MR guided radiotherapy in Heidelberg

磁共振引导放射治疗(MRGRT)有可能给放射治疗带来革命性的变化。在一个具有MR物理、辐射物理、计算机科学、诊断放射学、放射肿瘤学和内科肿瘤学领域专业知识的申请者联盟中，我们的目标是实施和开发MR引导放射治疗的方法，并将其应用于临床。MRGRT平台也将对外部用户群体的整合开放。申请者在成功开发和开拓放射治疗新技术方面有着悠久的传统，如调强放射治疗(IMRT)和立体定向身体放射治疗(SBRT)。放射肿瘤科在2014年治疗了4056名新患者。基于基础、转换和临床研究策略，我们计划探讨磁共振引导放射治疗的潜力。我们将建立6个主要研究领域，将由以下领域的经验丰富的团队开展：1)磁共振序列测试和开发，以实现最佳的分割间和分割内成像。2)新的适应策略，包括超快注册、重新规划、运动跟踪和剂量积累。3)在临床试验中对MRgRT进行临床评价，并与标准CT引导的RT和基于航天飞机的脱机MRgRT进行比较。4)剂量测定和质量保证计划，以确保实施全新的工作流程，并确保其符合法规要求。5)根据光子区的发展，探讨磁流变导质子和离子治疗的可能性。6)对这项伴随所有临床应用的耗时且昂贵的技术进行社会经济学分析。通过这一计划，将开发和探索新的特殊治疗方案。这应该能够清楚地评估一方的高投资和维护与另一方的耐心利益的权衡。我们计划确定在毒性、生活质量和生存方面获得最大改善的患者群体。有了MRGRT，在该计划获得批准后，最个性化和个性化的放射治疗方法很快就可以在海德堡开始。大学医院提供了一个MRGRT掩体，该掩体已被现有系统的两家制造商批准为合适并可供安装。原则上，拟议的项目可以用这两台机器来执行。出于科学原因，我们倾向于使用1.5T MR-LINAC系统。我们拥有操作治疗机和成功执行研究项目所需的所有工作人员。此外，目前正在招聘一个关于影像引导放射治疗的新教授职位，并将分配给这个项目。

Magnetic resonance guided Radiotherapy (MRgRT) has the potential to revolutionize the delivery of radiation therapy. In a consortium of applicants with expertise in the areas of MR physics, radiation physics, computer science, diagnostic radiology, radiation oncology and medical oncology we aim to implement and develop the method of MR-guided radiotherapy and bring it into clinical application. The MRgRT platform will also be open for integration of external user groups. The applicants have a long tradition of successful developments and pioneering of new technologies in radiotherapy like Intensity Modulated Radiotherapy (IMRT) and Stereotactic Body Radiotherapy (SBRT). The department of Radiation Oncology has treated 4056 new patients in 2014.Based on fundamental, translational and clinical research strategies we plan to investigate the potential of magnetic resonance guided radiotherapy. We will establish 6 major research areas, which will be carried by experienced groups in the following fields: 1) MR sequence testing and development for optimal inter- and intrafractional imaging. 2) New adaptation strategies including ultrafast registration, re-planning, motion tracking and dose accumulation. 3) Clinical evaluation of MRgRT within clinical trials with comparison to standard CT guided RT and offline shuttle-based MRgRT. 4) A dosimetry and quality assurance program assuring the implementation of a completely new workflow and its concordance to regulatory requirements. 5) Investigation of the possibilities of MR-guided proton and ion therapy based on the developments in the photon area. 6) Socioeconomic analysis of this time consuming and costly technique that accompanies all clinical applications.Through this program, new extraordinary treatment options shall be developed and explored. This is supposed to enable a clear assessment of the trade-off of high investment and maintenance on one side and patient benefit on the other side. We plan to identify patient groups that gain the most improvements in terms of toxicity, quality of life and survival.With MRgRT the most individualized and personalized method of radiotherapy could be started in Heidelberg very soon after approval of this program. A bunker for MRgRT is available at the University hospital which has been approved as suitable and ready for installation by both manufacturers of the available systems. In principle, the proposed projects can be performed with both machines. For scientific reasons we have a preference for a 1.5T MR-linac system.All necessary staff to operate the treatment machine and to successfully perform the research projects is available. Additionally, a new professorship on image-guided radiotherapy is currently being recruited and will be assigned to this project.