Last November, Dr. Parag Parikh, joined the radiation oncology department at Henry Ford Cancer to lead its MR-guided radiation program. HealthCare Business News sat down with him to find out how the new role is working out and why he feels that MR-guided radiation is such a promising field for the future of cancer treatment.

HCB News: Can you tell us a bit about your background in radiation oncology and what it's been like to join the team at Henry Ford?
Parag Parikh: I attended medical school and residency at Washington University in St. Louis. I had an early interest in technology development for tracking moving tumors and worked under Dr. Daniel Low to investigate CT scanning of lung tumor respiratory motion and implantable electromagnetic transponders that could be put into the lung to help guide radiation therapy.

I continued as a faculty member at Washington University for 12 years, and our team treated the first MR-guided radiation therapy patient in the world in 2014. With the novel adaptive MR-guided radiation therapy trial by Drs. Lauren Henke and Jeff Olsen, we realized that abdominal radiation therapy would never be the same.

I returned home to Detroit to join Henry Ford in 2018. As the group with the longest-running clinical MR-linear accelerator program, it was like jumping into a well-running automobile. We now have a one month waitlist for the ViewRay and we have doubled our therapy staff to support this.

HCB News: We've been hearing a lot recently about the cutting-edge capabilities of MR-guided radiation therapy. This is a field where Henry Ford is at the cutting edge. What kind of research are you currently conducting with these tools?
PP: We have several ongoing clinical trials. First, we are leading the national SMART study [NCT NCT03621644]. This study builds upon retrospective data (Rudra, Cancer Medicine, 2019) showing an almost doubling of survival in patients who received high-dose MR-guided radiation therapy to the pancreas, as compared with standard dose radiation. This is the only study using ablative doses of radiation given over 5 fractions, and has a goal of recruiting 133 patients.

We also have a study using 5 fractions of radiation to treat prostate cancer, using the MRI to help boost the dose of the dominant nodule of prostate cancer in each patient. Finally, we have a corollary study for brain tumor patients looking at new imaging information that may inform how or when to change radiation therapy for glioblastoma.

HCB News: The MR environment has unique shielding and safety demands. Is the same true for MR-guided radiation therapy? If so, what kind of strategies are being used to make sure staff follow protocols?
PP: The MR environment is new to most radiation oncology departments and we worked hand-in-hand with our radiology colleagues to implement best practices for MR safety. We are included in the hospital-wide MR safety conferences and we also had our staff take the same training as offered to radiology staff. A robust safety culture has prevented any MR safety-related events in the two years our center has been open.

HCB News: Is MR-guided radiation therapy still primarily in the research phase or is it being used more clinically for certain indications? What is the reimbursement situation like?
PP: There are now over 20 programs offering clinical MR-guided radiation therapy. For almost all of the sites, it has certainly become the standard of care for hepatobiliary cancers, as well as small amounts of lymph node disease in the abdomen or pelvis. The ability to visualize these tumors, control for respiratory motion and change the radiation plan based on stomach and intestine position allow safer and faster ablative radiation doses.

The current reimbursement for MR-guided adaptive radiation therapy is favorable. We will obtain reimbursement for additional radiation therapy plans delivered during the radiation course if the anatomy changes in a meaningful fashion and these charges have almost universally been accepted.

HCB News: Looking ahead, what role do you imagine MR-guided radiation therapy playing in cancer treatment a decade from now? What challenges (in terms of cost, access, illustrating benefits, etc.) need to be addressed?
PP: The long-term radiation therapy practice will need to show simultaneous clinical efficacy with heightened efficiency. With the advent of the alternative payment model, essentially capitating both professional and technical charges per diagnosis in 90 day events, there is an incentive for improvement in outcomes without increasing number of treatments. MR-guided radiation therapy machines are uniquely positioned to do this, allowing safe, effective treatments in one week or less for many diseases traditionally treated over 5 ½ weeks. Moreover, some users are using their systems to do away with traditional simulation, which will shorten treatment times further and improve value for the patient. I see MR-guided radiation therapy becoming a standard machine in any dual linear accelerator clinic.

Challenges being addressed currently are treatment times, distribution of adaptive radiation responsibilities to therapists from the physician/physicists, and physician training. For a technology that is less than five years old, these steps are occurring rapidly.