The role of diffusion-weighted MRI in biological image-guided radiation therapy: a roadmap

This roadmap provides a comprehensive framework for integrating diffusion-weighted imaging (DWI) into radiation therapy (RT), with an emphasis on its application in magnetic resonance imaging-guided radiotherapy and its potential for driving biological image-guided adaptive radiotherapy (ART). Developed through collaboration among experts in medical physics, magnetic resonance imaging science, and radiation oncology, the paper aims to bridge disciplinary gaps and foster a shared understanding across scientific, technical, and clinical domains. It benchmarks the current state of DWI in RT, identifies critical challenges, and highlights recent advancements in acquisition, reconstruction, biophysical modeling, quality assurance, clinical validation and translation, as well as emerging concepts. By outlining ongoing efforts and forecasting future developments, this roadmap supports the adoption of DWI as a quantitative imaging biomarker for personalized and ART in precision oncology.