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Abstract：
The new radiotherapy high field, 1.5 Tesla MRI-guided linear accelerator (MR-Linac) is being clinically introduced. Sensing and evaluating opportunities and barriers at an early stage will facilitate its eventual scale-up. This study investigates the opportunities and barriers to the implementation of MR-Linac into prostate cancer care based on 43 semi-structured interviews with Dutch oncology care professionals, hospital and division directors, patients, payers and industry. The analysis was guided by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework of new medical technologies and services. Opportunities included: the acquirement of (1) advanced MRI-guided radiotherapy technology with (2) the potential for improved patient outcomes and (3) economic benefits, as well as (4) professional development and (5) a higher hospital quality profile. Barriers included: (1) technical complexities, (2) substantial staffing and structural investments, (3) the current lack of empirical evidence of clinical benefits, (4) professional silos, and (5) the presence of patient referral patterns. While our study confirms the expected technical and clinical prospects from the literature, it also reveals economic, organizational, and socio-political challenges.
摘要：
新的放射治疗高场，1.5特斯拉MRI引导直线加速器（MR-Linac）正在临床上推出。在早期阶段感知和评估机会和障碍将有助于其最终扩大规模。本研究基于对荷兰肿瘤护理专业人员的43次半结构化访谈，调查了将MR-Linac应用于前列腺癌护理的机会和障碍。医院和部门主任，病人,付款人和行业。分析是由不采用，放弃,放大,传播,以及新医疗技术和服务的可持续性框架。机会包括：获得（1）先进的MRI引导放射治疗技术，（2）改善患者预后的潜力和（3）经济效益，以及（4）专业发展和（5）更高的医院质量。障碍包括：(1)技术复杂性，(2)大量人员配置和结构性投资，(3)目前缺乏临床获益的经验证据,(4)专业筒仓，（5）患者转诊模式的存在。虽然我们的研究证实了文献中预期的技术和临床前景，它也揭示了经济，组织，和社会政治挑战。
