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First Patient Study With Visual Biofeedback for Gating Delivery Efficiency Improvements on a 1.5 T MR-Linac.

F P D van Gameren1, P T S Borman1, L T C Meijers1

  • 1Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.

International Journal of Radiation Oncology, Biology, Physics
|February 23, 2026
PubMed
Summary
This summary is machine-generated.

Biofeedback (BF) during radiotherapy gating treatments on an MR-linac improved delivery efficiency to 63% and enhanced patient experience. Patients found the BF system easy to use and clear, with some reporting reduced claustrophobia.

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Area of Science:

  • Medical physics
  • Radiotherapy technology
  • Clinical oncology

Background:

  • Breathing motion in abdominothoracic lesions introduces uncertainty in radiotherapy delivery.
  • Beam gating enhances precision but increases treatment time.
  • Biofeedback (BF) may counteract extended delivery times and improve patient experience.

Purpose of the Study:

  • To investigate if biofeedback (BF) improves radiotherapy delivery efficiency.
  • To assess the impact of BF on patient experience during MR-linac treatments.
  • To evaluate patient preference for different biofeedback graphical user interfaces (GUIs).

Main Methods:

  • A 1.5 T MR-linac with cine-MRI motion monitoring was used for gated treatment delivery.
  • 36 volunteers underwent 5-minute BF sessions, with GUI preference assessed in phase one (n=12 healthy volunteers).
  • Phase two (n=24 patients) compared subject-determined breath-hold (SDBH) and fixed breath-hold (FBH) using the preferred GUI, quantifying delivery efficiency and System Usability Scale (SUS) scores.

Main Results:

  • The graph-style GUI was preferred by 67% of healthy volunteers.
  • Average delivery efficiency was 64% for SDBH and 63% for FBH in patient volunteers.
  • Patients reported high usability (SUS score: 83), ease of use (96%), clarity (92%), and 62.5% experienced reduced claustrophobia.

Conclusions:

  • Biofeedback (BF) on the MR-linac achieved 63% delivery efficiency and high patient acceptance.
  • The BF system demonstrated excellent usability and patient comfort.
  • Individual patient performance improvements suggest the need for dedicated training sessions.