Slotman, Berend J.Clark, Mary AnnOzyar, EnisKim, MyungsooItami, JunTallet, AgnesDebus, JuergenPfeffer, RaphaelGentile, PierCarloHama, YukihiroAndratschke, NicolausRiou, OlivierCamilleri, PhilipBelka, ClausQuivrin, MagaliKim, BoKyongPedersen, AndersFelter, Mette van OvereemKim, Young IlKim, Jin HoFuss, MartinValentini, Vincenzo2023-02-212023-02-212022-01-0110.1186/s13014-022-02114-2https://hdl.handle.net/11443/2799http://dx.doi.org/10.1186/s13014-022-02114-2Background Magnetic resonance-guided radiotherapy (MRgRT) utilization is rapidly expanding, driven by advanced capabilities including better soft tissue imaging, continuous intrafraction target visualization, automatic triggered beam delivery, and the availability of on-table adaptive replanning. Our objective was to describe patterns of 0.35 Tesla (T)-MRgRT utilization in Europe and Asia among early adopters of this novel technology. Methods Anonymized administrative data from all 0.35T-MRgRT treatment systems in Europe and Asia were extracted for patients who completed treatment from 2015 to 2020. Detailed treatment information was analyzed for all MR-linear accelerators (linac) and -cobalt systems. Results From 2015 through the end of 2020, there were 5796 completed treatment courses delivered in 46,389 individual fractions. 23.5\% of fractions were adapted. Ultra-hypofractionated (UHfx) dose schedules (1-5 fractions) were delivered for 63.5\% of courses, with 57.8\% of UHfx fractions adapted on-table. The most commonly treated tumor types were prostate (23.5\%), liver (14.5\%), lung (12.3\%), pancreas (11.2\%), and breast (8.0\%), with increasing compound annual growth rates (CAGRs) in numbers of courses from 2015 through 2020 (pancreas: 157.1\%prostate: 120.9\%lung: 136.0\%liver: 134.2\%). Conclusions This is the first comprehensive study reporting patterns of utilization among early adopters of a 0.35T-MRgRT system in Europe and Asia. Intrafraction MR image-guidance, advanced motion management, and increasing adoption of on-table adaptive RT have accelerated a transition to UHfx regimens. MRgRT has been predominantly used to treat tumors in the upper abdomen, pelvis and lungs, and increasingly with adaptive replanning, which is a radical departure from legacy radiotherapy practices.MRI-guided radiotherapyMR-IGRTStereotactic body radiotherapySBRTStereotactic ablative radiation therapySABRARToARTOn-table adaptive radiation therapyCare patternsArticleWOS:000843128200002