Implementation of Magnetic Resonance Imaging-Guided Radiation Therapy in Routine Care: Opportunities and Challenges in the United States

Charisma Hehakaya; Ankur M Sharma; Jochem R N van der Voort Van Zijp; Diederick E Grobbee; Helena M Verkooijen; Enrique W Izaguirre; Ellen H M Moors

doi:10.1016/j.adro.2022.100953

Implementation of Magnetic Resonance Imaging-Guided Radiation Therapy in Routine Care: Opportunities and Challenges in the United States

Adv Radiat Oncol. 2022 May 25;7(5):100953. doi: 10.1016/j.adro.2022.100953. eCollection 2022 Sep-Oct.

Authors

Charisma Hehakaya¹, Ankur M Sharma^{2

3}, Jochem R N van der Voort Van Zijp¹, Diederick E Grobbee^{4

5}, Helena M Verkooijen^{1

4}, Enrique W Izaguirre², Ellen H M Moors⁶

Affiliations

¹ Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands.
² University of Tennessee Health Science Center, Memphis, Tennessee.
³ Centre for Evidence-Based Medicine and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
⁴ Utrecht University, Utrecht, The Netherlands.
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
⁶ Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht University, The Netherlands.

Abstract

Purpose: Magnetic resonance image (MRI)-guided radiation therapy with the 1.5 Tesla magnetic resonance linear accelerator (MR-Linac) is a rapidly evolving and emerging treatment. The MR-Linac literature mainly focused on clinical and technological factors in technology implementation, but it is relatively silent on health care system-related factors. Consequently, there is a lack of understanding of opportunities and barriers in implementing the MR-Linac from a health care system perspective. This study addresses this gap with a case study of the US health care system.

Methods and materials: An exploratory, qualitative research design was used. Data collection consisted of 23 semistructured interviews ranging from clinical experts at the radiation therapy and radiology department to insurance commissioners in 7 US hospitals. Analysis of opportunities and barriers was guided by the Nonadoption, Abandonment, Scale-up, Spread and Sustainability framework for new medical technologies in health care organizations.

Results: Opportunities included high-precision MR-guidance during radiation therapy with potential continued technical advances and better patient outcomes. MR-Linac also offers opportunities for research, professional, and economic development. Barriers included the lack of empirical evidence of clinical effectiveness, technological complexity, and large staffing and structural investments. Furthermore, the presence of patients with disadvantaged socioeconomic background, and the lack of appropriate reimbursement as well as regulatory conditions can hinder technology implementation.

Conclusions: Our study confirms the current literature on implementing the MR-Linac, but also reveals additional challenges for the US health care system. Alongside the well-known clinical and technical factors, also professional, socioeconomic, market, and governing influences affect technology implementation. These findings highlight new connections to facilitate technology uptake and provide a richer start to understanding its long-term effect.