Magnetic resonance image guidance in external beam radiation therapy planning and delivery

The use of magnetic resonance (MR) imaging in radiation oncology is improving dramatically. This review article discusses the necessity of image guidance and how MR finds a significant place in radiotherapy planning and delivery. The challenges to and current solutions for an in-house MR simulation, dedicated MR simulator, estimation of electron density using MR image sets and development of MR-compatible treatment planning systems are presented. This article also reviews the feasibility, advantages and limitations of MR image-guided radiation therapy (MR-IGRT) and its drive toward the integration of radiation beams with MR technology. Specifications of Co-60 MR technology and three other MR-linac projects worldwide are presented. Online and real-time MR guidance is also discussed.