The Magnetic Resonance Imaging–Linac System

The current image-guided radiotherapy systems are suboptimal in the esophagus, pancreas, kidney, rectum, lymph node, etc. These locations in the body are not easily accessible for fiducials and cannot be visualized sufficiently on cone-beam computed tomographies, making daily patient set-up prone to geometrical uncertainties and hinder dose optimization. Additional interfraction and intrafraction uncertainties for those locations arise from motion with breathing and organ filling. To allow real-time imaging of all patient tumor locations at the actual treatment position a fully integrated 1.5-T, diagnostic quality, magnetic resonance imaging with a 6-MV linear accelerator is presented. This system must enable detailed dose painting at all body locations.