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. 2025 May;26(5):e70073.
doi: 10.1002/acm2.70073. Epub 2025 Mar 16.

Facilitating 1.5T MR-Linac adoption: Workflow strategies and practical tips

Madeline Michel  1 , Zelda Paquier  2 , Christelle Bouchart  1 , Akos Gulyban  2 , Nicolas Jullian  1 , Dirk Van Gestel  3 , Sara Poeta  2 , Nick Reynaert  4 , Philippe Martinive  1 , Robbe Van Den Begin  1
Affiliations

Facilitating 1.5T MR-Linac adoption: Workflow strategies and practical tips

Madeline Michel et al. J Appl Clin Med Phys. 2025 May.

Abstract

Background: MR-guided radiotherapy (MRgRT) offers new opportunities but also introduces workflow complexities requiring dedicated optimization. Implementing magnetic resonance linear accelerator (MR-Linac) technology comes with challenges such as prolonged treatment times and workflow integration issues.

Purpose: We present here our experience and share practical tips and tricks to streamline MR-Linac implementation, optimize workflow efficiency, and improve coordination.

Methods: The first 150 patients treated with a 1.5T MR-Linac Unity® at our institution were analyzed. Treatments were assessed based on session recordings, difficulties encountered were identified, and solutions documented.

Results: A total of 726 fractions were delivered, with a mean treatment time of 48 minutes. Key optimizations included standardized operating procedures (SOPs) and structured briefing sheets, leading to reduced delays and improved treatment consistency.

Conclusion: Strategic workflow standardization and optimized communication tools significantly improved the ability to deliver high-quality, patient-centered care by streamlining processes and enhancing coordination among team members. These insights provide practical guidance for centers integrating MR-Linac technology.

Keywords: MR‐Linac; MR‐guided radiotherapy (MRgRT); adaptive radiotherapy; workflow optimization.

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Conflict of interest statement

The Institut Jules Bordet radiation oncology department is a reference site for Elekta and has an ongoing research agreement with Elekta, which is independent of this work. Otherwise, the authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Treatment workflow step by step. The workflow starts with patient welcoming, positioning, and acquisition of a planning magnetic resonance imaging (MRI) for treatment adaptation. The new image is matched to the reference image to determine the adapt‐to‐position (ATP) or adapt‐to‐shape (ATS) pathway. For ATP, rigid registration is performed, and dosimetry is recalculated based on the shift. For ATS, deformable registration is followed by re‐contouring, re‐planning, and a verification MRI to confirm stability before plan approval. Treatment proceeds with cine‐MRI or CMM during beam‐on, and a post‐irradiation MRI completes the process. *CMM includes template validation before plan approval (not used here). **CMM also enables adjustments during beam‐on.
FIGURE 2
FIGURE 2
Screen recording set‐up.
FIGURE 3
FIGURE 3
Time distribution (in minutes) per treatment step and per fraction and stratified based on adapt‐to‐shape (ATS) (orange) or adapt‐to‐position (ATP) (blue).
FIGURE 4
FIGURE 4
Boxplot of total time (in minutes) spent on the table per pathology.
See this image and copyright information in PMC

References

    1. de Leon J, Twentyman T, Carr M, Jameson M, Batumalai V. Optimising the MR‐Linac as a standard treatment modality. J Med Radiat Sci. 2023;70(4):491‐497. doi:10.1002/jmrs.712 - DOI - PMC - PubMed
    1. Ocanto A, Torres L, Montijano M, et al. MR‐Linac, a new partner in radiation oncology: Current landscape. Cancers. 2024;16(2):270. doi:10.3390/cancers16020270 - DOI - PMC - PubMed
    1. Corradini S, Alongi F, Andratschke N, et al. MR‐guidance in clinical reality: Current treatment challenges and future perspectives. Radiat Oncol. 2019;14(1):92. doi:10.1186/s13014-019-1308-y - DOI - PMC - PubMed
    1. Stanescu T, Shessel A, Carpino‐Rocca C, et al. MRI‐guided online adaptive stereotactic body radiation therapy of liver and pancreas tumors on an MR‐Linac system. Cancers. 2022;14(3):716. doi:10.3390/cancers14030716 - DOI - PMC - PubMed
    1. Liu X, Li Z, Yin Y. Clinical application of MR‐Linac in tumor radiotherapy: A systematic review. Radiat Oncol. 2023;18(1):52. doi:10.1186/s13014-023-02221-8 - DOI - PMC - PubMed

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