Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience

Abstract Background Main purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive MR-guided radiotherapy (MRgRT), especially new risks in workflow due to the new technique. We herein report the single center experience for the implementati...

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Autores principales:	Helena Isabel Garcia Schüler, Matea Pavic, Michael Mayinger, Nienke Weitkamp, Madalyne Chamberlain, Cäcilia Reiner, Claudia Linsenmeier, Panagiotis Balermpas, Jerome Krayenbühl, Matthias Guckenberger, Michael Baumgartl, Lotte Wilke, Stephanie Tanadini-Lang, Nicolaus Andratschke
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	MR-guided radiotherapy Online-adaptive radiotherapy Image-guided radiotherapy Risk analysis SBRT Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/943f7c1529c74adca9f52e9e253747b1
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spelling	oai:doaj.org-article:943f7c1529c74adca9f52e9e253747b12021-11-21T12:14:07ZOperating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience10.1186/s13014-021-01945-91748-717Xhttps://doaj.org/article/943f7c1529c74adca9f52e9e253747b12021-11-01T00:00:00Zhttps://doi.org/10.1186/s13014-021-01945-9https://doaj.org/toc/1748-717XAbstract Background Main purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive MR-guided radiotherapy (MRgRT), especially new risks in workflow due to the new technique. We herein report the single center experience for the implementation of (MRgRT) and present an overview on our treatment practice. Methods Descriptive statistics were used to summarize clinical and technical characteristics of treatment and patient characteristics including sites treated between April 2019 and end of March 2020 after ethical approval. A risk analysis was performed to identify risks of the online adaptive workflow. Results A summary of the processes on the MR-Linac including workflows, quality assurance and possible pitfalls is presented. 111 patients with 124 courses were treated during the first year of MR-guided radiotherapy. The most commonly treated site was the abdomen (42% of all treatment courses). 73% of the courses were daily online adapted and a high number of treatment courses (75%) were treated with stereotactic body irradiation. Only 4/382 fractions could not be treated due to a failing online adaptive quality assurance. In the risk analysis for errors, the two risks with the highest risk priority number were both in the contouring category, making it the most critical step in the workflow. Conclusion Although challenging, establishment of MRgRT as a routinely used technique at our department was successful for all sites and daily o-ART was feasible from the first day on. However, ongoing research and reports will have to inform us on the optimal indications for MRgRT because careful patient selection is necessary as it continues to be a time-consuming treatment technique with restricted availability. After risk analysis, the most critical workflow category was the contouring process, which resembles the need of experienced staff and safety check paths.Helena Isabel Garcia SchülerMatea PavicMichael MayingerNienke WeitkampMadalyne ChamberlainCäcilia ReinerClaudia LinsenmeierPanagiotis BalermpasJerome KrayenbühlMatthias GuckenbergerMichael BaumgartlLotte WilkeStephanie Tanadini-LangNicolaus AndratschkeBMCarticleMR-guided radiotherapyOnline-adaptive radiotherapyImage-guided radiotherapyRisk analysisSBRTMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENRadiation Oncology, Vol 16, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	MR-guided radiotherapy Online-adaptive radiotherapy Image-guided radiotherapy Risk analysis SBRT Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	MR-guided radiotherapy Online-adaptive radiotherapy Image-guided radiotherapy Risk analysis SBRT Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Helena Isabel Garcia Schüler Matea Pavic Michael Mayinger Nienke Weitkamp Madalyne Chamberlain Cäcilia Reiner Claudia Linsenmeier Panagiotis Balermpas Jerome Krayenbühl Matthias Guckenberger Michael Baumgartl Lotte Wilke Stephanie Tanadini-Lang Nicolaus Andratschke Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
description	Abstract Background Main purpose was to describe procedures and identify challenges in the implementation process of adaptive and non-adaptive MR-guided radiotherapy (MRgRT), especially new risks in workflow due to the new technique. We herein report the single center experience for the implementation of (MRgRT) and present an overview on our treatment practice. Methods Descriptive statistics were used to summarize clinical and technical characteristics of treatment and patient characteristics including sites treated between April 2019 and end of March 2020 after ethical approval. A risk analysis was performed to identify risks of the online adaptive workflow. Results A summary of the processes on the MR-Linac including workflows, quality assurance and possible pitfalls is presented. 111 patients with 124 courses were treated during the first year of MR-guided radiotherapy. The most commonly treated site was the abdomen (42% of all treatment courses). 73% of the courses were daily online adapted and a high number of treatment courses (75%) were treated with stereotactic body irradiation. Only 4/382 fractions could not be treated due to a failing online adaptive quality assurance. In the risk analysis for errors, the two risks with the highest risk priority number were both in the contouring category, making it the most critical step in the workflow. Conclusion Although challenging, establishment of MRgRT as a routinely used technique at our department was successful for all sites and daily o-ART was feasible from the first day on. However, ongoing research and reports will have to inform us on the optimal indications for MRgRT because careful patient selection is necessary as it continues to be a time-consuming treatment technique with restricted availability. After risk analysis, the most critical workflow category was the contouring process, which resembles the need of experienced staff and safety check paths.
format	article
author	Helena Isabel Garcia Schüler Matea Pavic Michael Mayinger Nienke Weitkamp Madalyne Chamberlain Cäcilia Reiner Claudia Linsenmeier Panagiotis Balermpas Jerome Krayenbühl Matthias Guckenberger Michael Baumgartl Lotte Wilke Stephanie Tanadini-Lang Nicolaus Andratschke
author_facet	Helena Isabel Garcia Schüler Matea Pavic Michael Mayinger Nienke Weitkamp Madalyne Chamberlain Cäcilia Reiner Claudia Linsenmeier Panagiotis Balermpas Jerome Krayenbühl Matthias Guckenberger Michael Baumgartl Lotte Wilke Stephanie Tanadini-Lang Nicolaus Andratschke
author_sort	Helena Isabel Garcia Schüler
title	Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
title_short	Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
title_full	Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
title_fullStr	Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
title_full_unstemmed	Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience
title_sort	operating procedures, risk management and challenges during implementation of adaptive and non-adaptive mr-guided radiotherapy: 1-year single-center experience
publisher	BMC
publishDate	2021
url	https://doaj.org/article/943f7c1529c74adca9f52e9e253747b1
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Operating procedures, risk management and challenges during implementation of adaptive and non-adaptive MR-guided radiotherapy: 1-year single-center experience

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