MR-linac clinical and physics evidence — on-table adaptation, gating, daily-online plan adapt. Curated daily from Europe PMC (PubMed + PMC + preprints) and OpenAlex — free-full-text link on each open-access paper.
BACKGROUND: Patient-Specific Quality Assurance (PSQA) for Elekta Unity MR-Linac treatments delivered under Comprehensive Motion Management (CMM) is challenging because beam gating, unexpected interruptions, and split sub-segments introduce delivery complexities that are not fully addressed by conventional quality assurance workflows. PURPOSE: This study aimed to develop and eva…
Nishitani M, Okamoto H, Chang W, Kuwahara J et al.
Current quality assurance phantoms often lack MR signal, deformability, or real-time dosimetry capability, limiting comprehensive end-to-end evaluation for MR-guided online adaptive radiotherapy (MRgOART), including verification of deformable image registration (DIR) accuracy and the adaptive workflow within a single phantom. This study aimed to develop a CT/MRI-compatible anth…
Deepikaa Balaji, Sonja Wegener, Sebastian Klüter, Sara L. Hackett
BACKGROUND: The accuracy of radiotherapy is limited by anatomical variations occurring over time scales ranging from sub-seconds to days. Online Adaptive Radiotherapy (OART) addresses this by enabling daily plan adaptation based on real-time imaging. While OART offers improved dose conformity, its dynamic, time-constrained workflow introduces novel failure modes that challenge …
Stereotactic ablative radiotherapy (SABR) is emerging as an alternative treatment for patients with locally recurrent prostate cancer after previous radiation. This approach allows for precise target coverage while limiting toxicity to surrounding organs. However, reported outcomes following re-irradiation of the prostate with SABR remain variable. This systematic review and me…
Adaptive radiotherapy (ART) has emerged as one of the most significant advances in modern radiation oncology, enabling increasingly precise and individualized treatment through adaptation to patient-specific changes occurring during therapy. While ART encompasses both anatomical and biological adaptation, most clinical implementation and technological development to date have f…
Magnetic resonance guided radiation therapy (MRgRT) combines magnetic resonance imaging (MRI) and radiation therapy to enable the visualization of anatomy in real time during treatment. The presence of a magnetic field in MRgRT affects charged particle radiation and detector responses, necessitating changes to traditional reference dosimetry procedures. The American Association…
Abstract Background Prostate volume changes during radiotherapy may compromise target coverage. We quantified longitudinal swelling across longer fractionation (≥15 fractions)(LFRT) and stereotactic body radiotherapy (SBRT) regimes during MR-guided adaptive radiotherapy (MRgART) to identify predictors of clinically significant swelling (CSS, defined as ≥ 15% volume increase). M…
Magnetic resonance imaging (MRI) is increasingly integrated into radiation oncology through dedicated MRI simulators and MR guided radiotherapy systems, improving target delineation and enabling adaptive treatment strategies. However, MRI introduces a distinct set of safety risks compared with conventional radiotherapy equipment, including hazards related to static magnetic fie…
Existing volumetric MRI techniques are constrained by the trade-off between acquisition time and image quality, limiting accuracy in motion-impacted sites such as the liver. To enable fast, high-quality volumetric imaging with sufficient spatiotemporal resolution, we developed a time-resolved volumetric MRI technique that recovers 3D volumes from two orthogonally acquired MR sl…
Problems: Adaptive radiotherapy requires clinically practical methods for responding to patient-anatomy changes that occur between the original planning images and the day of treatment delivery. Registering a previously acquired computed tomography scan to a newly acquired magnetic resonance image can introduce cross-modality uncertainty and may delay replanning. This thesis ev…
Yunxiang Li, Yan Dai, Yen‐Peng Liao, Jie Deng et al.
Background: Magnetic resonance imaging-guided linear accelerators (MR-Linacs) allow diffusion-weighted imaging (DWI) to be acquired at every treatment fraction, but converting these low-signal-to-noise-ratio acquisitions into clinical decisions requires both reliable quantitative processing and an interpretation that reconciles a scattered and often contradictory literature. Pu…
Aim: To evaluate the gamma-ray shielding properties of EGFR-targeting monoclonal antibodies by determining the mass attenuation coefficient (μ/ρ), effective atomic number (Zeff), electron density (Nel), exposure buildup factor (EBF), and energy absorption buildup factor (EABF).Materials and Methods: Theoretical μ/ρ values were calculated using WinXCom software, and Zeff, Nel, E…
Xiaoxia Duan, Yuxin Guo, Yanyan Yu, Sheng Li et al.
