What does Mayo say about MRgRT (e.g. MRIdian)?

Mayo doesn't have operable MRIdian, though that may change. I think they have a broken machine. I called and called both Rochester and Scottsdale and was assured that they both were using the MRIdian Viewray. The staff just doesn't know. It was particularly aggravating to waste time and cash with an appointment that was useless. I tried to get a reduction in fee, though I felt like I shouldn't pay at all having been completely misled. No luck.
New patient coordinators at both facilities told me that they had capability, so don't be misled.
That said, I don't think for a second that they misled me purposefully. And I don't think the doctors would push you in deceitful way.
At UCLA Kishan (who also has an inoperable MRIdian) said that the technology has developed so much since the Viewray studies that he could get close to what the Viewray MRIdian can do. But the advantage is in the margin reduction from 3mm with all other equipment to 2mm with MRIdian.
My understanding is that the company has been invested out of bankruptcy. I would think that anyplace (Mayo included) would contract with the new ownership for repairs if they've already purchased the MRIdian.
Were I in your situation, I would find a Viewray MRIdian and travel.

@johnpca, I was able to get some information for you. Mayo Clinic does not currently use MRI guided Adaptive Radiotherapy systems like Elekta Unity; ViewRay MRIdian. For prostate cancer these systems can reduce the margins available for treatment with imaged guided adaptive radiotherapy.

Mayo Clinic in Rochester has the Ethos platform from Varian (Ethos | Varian) which provides CT-based reduced margin adaptive radiotherapy. Patients are actively being treated on this system both clinically and on clinical trials. Mayo Clinic also offers traditional photon and proton based SBRT for eligible patients. Proton beam in MN and AZ.

Implanted fiducials is standard practice for almost all prostate patients. Treatment options are based on what is best for the patient, considering treatment outcomes and patient choice. Options may include short course proton and x-rays with seed-based alignment, adaptive radiotherapy with the Varian Ethos system, low dose rate prostate seed implants and high dose rate short-course brachytherapy.

Not all patients are candidates for MR guided radiotherapy, adaptive radiotherapy, or SBRT. It is important to consult with a radiation oncologist to determine the most appropriate treatment options for your prostate cancer.

Thanks Colleen, very helpful!

yes very helpful. The advances in radiology are immense. If I do not have any information available, it is lost in space . No one around here Fairbanks Alaska ( where there is only I radiolgist ) thinks about it. Mired in the past with casodex etc. This is my bad for not doing the homework and engaging in more modern curative intent.
thanks for the breath of fresh air.

It's really more of a comment on finances. It's rare to find places that do both MRgRT and Proton. Mostly I think because proton sucks up so much of the budget. MSK and MDA do both, but there aren't many others.

What is MSD?

A previous RO told me that MRI has not been embraced because the treatment sessions can take too long. The radiation shuts off if the target goes out of the preselected area- due to peristalsis or a gas bubble. It only comes on when the target is back in range thereby minimizing marginal tissue damage. Some sessions can take over 45 mins as opposed to CAT based treatment which is much shorter.
Time is money. You can treat more patients in a day using Cyberknife vs Meridian and the insurance reimbursement is the same. More patients treated = more money.

@heavyphil my experience with the Meridian was that I was in and out in about 20 minutes. There were 3 people operating the machine and monitoring the treatment, the RO, a physicist and a dosimitrist. This accounts for more labor cost but the Mirage randomized trial showed a significant difference in toxicity and side effect results between MRI guided and non mri guided radiation. So much so that there were quite a few institutions spending millions to buy both the MRIdian and now the Elekta.

Same here with the Mridian--20 minutes.

Ha! The RO probably downplayed the efficacy of it because his hospital didn’t have one! He was a highly published pompous ass anyway and I never went back.
Glad you guys had the best (IMHO) medicine has to offer!