MRLinac into the UK: Rationale and applications.

1. Dr Vincent Khoo
GenesisCare Chief Medical Officer & Clinical Leaders Forum member
Royal Marsden Hospital & Institute of Cancer Research
St George’s Hospital & University of London
ONJCC & Austin Health, University of Melbourne & Monash University
MR-Linac into the UK: Rationale and
applications

2. Page 2
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Disclosure

3. The Present

4. A Future

5. The GenesisCare Values

6. • Ability to “Tailor”
– Dose fractionation
– RT Method
– RT Delivery
– Efficiency
• Tumour clonogenic densities
• Different locations
• Inhomogenous disstributions
• Radiosensitivity & Physiology
• Tumour vs NT
• Response
• Quantification
• Capability to “Adapt”
RT: Ideal Aims

7. MRI
• Greater capability
• Functional imaging
– Proliferation / Apoptosis
(dwMRI)
– Angiogenesis (dceMRI)
– Hypoxia (BOLD MRI)
– Metabolism (MRS)
• Gold standard
– Soft tissue
– Many disease sites
Khoo et al
IJROBP 2000

8. RT integrated with MRI: Aims
Optimal ST imaging Optimal TVD
Setup
Verify
Treatment
Response
Functional imaging
No surrogate vol
Motion Mx &
Real-time
Tracking
Biol TVD adaptation
No RT dose
Issues
• Physics
• Workflow
• Costs

9. Strategic Workflow: Online, Real-time & Adaptive
Disease Adaptation,
Biological Targeting
& Physiological
Maintenance /
Optimisation
FEEDBACK
Daily dose
localisation &
prediction
MR sim &
planning

10. RMH: MR Linac

11. MRI Linac: Summary
Rationale Potential benefits
• Machines A reality (different versions)
• Physics issues Surmountable
• Clinical workflows Being developed
• Clinical applications Being evaluated
• Outcomes To be defined in clinical trials
• Efficiencies Elekta Atlantic Consortium
• Costs To be defined
• Future Here to stay…..

12. Our Future

13. Thank-you