MRI-guided brachytherapy — using magnetic resonance imaging (MRI) to precisely locate tumours in order to place internal radiation to treat the cancer while sparing normal tissues — is the ideal method to treat gynecological cancers.
At Sunnybrook, a new suite is taking that to the next level. It houses an operating room and an MRI machine in a lead-lined bunker so that patients can undergo the complex, multistep brachytherapy procedure all in one place and under general anesthetic. Currently, most brachytherapy procedures take place over the course of hours. The new suite means a faster and more streamlined experience for patients.
Ananth Ravi, PhD, a medical physicist and operations lead for brachytherapy, and Dr. Eric Leung, radiation oncologist and clinical lead for gynecological interstitial brachytherapy, agree MRI-guided brachytherapy helps them offer optimal, tailored care for each patient. But they didn’t want to stop there. Both Ananth and Eric have been involved in bringing the MR-Brachytherapy Suite to fruition — and for making it become the best it can be.
We caught up with Ananth and Eric about their work.
What makes Sunnybrook’s MRI-Brachytherapy Suite unique?
Ananth Ravi (AR): Brachytherapy strikes tumours with high doses of radiation and is used in the treatment of prostate, breast and gynecological cancers. This new suite is a Swiss Army Knife of a room. It’s got everything: operating room, radiation bunker and MRI machine for imaging. But for us, it’s more than just having a new room. It’s the possibilities this room holds.
Dr. Eric Leung (EL): Absolutely. We want to figure out: How can we use this room to make things better for our patients? How can we have even better outcomes? How can we improve the patient experience? How can we take the standard of care and take it to the next level? The new room has inspired so many research projects in these areas.
What’s one way this suite can “take things to the next level”?
EL: Right now, the patient goes under anesthetic and we put in an applicator. Then the patient goes to recovery room. They wake up. We do MR-imaging to check placement of the applicator. Then we do the radiation treatment. It can be a rather long process for patients that can take up to six hours and they may have some discomfort from the applicator, which we try to control with pain medications.
AR: Once we have all the technical things in place, we will be able to do it all in one go. That’s the full gain in the MRI-Brachytherapy Suite. We are pleased with our new suite. But we want to make things even better for our patients. And that would be doing it all in one go under general anesthetic.
EL: Yes, it’s the “real time” part. Right now, we use MRI to guide the brachytherapy planning, where the radioactive sources will go. It’s much more precise than the previous techniques, using X-rays. But our new suite has the capability for us to take this further and image MR in real time; for applicator placement, planning and even treatment. The patient won’t have to be awake with the applicator in place and instead can have the treatment all done while under anesthesia.
What does this mean for you each, personally?
AR: This is the biggest highlight of my career, getting this MR-Guided Brachytherapy Suite up and running. I started on this project when I started at Sunnybrook in 2009. But even bigger for me will be realizing the next step: making sure we can use this suite to deliver the best possible care to our patients.
EL: I agree. MR-guided brachytherapy is becoming the standard of care, but we want to elevate it even further. It’s exciting to be a part of novel things. Using MRI already improves patient outcomes. The MRI helps us provide precise, personalized treatment. Next we must improve the experiences of our patients. There are a lot of opportunities for the team to develop new techniques, improve the patient experience and ensure we are doing the absolute best we can.
AR: We have to be thinking, ‘What will the best practice be 10 years from now?’ And that’s something we are uniquely positioned to do here at Sunnybrook because of our case volumes and our specialized team. We have to balance this high-quality treatment with efficiency. So, our current way takes about 6 to 8 hours for one case. In the future, can we improve the flow by doing the planning, imaging and treatment all in one room? That’s the workflow we are working toward to provide an even better experience for our patients.
It seems like this will be a big change for workflow. How do you get the team on board to change the way you all work?
AR: Change management is a huge part of any project like this. But team engagement hasn’t been an issue for us. The brachytherapy team sees a huge number of patients, and yet I can’t even count the number of times I’ve heard a patient say thank you for the tender, individualized care they receive at their hands. We hear it so often. The team is always coming up with ways to improve the workflow and improve the patient experience. We haven’t had to pitch or sell them on anything as we move toward real-time MRI guided brachytherapy. The team is so patient-centred and they know this will be better for our patients.
EL: Change totally can be difficult if you are used to practicing one way. But the brachytherapy team puts patients first. If it’s improving quality of life for our patients, we all get on board.