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Academic literature on the topic 'MR-Linac Adaptive Workflows'

Author: Grafiati
Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "MR-Linac Adaptive Workflows"

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Dunkerley, David A. P., Daniel E. Hyer, Jeffrey E. Snyder, Joël J. St-Aubin, Carryn M. Anderson, Joseph M. Caster, Mark C. Smith, John M. Buatti, and Sridhar Yaddanapudi. "Clinical Implementational and Site-Specific Workflows for a 1.5T MR-Linac." Journal of Clinical Medicine 11, no. 6 (March 16, 2022): 1662. http://dx.doi.org/10.3390/jcm11061662.

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MR-guided adaptive radiotherapy (MRgART) provides opportunities to benefit patients through enhanced use of advanced imaging during treatment for many patients with various cancer treatment sites. This novel technology presents many new challenges which vary based on anatomic treatment location, technique, and potential changes of both tumor and normal tissue during treatment. When introducing new treatment sites, considerations regarding appropriate patient selection, treatment planning, immobilization, and plan-adaption criteria must be thoroughly explored to ensure adequate treatments are performed. This paper presents an institution’s experience in developing a MRgART program for a 1.5T MR-linac for the first 234 patients. The paper suggests practical treatment workflows and considerations for treating with MRgART at different anatomical sites, including imaging guidelines, patient immobilization, adaptive workflows, and utilization of bolus.
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Randall, James W., Nikhil Rammohan, Indra J. Das, and Poonam Yadav. "Towards Accurate and Precise Image-Guided Radiotherapy: Clinical Applications of the MR-Linac." Journal of Clinical Medicine 11, no. 14 (July 13, 2022): 4044. http://dx.doi.org/10.3390/jcm11144044.

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Advances in image-guided radiotherapy have brought about improved oncologic outcomes and reduced toxicity. The next generation of image guidance in the form of magnetic resonance imaging (MRI) will improve visualization of tumors and make radiation treatment adaptation possible. In this review, we discuss the role that MRI plays in radiotherapy, with a focus on the integration of MRI with the linear accelerator. The MR linear accelerator (MR-Linac) will provide real-time imaging, help assess motion management, and provide online adaptive therapy. Potential advantages and the current state of these MR-Linacs are highlighted, with a discussion of six different clinical scenarios, leading into a discussion on the future role of these machines in clinical workflows.
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Marciscano, Ariel E., Jonathan P. S. Knisely, Himanshu Nagar, Andrew Brandmaier, Ryan T. Pennell, Michael Speiser, Sungheon G. Kim, et al. "SPIN-02 LEVERAGING AN MRI-GUIDED LINEAR ACCELERATOR PLATFORM FOR POST-OPERATIVE STEREOTACTIC BODY RADIATION THERAPY (SBRT) OF SPINAL METASTASES." Neuro-Oncology Advances 4, Supplement_1 (August 1, 2022): i11. http://dx.doi.org/10.1093/noajnl/vdac078.043.

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Abstract PURPOSE/OBJECTIVE(S) Post-operative spine SBRT presents unique clinical challenges. Spinal hardware produces CT and high-field strength MRI artifacts that obscure visualization of the spinal cord and unresected disease. Existing workflows incorporate additional invasive procedures with CT myelogram and quality control for these procedures can introduce uncertainty into SBRT planning. Reducing metallic imaging artifact with a low-field strength (0.35 T) MRI integrated into a MR-Linac (MRL) may facilitate superior visualization of the spinal cord, improved target delineation and treatment localization. The primary objective is to determine the feasibility of MRL-based simulation workflow to facilitate MR-guided post-operative spine SBRT without the need for CT myelogram or CT-based target delineation. MATERIALS/METHODS A single-institution, single-arm interventional feasibility study is planned. A total of 10 patients who underwent surgical resection of solid tumor spinal metastases with an indication for post-operative SBRT will be enrolled and undergo radiation planning and treatment on a MRL platform that combines a 6MV Linac and 0.35 T on-board MRI system. Enrolled subjects will undergo CT and MR simulation followed by standard-of-care post-operative spine SBRT and follow-up spine imaging every 3 months. RESULTS The primary endpoint is feasibility of MR-guided post-operative spine SBRT without CT myelogram. Feasibility is defined as > 70% of participants with clinically acceptable visualization/delineation as determined by blinded dual neuroradiologist review for clinically acceptable visualization/delineation of organs-at-risk (OARs) and target volume(s). Exploratory endpoints involve radiation dosimetry analysis of OARs and target volumes as well as documenting the use of adaptive planning. Radiation site progression-free survival will be recorded at 6-months after SBRT. CONCLUSION If feasible, an MRL-based workflow for post-operative spine SBRT represents a patient-centric approach to improve efficiency, minimize treatment delays, and avoid invasive procedures that may improve clinical management of solid tumor spinal metastases.
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Jones, S., R. Chuter, A. J. Pollitt, M. Warren, and A. McWilliam. "OC-0615: Investigating online adaptive workflows for prostate patients on the MR-Linac: an in-silico study." Radiotherapy and Oncology 127 (April 2018): S325. http://dx.doi.org/10.1016/s0167-8140(18)30925-3.

