Use of linear accelerators with on-board magnetic resonance imaging (MRI) for real-time MRI-guided radiation therapy treatments

Notice Santécom: 125883

Curative radiotherapy treatments (RT) are administered using an imaging-guided approach (IGRT) in the treatment room, and the most common IGRT devices are linear accelerators (linac) with on-board computed tomography (CT). Despite the quality of current technologies, certain clinical situations pose challenges for the administration of effective and safe radiotherapy treatment. Magnetic resonance-guided radiotherapy (MRgRT) is a novel IGRT modality. The MR-linac represents the latest generation of MRgRT machines.

L’INESSS was asked to evaluate the relevance of making MRgRT with MRI-linacs available to patients with tumours that are difficult to treat with conventional IGRT, and to determine the recommended conditions for introducing this technology in Québec, given its maturity.

Because of the considerable uncertainty regarding the therapeutic value of MR-linac, INESSS is of the opinion that this treatment modality should be made available only in a clinical research context. In such a case, if applicable, the purchase of these devices should:

• be limited to a small number, because of the low volume of patients for whom a potential benefit is anticipated at this time;
• include a commitment on the part of the facilities concerned to participate in generating evidence to help define the role of MR-linac in radiation oncology’s therapeutic arsenal;
• involve an agreement with the manufacturer to limit the financial risk and share the burden of generating evidence.