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Adaptive radiotherapy · London

MR-Linac adaptive radiotherapy - private in London.

A 1.5T MRI scanner integrated with a linear accelerator, delivering daily online adaptive radiotherapy for prostate, pancreas, liver, lung and other MR-visible targets. Elekta Unity and ViewRay MRIdian centres in London and the UK.

A stethoscope on a clinical desk

What MR-Linac is

A linear accelerator with a 1.5T MRI scanner built around it.

The Elekta Unity is a 7MV linac integrated with a diagnostic-grade 1.5T MRI. The ViewRay MRIdian pairs a 0.35T MRI with a linac and cine-gating. Both deliver radiotherapy while the tumour and surrounding organs are watched in real time on MRI.

  • Real-time MRI, not CT

    Soft-tissue targets (prostate, pancreas, liver) are seen directly, without ionising imaging dose and without needing invasive fiducial markers.

  • Daily online adaptation

    Before every fraction the plan is re-optimised to today's bowel gas, bladder filling and tumour position. Yesterday's anatomy is not tomorrow's.

  • Reduced PTV margins

    Because the target is imaged with millimetre precision, the planning target volume margin drops from 5 to 10mm to 2 to 3mm. Less normal tissue in the high-dose zone.

    • Indicative pricing

    What a private MR-Linac course costs in London.

    Indicative all-inclusive ranges across UK centres, covering planning, delivery and consultant follow-up.

    In short

    £18,000-£28,000 typical, £22,000-£38,000 for complex indications.

    Indication Indicative range
    Second-opinion review of scans and pathology £350–£650
    Prostate SBRT, 5-fraction Unity £18,000–£24,000
    Pancreatic SBRT, 5-fraction MRIdian or Unity £24,000–£32,000
    Liver oligometastasis SBRT, 3–5 fractions £20,000–£28,000
    Lung mobile-tumour SBRT, 5-fraction £20,000–£28,000
    Complex re-irradiation or dose-escalation course £22,000–£38,000

    Prices vary by centre, by which consultant clinical oncologist leads your care, and by tumour site and complexity.

    The adaptive workflow

    From referral to response imaging - what happens, in order.

    One consultant, one MDT, one team from first message to response imaging. Daily plan re-optimisation is what makes MR-Linac different.

    1. 03

      Before

      Planning MRI and CT simulation

      A planning MRI on the Unity (or MRIdian) plus a planning CT for electron density. Fiducials are not usually needed. Bladder and rectal filling protocol explained.

    2. 04

      On treatment

      Arrival for fraction one

      Arrival, a chat with the radiographers and consultant. You lie on the couch inside the 1.5T bore. Total in-room time is 45 to 60 minutes per fraction.

    3. 05

      On treatment

      Online adaptive replanning

      A daily MRI is acquired. The plan is re-optimised in 20 to 40 minutes to today's anatomy, margins are re-drawn, and dose is delivered while the tumour is watched in real time.

    4. 06

      On treatment

      Home the same day

      A short debrief, written aftercare, and home the same day. Five fractions across one to two weeks for most SBRT indications.

    5. 07

      After

      Follow-up and response imaging

      Consultant review at 4 to 6 weeks, then response imaging at 3 months (MRI or PSMA-PET as indicated). Long-term surveillance handed back to your referring team.

    Typical end-to-end: 2-3 weeks from first appointment to first fraction. Per fraction: 45-60 min. Response imaging: 3 months.

    Indications

    When MR-Linac is the right step - and when it is not.

    The tumour sites where MR-guided online adaptive radiotherapy earns its cost, plus the situations where a standard linac or a different modality is the better call.

    • Prostate SBRT (5-fraction ultra-hypofractionation)

      MRI-visible prostate treated in five fractions across one to two weeks. PTV margins reduced to 2 to 3mm with daily adaptation.

    • Pancreatic SBRT with dose escalation

      Locally advanced or borderline resectable pancreatic cancer. Daily adaptation to bowel and stomach position allows 50Gy in 5 fractions without exceeding OAR tolerance.

    • Liver oligometastases

      One to three liver deposits treated in 3 to 5 fractions with real-time MRI tracking of the lesion, no fiducials needed.

    • Lung mobile tumours

      Peripheral or central lung tumours with respiratory motion, treated with cine-MRI gating rather than fiducial or 4D-CT surrogates.

