter 18: Online MR-guided radiotherapy in rectal cancer—Dose escalation and beyond
Abstract
Evolution of the current standard multimodality treatment of rectal cancer: From blunt resection to total neoadjuvant therapy
Role of magnetic resonance imaging in the staging of rectal cancer
Potential benefit of online MR-guided radiotherapy in rectal cancer
Organ preservation in case of a clinical complete response to radiotherapy
Data available on online adaptive MR-guided radiotherapy
Concluding remarks
References
Chapter 19: Oligometastatic disease: Adrenal, lymph nodes, bone
Abstract
Introduction
Stereotactic body radiotherapy trials (SBRT): Success and toxicity
MR-guided SBRT for metastatic disease: Dosimetric data and case reports
MR-guided SBRT for oligometastatic disease: Clinical data
Future perspectives
Concluding remarks
Appendix: Supplementary material
Appendix: Supplementary material
References
Chapter 20: Gynecological tumors
Abstract
Introduction
The use of MRg-RT in cervical cancer
The use of MRg-RT in endometrial cancer
The use of MRg-RT in ovarian cancer
Special conditions
Concluding remarks
References
Further reading
Chapter 21: Magnetic resonance-guided radiotherapy in pediatric cancers
Abstract
Introduction
Major tumor types, local approaches, and outcomes
Radiotherapy-related toxicity profile for major pediatric tumor types
Is late toxicity avoidable by MRgRT?
Survey on the potential role of MRgRT in pediatric radiotherapy among future users
The ideal niche for MRgRT in pediatric patients
Current challenges for MRgRT in pediatrics
Concluding remarks
References
Chapter 22: MR-guided SBRT for unusual tumors (cardiac, kidney, bladder)
Abstract
Cardiac and pericardiac tumors
Bladder cancer
Kidney
Oligometastatic RCC
Concluding remarks
References
Chapter 23: Patient reported outcomes in the use of MR-guided radiotherapy
Abstract
Patient experience
PROMs
Concluding remarks
References
Chapter 24: Use of artificial intelligence in MR-guided RT
Abstract
Artificial intelligence in the MR-guided RT workflow
AI1: Automatic segmentation
AI2: Synthetic CT
AI3: Automatic planning
AI4: Automatic QA
AI5: Motion management
Concluding remarks
References
Chapter 25: Radiomics for MR-Linacs: State of the art and future directions
Abstract
The radiomics concept
Radiomics experiences on MR-Linac
Concluding remarks
References
Index

Sara L. Hackett

Sara Hackett completed her B.Sc. (Hons) in Physics and Mathematics at the University of Western Australia in 2003, was awarded a Ph.D. with Distinction in 2008 by the same institute. She trained as a Medical Physicist, specializing in Radiotherapy, and received her certification in 2010. During this period she also completed an M.Sc. in Medical Physics with the Royal Melbourne Institute of Technology. After working as a postdoctoral fellow at the Université catholique de Louvain and the University of Oxford, she joined the Experimental Medical Physics group at University Medical Center Utrecht (UMCU) as a postdoctoral physis fellow to work on the clinical introduction of the MR-linac. Dr. Hackett now works as a clinical physicist at UMCU with the primary responsibility for treatment planning. The Radiotherapy department has three MR-linacs, as well as ten Agility linacs. She is involved with lung radiotherapy on the MR-linac and is supervising M.Sc. and Ph.D. students in the development of gating, tracking and real-time-adapted radiotherapy.

Affiliations and expertise

University Medical Center, Utrecht, The Randstad, The Netherlands

Cem Onal

Prof. Cem Onal is the founder and Chair of the Radiation Oncology Department at Baskent University. Prof. Onal completed his residency in radiation oncology in 2004 at Hacettepe University School of Medicine in Ankara. His primary research interests are prostate cancer, breast cancer, and gynecological malignancies. He has extensive experience using intensity modulated radiotherapy and image guided radiotherapy to treat prostate cancer, as well as brachytherapy for gynecological tumors, stereotactic radiotherapy, and radiosurgery. He is the director of the MR-Linac unit and has extensive experience treating prostate cancer and abdominal tumors with MR-Linac. He is also skilled in computed tomography-guided brachytherapy, intensity modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy/radiosurgery, and helical tomotherapy. He has over 150 articles published in international and national journals. He has also presented over 350 international and national abstracts at various scientific meetings. He serves as the editorial board member and peer reviewer in several journals.

Affiliations and expertise

Baskent University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey

Enis Ozyar

Enis Ozyar M.D., graduated from Ankara University, Medical School, Ankara, Turkey in 1985 and finished his residency at Hacettepe University, School of Medicine, Department of Radiation Oncology, Ankara in 1993. He worked at the same department between 1993-2008. He obtained his associate professorship degree in 1998 and professorship degree in 2003. He was appointed as Chair and Professor of Radiation Oncology at the Acibadem MAA University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey in 2008. Dr. Ozyar currently works at flaghship hospital – Acibadem Maslak Hospital – of the Acibadem Health Group (AHG). AHG is the largest private health care group in Turkey and have 8 Radiation Oncology centers equipped with high tech systems such as MRIdien Mr-Linac, IGRT-IMRT-SRT linac systems, robotic linacs, Gammaknife, brachytherapy and intraoperative radiotherapy. Dr. Ozyar is also working as coordinator of Radiation Oncology Centers of AHG. He is also charing Acibadem RTT school and Health Physics programme of Acibadem MAA University. His main interest areas are head and neck cancer, prostate cancer, gynecological cancers, sterotactic radiotherapy and MR guided radiotherapy. Dr. Ozyar published more than 100 manuscripts published in international SCI journals. His h-index is 27.

Affiliations and expertise

Department of Radiation Oncology, Acibadem MAA University, Istanbul, Turkey

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MR Linac Radiotherapy

A New Personalized Treatment Approach

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Institutional subscription on ScienceDirect

Sara L. Hackett

Cem Onal

Enis Ozyar