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MR-Guided Radiation Therapy for Prostate and Pancreas Cancer Treatment: A Dosimetric Study Across Two Major MR-Linac Platforms
Journal article   Open access   Peer reviewed

MR-Guided Radiation Therapy for Prostate and Pancreas Cancer Treatment: A Dosimetric Study Across Two Major MR-Linac Platforms

Huiming Dong, Jonathan Pham, Michael V. Lauria, Caiden Atienza, Brett Sloman, Paul Barry, Jennifer Davis, Michael Saracen, Amar Kishan, Ann Raldow, …
Cancers, Vol.17(16), 2708
08/20/2025
DOI: 10.3390/cancers17162708
PMCID: PMC12384352
PMID: 40867337
url
https://doi.org/10.3390/cancers17162708View
Published (Version of record) Open Access

Abstract

Magnetic resonance–guided radiation therapy (MRgRT) integrates MR imaging with precise radiation delivery, enabling improved soft-tissue visualization and online adaptive planning. Elekta Unity and ViewRay MRIdian are two leading MR-linac platforms with distinct designs that may affect treatment dosimetric characteristics. This study compared prostate and pancreas cancer treatments by retrospectively re-creating 20 MRIdian clinical cases on the Unity system under MIRAGE and SMART trial protocols. Plans were matched for imaging, contours, beam geometry, and dose prescription to ensure consistency. Target coverage, organ-at-risk (OAR) doses, and treatment times were assessed. Both systems achieved comparable plan quality and efficiency, with Unity showing modest OAR dose reductions. These findings highlight the dosimetric implications of MR-linac design differences and support informed clinical and technological decision-making. Background/Objectives: MR-guided radiation therapy (MRgRT) has rapidly evolved into an important treatment modality, with the Elekta Unity and ViewRay MRIdian systems being two major MR-linac platforms. Despite the shared concept of MRgRT, the two platforms elected different system designs that could potentially impact the dosimetric characteristics and quality of a treatment. In this study, we aim to perform a comparative dosimetric investigation between these two MR-linac systems in prostate and pancreas cancers. Methods : Dosimetric characteristics were evaluated by retrospectively re-creating 20 clinical prostate and pancreas cases originally treated on MRIdian using the Unity system, adhering to MIRAGE and SMART clinical trial constraints. Treatment plans were re-created with matching planning images, structures, beam geometry, and dose parameters. To ensure comparison consistency, all Unity treatment plans were normalized to match the target coverage of the MRIdian counterparts, and the organ-at-risk (OAR) dose was investigated. Results : Most OARs’ dose-volume metrics showed no statistically significant differences. For prostate patients, Unity demonstrated lower rectum V36Gy ( p = 0.0095), V38Gy ( p = 0.0043), V40Gy ( p = 0.0469), and lower left ( p = 0.0137) and right femur V20Gy ( p = 0.0020). For pancreas patients, Unity plans had a lower mean liver dose ( p = 0.0371). All Unity plans had a Gamma passing rate > 90%, confirming the clinical deliverability. Mean delivery times were 12.78 ± 1.68 and 13.53 ± 1.88 min for MRIdian and Unity prostate plans, respectively, and 14.58 ± 2.78 and 17.40 ± 3.77 min for MRIdian and Unity pancreas plans, respectively. Conclusions : Overall, comparable treatment quality and delivery times were observed between the two platforms.
 MR-guided radiation therapy MR-linac dosimetric comparison prostate cancer pancreas cancer SBRT

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