Exploring digital twinning in MRI: A systematic review of current applications, barriers, and future opportunities

INTRODUCTION: Digital twinning (DT) - the development of dynamic virtual replicas bidirectionally linked to their real-world counterparts - has the potential to enhance diagnostic precision, optimise interventions, and support patient-specific care, yet its impact within the magnetic resonance imaging (MRI) domain remains underexplored. This study systematically reviews how DT is being applied to MRI, maps current applications and outlines priorities to accelerate safe and sustainable implementation. METHODS: Five electronic databases were searched for original articles published between January 2020 and June 2025 that explicitly described a DT implementation within MRI. Screening and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Two academic MRI radiographers independently screened records and extracted study-level data. A mixed qualitative-quantitative synthesis and thematic content analysis were used to identify principal application domains. RESULTS: After duplicate removal and full-text assessment, 51 studies met inclusion criteria. Over half of the included articles related to two main DT-MRI categories: (1) cardiac prediction, treatment and imaging; and (2) cancer diagnosis and therapy optimisation. Six themes emerged: (1) diagnosis, treatment planning and monitoring (63%); (2) hardware, protocol and infrastructure (20%); (3) safety and quality assurance (5.5%); (4) operational efficiency and cost (5.5%); (5) training and education (3%); and (6) energy and environmental sustainability (3%). CONCLUSIONS: Digital twinning shows substantial promise for personalised diagnosis, treatment planning and facility-level optimisation in MRI, particularly within cardiology and oncology. Radiography-centred opportunities such as models for improving training, safety and operational applications remain understudied. IMPLICATIONS FOR PRACTICE: The review identified the need for medical imaging departments to prioritise the development of training simulations, safety-validation pilots and operational integration initiatives, supported by interoperability and governance measures, to expand the scope and effective use of digital twinning within MRI practice.