1 INTRODUCTION

As several major non-inferiority phase 3 clinical trial studies published their promising results,^{1, 2} and as the reimbursement pattern is reforming from fee-for-service payment to episode-based payment,³ the radiation oncology field is undergoing a major paradigm shift, from a majority of standard fractionation treatments to more hypo-fractionation and stereotactic body radiotherapy (SBRT). With this change, the need to verify daily radiotherapy dose and adapt the radiotherapy plan according to daily anatomy has become essential.⁴ Currently, the most common platforms for online adaptive radiotherapy (ART) include MRI-guided ART (MRgART) and CT (or cone-beam CT)-guided ART (CTgART), both of which have only been adopted by a handful of large-scale hospital-based cancer centers around the world. As more experience is collected and technology matures, one would hope that advanced online ART platforms should become more affordable and accessible to a larger community. That brings this month's debate topic: “Future mainstream platform for online adaptive radiotherapy will be using on-board MR rather than on-board (CB) CT images.” Herein, we invited Dr. Daniel Hyer and Dr. Bin Cai to join us for this debate.

Parallel to this opinion is Dr. Daniel Hyer. Dr. Hyer received his PhD in Medical Physics from the University of Florida in 2010 and was certified by the American Board of Radiology in 2013. Dr. Hyer is currently an Associate Professor and the Director of Clinical Physics at the University of Iowa. His research interests include MRI-guided radiotherapy and proton beam therapy. On the latter topic, Dr. Hyer currently holds a National Cancer Institute grant for the development of a proton collimator. Clinically, he is the technical director of the Elekta Unity program at the University of Iowa and has been involved with the project since 2017.

Opposed to this opinion is Dr. Bin Cai. Dr. Cai is Associate Professor and Director of Advanced Physics Service in the Department of Radiation Oncology at the University of Texas Southwestern Medical Center. Dr. Cai received his Ph.D. in Physics from Ohio University and completed his medical physics residency training at Washington University School of Medicine. Dr. Cai stayed as a faculty member for 6 years at Washington University after residency. In 2021, he joined UT Southwestern to help develop the adaptive radiotherapy program as well as to lead the implementation of biology-guided radiotherapy. Dr. Cai is one of the key team members that led the clinical implementation of the world's first MRgART platform. Later he also led the clinical development and implementation of the first CBCT-guided online adaptations in the United States. Therefore Dr. Cai has extensive and balanced experience on both CTgART and MRgART platforms.

中文翻译：

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未来在线自适应放射治疗的主流平台将使用机载 MR 而不是机载 (CB) CT 图像

1 介绍

随着几项主要的非劣效性 3 期临床试验研究发表了他们有希望的结果，^1、2以及随着报销模式从按服务付费向基于发作的付费方式转变，³放射肿瘤学领域正在经历重大的范式转变，从大多数标准分次治疗到更多的低分次和立体定向全身放疗 (SBRT)。随着这种变化，验证每日放疗剂量并根据每日解剖结构调整放疗计划的需求变得必不可少。⁴目前，在线自适应放疗（ART）最常见的平台包括MRI引导的ART（MRgART）和CT（或锥束CT）引导的ART（CTgART），这两种方法都只被少数大公司采用。世界各地以医院为基础的癌症中心的规模。随着更多经验的积累和技术的成熟，人们希望先进的在线 ART 平台应该变得更实惠，更容易为更大的社区所用。这使本月的辩论话题：“未来的主流平台，在线自适应放疗将使用上-板MR而不是-板（CB）CT图像。” 在此，我们邀请了Daniel Hyer 博士和Bin Cai 博士加入我们的辩论。

与此观点相似的是 Daniel Hyer 博士。Hyer 博士于 2010 年获得佛罗里达大学医学物理学博士学位，并于 2013 年获得美国放射学委员会的认证。 Hyer 博士目前是爱荷华大学的副教授和临床物理学主任。他的研究兴趣包括MRI引导的放射治疗和质子束治疗。在后一个主题上，Hyer 博士目前持有美国国家癌症研究所用于开发质子准直器的资助。在临床上，他是爱荷华大学 Elekta Unity 项目的技术总监，自 2017 年以来一直参与该项目。

反对这种意见的是蔡斌博士。蔡博士是德克萨斯大学西南医学中心放射肿瘤学系副教授兼高级物理服务主任。蔡博士获得博士学位。在俄亥俄大学获得物理学博士学位，并在华盛顿大学医学院完成了医学物理学住院医师培训。蔡博士毕业后在华盛顿大学任教6年。2021 年，他加入 UT Southwestern，帮助开发自适应放射治疗计划并领导生物引导放射治疗的实施。蔡博士是领导全球首个 MRgART 平台临床实施的主要团队成员之一。后来他还领导了美国第一个 CBCT 指导的在线改编的临床开发和实施。