MRI Safety and Disaster Management for MR-Simulator and MR-Linacs

Magnetic resonance imaging (MRI) is increasingly integrated into radiation oncology through dedicated MRI simulators and MR guided radiotherapy systems, improving target delineation and enabling adaptive treatment strategies. However, MRI introduces a distinct set of safety risks compared with conventional radiotherapy equipment, including hazards related to static magnetic fields, radiofrequency energy deposition, gradient switching, and cryogenic systems. Despite the growing adoption of MRI in radiation oncology, most reported safety incidents and lessons learned originate from radiology settings. While prior work has described implementation considerations for MRI and MR guided radiotherapy programs, there remains limited literature connecting potential disaster scenarios with their consequences within radiation oncology workflows. This review focuses on evidence primarily reported in radiology, together with clinical experience, to contextualize potential disaster scenarios, their consequences, and mitigation strategies within radiation oncology environments. Key disaster scenarios are examined, including projectile incidents, thermal injuries, cryogen related events, fires, and medical emergencies, with representative cases illustrating the impact of failures in screening, access control, and operational protocols. The manuscript further outlines essential infrastructure considerations, emergency response strategies, and governance frameworks required for safe implementation. Risk mitigation strategies are discussed with emphasis on structured safety programs, staff training, patient screening, incident reporting, and simulation based preparedness. MRI safety in radiation oncology requires a coordinated, multidisciplinary approach to prevent rare but potentially catastrophic events and to support the safe expansion of MRI integrated treatment technologies.