{"entity":{"id":"mr-linac","kind":"technology","name":"MR-guided adaptive radiotherapy","aka":[],"tldr":"An MR-linac is a radiation machine with an MRI scanner built in, so images taken during setup let the plan be re-optimised in minutes to that day's anatomy. It allows tighter margins and higher doses in pancreatic and prostate cancer, but treatment is slow and costly, and whether daily adaptation improves cure rates rather than only toxicity is unproven.","summary":"An MR-linac integrates an MRI scanner into the treatment machine, acquiring images during setup and delivery so the plan can be re-optimised in minutes to the anatomy of that day. Elekta Unity and ViewRay MRIdian enable daily online adaptation and gating on soft-tissue targets such as pancreas, prostate, and liver, allowing tighter margins and dose escalation in pancreas. The MIRAGE trial showed reduced toxicity in prostate SBRT with MR guidance. Biology-guided radiotherapy (RefleXion, PET-guided) is a parallel approach that tracks the tumour's metabolic signal instead. Slow throughput and cost are the practical limits, and whether daily adaptation improves cure rates rather than only toxicity is still being tested. The simple version is a radiation machine with an MRI inside it.","status":"established","asOf":"2026-09-04","links":[{"label":"MIRAGE: MRI-guided versus CT-guided stereotactic body radiotherapy for prostate cancer (JAMA Oncology 2023)","url":"https://doi.org/10.1001/jamaoncol.2022.6558"}],"tags":[],"related":["ring-gantry-linac","biology-guided-radiotherapy"],"cancers":["pancreatic","prostate"],"sections":["radiation"],"technologies":[],"targets":[],"drugs":[],"companies":["elekta","reflexion","viewray","philips"],"institutions":["umc-utrecht","nki","amsterdam-umc","the-christie","royal-marsden","md-anderson","tum-munich","heidelberg-nct","uw-carbone","wustl-siteman","ucla-jonsson","sunnybrook-odette"],"pathways":[],"terms":[],"trials":["nct07337876","nct06840665"],"people":[],"bottlenecks":[],"keyPapers":["paper-kishan-jama-oncol"],"journals":[],"dependsOn":["mri","imrt-igrt"],"notes":[],"principle":"Integrated MRI acquires images during setup and delivery; plan re-optimised in minutes.","strengths":["Tighter margins, dose escalation in pancreas"],"limitations":["Slow throughput","Cost"]},"route":"/technologies/mr-linac/","neighbours":{"technology":[{"id":"adaptive-radiotherapy","kind":"technology","name":"Adaptive radiotherapy (online replanning)","route":"/technologies/adaptive-radiotherapy/"},{"id":"auto-contouring-ai","kind":"technology","name":"AI auto-contouring and adaptive planning","route":"/technologies/auto-contouring-ai/"},{"id":"biology-guided-radiotherapy","kind":"technology","name":"Biology-guided radiotherapy (RefleXion X1, SCINTIX)","route":"/technologies/biology-guided-radiotherapy/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"in-room-imaging-systems","kind":"technology","name":"In-room imaging for radiotherapy (cone-beam CT, ExacTrac, CT-on-rails, HyperSight)","route":"/technologies/in-room-imaging-systems/"},{"id":"radiotherapy-equipment-manufacturing","kind":"technology","name":"Linac, proton system and brachytherapy machine manufacturing","route":"/technologies/radiotherapy-equipment-manufacturing/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"mri-field-strengths","kind":"technology","name":"MRI field strengths: 1.5 T, 3 T and 7 T","route":"/technologies/mri-field-strengths/"},{"id":"radiotherapy-qa-phantoms-dosimeters","kind":"technology","name":"Radiotherapy QA phantoms and dosimeters (Sun Nuclear, IBA Dosimetry, PTW)","route":"/technologies/radiotherapy-qa-phantoms-dosimeters/"},{"id":"treatment-planning-systems","kind":"technology","name":"Radiotherapy treatment planning and QA software","route":"/technologies/treatment-planning-systems/"},{"id":"respiratory-gating-tumour-tracking-systems","kind":"technology","name":"Respiratory gating and tumour tracking systems (RPM, ABC, Calypso, Synchrony)","route":"/technologies/respiratory-gating-tumour-tracking-systems/"},{"id":"respiratory-motion-management","kind":"technology","name":"Respiratory motion management (4D-CT, gating, breath-hold, tracking)","route":"/technologies/respiratory-motion-management/"},{"id":"ring-gantry-linac","kind":"technology","name":"Ring-gantry linacs (Halcyon, Ethos)","route":"/technologies/ring-gantry-linac/"}],"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"company":[{"id":"elekta","kind":"company","name":"Elekta","route":"/companies/elekta/"},{"id":"philips","kind":"company","name":"Philips","route":"/companies/philips/"},{"id":"reflexion","kind":"company","name":"RefleXion