The MRIdian – an advanced MR linac

Written in association with: Dr Crispin Hiley
Published: | Updated: 30/10/2024
Edited by: Karolyn Judge

The MRIdian is a groundbreaking technology that combines high-resolution magnetic resonance imaging (MRI) with precise radiotherapy to treat tumours with exceptional accuracy. Known as magnetic resonance image-guided radiotherapy (MRIgRT), this method offers significant advantages over conventional radiotherapy by enabling real-time visualisation of tumours and their movement during treatment.

The MRIdian is a groundbreaking technology in tumour treatment.

What are the benefits of MRIdian?

 

Accurate targeting


The MRIdian uses real-time MRI to continuously monitor the exact location and shape of the tumour throughout treatment. This allows for precise targeting of the radiation beam, ensuring it hits only the tumour while sparing surrounding healthy tissues.

 

Greater control and precision


Uniquely, the MRIdian offers automated beam control. If the tumour moves, even slightly, during the procedure, the system will automatically pause the radiation beam until the tumour returns to its optimal position. This feature reduces the risk of damaging nearby organs and tissues.

 

Reduced side effects


Because the radiation is so precisely targeted, the likelihood of side effects is significantly reduced compared to conventional radiotherapy, which often affects healthy tissue around the tumour. This increased accuracy means fewer complications and a better quality of life for patients.

 

Fewer treatment sessions


Where traditional radiotherapy may require up to 37 sessions, the MRIdian's focused precision means that many patients only need five sessions. This not only reduces the overall treatment time but also minimises disruption to patients' daily lives.

 

 

Who can benefit from MRIdian treatment?

 

More than 20,000 people worldwide have already benefitted from MRIdian treatment, particularly those with tumours located near vital organs or in areas that are prone to movement, such as the lungs, liver and pancreas. The MRIdian’s precision makes it suitable for treating:

 

  • Lung cancer
  • Pancreatic cancer
  • Prostate cancer
  • Kidney cancer
  • Liver cancer

 

It's also beneficial in cases where cancer has metastasised (spread to other areas) and in treating areas previously irradiated, where additional radiation poses greater risk.

 

 

What does MRIdian treatment involve?

 

The process involves four key stages:

  1. Simulation appointment
    Before starting treatment, a simulation scan will be performed to assess your tumour and determine the most accurate treatment plan. You’ll be briefed on preparation instructions during this appointment.
  2. Planning
    Your care team will use the simulation data to create a detailed plan tailored to the size, shape, and location of your tumour. This plan ensures the radiation dose is delivered with maximum precision.
  3. Treatment
    The actual treatment typically involves five sessions, either over alternate days or consecutively, depending on your condition and location of the tumour. Each session is quick, with real-time MRI imaging ensuring the radiation is delivered only when the tumour is in the correct position.
  4. Follow-up
    After treatment, follow-up appointments will monitor your progress and check for any side effects. The care team will provide ongoing support and guidance throughout your recovery.

 

What are the side effects of MRIdian treatment?

 

 

The side effects of MRIdian treatment, for example: for lung cancer, can vary based on the tumour's location within the lungs and its proximity to other organs. Here is a breakdown of possible short- and long-term side effects patients may experience during and after lung radiotherapy with MRIdian.

 

Short-term side effects

 

During the treatment course, patients may notice certain side effects, which usually subside within three to four weeks. Common short-term effects include:

  • Fatigue: A general feeling of tiredness, which is common in most radiotherapy treatments.
  • Dry cough: Often a mild and manageable symptom.

 

Less commonly, patients may experience:

  • Inflammation of lung tissue: This can cause discomfort and may need management.
  • Shortness of breath: This may arise but is usually mild.
  • Fever: A less common response but one to monitor.
  • Skin reactions: Skin may show signs of redness (in people with lighter skin tones) or darkening (in people with brown or black skin) near the treatment area.

 

 

Long-term side effects

 

Long-term effects of MRIdian radiotherapy are largely influenced by the tumour’s position and proximity to nearby organs. Attending follow-up appointments is vital to monitor, detect, and address any issues early on. Your consultant will discuss which, if any, of these side effects that you may be likely to experience, and they will provide advice on managing them effectively. For example, some patients may experience lasting fatigue, minor respiratory issues or very localised changes in skin colour.