Precise anatomical understanding and spatial cognition are fundamental to effective oncologic management. While traditional two-dimensional imaging serves as the diagnostic standard, it often lacks the intuitive depth required for complex decision-making. This review synthesizes the role of visualization-driven digital technologies in oncology—including AI-driven 3D reconstruct…
Francesco Cuccia, Gianluca Mortellaro, Maria Campione, Vanessa Figlia et al.
Background The use of stereotactic body radiotherapy for primary and secondary lung lesions is well established. Although being supported by international guidelines, the application of single-fraction treatments is less reported in the literature. Methods We report a mono-institutional, retrospective analysis of inoperable patients with small lung lesions—including both primar…
Artificial Intelligence (deutsch: Künstliche Intelligenz) ACE Adult Comorbidity Evaluation -27 ANN Artificial neural network (deutsch: Künstliches neuronales Netzwerk) ASA American Society of Anesthesiologists CT Computertomographie GPT Generative Pre-trained Transformer ECOG-PS Eastern Cooperative Oncology Group -Performance Status EHR Electronic Health Record (Elektronische G…
Mean apparent diffusion coefficient (ADC) is the dominant quantitative endpoint in MR-guided radiotherapy response assessment. We prove that for any symmetric local coupling between tumour sub-regions, the coupling term cancels exactly from the volume mean. Mean ADC is therefore structurally blind to spatial interaction, not merely insensitive to it. We define the Tumour Coupli…
Peer-ReviewedPubMedClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
Oligometastatic disease (OMD) and oligoprogression are clinically actionable states in which local treatment of limited tumour burden can prolong disease control for selected patients. Randomised phase II trials support metastasis-directed therapy (MDT), usually stereotactic body radiotherapy (SBRT/SABR), in several settings, but the effect is not uniform across tumour types. S…
Rahnama N, Tanadini-Lang S, Joy VN, Elter AS et al.
Abstract Background MRI-based autocontouring has the potential to improve radiotherapy planning and adaptive workflows by reducing contouring time while maintaining clinical quality. We evaluated a prototype deep learning–based MRI autocontouring tool for organ-of-interest (OOI) and target delineation in brain metastases and prostate cancer. Methods Fifty-seven patients (27 bra…
The purpose of this study is to explore whether spacer hydrogel morphology changes during the course of stereotactic body radiation therapy (SBRT) radiation to the prostate. A total of 198 patients at our institution each received spacer gel before SBRT on magnetic-resonance-guided linear accelerator (MR-Linac) between October 2023 and March 2025. Each patient received at least…
Pisaturo O, Ghandour S, Miéville F, Pitteloud N et al.
ObjectiveAccurate modelling of dose deposition remains a central challenge in external beam radiotherapy, particularly for modern treatment systems involving complex beam configurations and magnetic field effects. While convolution/superposition (CS) algorithms are widely used in clinical treatment planning systems, they typically rely on numerical implementations and symmetric…
Background: Glioblastoma, IDH-wild-type, is a highly invasive tumor, and prognosis largely depends on the extent of resection. Contrast-enhanced (CE) MRI often underestimates tumor borders, resulting in incomplete resection. Prospective multicenter evidence on positron emission tomography (PET)/magnetic resonance (MR)-guided resection planning in newly diagnosed glioblastoma re…
Transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) allows precise focal heating under magnetic resonance imaging (MRI) guidance for neurological therapies. However, large hemispherical transducers inherently affect the transmit radiofrequency (RF) field (|B1+|) inhomogeneity, producing dark/black-band artifacts owing to general electromagnetic (EM) field inter…
BackgroundReal-time multi-class motion tracking on cine images during magnetic resonance-guided radiation therapy (MRgRT) would enable instant monitoring of anatomical structures, facilitating dynamic beam control to minimize overdose to normal tissues and maximize tumor dose. However, conventional segmentation strategies incur significant time delays, making their clinical app…
BackgroundEmerging evidence suggests that the risk of cardiotoxicity increases with increased radiation dose to coronary arteries (CAs). However, robust tools to evaluate this increased burden for cancer patients are not available due to current limitations in imaging for radiotherapy treatment planning.PurposeWe have developed a novel, statistical methodology to define coronar…