    • Oesophageal, gastric, cervical, kidney

      Selected soft-tissue targets where daily anatomy changes (bowel gas, gastric filling, bladder) make a standard linac plan suboptimal.

    • MR-visible soft tissue targets

      Any tumour that is clearly visible on MRI but poorly seen on cone-beam CT is a candidate for MR-guided adaptive delivery.

    • Re-irradiation of previously treated volumes

      Where cumulative OAR dose is the limiting factor, daily adaptation can shave the margin and allow safe re-treatment in selected cases.

    • Not for: bone-only mets, whole-brain, palliative flash

      Simple palliative bone or brain fractions are better delivered on a standard linac. MR-Linac is reserved for cases where adaptation earns its cost.

    Technology and modality comparison

    MR-Linac, CyberKnife, standard SBRT, proton - the honest comparison.

    MR-Linac is online-adaptive with soft-tissue MRI guidance and no fiducials. CyberKnife tracks fiducials in real time. Standard SBRT uses cone-beam CT. Proton is dose-shape not adaptation. The right tool depends on the tumour site.

    • Elekta Unity 1.5T MR-Linac

      The first-generation MR-Linac in UK private practice. High-field 1.5T diagnostic-grade MRI integrated with a 7MV linac. Adapt-to-shape and adapt-to-position workflows.

    • ViewRay MRIdian 0.35T MR-Linac

      Lower-field 0.35T MRI paired with a linac, with real-time cine-MRI gating. Strong pancreatic and abdominal SBRT programme (SMART trial platform).

    • Adapt-to-position (ATP)

      The reference plan is shifted and re-weighted to today's anatomy. Faster (15 to 25 minutes) but keeps the reference contours.

    • Adapt-to-shape (ATS)

      Contours are re-drawn on today's MRI and the plan is fully re-optimised. Slower (30 to 45 minutes) but the gold standard for changing anatomy.

    • Real-time cine-MRI gating

      The beam is automatically held when the tumour drifts outside a gating window. Standard on MRIdian, in development on Unity.

    • CyberKnife SBRT

      Robotic linac with real-time fiducial tracking. Excellent for prostate and small intracranial or spinal targets. No MRI in-room, no online replan.

    • Standard linac SBRT (CBCT-guided)

      Modern Varian Halcyon or TrueBeam SBRT with cone-beam CT. Faster and cheaper, less soft-tissue detail, no online plan adaptation.

    • Proton beam therapy

      Excellent dose distribution for paediatric, base-of-skull and re-irradiation cases. Not typically online-adaptive in UK NHS or private practice.

    The evidence base

    Trials and registries behind MR-guided adaptive radiotherapy.

    MR-Linac is a mature technology with a growing evidence base. The trials and registries are cited so you can look them up before making a decision.

    • MOMENTUM registry

      A multi-institutional international registry of MR-Linac patients tracking toxicity, quality of life and disease control across every treated site.

    • HERMES prostate ultra-hypofractionation

      Randomised trial comparing 5-fraction MR-Linac prostate SBRT with standard 20-fraction moderate hypofractionation. Non-inferior toxicity, similar early biochemical control.

    • SMART pancreatic trial

      Prospective multicentre study of 50Gy in 5 fractions to the pancreas on the MRIdian. Outstanding local control at 12 months with acceptable GI toxicity.

    • MASTERPLAN pancreatic

      A UK-led adaptive radiotherapy programme for pancreatic cancer, examining outcomes with online adaptation and MR guidance.

    Side effects and safety

    What to expect afterwards - by tumour site, honestly.

    MR-Linac is a well-established therapeutic radiotherapy platform. Side effects depend on the tumour site, dose and prior treatment. The things worth planning are the MRI screening, the daily fraction time, and site-specific acute effects.

    • Prostate: mild urinary and rectal symptoms

      Frequency, urgency and mild proctitis peak at weeks 2 to 6 and settle by 3 months in most patients. Late toxicity is lower than with 20-fraction schedules in HERMES data.

    • Pancreatic: mild nausea and fatigue

      Nausea and fatigue during the fraction week are the commonest issues. Serious GI toxicity is uncommon with online adaptation and strict duodenal constraints.

    • Liver: transient LFT rise

      A transient rise in liver enzymes at 6 to 12 weeks is expected. Radiation-induced liver disease is rare when the mean liver dose is kept low.

