Radiotherapy is a highly effective local anti-cancer treatment delivered to around 50-60 per cent of cancer patients. Installation of the Bayer-Medrad contrast injector on The Christie’s Unity MR linear accelerator (believed to be a world first) will allow the radiotherapy team to administer contrast agent to aid in tumour and organ at risk (OAR) visualisation as well as undertake Dynamic Contrast Enhanced (DCE) MR imaging to assess treatment response with a view to real-time biological based adaptations.
To enhance real-time re-planning, the team will be able to use contrast agents to enhance tumours, or malignant nodal involvement for better visualisation and more precise treatment delivery. Contrast enhancement can also help to delineate surrounding structures, specifically OAR’s. Currently within the radiotherapy pathway, MR contrast-enhanced imaging is only routinely conducted at pre-treatment stage for planning purposes in specific tumour disease types. The use of the contrast injector will allow the MR-linac team to undertake serial contrast enhanced and functional imaging over the course of a patient’s treatment. This may lead to adaptation for truly personalised care. Research is ongoing at The Christie investigating the effects of contrast agents on radiation dose, to ensure there is no impact on the radiation treatment.
Additionally, research studies have shown the inclusion of perfusion information obtained using DCE imaging may allow visualisation of hypoxic regions within tumours. This could permit us to carry out biologically adaptive radiotherapy. Not all patients have hypoxic elements to their tumours, but in some cases, treatment modification has been shown to improve outcome.
Picture: MRL research radiographers Rebecca Benson, Claire Nelder, Lisa McDaid, Abigael Clough and Bayer MR KAM for the North of England Steve Broadhurst.
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