Primary liver and biliary tract cancers remain major causes of global cancer mortality, with liver and intrahepatic bile duct cancers accounting for 866,136 new cases and 758,725 deaths worldwide in 2022. Curative surgery, transplantation, ablation, embolotherapy, and systemic therapy have improved outcomes, but many patients remain limited by cirrhosis, liver reserve, vascular…
Objective: The motion of abdominal organs complicates accurate radiotherapy planning and delivery. Accurate short-term prediction of respiratory motion is essential for image-guided adaptive radiotherapy in the abdomen. This study evaluates the performance of a kernel ridge regression-based breathing motion prediction framework (KRR-BMP) for abdominal organs, with particular em…
BackgroundMagnetic resonance-guided focused ultrasound (MRgFUS) is an expanding therapy for tremor in Parkinson's disease (PD). This study aimed to characterize trajectories of tremor and cognitive functions following MRgFUS treatment over 24 hours, 1 month, and 6 months, and to explore potential predictors of outcomes.MethodsThis single-center, prospective, observational cohor…
ObjectiveMagnetic Resonance guided Radiation Therapy (MRgRT) integrates magnetic resonance imaging (MRI) with radiation delivery, providing superior soft-tissue contrast and real-time treatment guidance. For preclinical MRgRT irradiators, a critical concern is whether the ambient magnetic fields compromise the radiation dose distribution. This study aims to investigate the infl…
Gunsaulus M, Parthasarathy J, Richardson C, Schmitt C et al.
Understanding congenital heart disease requires a 3D mental framework, yet clinicians typically rely on 2D imaging. Multi-disciplinary case management conference (CMC) discussions often involve review of complex anatomy utilizing cross-sectional imaging. Mixed reality (MR) offers immersive 3D visualization that may enhance these discussions. Our objectives were to demonstrate t…
Peer-ReviewedPubMedPhysica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2026
Daly M, Choudhury A, McWilliam A, Radhakrishna G et al.
BackgroundRespiratory motion is a challenge for accurate stereotactic ablative radiotherapy (SABR) to the liver. This study compares the dosimetric impact of abdominal compression (AC), breath hold (BH) and free-breathing (FB) strategies for liver SABR on conventional C-arm linear accelerators (Linacs) and magnetic resonance Linacs (MR Linacs).MethodsFive patients undergoing li…
Arabestanino AR, Irvani SN, Vahidimoghaddam R, Ardestani MS et al.
Abstract Background Distinguishing true tumor progression (PD) from treatment-induced pseudoprogression (PsP) in glioblastoma (GBM) remains a critical imaging challenge. While liquid biopsy offers a potential non-invasive solution, its sensitivity in central nervous system malignancies is restricted by low biomarkers shedding across the blood-brain barrier (BBB). We evaluated t…
BackgroundFocused ultrasound-mediated blood-brain barrier opening (BBBO) is hypothesized to enhance liquid biopsy by facilitating the release of tumor material into the circulation. This study aimed to evaluate the impact of MR-guided FUS-BBBO on plasma extracellular vesicle (EV) concentrations and size distributions, alongside cell-free DNA (cfDNA) profiles, to determine the c…
Rationale and objectivesMR-guided focused ultrasound (MRgFUS) thalamotomy is an emerging treatment for medication-refractory essential tremor (ET), but its effects on the motor network remain unclear. This study investigated static and dynamic functional connectivity (FC) within the motor network following MRgFUS in ET and explored correlations between changes in network proper…
Background: Independent end-to-end verification of adaptive radiotherapy on MR-Linac systems is limited by the lack of patient-specific phantoms able to reproduce imaging and dosimetric properties from CT and MRI scanners. We present a method for automated generation of 4D, patient-specific, multi-material 3D-printable phantoms for quality assurance of adaptive radiotherapy on …
Purpose.Accurate modeling of intraluminal gas in synthetic computed tomography (sCT) is often compromised by the stochastic nature of bowel and rectal gas, which complicates magnetic resonance imaging (MRI)/CT deformable image registration (DIR) and necessitates time-consuming manual corrections. Here, we propose a novel, DIR-free, two-stage deep learning framework designed to …
BackgroundMagnetic resonance imaging (MRI) provides superior soft-tissue contrast compared to computed tomography (CT), making it a valuable modality for target delineation in radiotherapy. However, geometric distortion inherent to MRI can compromise spatial accuracy and remains a critical consideration in treatment planning.MethodsThis narrative review summarizes current knowl…
