Integrated MRI-RT Systems Making Their Way in the Field Of Image-Guided Radiotherapy

Integrated MRI-RT platforms offer precise and effective visualization of patient’s anatomical and physiological changes; that results in greater procedural accuracy and improved therapeutic outcome

Traditionally, computed tomography (CT) has been first choice for oncologists/radiologists to outline an effective therapeutic plan. However, cancerous and normal tissues are usually tough to distinguish in several cases owing to limited contrast/resolution capability of CT imaging. Therefore, industry-academia stakeholders have constantly strived to develop innovative imaging modalities; those could be integrated with conventional radiotherapy devices for better clinical outcomes. In lieu of this, magnetic resonance imaging (MRI) is increasingly being explored by researchers across the globe especially in the field of adaptive radiotherapy; as it provides real-time visualization capabilities.

Integration of MRI-LINAC system had been a relatively unexplored territory till last decade owing to techno-commercial challenges associated with them such as significant energy loss, electromagnetic coupling, and mandatory need for magnetic shielding. Also, magnetic shielding used with MRI-LINAC system often results in reduced image quality and limited operational flexibility while requiring regular optimization of magnetic fringe field.  Leading researchers in this field are continuously trying to identify optimal MRI strength that can be utilized for effective and affordable clinical procedure.

However, with changing market need and growing provider’s preference on effective therapeutic modalities; various stakeholders are focused on development and commercialization of novel integrated platforms. Such commercially available platforms offer superior procedural capabilities such as precise radiation dose determination, high quality & real-time image acquisition, accurate tumor visualization, and operational flexibility. Moreover, these integrated MRI systems have in-built software for effective treatment planning and precise decision making process.

Therefore, radiotherapy industry players are witnessed with increasing number of partnerships and collaborations with imaging system manufacturers; that mandates development of integrated radiotherapy platforms with enhanced clinical workflow and personalized patient care. Major players in radiotherapy industry are involved in research and development of such integrated systems.  For instance, Elekta Unity (US) offers MR/RT system; that comprise of 1.5T MRI scanner (manufactured by Philips), LINAC platform, and high-quality imaging software. This product is CE mark approved, awaiting FDA approval, and is often considered superior to ViewRay MRIdian (which is the only FDA approved MRI-guided cobalt teletherapy system as of December 2018). Similarly, emerging players and research institutes are also working towards the development of innovative products in the field. One such company is the MagnetTx Oncology Solutions, Inc. with its product is the Aurora RT system (awaiting FDA approval); that offers cryogen-free 0.5T MRI system without need for vent stack.

Technological evolution of MRI to lead the future path of integrated systems

MRI is increasingly gaining acceptance for various radiotherapy application owing to associated procedural capabilities such as soft tissue visualization and improved clinical accuracy. Research pipeline analysis carried out by MarketsandMarkets™ while working on the recently published research study on Radiotherapy Market in this product area outlined several major clinical studies; those aim to expand clinical horizons of MRI-guided radiation therapy with real-time imaging and adaptive therapeutic response – said Ms. Ashwini Shetty (Healthcare Research analyst at MarketsandMarkets™).

Moreover, 4D MRI system are poised to replace 4D CT and 4D PET for potential integration with radiotherapy platforms as it offer superior resolution and imaging capabilities as compared to others. Although these platforms are expected to be premium-priced with expensive maintenance that could limit their wide spread market adoption in short term; as envisaged by Mr. Rajiv Kalia (Associate Vice President, Healthcare Research at MarketsandMarkets™).

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