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Automated MR-only radiotherapy outperforms CT-based radiotherapy and decreases hands-on time for head-and-neck cancer treatment

Lookup NU author(s): JJ Wyatt, Dr Rachel Pearson

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2026 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/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.

Publication metadata

Author(s): Lauwers I, Capala M, Kaushik S, Rusko L, Cozzini C, Szabo E, Kekesi A, Deak-Karancsi B, Wyatt J, Pearson R, Verduijn G, Wiesinger F, Hernandez-Tamames J, Petit S

Publication type: Article

Publication status: Published

Journal: Clinical and Translational Radiation Oncology

Year: 2026

Volume: 58

Print publication date: 01/05/2026

Online publication date: 13/02/2026

Acceptance date: 07/02/2026

Date deposited: 21/04/2026

ISSN (electronic): 2405-6308

Publisher: Elsevier Ireland Ltd

URL: https://doi.org/10.1016/j.ctro.2026.101122

DOI: 10.1016/j.ctro.2026.101122

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