ArticleClinical and translational radiation oncology2026
Automated MR-only radiotherapy outperforms CT-based radiotherapy and decreases hands-on time for head-and-neck cancer treatment.
Article in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Cancer incidence is expected to increase in Europe by 18% in eighteen years. To account for the increasing patient numbers, the workload per patient needs to be reduced. One step towards future-proof radiotherapy is automated MR-only radiotherapy as it could eliminate the need for (i) a planning CT and (ii) for manual organ at risk (OAR) delineations. The aim of this study was to evaluate the feasibility of an automated MR-only workflow for head-and-neck radiotherapy. Method: Automated MR-only radiotherapy consisted of a Zero-Echo-Time-based synthetic CT for dose calculations and automated T2w-based OAR delineations. Automated MR-Only RT was compared to the clinical workflow consisting of CT-based dose calculation and CT-based OAR delineations. Both approaches were benchmarked to a gold standard consisting of the planning CT for dose calculations and manual delineations on the T2w MR scan. Dice similarity coefficients (DSC), 95% Hausdorff distances and absolute DVH metrics were compared between the clinical and MR-only workflow using a linear mixed-effect model. A p-value < 0.05 was deemed significant. Results: Seventeen head-and-neck cancer patients were included. The automated MR-only delineations were more accurate compared to the clinical CT delineations (DSC of 0.79 vs. 0.67; 95% Hausdorff distance 4.0 vs 5.8 mm (p-values < 0.001)). The average dose calculation errors of the automated MR only RT were smaller than the clinical workflow (+0.34 Gy vs. -1.39 (p-value < 0.01)). Discussion: The automated MR-only head-and-neck radiotherapy workflow was more accurate than the standard CT based clinical workflow, demonstrating the feasibility of automated MR-only RT to decrease the workload for head-and-neck RT treatment preparation.
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