    • Lung: cough and mild pneumonitis

      A dry cough during and after treatment is common. Symptomatic pneumonitis is uncommon in peripheral SBRT; central tumours carry a small airway toxicity risk.

    • Claustrophobia inside the 1.5T bore

      Each fraction is 45 to 60 minutes lying inside a diagnostic-grade MRI.

    • Implants and prostheses screened first

      MR safety screening happens before planning. Most hip replacements, coronary stents and dental work are fine; some pacemakers and cochlear implants are not.

    • Bladder and rectal filling protocol

      For pelvic treatments, a comfortably full bladder and an empty rectum are usually requested. Written instructions are normally provided before the planning scan.

    • No fiducials for soft tissue targets

      Because the tumour is seen directly on MRI, invasive fiducial marker placement is not usually needed for prostate, liver, pancreas or kidney.

    • Red flags after discharge

      New severe pain, heavy rectal bleeding, jaundice, breathlessness, fever or vomiting during or after treatment should be reported to the on-call oncology team the same day.

    Reading your radiotherapy summary

    Your MR-Linac summary in four parts. Read the last one first.

    Whichever centre delivers your course, the end-of-treatment summary keeps to the same shape.

    A UK clinical oncologist reviewing an MR-Linac adaptive radiotherapy summary

    A quiet reminder

    Radiotherapy language is precise and can read coldly - ask your care team to explain anything that is unclear.

    If you would like someone to talk you through the summary before your follow-up, ask the clinician who wrote it.

    1. 01 Header

      Diagnosis, staging and prior treatment

      Tumour site, histology, stage, prior radiotherapy or surgery, and the specific MR-Linac indication (e.g. prostate SBRT 5#, pancreatic SMART).

    2. 02 Technique

      Machine, dose and fractionation

      Elekta Unity or ViewRay MRIdian, total dose in Gray, number of fractions, PTV margin, adapt-to-shape or adapt-to-position, and whether cine-MRI gating was used.

    3. 03 Findings

      On-treatment adaptation and OAR sparing

      How often the plan was re-optimised, any fractions replanned for anatomy change, and the maximum dose to bowel, rectum, bladder, duodenum or heart.

    4. 04 Impression

      Response imaging and follow-up plan

      Read this first: when response MRI or PSMA-PET is booked, expected acute side-effect timeline, and who your long-term surveillance clinician is.

    Recognised by major UK insurers

    BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

    Cover for MR-Linac varies by insurer and by indication - typically funded when medically indicated for approved SBRT sites.

    Frequently asked

    Common questions about MR-Linac.

    Quick answers on claustrophobia, implants, insurance cover, outpatient logistics, MDT review and re-irradiation.

    • I am claustrophobic. Can I still have MR-Linac treatment?

      Each fraction is 45 to 60 minutes lying inside a 1.5T (Unity) or 0.35T (MRIdian) MRI bore. Severe claustrophobia can be a reason to choose CyberKnife or standard SBRT instead.

    • I have a pacemaker or a hip replacement. Am I eligible?

      MR safety screening is done before planning. Most modern hip replacements, coronary stents, spinal rods and dental work are compatible. Some older pacemakers, cochlear implants, aneurysm clips and drug pumps are not, and would point towards CyberKnife or a standard linac.

    • Will my insurance cover MR-Linac adaptive radiotherapy?

      The major UK insurers (Bupa, AXA, Vitality, Aviva, WPA, Cigna, Healix) fund MR-Linac SBRT for approved indications, most commonly prostate, liver oligometastases and selected pancreatic cases. Cover for newer indications (kidney, cervix, gastric) is confirmed case by case. It is worth confirming cover in writing with your insurer before booking.

    • Is MR-Linac done as an outpatient or do I stay in?

      It is an outpatient course. You come in for the planning MRI and CT, then five (or three) daily fractions across one to two weeks, and go home after each fraction. Overnight admission is not needed unless an unrelated medical issue requires it.

    • Do I need to be discussed at an MDT first?

      Yes. It is one of the reasons the recommendation is honest: sometimes MDT concludes surgery, brachytherapy or a different modality is the better option.

    • Can MR-Linac be used to re-irradiate a previously treated area?

      In selected cases, yes. Because daily adaptation allows a reduced PTV margin and precise tracking of today's anatomy, cumulative OAR dose can sometimes be respected where it would not be on a standard linac. Re-irradiation always requires detailed prior-dose recovery, MDT discussion and a longer planning cycle.

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