Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy

Daniela Thorwarth; Daniel A Low

doi:10.3389/fonc.2021.634507

Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy

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

Authors

Daniela Thorwarth¹, Daniel A Low²

Affiliations

¹ Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.
² Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States.

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.

Publication types

Review