Evidence map›Paper›PMID 41331541›Full record

ArticleLa Radiologia medica2026

Step-by-step assessment of MRI-only workflow in pelvic radiotherapy: feasibility and practical implementation.

Xin Xin, Min Liu, Jie Li, Xianliang Wang, Qingxian Zhang, Fan Wu, Bin Tang, Vincenzo Valentini, Luca Boldrini, Lucia Clara Orlandini

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in La Radiologia medica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Xin Xin *Department of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China.
Min Liu *Department of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China.
Jie LiDepartment of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China.
Xianliang WangDepartment of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China.
Qingxian ZhangThe College of Nuclear Technology and Automation Engineering, Chengdu University of Technology, Chengdu, China.
Fan WuDepartment of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China. huaomaru@163.com.
Bin TangDepartment of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China. jackytang86@163.com.ORCID http://orcid.org/0000-0001-6920-6478
Vincenzo ValentiniDepartment of Radiotherapy and Medical Oncology and Radiology, Isola Tiberina -Gemelli Isola Hospital, Rome, Italy.
Luca BoldriniFondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Lucia Clara OrlandiniDepartment of Radiation Oncology, Presicion Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China.ORCID http://orcid.org/0000-0002-7033-9689

Funding

Sichuan Province Science and Technology Support Program 2023YFWZ0004Sichuan Province Science and Technology Support Program 2024NSFSC1878
6 · The paper itself

Abstract

purposeMagnetic resonance imaging-only (MRI-only) radiotherapy workflow capitalizes on the superior soft tissue contrast of MRI while eliminating computed tomography-MRI (CT-MRI) registration uncertainties. Most existing studies focus on optimizing individual components of this workflow, i.e., synthetic CT (sCT) generation, dose calculation accuracy, and the reliability of MRI-based patient positioning, while often neglecting comprehensive evaluation of the whole clinical process and its interdependent technical requirements.

methodsA total of 55 pelvic cancer patients, who underwent the standard radiotherapy workflow based on CT-MRI co-registration and involving a variety of imaging scanners, treatment planning systems (TPSs), and linear accelerators (LINACs), were included. For each patient, a fully integrated MRI-only approach was developed through a step-by-step evaluation of the different radiotherapy phases, including MRI-alone delineation, sCT generation with dose calculation, and cone beam CT-MRI (CBCT-MRI)-guided positioning. Comparative evaluations with the standard workflow were performed for target segmentation (dice similarity coefficient [DSC] and Hausdorff distance [HD]), dose calculation (DVH parameters and gamma analysis), and daily patient positioning (CBCT-CT versus CBCT-MRI registrations).

resultsThe proposed MRI-only workflow is applicable throughout all radiotherapy phases and compatible across multiple imaging systems, treatment planning systems, and linear accelerators. MRI-only delineation showed excellent agreement for the prostate (DSC = 0.948 ± 0.028) and cervix (DSC = 0.940 ± 0.015), whereas contour agreement for the rectum and prostate bed (DSC = 0.696 ± 0.037 and 0.689 ± 0.047, respectively) fell within the range of inter-observer variability. Dosimetric comparisons revealed no significant differences between CT- and sCT-based plans (p > 0.05), with median gamma pass rates of 99.0% and 97.9% for the whole body using 3%/3 mm and 2%/2 mm criteria, respectively. CBCT-MRI registration indicated positioning errors comparable to CBCT-CT.

conclusionMRI-only pelvic radiotherapy workflows are clinically feasible through customized protocols for target and OAR segmentation, MRI scanner setup and immobilization, sequence selection, sCT-based dose calculation validation, and CBCT-MRI matching reliability.

Indexed as

Magnetic Resonance ImagingPelvic NeoplasmsRadiotherapy, Image-GuidedRadiotherapy Planning, Computer-AssistedWorkflowAgedCone-Beam Computed TomographyFeasibility StudiesFemaleHumansMaleMiddle AgedPatient PositioningRadiotherapy DosageReproducibility of ResultsTomography, X-Ray ComputedGamma analysisImage registrationMRI-only workflowRadiotherapySynthetic CT

Identifiers

PMID41331541
PMCPMC13102943

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.