Cancer Featured Innovation Research

Behind the research: Journey to MR-Linac first treatment a true team effort

MR-Linac team members

Sunnybrook’s MR-Linac team has been working for years to help bring this new technology to patients as part of the Cancer Ablation Therapy Program.

Here, some members of the team explain their roles, what getting Health Canada approval feels like, and what treating the first patient in Canada means to them.

Dr. Brian Keller, lead medical physicist (in photo below)

I have had the pleasure of being involved in this project since January 2013.

The initial version of this machine was a research version, which was eventually upgraded to a clinical version able to treat patients.

Over the years, our physics group in the cancer centre has worked closely with the company Elekta to help validate this machine for clinical use and to help produce a final product that is now able to treat patients.

Witnessing the evolution of this technology from inception to clinical validation to patient treatment is a unique experience that exemplifies how basic science and teamwork can lead to real benefits for our cancer patients.

Brian Keller testing MR-Linac

Brian Keller testing MR-Linac.

Darby Erler, clinical specialist radiation therapy

I’ve been the radiation therapy representative on the Clinical Workflow working group within the MR-Linac consortium since 2014, participating in the development of the clinical system and definition of workflows. Through this process, I felt it was my responsibility to ensure the patient remained the central focus and not the technology itself.  As a clinical specialist radiation therapist, I am part of the multi-disciplinary clinical implementation team here at Odette that has been establishing how use the machine safely and effectively.

It has been an amazing technologic feat to combine these technologies and the MR-Linac has the potential to change the way radiation therapy treatment is delivered with the ultimate aim of improving patient outcomes.

Shawn Binda, radiation therapist and dosimetrist

As a radiation therapist, I was tasked with becoming a subject matter expert in the MR-Linac planning system, as well as training the Radiation Therapy Team.

The diverse MR-Linac Radiation Therapy Team of treatment planners and technologists has all worked together to make this day possible.

But this is now only the beginning; it’s the first step in redefining how cancer is treated in Canada and ultimately improving patient care.

The delivery team puts a part of the MR-Linac in place in 2017.

Dr. Jay Detsky, radiation oncologist

My role in implementing the MR-Linac is to help develop protocols for how are going to treat both brain tumours and prostate cancer on the MR-Linac. My expertise in magnetic resonance imaging (MRI) also means that I will help develop the best way to use the “MR” portion of the “MR-Linac” to get the best images possible so we can best see the tumours we are treating.

Approval of the MR-Linac means we can finally start pushing the entire field of radiation oncology forward. We will figure out how much better of a radiation plan can we deliver to patients with the MR-Linac compared the conventional Linac machine, to improve cure rates and minimize the side effects of treatment.

This is an exciting time, and Sunnybrook is the first centre in Canada and one of only a handful in the world with access to this new technology. We are all looking forward to the exciting possibilities it will bring to deliver the best personalized cancer care in the world.

Dr. Irene Karam, radiation oncologist

I have been involved in integrating the MR-Linac technology into our head and neck tumour site group. As a member of the consortium, I have been involved in protocol development for adaptive radiation therapy in head and neck cancers and development of head and neck delineation guidelines (to determine the best volume of radiation to deliver).

This is an exciting time, and I am looking forward to further collaboration with other MR-Linac institutions to help further improve patient care and outcomes for our head and neck cancer population. This approval means we can finally start offering participation into adaptive clinical trials for our head and neck cancer patients, which will allow us to monitor tumour motion, size and position.

Members of the MR-Linac team during work in progress, 2017

Dr. Chia-Lin (Eric) Tseng, radiation oncologist

I am a CNS (central nervous system) and GU (genitourinary) radiation oncologist and have been quite heavily involved in the clinical implementation of these two priority anatomic sites as part of our MR-Linac vision. On the research side, I am the co-principal investigator of the Brain Tumour Site Group, which Sunnybrook is leading within the global MR-Linac Research Consortium. This work dates back to my fellowship in 2015.

The whole team is excited to translate years of preparatory work and research into a clinical reality for us to be able to treat patients under MR image guidance. The capabilities of the machine are transforming our way of thinking about motion management, adaptive radiotherapy, and more importantly personalized treatment via functional imaging and radiomics, which may allow us to individualize treatment strategies based on non-invasive imaging characteristics that can predict tumour behaviour and response.

Dr. Claire McCann, medical director and medical physicist

As medical director Odette Cancer Centre Clinical trials, I have been involved from the ethics and regulatory perspectives helping to ensure the testing, evaluation, implementation and research use of this system from a clinical and research perspective is conducted accordingly. I have also been involved as the Principal Investigator of the Volunteer Imaging study, the first clinical research study conducted on the MR-Linac, for which our first patient was scanned. I am also a co-investigator on the Momentum study and upcoming studies.

I have also been involved as a clinical medical physicist, working in the clinical implementation of the system in terms of creating novel workflows to build this adaptive radiation treatment paradigm that leverages the unique capabilities of this system. This has been a tremendous multidisciplinary effort involving physicians, therapists and physicists. I am part of the core physics team that will be involved in the daily clinical use of this technology for treatment and research.

My involvement from the regulatory and ethics side of things started before there was even a machine and so to see this system ready for clinical implementation after the complex steps, processes and tremendous learning opportunities is hugely exciting, especially given the potential of the system to change the way in which we see, treat, guide and adapt radiation treatment.

Angus Lau, MRI scientist

As the MRI scientist on the team, my role is to develop imaging techniques for the MR-Linac technology. These include new MRI scans to track moving tumours while patients are receiving their radiation treatment, and new scans to determine earlier if the treatment is working as planned, or whether changes to the treatment should be made.

We have been developing the new imaging methods with a separate MRI scanner used for radiation treatment planning over the past few years, so it is exciting to finally see these methods used to improve a patient’s radiation treatment with the MR-Linac.

James Stewart, research associate

I work on modelling and quantifying the treatments that the MR-Linac technology will provide. This helps us to determine how to best use this advanced technology for the benefit of our patients before we even start the very first treatment.

It was immensely gratifying to clear one of the last hurdles of Health Canada approval before we deployed the MR-Linac for our patients. It really demonstrates the value of the unique inter-disciplinary team here at the Odette Cancer Centre.

The MR-Linac – Elekta Unity at Sunnybrook

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About the author

Alexis Dobranowski

Alexis Dobranowski is a Communications Advisor at Sunnybrook.