Towards quantitative MRI Driving online adaptive MRgRT for lung tumors

qMRI studies integrated in online MRgART for lungs are, at present, extremely limited; nevertheless, establishing a clear snapshot of the current state-of-the-art is essential, as this topic is expected to become highly prevalent and of particular interest in the near future. To our knowledge, this is the first review centered on online MRgART for lung tumors, with a dedicated subsection summarizing the nascent evidence on qMRI. Looking ahead, integrating AI-driven motion compensation, auto-segmentation and adaptive replanning with qMRI-enabled biomarkers could standardize workflows and accelerate truly personalized online MRgART. Prospective multi-center studies are needed to validate biomarkers and demonstrate clinical benefit.