MRIgRT Technology

Radiation therapy is an important part of a cancer patient’s journey. Every patient is unique with unique treatment needs. Being able to adapt the treatment based on the needs of the patient is essential to achieving the best possible outcomes. MRIgRT is transforming the conventional radiation therapy workflow to a SCAN-PLAN-TREAT approach.

Isotropic 3D visualisation in five different ways with sub-millimetre resolution.

By visualising anatomy with the Unity system’s five different tissue contrasts, enables us to see daily tumour changes in:

Daily adaptive planning for online dose reshaping.

Fast adaptive planning workflows allow us to respond to day-to-day changes in the patient.

1. Adapt to shape: a simple adaptive solution using fast rigid registration
2. Adapt to shape: a comprehensive plan re-optimisation solution using deformable registration.
3. Make fast on-the-spot clinical decisions based on the system’s predictive insights

Real-time target visualisation

The ability to see the tumour in three planes while we treat with stereotactic precision.

1. Elekta Unity enables us you to clearly see and monitor anatomical motion in real-time during treatment
   
2. Gain visual confidence to reduce margins and expand treatment options
3. Assess the treatment response of tumours with functional imaging capabilities

Unity delivers on all fronts using combined state-of-the-art technologies with ergonomic design to give unparalleled advantages and enabling precise, personalised treatments.

The MR-Linac gives us the potential to transform our service and we now have the opportunity to develop new clinical paradigms to improve outcomes, even for those hard to treat cancers.

We are committed to an environment of clinical excellence, objectivity and accountability. Our Processes are adapted from international best practice and our team has undertaken training with centres including Tubingen University Hospital, UMC Utrecht Cancer Centre as well as Elekta Training Centre, UK.

The introduction of the Unity has been overseen by a dedicated clinical and research team. The groups are comprised of clinicians, radiation therapist and physicists who have undergone extensive Unity training and have a vast cumulative experience of delivering highly technical radiation therapy.

The group also oversees research activity, developing joint protocols with our research partners. GenesisCare will treat more patients with MRIgRT than any other institute globally and will therefore be at the vanguard of translating research into everyday precision radiation medicine

Multidisciplinary teamworking is at the heart of excellent patient care in cancer management. To facilitate this in an independent setting, we have established an MR Linac advisory team which enables peer-to-peer collaboration for both rural and regional clinicians. This forum allows clinicians to submit patient cases for review and opinion for MR Linac treatment. A fortnightly meeting via video conferencing will be held to discuss patient cases.

The advisory team enhances clinical processes, using real-time data  tracking and video to enable the clinical team and wider clinical teams to discuss patient cases while protecting the flow of sensitive data.

The evidence base for stereotactic body radiation therapy (SBRT) is growing and there is currently a range of clinical scenarios into which it can be integrated. At GenesisCare, we offer SBRT in the following situations:

1. Localised prostate cancer, where hypofractionated treatment offers an alternative to conventional therapy
2. Tumours that are difficult or impossible to see with conventional CT imaging
3. Selected cases of oligometastatic and oligo-progressive cancers
4. Early stage lung cancer
5. Hepatobiliary cancer, including primary liver cancers and inoperable/recurrent pancreatic cancer
6. Pelvic reirradiation
7. Partial breast

All referrals will be assessed for a possible benefit of treatment using MRIgRT. For example:

• Tumours where there is significant movement, e.g. in the upper abdomen and lung
• Tumours that are in close proximity to organs at risk (OARs), e.g. in the prostate, upper abdomen and central lung

Through our collaborations, we will build on the body of evidence for MR Linac Radiation therapy. Our strategy for the introduction of MRIgRT is to align with international best practice based on evidence-based protocols. There is an increasing international evidence base for MR-Linac.

The safety and efficacy of the Elekta MR-linac system in a clinical setting have been demonstrated and quantified. The results, published in *Physics in Medicine & Biology, further validate an extensive clinical research plan as developed by the Elekta MR-linac Consortium.