Background.The purpose of this study was to demonstrate the feasibility of multi-target 3D-motion tracking for use in magnetic resonance-imaging (MRI)-guided, stereotactic body radiotherapy for upper abdominal targets. This paper focuses on the clinical testing of a real-time 3D-motion tracking process for both clinical targets and organs-at risk-for automatic beam gating in MR…
Abstract Traditional surgical navigation markers rely on a fixed external reference frame. However, in mixed reality (MR) surgical navigation, the tracking camera moves with the surgeon's head, making conventional markers unsuitable for this application. This study proposes that markers for MR navigation must satisfy three design constraints: omnidirectional recognizability, X-…
PurposeThe SMART (Stereotactic MR-Guided Adaptive Radiation Therapy) protocol for prostate SBRT has demonstrated favorable clinical outcomes using a 3T-MRI for delineation and a 0.35 T MR-Linac for adaptation, addressing challenges associated with low-field MRI delineation. However, this workflow necessitates three distinct simulation scans (CT, 3T-MRI, and 0.35T-MRI), resultin…
Objective. The use of Feraheme (ferumoxytol) as a contrast agent in MR-guided focused ultrasound (MRgFUS) tumor ablations could enhance treatment safety and efficacy by improving vascular visualization through strong T1 and T2 shortening effects. However, Feraheme impact on MR thermometry and tissue heating is unclear. This study evaluates the feasibility of incorporating Ferah…
Background and purposeMR-guided radiotherapy (MRgRT) offers superior soft-tissue contrast and enables adaptive treatments which improve tumor targeting and organ-at-risk sparing. However, integrated MR-Linac systems remain financially and logistically inaccessible for many hospitals. To address this gap, we implemented a modular MRgRT workflow - termed the "Virtual MR-Linac"- w…
Campos J, Schreiber M, Barrington N, Eguh BR et al.
Glioblastoma (GBM) is the most aggressive primary malignant brain tumor in adults, with persistently poor survival despite chemoradiation and temozolomide (TMZ). Limited intratumoral drug delivery imposed by the blood-brain barrier (BBB), along with intrinsic and acquired resistance mechanisms, constrains TMZ efficacy. Focused ultrasound (FUS)-mediated BBB opening (BBBO) has em…
ObjectivesTo evaluate local tumor control and determinants of treatment success following magnetic resonance (MR)-guided microwave ablation (MWA) of liver malignancies.Materials and methodsThis single-center retrospective study evaluated prospectively included patients undergoing MR-guided MWA between September 2021 and February 2025. Procedures were performed under general ane…
ObjectiveThe objective of this study is to evaluate the 6-year clinical and technological evolution of MR-guided Laser Interstitial Thermal Therapy (MRgLITT) in a pediatric and young adult cohort. We specifically analyze the paradigm shift from "rescue therapy" to a "first-line" intervention for complex, deep-seated lesions, enabled by the transition from manual stereotaxis to …
ObjectiveAccurate targeting of the ventral intermediate nucleus (VIM) remains a critical challenge in thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD). Indirect atlas-based methods suffer from anatomical variability and poor visualization of thalamic substructures. Here, the authors evaluated the clinical impact of a direct targeting strategy…
ObjectiveReal-time tumor-tracked radiation therapy has the potential to enhance geometric treatment accuracy by adapting radiation delivery to tumor motion during irradiation. The multi-leaf collimator (MLC) plays an important role in real-time tracking, as it dynamically conforms the radiation beam to the moving target. However, an inherent time delay exists between the target…
Conti A, Grossi M, De Andrade PC, Duggento A et al.
BackgroundFocused ultrasound (FUS) combined with microbubbles enables transient and noninvasive blood-brain barrier (BBB) opening, facilitating targeted drug delivery. However, accurate treatment planning remains difficult due to inter-patient anatomical variability and the common assumption in simulations that brain tissues behave like water.PurposeTo develop and evaluate MODF…
BackgroundThe template-based treatment planning workflow in the Unity magnetic resonance-guided linear accelerator (MR-Linac) helps facilitate the treatment planning process; however, dose optimization and calculation remain time-consuming in complex cases. In addition, the deformable image registration (DIR) algorithm used during adaptive planning may produce inaccurate result…
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