 

In addition to physical follow-ups, psychological support and wellbeing therapies are also available.

 

The MRIdian represents a major advancement in cancer treatment, offering unparalleled precision and reduced side effects. It is particularly useful for tumours located near critical organs and for patients requiring re-irradiation. With fewer treatments needed, it offers an effective and more comfortable experience for patients undergoing radiotherapy.

By Dr Crispin Hiley
Clinical oncology

Dr Crispin Hiley is an internationally recognised expert in oncology, bringing cutting-edge science and compassionate care to his patients. Privately practising at London Cromwell Hospital, LOC (Leaders in Oncology Care) at The Harley Street Clinic - HCA Healthcare and Proton International @ UCLH, he specialises in all the different kinds of lung cancer and also possesses a significant amount of expertise in chemotherapy, cancer immunotherapy, radiotherapy and proton beam therapy, as well as mesothelioma, amongst many others.

As an Associate Professor in Oncology at University College London and a Consultant Oncologist at University College London Hospital, Dr Hiley is at the forefront of cancer treatment and research. He also serves as the Clinical Director for Lung Cancer at GenesisCare UK, which offers private healthcare across 14 specialist centres in the UK.

Dr Hiley is dedicated to providing personalised care tailored to each patient's unique needs. He is available for private consultations in London and offers comprehensive chemotherapy and radiotherapy services across the UK. For patients who prefer treatment at home, he can arrange for chemotherapy to be administered where appropriate.

Specialising in non-surgical treatments for lung cancer, Dr. Hiley is an expert in chemotherapy, immunotherapy and targeted therapy, alongside radiotherapy, including advanced techniques such as volumetric arc therapy (VMAT), intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT) as well as proton therapy and stereotactic radiotherapy (SBRT).

Through his work in clinical trials and translational research Dr Hiley has published important research in the mechanism of resistance to EGFR inhibitors such as Osimertinin and immunotherapy such as Atezolizumab and Pembrolizumab.

As the UCLH Lead for Lung Proton Therapy, Dr Hiley was the first oncologist in the UK to treat lung cancer patients with this cutting-edge technology. He is also the chief investigator of the HIT-MESO trial, which explores the use of proton beam radiotherapy for mesothelioma patients. Through his role with Proton International@UCLH, Dr Hiley offers advanced proton therapy treatments for private patients.

Dr Hiley’s expertise extends beyond lung cancer. He specializes in stereotactic radiotherapy (SBRT) for oligo metastatic and oligo progressive diseases in various cancers, including breast, prostate and colorectal, gynaecological, sarcoma and lung.

He utilises state-of-the-art technology, including MRI-guided SABR with the ViewRay MRIdian system, to treat challenging tumour lesions. Additionally, he offers reirradiation therapy for patients who have previously undergone radiotherapy.

Dr Hiley graduated with honours from the University of Manchester in 2005 and has trained at prestigious institutions such as the Christie Hospital, MD Anderson Cancer Centre, Kings College, and the Royal Marsden. He holds a PhD from the University of London and has completed postdoctoral research fellowships at the Francis Crick Institute and the UCL Cancer Institute.

As a consultant since 2018, Dr Hiley leads the clinical oncology lung team at UCLH. His roles include UCLH Lead for Lung Proton Therapy, Deputy Lead of Clinical Trials for the CRUK Lung Cancer Centre of Excellence and NIHR Clinical Research Network Specialty Research Lead in Radiotherapy for North London.

He heads a research group focused on understanding resistance to cancer treatments and is the principal investigator for numerous clinical trials. His work has been published in leading journals such as NEJM, The Lancet, Nature, and Cell. Dr Hiley also contributed to the Royal College of Radiologists Consensus Statement on Radiotherapy for Lung Cancer which defines the standard of practice in the UK.

For more details and to book a consultation with Dr Hiley, you can arrange a consultation with him at London Cromwell Hospital or at LOC (Leaders in Oncology Care) at The Harley Street Clinic - HCA Healthcare. Just select the location and time in the 'REQUEST APPOINTMENT NOW' box on the right-hand side of this page.

Dr Crispin Hiley combines world-class expertise with compassionate care to provide the best possible outcomes for his patients. If you’re seeking a top oncologist in the UK, he is here to help.

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