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Development and Validation of a Magnetic Resonance Imaging-Guided Adaptive Radiotherapy Workflow for Long, Continuous

Lingling Yan1, NingYu Wang1, Ke Zhang1

  • 1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Technology in Cancer Research & Treatment
|January 19, 2026
PubMed
Summary

This study developed a new magnetic resonance imaging-guided adaptive radiotherapy (MRIgART) workflow to treat long tumors previously untreatable with MR-Linac. The validated workflow expands MRIgART applications for extended planning target volumes (PTVs).

Keywords:
MR-Linac field size limitationdose verificationdual-isocenter MRIgART workflowextended planning target volumesfield overlap region

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Magnetic Resonance Imaging

Background:

  • Current magnetic resonance (MR)-Linac systems have field size limitations restricting treatment of tumors longer than 20 cm.
  • This necessitates the development of advanced radiotherapy techniques to accommodate larger target volumes.

Purpose of the Study:

  • To develop and validate an expanded magnetic resonance imaging-guided adaptive radiotherapy (MRIgART) workflow for treating long, continuous planning target volumes (PTVs).
  • To overcome the limitations of current MR-Linac field sizes for extended PTVs.

Main Methods:

  • The proposed MRIgART workflow divides long PTVs into sub-volumes with defined isocenters and a field overlap region.
  • It incorporates adjusted MR scan ranges, online/offline adaptive procedures, synchronized adaptive processes, and pretreatment dose evaluation.
  • Validation was performed using an MR phantom, with dose verification via ArcherQA Monte Carlo, ArcCHECK phantom, and ionization chamber measurements.

Main Results:

  • The workflow demonstrated feasibility for treating PTVs up to 40 cm (minus overlap region) in two clinical scenarios (ATP and ATS/ATP).
  • Average gamma pass rates for adaptive plans were high (95.74%–98.63% for PTVs, 95.50% for overlap region).
  • Ionization chamber measurements showed less than 2% difference from calculated results, confirming accuracy.

Conclusions:

  • The developed MRIgART workflow is feasible, safe, and accurate for treating long PTVs.
  • This innovation effectively expands the clinical applicability of MRIgART to patients requiring treatment for extended target volumes.