MR guided radiotherapy in Heidelberg

磁共振引导放射治疗（MRgRT）有可能彻底改变放射治疗的交付。在MR物理学，辐射物理学，计算机科学，诊断放射学，放射肿瘤学和医学肿瘤学领域的专业申请人联盟中，我们的目标是实施和开发MR引导放射治疗的方法，并将其投入临床应用。MRgRT平台也将开放，以整合外部用户组。申请人在放射治疗新技术的成功开发和开拓方面有着悠久的传统，如调强放射治疗（IMRT）和立体定向体部放射治疗（SBRT）。放射肿瘤科2014年共治疗4056例新患者，基于基础、转化和临床研究策略，我们计划探讨磁共振引导放射治疗的潜力。我们将建立6个主要的研究领域，这些领域将由以下领域的经验丰富的团队进行：1）MR序列测试和开发，以实现最佳的分次间和分次内成像。2)新的适应策略包括超快配准、重新规划、运动跟踪和剂量累积。3)临床试验中MRgRT的临床评价，与标准CT引导RT和离线基于穿梭机的MRgRT进行比较。4)剂量测定和质量保证计划，确保实施全新的工作流程及其与法规要求的一致性。5)基于光子领域的发展，研究磁共振引导质子和离子治疗的可能性。6)社会经济学分析这种耗时和昂贵的技术，伴随着所有的临床应用。通过这个程序，新的非凡的治疗方案应开发和探索。这应该能够明确评估高投资和维护与患者利益之间的权衡。我们计划确定在毒性、生活质量和生存率方面获得最大改善的患者群体。随着MRgRT，最个性化和个性化的放射治疗方法将在该计划获得批准后很快在海德堡开始。大学医院有一个用于MRgRT的掩体，该掩体已被两个可用系统的制造商批准为合适的并准备安装。原则上，建议的项目可以用两台机器执行。出于科学原因，我们优先选择1.5T MR直线加速器系统。所有必要的工作人员都可以操作治疗机并成功执行研究项目。此外，目前正在招聘一个新的图像引导放射治疗教授职位，并将分配给该项目。

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.