MRI-guided linear accelerator MRI—LINAC is a recently developed and advanced radiation treatment system. As indicating the name, the MRI—LINAC is fully integrated with the MRI for imaging soft-tissue tumors together with LINAC for the radiotherapy to treat cancers throughout the body.

The advantage of MRI-based imaging on a linear accelerator has superior high-definition image quality, especially for some soft-tissue cancers compared with CT-based imaging in the traditional linear accelerators to visualize the target area and adjacent anatomy for treatment setup and delivery.

The first technical prototype MR—Linac was developed and installed in the University Medical Center Utrecht in Utrecht, The Netherlands. Similar types of measurements have been performed on a hybrid MRI Cobalt device [ ].

The first clinically active MRI-guided radiation therapy machine ViewRay was installed at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital at the Washington University School of Medicine St. Louis, MO, USA. The treatment of the first patients was announced in February LINAC is affected by MRI.

Two main configurations of MRI—LINAC that are being pursued with the radiotherapy beam are either parallel or perpendicular to the main magnetic field. This configuration is affected by the interference between the delivery of the radiation beam of LINAC and MRI.

The operation of the multileaf collimator in the strong magnetic field can be a problem in the shaping of the X-ray beam [ ]. Both configurations have this problem, and vendors lowered magnetic field to minimize this issue.

Another issue in the MRI—LINAC is that the accelerated electrons used to produce the X-ray beam can be deviated or defocused, thus causing a loss of the beam current. Previous studies showed that the perpendicular configuration is dominant to the total beam loss compared with the parallel one [ , ].

Skin dose can be increased by secondary electrons owing to the influence of the magnetic field [ ]. In this case, the perpendicular configuration should be advantageous, although the electron return effect can still appear [ ].

Receiver coils can cause attenuation of the primary beam and can increase the skin dose. Detailed explanation can be found in another paper [ ]. MRI quality is also affected by the LINAC.

Any RF noise generated by the LINAC can cause artifacts or noise in images. In addition, LINAC components, such as the accelerator or multileaf collimators cause inhomogeneity of the main magnetic field, thus worsening the imaging quality [ ]. Finally, the radiation beam can affect conductors or electronics in the coil, causing imaging artifacts [ , ].

The MRI-LINAC can adapt the radiation treatment plan based on movement of the organs or tumor, and also track the motion of the tumor. This system reduces complications after radiation treatments. The MRI—LINAC can be used to improve the personalization of the radiation therapy using existing contrast imaging mechanisms, such as diffusion, perfusion, functional, and metabolic, to evaluate treatment effects.

The hybrid system has been focused on daily plan changes based on geometric changes in the organs-at-risk [ , ]. Furthermore, MRI has been used to evaluate radiation treatment effects [ ]. Currently, this hybrid system is used to treat patients with prostate cancer [ ], pelvic lymph nodes [ ], and the esophagus [ ].

The research was supported by the National Research Foundation of Korea grant funded by Ministry of Science and ICT No. The authors confirm that the data supporting the findings of this study are available within the article.

Conceptualization: Geon-Ho Jahng. Data curation: Geon-Ho Jahng, Soonchan Park, Chang-Woo Ryu, and Zang-Hee Cho. Writing—original drafting: Geon-Ho Jahng.

Keywords : Magnetic resonance imaging, History, Technical development, Clinical application, Review. Current Issue Archives. Chang Hyun Yoo 1 , Junghwan Goh 1 , Geon-Ho Jahng 2. Yona Choi 1,2 , Kook Jin Chun 2 , Eun San Kim 2 , Young Jae Jang 1,2 , Ji-Ae Park 3 , Kum Bae Kim 1 , Geun Hee Kim 4 , Sang Hyoun Choi 1.

Received : May 29, ; Revised : August 1, ; Accepted : September 1, International contributions The first nuclear magnetic resonance NMR signals from a living animal were acquired from an anesthetized rat in [ 1 ]. Figure 1. Timeline of MRI developments and summary of the major contributions.

MRI, magnetic resonance imaging; M, magnetic; R, resonance; I, imaging; F, functional; NMR, nuclear magnetic resonance; BOLD, blood oxygen level-dependent; NIH, National Institutes of Health; PET, positron emission tomography; MRI—LINAC, MRI-guided linear accelerators.

Domestic contributions The first MRI system was developed by the Korean Advanced Institute of Science and Technology Daejeon, Korea , and was installed in Shin Hwa Hospital Shin Hwa Nursing Hospital, Seoul, Korea in Development of basic imaging contrast In , spin echoes and free induction decay were detected by Hahn [ 13 , 14 ].

Figure 2. Patient cases to show imaging contrasts acquired from a year-old female, b year-old male, and c year-old male using a 3 T MRI system.

Technical developments Several pulse sequences for fast imaging were developed, such as TSE or turbo field echo, half-Fourier, single-shot turbo spin echo HASTE , gradient and spin echo GRASE , balanced steady-state free-precession bSSFP , EPI, and spiral [ 20 ].

Clinical applications Ultrafast imaging is used to eliminate the effects of physiological motion, thus capturing dynamic events in real time or shortening the total scan time.

Technical developments Diffusion-weighted imaging DWI was developed to investigate microstructural properties by evaluating the proton diffusion process. Clinical applications Diffusion MRI techniques, including DWI, DTI, and tractography, are currently extensively used in clinical settings.

Technical developments Details of perfusion MRI were summarized in a previous paper [ 77 ]. Clinical applications Perfusion MRI is a promising tool used to assess stroke, tumors, and neurodegenerative diseases.

Technical developments of MRS 1 Pulse sequences A single voxel spectroscopy SVS study is performed with short or long TE values.

Molecular imaging tools other than MRS CEST can be used to apply molecular imaging [ ]. Clinical applications The goal of clinical spectroscopy is to provide physicians with biochemical information that will assist in the differential diagnosis when standard clinical and radiologic tests fail or are too invasive.

PET—MRI PET—MRI is an imaging system that incorporates MRI and PET to gain from the benefits of soft tissue morphological imaging MRI and metabolic imaging PET. MR-guided focused ultrasound surgery High-intensity focused ultrasound HIFU is a noninvasive therapeutic technique that uses nonionizing ultrasonic waves to heat tissue [ ].

MRI-guided linear accelerator MRI-guided linear accelerator MRI—LINAC is a recently developed and advanced radiation treatment system.

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