Advantages and challenges in Magnetic Resonance guided Radiation Therapy
– A potentially groundbreaking verification technique
DOI:
https://doi.org/10.7577/radopen.6102Keywords:
Radiotherapy, Magnetic Resonance-guided Radiation Therapy, MRgRT, Radiotherapy VerificationAbstract
Background: The incidence of cancer is increasing in the population, and it is expected that 1 in 5 individuals will develop the disease. Of these, over 50% will require radiation therapy. The effectiveness of radiation therapy depends on the precise delivery of the radiation dose to the tumor while minimizing the radiation dose to normal tissue and organs at risk. This requires accurate patient positioning and a treatment plan that is individually tailored, with strict requirements and guidelines for dosing and margins. Technological advancements have led to advanced techniques such as image-guided radiation therapy, currently utilizing Cone-Beam Computed Tomography (CBCT). MRI in combination with a linear accelerator (Linac) is currently used for MR-guided Radiation Therapy (MRgRT). MRgRT offers several advantages, including improved soft tissue contrast and visualization, as well as real-time adjustments of the radiation dose, which can reduce treatment margins. This technology also present challenges, such as the lack of electron density information and technical complications related to the magnetic field. This article summarizes the advantages and challenges of using MRgRT, that is described in other review articles.
Methods: We conducted a systematic literature search in Oria and PubMed. The inclusion criteria were that the articles had to be review articles published in Norwegian or English, addressing the use of MRI in verification or the historical development of verification technologies. Exclusion criteria filtered out all articles primarily focused on brachytherapy, stereotactic radiotherapy, proton therapy, and articles with a specific cancer type as the main topic. Ten articles were included, eight from PubMed and two from Oria. The analysis of the articles was carried out using Evans' analysis model.
Results: All the articles described the benefits and challenges of MRgRT, identifying a total of 6 benefits and 13 challenges. The recurring benefits included improved soft tissue contrast, real-time MR imaging, functional MR imaging, and enhanced delineation margins. The challenges mainly concerned the resource demands of MR-Linac, such as being time-consuming and costly, requiring staff competence and training, the need for MR-compatible equipment, and technical difficulties in combining MR and Linac.
Conclusion: All the articles described the benefits and challenges of MRgRT, identifying a total of 6 benefits and 13 challenges. The recurring benefits included improved soft tissue contrast, real-time MR imaging, functional MR imaging, and enhanced delineation margins. The challenges mainly concerned the resource demands of MR-Linac, such as being time-consuming and costly, requiring staff competence and training, the need for MR-compatible equipment, and technical difficulties in combining MR and Linac.
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