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First clinical experiences with a high field 1.5 T MR linac.

Anders S Bertelsen1, Tine Schytte2,3, Pia K Møller2,4

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The 1.5 Tesla MR Linac (MRL) enables daily online adaptive radiotherapy (ART) with MR imaging (MRI). Initial clinical use shows MRL treatments are feasible, well-tolerated, and dosimetrically accurate within acceptable timeframes.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • The 1.5 Tesla MR Linac (MRL) integrates magnetic resonance imaging (MRI) with a linear accelerator for advanced cancer treatment.
  • Online plan adaptation using daily MR images is a key feature of MRL workflows, enabling real-time treatment adjustments.
  • Evaluating initial clinical experiences is crucial for understanding the feasibility and efficacy of novel MRL treatment protocols.

Purpose of the Study:

  • To report on initial clinical experiences with the 1.5T MR Linac (MRL) after five months of use.
  • To assess patient compliance, treatment workflow (WF) timings, and dosimetric accuracy of MRL treatments.
  • To evaluate two distinct MRL workflows: Adapt To Position (ATP) and Adapt To Shape (ATS).

Main Methods:

  • Two workflows, ATP and ATS, were employed, utilizing daily 3D MRI scans for plan adaptation.
  • ATP involved rigid adjustment of the reference plan, while ATS used deformable image registration for anatomical changes.
  • Patient compliance, WF timings, and dose delivery accuracy (using a diode phantom and gamma analysis) were recorded.

Main Results:

  • Nineteen patients completed treatment (176 fractions) for various cancers, including prostate and lymph node SBRT.
  • Median session times were 26 minutes for ATP and 42 minutes for ATS, with most fractions completed within clinical limits.
  • The median gamma pass rate of 99.2% confirmed good agreement between planned and delivered doses.

Conclusions:

  • MR Linac treatments incorporating daily MRIs, online plan adaptation, and accurate dose delivery are clinically feasible.
  • MRL treatments are well-tolerated by patients and can be completed within acceptable timeframes.
  • The study demonstrates the potential of MRL technology for precise and adaptive radiotherapy.