Physics Contribution
A Systematic Review of the Clinical Implementation of Pelvic Magnetic Resonance Imaging–Only Planning for External Beam Radiation Therapy

https://doi.org/10.1016/j.ijrobp.2019.06.2530Get rights and content
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The use of magnetic resonance (MR) imaging scans alone for radiation therapy treatment planning (MR-only planning) has been highlighted as one method of improving patient outcomes. Recent technologic advances have meant that introducing MR-only planning to the clinic is becoming a reality, with several specialist radiation therapy clinics using this technique for treatment. As such, substantial efforts are being made to introduce this technique into wide-spread clinical implementation. A systematic review of publications investigating the clinical implementation of pelvic MR-only radiation therapy treatment planning was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase, Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases were searched (timespan: all years to January 2, 2019). Twenty-six articles met the inclusion criteria. The studies were grouped into the following categories: (1) MR acquisition and synthetic computed tomography generation verification, (2) MR distortion quantification and phantom development, (3) clinical validation of patient treatment positioning in an MR-only workflow, and (4) MR-only commissioning processes. Key conclusions from this review are (1) MR-only planning has been implemented clinically for prostate cancer treatments; (2) a substantial amount of work remains to translate MR-only planning into widespread clinical implementation for all pelvic sites; (3) MR scanner distortions are no longer a barrier to MR-only planning, but they must be managed appropriately; (4) MR-only–based patient positioning verification shows promise, but limited evidence is reported in the literature and further investigation is required; and (5) a number of MR-only commissioning processes have been reported, which can aid centers as they undertake local commissioning; however, this needs to be formalized in guidance from national bodies.

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This study is funded by the National Institute for Health Research (NIHR) as part of an HEE/NIHR ICA Programme Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-005). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosures: No conflicts of interest to declare. D.B. is funded by a National Institute for Health Research Clinical Doctoral Research Fellowship for this research. R.S. is supported by a Cancer Research UK Centres Network Accelerator Award Grant (A21993) to the ART-NET consortium.