MR-linac – five years of revolutionary technology

Five years ago, The Royal Marsden NHS Foundation Trust became the first hospital in the UK to treat a patient using an MR-linac. This machine delivers radiotherapy with the guidance of an MRI scanner, which allows clinicians, radiographers, and physicists to work together to tailor the treatment precisely for patients in real-time, using detailed imaging.

The installation of the MR-linac – an Elekta Unity – was implemented together with The Institute of Cancer Research, London (ICR), funded by a £10-million grant from the Medical Research Council to the ICR and supported by The Royal Marsden Cancer Charity.

Trina Herbert, MR linac operational superintendent at The Royal Marsden NHS Foundation Trust, was on the team that treated this first patient. Here, Trina looks back on five years of this revolutionary technology and other innovations in radiotherapy that paved the way.

“I’ve worked in The Royal Marsden’s radiotherapy department in Sutton since qualifying as a therapeutic radiographer 25 years ago and, during this time, I’ve seen many advances in the field. This has included developments in image guidance such as the move away from x-ray films to electronic portal imaging, then to cone beam CT imaging, which enabled greater precision in treatment delivery. The introduction of state-of-the-art technology like the CyberKnife – The Royal Marsden has two of these machines thanks to funding from The Royal Marsden Cancer Charity – made stereotactic body radiotherapy and radiosurgery possible in the department. However, the most exciting development, in my opinion, is the MR-linac.

“I applied for my current role as I was intrigued by the MR-linac’s innovative technology. Being able to acquire MR images to clearly visualise anatomy and to adapt treatments in real-time is a huge leap forwards from the x-rays we used to plan treatment when I first joined the trust, which were often difficult to interpret. While the MR-linac was being installed, I spent six months in our diagnostic MRI department preparing for this role and learnt about how to operate the technology safely, position patients and acquire MR images.

“I can’t quite believe it’s been five years since we treated our first patient in the hospital.  On the day, felt nervous but very excited, and I was so proud of how well the team had prepared.  For example, we had recruited patient volunteers to help us practice the treatment’s complicated workflow steps in the weeks leading up to the launch, which meant everyone was sure of their individual roles.  It was daunting but I had a strong sense of how special this technology was and felt privileged to be a part of it.

“It’s been wonderful to watch this treatment option open up to more patients over the last five years. After an initial research trial for prostate cancer patients, many other tumour types, including gynaecological and head and neck cancers, have since been treated on the MR-linac. Studies investigating variations in treatment delivery, including changes to dose, margins and frequency, are also ongoing aiming to improve patient outcomes and reduce time spent in hospital.

“As radiotherapy has developed, the role of therapeutic radiographers has grown, and we’ve learnt new skills to keep up with the latest in imaging and treatment. Plus, over the last couple of years, along with other therapeutic radiographers who work with the MR-linac, I have taken on more responsibilities. As the machine allows us to adapt treatment according to the patient’s anatomy on the day, we’ve undertaken training and assessments so we can carry out online anatomy contouring. It’s been really empowering to take on this task, which would normally be in a clinician’s remit, and it benefits the hospital by freeing up doctors’ time.

“I was first drawn to therapeutic radiography because of the daily contact with patients, sometimes over several weeks. It’s nice to develop a rapport and personalise their care. I was excited to start at The Royal Marsden 25 years ago because of its reputation for innovation and change and it hasn’t disappointed! Working here has meant I’m part of an ever-changing radiotherapy department, that continually drives improvement, research, and excellent patient care.”

Submitted by Trina Herbert, MR linac operational superintendent at The Royal Marsden NHS Foundation Trust.