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Wegener, Daniel, Alexandra Thome, Frank Paulsen, Cihan Gani, Jessica Boldt, Sarah Butzer, Daniela Thorwarth, et al. "First Experience and Prospective Evaluation on Feasibility and Acute Toxicity of Online Adaptive Radiotherapy of the Prostate Bed as Salvage Treatment in Patients with Biochemically Recurrent Prostate Cancer on a 1.5T MR-Linac." Journal of Clinical Medicine 11, no. 16 (August 9, 2022): 4651. http://dx.doi.org/10.3390/jcm11164651.

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Introduction: Novel MRI-linear accelerator hybrids (MR-Linacs, MRL) promise an optimization of radiotherapy (RT) through daily MRI imaging with enhanced soft tissue contrast and plan adaptation on the anatomy of the day. These features might potentially improve salvage RT of prostate cancer (SRT), where the clinical target volume is confined by the mobile organs at risk (OAR) rectum and bladder. So far, no data exist about the feasibility of the MRL technology for SRT. In this study, we prospectively examined patients treated with SRT on a 1.5 T MRL and report on workflow, feasibility and acute toxicity. Patients and Methods: Sixteen patients were prospectively enrolled within the MRL-01 study (NCT: NCT04172753). All patients were staged and had an indication for SRT after radical prostatectomy according to national guidelines. RT consisted of 66 Gy in 33 fractions or 66.5/70 Gy in 35 fractions in case of a defined high-risk region. On the 1.5 T MRL, daily plan adaption was performed using one of two workflows: adapt to shape (ATS, using contour adaptation and replanning) or adapt to position (ATP, rigid replanning onto the online anatomy with virtual couch shift). Duration of treatment steps, choice of workflow and treatment failure were recorded for each fraction of each patient. Patient-reported questionnaires about patient comfort were evaluated as well as extensive reporting of acute toxicity (patient reported and clinician scored). Results: A total of 524/554 (94.6%) of fractions were successfully treated on the MRL. No patient-sided treatment failures occurred. In total, ATP was chosen in 45.7% and ATS in 54.3% of fractions. In eight cases, ATP was performed on top of the initial ATS workflow. Mean (range) duration of all fractions (on-table time until end of treatment) was 25.1 (17.6–44.8) minutes. Mean duration of the ATP workflow was 20.60 (17.6–25.2) minutes and of the ATS workflow 31.3 (28.2–34.1) minutes. Patient-reported treatment experience questionnaires revealed high rates of tolerability of the treatment procedure. Acute toxicity (RTOG, CTC as well as patient-reported CTC, IPSS and ICIQ) during RT and 3 months after was mild to moderate with a tendency of recovery to baseline levels at 3 months post RT. No G3+ toxicity was scored for any item. Conclusions: In this first report on SRT of prostate cancer patients on a 1.5 T MRL, we could demonstrate the feasibility of both available workflows. Daily MR-guided adaptive SRT of mean 25.1 min per fraction was well tolerated in this pretreated collective, and we report low rates of acute toxicity for this treatment. This study suggests that SRT on a 1.5 T MRL can be performed in clinical routine and it serves as a benchmark for future analyses.
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Song, Yajun, Zhenjiang Li, Huadong Wang, Yun Zhang, and Jinbo Yue. "MR-LINAC-Guided Adaptive Radiotherapy for Gastric MALT: Two Case Reports and a Literature Review." Radiation 2, no. 3 (July 13, 2022): 259–67. http://dx.doi.org/10.3390/radiation2030019.

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It is still very challenging to use conventional radiation therapy techniques to treat stomach tumors, although image-guided radiotherapy, mainly by kV X-ray imaging techniques, has become routine in the clinic. This is because the stomach is one of the most deformable organs, and thus it is vulnerable to respiratory motions, daily diet, and body position changes. In addition, X-ray radiographs and CT volumetric images have low contrast in soft tissues. In contrast, magnetic resonance imaging (MRI) techniques provide good contrast in images of soft tissues. The emerging MR-guided radiotherapy, based on the MR-LINAC system, may have the potential to solve the above difficulties due to its unique advantages. The real-time imaging feature and the high-contrast of soft tissues MR images provided by the MR-LINAC system have facilitated the therapeutic adaptive planning. Online learning capabilities could be used to optimize the automatic delineation of the target organ or tissue prior to each radiotherapy session. This could greatly improve the accuracy and efficiency of the target delineation in adaptive planning. In this clinical case report, we elaborated a workflow for the diagnosis and treatment of two patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. One patient underwent MR-guided daily adaptive radiotherapy based on daily automated segmentation using the novel artificial intelligence (AI) technique for gastric delineation.
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Mulder, Samuel L., Jolien Heukelom, Brigid A. McDonald, Lisanne Van Dijk, Kareem A. Wahid, Keith Sanders, Travis C. Salzillo, Mehdi Hemmati, Andrew Schaefer, and Clifton D. Fuller. "MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers." Cancers 14, no. 8 (April 10, 2022): 1909. http://dx.doi.org/10.3390/cancers14081909.

