Dr Vincent KhooGenesisCare Chief Medical Officer & Clinical Leaders Forum memberRoyal Marsden Hospital & Institute of Cancer ResearchSt George’s Hospital & University of London ONJCC & Austin Health, University of Melbourne & Monash University

MR-Linac into the UK: Rationale and applications

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My participation in this Event does not interfere with any other obligations I have undertaken, in particular in connection with my current employment (if any) and that my institution has no objections to my participation in the Event.

I acknowledge that I have no imposing duty or obligation to refer to the institution or any other health care organization, patient, or physician to any health care institution or provider supplied by GenesisCare or its affiliates or to endorse or recommend the ordering or purchasing of any product or service of GenesisCare or its affiliates.

I hereby certify that I will comply with all applicable provisions of law and other rules and regulations of any and all governmental authorities in performing my obligations under my Speaker Letter Agreement, as well as GenesisCare’s own ethics codes and policies, and that I have been furnished with copies of the relevant GenesisCare codes

and policies. I hereby agree that my will at all times fully cooperate with GenesisCare in meeting its obligations thereunder and that my will be bound by the ethical principles underlying such regulations.

I further agree to keep strictly secret all confidential information of GenesisCare or its affiliates which I learn during the Event. I will perform all services in compliance with applicable laws and regulations and apply my best efforts to the performance of the services.

I also grant GenesisCare permission to use my speech of presentation in other capacities within the Scope of Work. I also authorize and license GenesisCare to reproduce or distribute the materials used in the Scope of Work via the GenesisCare websites. GenesisCare shall maintain the appropriate attribution to Speaker. GenesisCare may modify

the materials however, any modification of statements of Speaker that would fundamentally distort the meaning of Speaker’s statements are not authorized by this authorization and license. This authorisation and license shall be for the purpose of advertising, promotion of marketing of GenesisCare and its products and services, and for

any other purpose that is in the spirit of the original Scope of Work. For example, the presentation or speech may be recorded, taped, captured via “LiveMeeting” and may be added to the GenesisCare website.

To the extent that it has not been previously collected, GenesisCare may require collecting certain personal data from my like my name and email address. GenesisCare will do so only for the purposes required under this Letter Agreement, and always in compliance with applicable law. We will only transfer my data to GenesisCare affiliates, to the extent necessary for the fulfilment of this Letter Agreement, and specifically, to Genesis Care UK Limited, Wilson House, Waterberry Drive, Waterlooville, Hampshire ,

PO7 7XX and my hereby consent to such transfer to the extent that it is done solely for the purposes of this Letter Agreement and in compliance with applicable law.

I also acknowledge that my are an independent contractor, subject to GenesisCare’s direction only as to specific interests where GenesisCare wants the benefit of my services and advice. Nothing in this Speaker Letter Agreement makes my an employee or agent of GenesisCare, or authorises Speaker to speak for, represent or obligate GenesisCare

in any way.

Disclosure

The Present

A Future

The GenesisCare Values

• Ability to “Tailor”– Dose fractionation – RT Method– RT Delivery– Efficiency

• Tumour clonogenic densities• Different locations• Inhomogenous disstributions

• Radiosensitivity & Physiology• Tumour vs NT

• Response• Quantification

• Capability to “Adapt”

RT: Ideal Aims

MRI• Greater capability

• Functional imaging– Proliferation / Apoptosis

(dwMRI)– Angiogenesis (dceMRI)– Hypoxia (BOLD MRI)– Metabolism (MRS)

• Gold standard – Soft tissue– Many disease sites

Khoo et al IJROBP 2000

RT integrated with MRI: AimsOptimal ST imaging Optimal TVD

SetupVerify

Treatment Response

Functional imaging

No surrogate vol

Motion Mx & Real-timeTracking

Biol TVD adaptation

Real

TimeDyna

mic Imaging

No RT doseIssues• Physics• Workflow• Costs

Strategic Workflow: Online, Real-time & Adaptive

Disease Adaptation, Biological Targeting

& Physiological Maintenance / Optimisation

FEEDBACK

Daily dose localisation &

prediction

RMH: MR Linac

MRI Linac: SummaryRationale Potential benefits• Machines A reality (different versions)• Physics issues Surmountable• Clinical workflows Being developed• Clinical applications Being evaluated• Outcomes To be defined in clinical trials• Efficiencies Elekta Atlantic Consortium• Costs To be defined• Future Here to stay…..

Our Future

Thank-you