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The magnetic resonance linear accelerator (MR‐Linac) offers a new treatment paradigm, providing improved visualisation of targets and organs at risk while allowing for daily adaptation of treatment plans in real time. Online MR‐guided adaptive treatment has reduced treatment uncertainties; however, the additional treatment time and resource requirements may be a concern. We present our experience of integrating an MR‐Linac into a busy department and provide recommendations for improved clinical and resource efficiency. Furthermore, we discuss potential future technological innovations that can further optimise clinical productivity in a busy department.

Abstract We present the first case in the literature of a 78‐year‐old woman with recurrent cardiac sarcoma adjacent to a bioprosthetic mitral valve treated with magnetic resonance linear accelerator (MR‐Linac) guided adaptive stereotactic ablative body radiotherapy (SABR). The patient was treated using a 1.5 T Unity MR‐Linac system (Elekta AB, Stockholm, Sweden). The mean gross tumour volume (GTV) size was 17.9 cm3 (range 16.6–18.9 cm3) based on daily contours and the mean dose received by the GTV was 41.4 Gy (range 40.9–41.6 Gy) in five fractions. All fractions were completed as planned and the patient tolerated the treatment well with no acute toxicity reported. Follow‐up appointments at 2 and 5 months after the last treatment showed stable disease and good symptomatic relief. Results of transthoracic echocardiogram after radiotherapy showed that the mitral valve prosthesis was normally seated with regular functionality. This study provides evidence that MR‐Linac guided adaptive SABR is a safe and viable option for the treatment of recurrent cardiac sarcoma with mitral valve bioprosthesis.

Abstract The introduction of magnetic resonance (MR) linear accelerators (MR‐Linac) marks the beginning of a new era in radiotherapy. MR‐Linac systems are currently being operated by teams of radiation therapists (RTs), radiation oncology medical physicists (ROMPs) and radiation oncologists (ROs) due to the diverse and complex tasks required to deliver treatment. This is resource‐intensive and logistically challenging. RT‐led service delivery at the treatment console is paramount to simplify the process and make the best use of this technology for suitable patients with commonly treated anatomical sites. This article will discuss the experiences of our department in developing and implementing an RT‐led workflow on the 1.5 T MR‐Linac.

Abstract The introduction of magnetic resonance (MR) linear accelerators (MR‐Linacs) into radiotherapy departments has increased in recent years owing to its unique advantages including the ability to deliver online adaptive radiotherapy. However, most radiation oncology professionals are not accustomed to working with MR technology. The integration of an MR‐Linac into routine practice requires many considerations including MR safety, MR image acquisition and optimisation, image interpretation and adaptive radiotherapy strategies. This article provides an overview of training and credentialing requirements for radiation oncology professionals to develop competency and efficiency in delivering treatment safely on an MR‐Linac.

Background: Analysis of Data to Advance Personalised Therapy with MR-Linac (ADAPT-MRL) is a multi-site, multinational, observational cohort registry designed to collect data on the use of the magnetic resonance linear accelerator (MR-Linac) for radiation therapy and patient outcomes. The registry will provide a linked repository of technical and clinical data that will form a platform for prospective studies and technology assessment. Methods: Design: This registry aims to include an estimated 10,000 eligible participants across Australia and other countries over a 7- to 10-year period. Participants will undergo treatment and assessments in accordance with standard practice. Toxicity and survival outcomes will be assessed at baseline, during treatment, and with 3 monthly follow-up until 24 months, patient reported outcome measures will also be collected. Participants with a variety of cancers will be included. Discussion: Data obtained from the ADAPT-MRL registry is expected to provide evidence on the safety and efficacy of the MR-Linac, a new technical innovation in radiation oncology. We expect this registry will generate data that will be used to optimise treatment techniques, MR-Linac software algorithms, evaluate participants’ outcomes and toxicities and to create a repository of adapted plans, anatomical and functional MR sequences linked to participants’ outcomes.