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MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT).
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Stanescu, Teo, Andrea Shessel, Cathy Carpino-Rocca, Edward Taylor, Oleksii Semeniuk, Winnie Li, Aisling Barry, Jelena Lukovic, Laura Dawson, and Ali Hosni. "MRI-Guided Online Adaptive Stereotactic Body Radiation Therapy of Liver and Pancreas Tumors on an MR-Linac System." Cancers 14, no. 3 (January 30, 2022): 716. http://dx.doi.org/10.3390/cancers14030716.

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Purpose: To describe a comprehensive workflow for MRI-guided online adaptive stereotactic body radiation therapy (SBRT) specific to upper gastrointestinal cancer patients with abdominal compression on a 1.5T MR-Linac system. Additionally, we discuss the workflow’s clinical feasibility and early experience in the case of 16 liver and pancreas patients. Methods: Eleven patients with liver cancer and five patients with pancreas cancer were treated with online adaptive MRI-guidance under abdominal compression. Two liver patients received single-fraction treatments; the remainder plus all pancreas cancer patients received five fractions. A total of 65 treatment sessions were investigated to provide analytics relevant to the online adaptive processes. The quantification of target and organ motion as well as definition and validation of internal target volume (ITV) margins were performed via multi-contrast imaging provided by three different 2D cine sequences. The plan generation was driven by full re-optimization strategies and using T2-weighted 3D image series acquired by means of a respiratory-triggered exhale phase or a time-averaged imaging protocol. As a pre-requisite for the clinical development of the procedure, the image quality was thoroughly investigated via phantom measurements and numerical simulations specific to upper abdominal sites. The delivery of the online adaptive treatments was facilitated by real-time monitoring with 2D cine imaging. Results: Liver 1-fraction and 5-fraction online adaptive session time were on average 80 and 67.5 min, respectively. The total session length varied between 70–90 min for a single fraction and 55–90 min for five fractions. The pancreas sessions were 54–85 min long with an average session time of 68.2 min. Target visualization on the 2D cine image data varied per patient, with at least one of the 2D cine sequences providing sufficient contrast to confidently identify its location and confirm reproducibility of ITV margins. The mean/range of absolute and relative dose values for all treatment sessions evaluated with ArcCheck were 90.6/80.9–96.1% and 99/95.4–100%, respectively. Conclusion: MR-guidance is feasible for liver and pancreas tumors when abdominal compression is used to reduce organ motion, improve imaging quality, and achieve a robust intra- and inter-fraction patient setup. However, the treatment length is significantly longer than for the conventional linac, and patient compliance is paramount for the successful completion of the treatment. Opportunities for reducing the online adaptive session time should be explored. As the next steps, dose-of-the-day and dose accumulation analysis and tools are needed to enhance the workflow and to help further refine the online re-planning processes.
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Fredén, E., D. Tilly, and A. Ahnesjö. "PO-1713 DVH based evaluation of dose accumulation in an adaptive MR-linac workflow." Radiotherapy and Oncology 170 (May 2022): S1512—S1514. http://dx.doi.org/10.1016/s0167-8140(22)03677-5.

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Costa, F., I. Hanson, S. Doran, J. Adamovics, S. Nill, and U. Oelfke. "PV-0482 Dosimetric verification of Elekta MR-linac adaption workflow using 3D dosimeters." Radiotherapy and Oncology 133 (April 2019): S248—S249. http://dx.doi.org/10.1016/s0167-8140(19)30902-8.

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Book chapters on the topic "MR-Linac Adaptive Workflows"

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Lavender, Frances. "Imaging for treatment delivery: Image-guided radiotherapy." In Physics for Clinical Oncology, 163—C10.F5. 2nd ed. Oxford University PressOxford, 2022. http://dx.doi.org/10.1093/med/9780198862864.003.0010.

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Abstract This chapter, ‘Imaging for treatment delivery: Image-guided radiotherapy’, discusses the technology and workflows used to verify the geometric accuracy of treatment delivery. A review of the relevant photon interaction processes (photoelectric effect and Compton scattering) precedes a discussion on cone beam CT imaging (CBCT), how this differs from fan-beam CT imaging and how it is used in clinical practice. The importance of patient positioning is highlighted. Other techniques used to improve treatment accuracy, such as gating and tracking are described. The use of adaptive radiotherapy is outlined and the chapter closes with a brief introduction to the possibilities presented by MR-linac technology.
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