BOSTON — On a recent Wednesday morning at Brigham and Women’s Hospital, a team of two radiation therapists, a radiation oncologist, and a physicist sat glued to a screen filled with black-and-white scans of a torso, watching as the tissues shifted slightly with each breath.
But the cancer treatment team wasn’t imaging a real tumor. Instead they were looking at a healthy adrenal gland. The person in the machine wasn’t a patient with cancer, but an academic administrator. And to the relief of everyone involved, the machine wasn’t turned on all the way.
“I secretly stopped short. We’re not going to deliver any radiation today,” Dr. Daniel Cagney, a radiation oncologist at the hospital, laughing as he reassured the radiation therapists, physicists, and reporters in the room.
Cagney and his colleagues were doing a dry run of the newest technology to hit the halls of the radiation oncology wing of the Dana-Farber/Brigham and Women’s Cancer Center. Dozens of volunteers have signed up to help doctors, radiation therapists, and physicists here learn how to use the massive machine, which is known as an MRI-Linac, or an MRI linear accelerator.
Their training reflects a reality for hospitals across the U.S. Hospitals invest hundreds of thousands of dollars into cutting-edge technologies that offer a way to make treatments more precise. But implementing a new technology isn’t as simple as buying it or building a space for it — it can take weeks or months of training before a tool like the MRI-Linac is ready for prime time with actual patients.
Just a handful of U.S. hospitals have debuted the machine, which was only approved by the Food and Drug Administration in December. It’s an upgrade to the linear accelerator, a longtime workhorse of cancer care that hits a patient’s tumors with radiation. The MRI-Linac merges that machine with its other namesake, a magnetic resonance imaging scanner, or MRI. The result is a massive machine that aims to treat cancer far more precisely than the tools widely used for years.
“With the MRI-Linac, we can image better. Target better. Track the tumor in real time. … But [it also] allows us to take what we see each day and adapt the radiation plan based on the conditions of that day,” said Dr. Raymond Mak, a radiation oncologist at the cancer center.
That’s especially important when you’re hitting a tumor with radiation. Everything inside the body is constantly on the move — organs, tissues, and even tumors. A tumor can shift an inch with just a deep breath. That has made radiation therapy — which beams high-energy rays at a tumor — a challenging business. The MRI-Linac is designed to tamp down on those toxic effects by giving providers a way to watch where radiation is hitting in real time and make modifications.
“We’re able to adjust the radiation plan on the fly daily, as opposed to just [using] the same radiation plan every day and hoping everything’s in the same place,” Mak said.
The MRI-Linac even has a screen that shows patients their tumor and the radiation area. It looks like two circles of a Venn diagram, one the tumor and one the radiation. Providers have the patient hold their breath until the tumor almost completely overlaps with the radiation area. When they need to take a breath, the tumor might move out of that radiation area — and the machine automatically knows to pause the radiation until the tumor is in the right spot again.
The hospital has another new tool in its arsenal to help make radiation therapy more precise: a machine known as an MRI simulator. The radiation team creates a personalized immobilization device — essentially, a kind of cast — that holds a patient in the right spot for radiation. They suit the patient up with that device, have her slide into the MRI simulator, and then capture images that help them plan her treatment.
The hospital staff is hopeful that together, the two machines will allow them to deliver far more targeted cancer treatments.
“Our hope is that with this machine that because we can see the organ better and see the tumor better, we can deliver that high-dose, high-precision radiation to the tumor while minimizing that risk for damage to the organ,” said Mak.
But before they could use the technology with patients, the team had to learn the ins and outs of the machines. That training started with the very basics, such as making sure staff don’t roll into the scanning room with their phones stuck in their scrubs. A radiation wing isn’t used to having an MRI — which is powered by an exceptionally strong magnet — in their area like a radiology unit would be.
The radiation team has also talked with other teams that already use an MRI-Linac, hoping to glean what’s worked best for them. And in recent weeks, they have practiced with their own machine nearly every day. They often pick relatively difficult organs to image, like the adrenal gland of the academic administrator. It is situated near the bowels and stomach, which are frequently moving and churning. They want to be prepared to treat all types of tumors.
“We deliberately pick areas that are slightly tricky to trace, just to allow us to really problem solve [and] identify potential issues that may exist when we actually have to try to treat a patient with this technology,” said Cagney.
And they have a long list of volunteers ready to help with those trial runs. The 25 slots the hospital had originally opened for healthy volunteers filled up so quickly that they had to add more slots for volunteers.
“It’s really been encouraging to see the amount of support from our staff to make this happen,” Mak said. “With all this practice, we’re pretty confident when we’re ready to treat the first patient, we [will] all know our roles [and] exactly what we’re doing.”