Medical","route":"/companies/reflexion/"},{"id":"viewray","kind":"company","name":"ViewRay (MRIdian)","route":"/companies/viewray/"}],"institution":[{"id":"astro","kind":"institution","name":"American Society for Radiation Oncology","route":"/institutions/astro/"},{"id":"amsterdam-umc","kind":"institution","name":"Amsterdam UMC / Cancer Center Amsterdam","route":"/institutions/amsterdam-umc/"},{"id":"cancer-care-alberta","kind":"institution","name":"Cancer Care Alberta (Alberta Health Services)","route":"/institutions/cancer-care-alberta/"},{"id":"champalimaud","kind":"institution","name":"Champalimaud Foundation, Champalimaud Clinical Centre","route":"/institutions/champalimaud/"},{"id":"chris-obrien-lifehouse","kind":"institution","name":"Chris O'Brien Lifehouse","route":"/institutions/chris-obrien-lifehouse/"},{"id":"estro","kind":"institution","name":"European Society for Radiotherapy and Oncology","route":"/institutions/estro/"},{"id":"heidelberg-nct","kind":"institution","name":"Heidelberg University Hospital / NCT / DKFZ","route":"/institutions/heidelberg-nct/"},{"id":"leeds-cancer-centre","kind":"institution","name":"Leeds Cancer Centre, St James's University Hospital","route":"/institutions/leeds-cancer-centre/"},{"id":"md-anderson","kind":"institution","name":"MD Anderson Cancer Center","route":"/institutions/md-anderson/"},{"id":"nki","kind":"institution","name":"Netherlands Cancer Institute (NKI-AvL)","route":"/institutions/nki/"},{"id":"wustl-siteman","kind":"institution","name":"Siteman Cancer Center, Washington University","route":"/institutions/wustl-siteman/"},{"id":"sunnybrook-odette","kind":"institution","name":"Sunnybrook Odette Cancer Centre","route":"/institutions/sunnybrook-odette/"},{"id":"the-christie","kind":"institution","name":"The Christie NHS Foundation Trust","route":"/institutions/the-christie/"},{"id":"royal-marsden","kind":"institution","name":"The Royal Marsden","route":"/institutions/royal-marsden/"},{"id":"tum-munich","kind":"institution","name":"TUM Klinikum rechts der Isar / CCC München","route":"/institutions/tum-munich/"},{"id":"ucla-jonsson","kind":"institution","name":"UCLA Jonsson Comprehensive Cancer Center","route":"/institutions/ucla-jonsson/"},{"id":"umc-utrecht","kind":"institution","name":"UMC Utrecht Cancer Center","route":"/institutions/umc-utrecht/"},{"id":"uw-carbone","kind":"institution","name":"University of Wisconsin Carbone Cancer Center","route":"/institutions/uw-carbone/"}],"trial":[{"id":"crossfire","kind":"trial","name":"CROSSFIRE","route":"/trials/crossfire/"},{"id":"nct06840665","kind":"trial","name":"MR-guided Adaptive Radiotherapy Combined With PD-1 Antibody and CAPOX for Locally Advanced Rectal Cancer","route":"/trials/nct06840665/"},{"id":"nct07337876","kind":"trial","name":"Organ Preservation in Rectal Cancer by Dose Escalated MR Guided Adaptive Radiotherapy","route":"/trials/nct07337876/"}],"paper":[{"id":"paper-kishan-jama-oncol","kind":"paper","name":"Magnetic Resonance Imaging-Guided vs Computed Tomography-Guided Stereotactic Body Radiotherapy for Prostate Cancer: The MIRAGE Randomized Clinical Trial","route":"/key-papers/paper-kishan-jama-oncol/"}],"person":[{"id":"amar-kishan","kind":"person","name":"Amar U. Kishan","route":"/people/amar-kishan/"},{"id":"bas-raaymakers","kind":"person","name":"Bas W. Raaymakers","route":"/people/bas-raaymakers/"},{"id":"claus-belka","kind":"person","name":"Claus Belka","route":"/people/claus-belka/"},{"id":"uwe-oelfke","kind":"person","name":"Uwe Oelfke","route":"/people/uwe-oelfke/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"idea":[{"id":"idea-fund-radiotherapy-innovation-pathway","kind":"idea","name":"A regulatory pathway for new radiotherapy techniques modelled on drug development","route":"/ideas/idea-fund-radiotherapy-innovation-pathway/"},{"id":"idea-fund-device-and-technique-translation-fund","kind":"idea","name":"A translation fund for academic surgical devices and radiotherapy technology","route":"/ideas/idea-fund-device-and-technique-translation-fund/"},{"id":"idea-fund-radiotherapy-trials-infrastructure","kind":"idea","name":"Core-funded radiotherapy trials infrastructure with central quality assurance","route":"/ideas/idea-fund-radiotherapy-trials-infrastructure/"},{"id":"idea-fund-adaptive-radiotherapy-evidence","kind":"idea","name":"Coverage-with-evidence registries for MR-guided and adaptive radiotherapy","route":"/ideas/idea-fund-adaptive-radiotherapy-evidence/"}],"term":[{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"roadmap":[{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}