Online MR image-guided radiotherapy: MR-linac

The concept of combining magnetic resonance imaging (MRI) technology with a linear accelerator (linac) was first realised in the early 2000s. The subsequent development of the MR-linac has enabled online MR image-guided radiotherapy (MRgRT) and thus online adaptive radiotherapy.

Currently there are two clinical systems available with two more in development phase (table 1). The MRIdian system (ViewRay), consisting of a 0.35T MRI scanner combined with a three head Cobalt 60 radiation source, was first to treat a patient in 2014. In 2017, the first patient was treated on the MRIdian MR-linac (6MV) and in 2018 the first patient was treated (spinal metastases) on the Elekta clinical system, the Unity MR-linac at UMCU (Utrecht).

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