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Review
. 2021 Mar 8:11:634507.
doi: 10.3389/fonc.2021.634507. eCollection 2021.

Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy

Daniela Thorwarth  1 , Daniel A Low  2
Affiliations
Review

Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy

Daniela Thorwarth et al. Front Oncol. .

Abstract

In the past few years, radiotherapy (RT) has experienced a major technological innovation with the development of hybrid machines combining magnetic resonance (MR) imaging and linear accelerators. This new technology for MR-guided cancer treatment has the potential to revolutionize the field of adaptive RT due to the opportunity to provide high-resolution, real-time MR imaging before and during treatment application. However, from a technical point of view, several challenges remain which need to be tackled to ensure safe and robust real-time adaptive MR-guided RT delivery. In this manuscript, several technical challenges to MR-guided RT are discussed. Starting with magnetic field strength tradeoffs, the potential and limitations for purely MR-based RT workflows are discussed. Furthermore, the current status of real-time 3D MR imaging and its potential for real-time RT are summarized. Finally, the potential of quantitative MR imaging for future biological RT adaptation is highlighted.

Keywords: MR-guided radiotherapy; MR-linac; MR-only radiotherapy; biologically adaptive radiotherapy; online adaptive radiotherapy; real-time adaptive radiotherapy.

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Conflict of interest statement

DT declares institutional collaborations including financial and non-financial support with Elekta, Philips, Siemens, PTW Freiburg, and IBA Dosimetry. DL declares institutional financial support by Varian.

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