UCLA Journal of Radiation Oncology SPRING 2024 - Flipbook - Page 31
UCLA RADIATION ONCOLOGY JOURNAL
MRI-GUIDED RADIATION THERAPY
AN EMERGING AND DISRUPTIVE PROCESS OF CARE:
HEALTHCARE ECONOMIC AND POLICY CONSIDERATIONS
MRI-guided radiation therapy (MRgRT) is an emerging, innovative technology that provides
opportunities to transform and improve the current clinical care process in radiation oncology. As
with many new technologies in radiation oncology, careful evaluation from a healthcare economic
and policy perspective is required for its successful implementation. In this review article, we describe
the current evidence surrounding MRgRT, framing it within the context of value within the healthcare
system. Additionally, we highlight areas in which MRgRT may disrupt the current process of care, and
discuss the evidence thresholds and timeline required for the widespread adoption of this promising
technology.
Introduction
Radiation oncology is a field constantly seeking to improve patient outcomes by bringing novel and
sophisticated treatment paradigms into the standard of care. Technological innovation in radiation
oncology often emphasizes enhancing precision and accuracy in planning and treatment delivery
by developing processes that widen the therapeutic ratio by allowing for dose-escalation to tumor
tissues while simultaneously reducing dose to surrounding normal tissues. MRI-guided radiation
therapy (MRgRT) is a rapidly emerging technology that seeks to achieve these goals through a variety
of mechanisms, including taking advantage of superior soft-tissue contrast compared with the current
standard of care CT-guided radiation therapy (CTgRT). 1 MRgRT further leverages MRI capabilities to
observe motion and deformation of tumor targets and organs at risk in real-time. This not only allows
for beam-on gating, whereby radiation is only delivered to the target structure when it falls within a
predefined gating margin, 2 but also the innovative and paradigm-shifting possibility of real-time, ontable adaptive treatment delivery 3 which can be augmented through integration of advanced imaging
techniques such as functional imaging. 4
Given the clinical promise of MRgRT, there has been significant work verifying and validating the
use of MRgRT in the United States, Europe, and Asia in recent years. 5, 6 Although still early in its
development, MRgRT appears to be capable of significantly disrupting the current process of care in
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