Implementation of Stereotactic MRI-Guided Adaptive Radiotherapy (SMART) for Hepatobiliary and Pancreatic Cancers in the United Kingdom - Fifty in Five.

The first MRIdian® MR linear accelerator (MR-Linac; ViewRay, Oakwood Village, Ohio) in the United Kingdom went live in December 2019 following a record installation time. Stereotactic MRI-guided Adaptive Radiotherapy (SMART) has since been implemented and has advantages of excellent soft tissue definition of both target and organs at risk (OARs), real-time target and OAR visualisation on cine-MRI, daily recontouring of target and critical OARs with live online plan adaptation/re-optimisation, and automatic respiratory-gated treatment delivery. We present a multi-disciplinary narrative and technical description of how this innovative technique was implemented for hepatobiliary (HPB) cancers. In particular, we explain how a collaborative approach and desire to push the boundaries and improve outcomes enabled 50 patients to be treated in the first five months, many with technically challenging tumours not always deliverable on other platforms. Physics, dosimetry, radiographer, and clinician perspectives on implementing SMART are presented. MRIdian® single fraction lung stereotactic ablative radiotherapy (SABR) will shortly be implemented along with innovative research in conjunction with our academic partners.

A diagnostic interview module for anabolic-androgenic steroid dependence: preliminary evidence of reliability and validity.

The syndrome of anabolic-androgenic steroid (AAS) dependence, though well recognized, remains poorly studied. In this preliminary psychometric study, American and British investigators separately administered a structured diagnostic interview module, based on recently proposed criteria for AAS dependence, to 42 male AAS users in Middlesbrough, England. Another investigator, blinded to the diagnostic interview findings, assessed self-reported symptoms of "muscle-dysmorphia"; effects of AAS on various aspects of functioning; and maximum proportion of annual income spent on AAS. We also assessed demographic measures, history of other substance use, and performance on a hypothetical AAS-purchasing task. The interview module yielded very good interrater reliability (kappa = 0.76 and overall intraclass correlation = 0.79) and strong internal consistency (Cronbach's alpha = 0.77-0.87). Men diagnosed as AAS-dependent, when compared to nondependent men, reported significantly earlier onset of AAS use, longer duration and higher maximum doses of AAS used, more frequent use of other performance-enhancing drugs, and a somewhat larger maximum percentage of income spent on AAS. Dependent users also "bought" more AAS in the hypothetical purchase task, but rated significantly more negatively the effects of AAS on their mental health-findings all suggesting that the diagnosis of AAS dependence shows construct validity. As a group, AAS users showed high preoccupation with muscular appearance, but dependence per se was not significantly associated with this measure-suggesting that the diagnosis of AAS dependence shows some evidence of discriminant validity. Collectively, these findings suggest that AAS dependence may be diagnosed reliably, with preliminary evidence for construct and discriminant validity.