Author: Hafsa Zameer, Ashar Amjad, Aisha Urooj
Affiliation: Dow University of Health Science
Background:
The integration of magnetic resonance imaging with linear accelerator technology (MR-Linac) has transformed radiotherapy practice by enabling superior soft-tissue visualization and online adaptive planning. Compared with conventional Linac systems, which rely on CT-based simulation and cone-beam CT (CBCT) for setup verification, the MR-Linac allows real-time imaging and plan modification based on daily anatomical changes. This evolution has significantly influenced the workflow and clinical responsibilities of radiation therapists.
Objective:
To compare the conventional Linac and MR-Linac workflows from a radiation therapist’s perspective, highlighting differences in imaging, treatment adaptation, and professional responsibilities.
Method:
A descriptive workflow comparison was conducted, outlining each treatment phase—from simulation to treatment delivery. Key differences were analyzed regarding image acquisition, patient positioning, plan verification, adaptation, and quality assurance.
Results:
Conventional Linac workflows follow an offline planning process with fixed treatment plans and limited daily variation. MR-Linac workflows incorporate daily MR imaging, online contour review, adaptive plan optimization, and real-time motion monitoring. These steps increase treatment time but enhance target precision and organ-at-risk sparing. Radiation therapists have expanded roles in MR image assessment, adaptive decision support, MR safety, and patient communication.
Conclusions:
The MR-Linac introduces a dynamic, adaptive workflow that elevates treatment precision and expands the radiation therapist’s role. As frontline professionals, therapists are integral to the success of MR-guided adaptive radiotherapy, requiring ongoing training, multidisciplinary collaboration, and workflow refinement to ensure safe and efficient clinical implementation.