MR guided FUS

[beachbum87]

Hey everyone, M1 here and first time posting in this forum. I wanted to ask the residents and attendings what you all think about MRgFUS. How do you think this is going to affect radiation oncology down the road? Will radiologists be the only ones using this modality, or do you think it would be incorporated into radiation oncology training if it catches on as a better therapeutic option?

I've been interested in RO and have done some preceptor work but was kind of taken back when I heard a presentation by a radiologist talking about this MRgFUS. She (the radiologist) may have just been really excited about this since it's her thing, but the way she was talking, it could really cut into part of what radiation oncology treats today.

Here's a paper that I found helpful, but most of the authors were from departments of Radiation Oncology. So, back to my initial question, who is performing these procedures and who do you think will do this in the long run ( i know it's impossible to predict, but any guess is appreciated).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724793/

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[Gfunk6]

This is a temperature ablative technology. As such, okay to use in organs at risk with parallel arrangement (bones, uterus). Currently, not a great idea to use in situations where organs at risk have a serial arrangement (CNS, spinal cord) or where there is a lot of motion (lung, liver). The one tremendous advantage that photons have is reliable, accurate, and reproducible dose distribution which can be calculated prior to treatment (dosimetry).

As I understand it, non-invasive temperature sensing technology has a long way to go for development. You can burn the hell out of the target, but how can you know for sure that peripheral tissues won't be damaged? This is part of the reason why hyperthermia for deep targets is not widespread.

Also, you have high capital costs for a machine that is a one-trick pony and may not be reimbursed. Linacs, on the other hand, are versatile workhorses and can do 2D palliation up to SBRT/SRS.

As to turf wars, I expect it will be heterogeneous between Rad Onc and IR but probably more with the former. IR tends to be not as interested with non-invasive techniques.

 

[beachbum87]

Thanks so much for your response, Gfunk6. I appreciate it.