Advances in radiotherapy technologies have enabled more precise target guidance, improved treatment verification, and greater control and versatility in radiation delivery. Amongst the recent novel technologies, Magnetic Resonance Imaging (MRI) guided radiotherapy (MRgRT) may hold the greatest potential to improve the therapeutic gains of image-guided delivery of radiation dose. The ability of the MRI linear accelerator (LINAC) to image tumors and organs with on-table MRI, to manage organ motion and dose delivery in real-time, and to adapt the radiotherapy plan on the day of treatment while the patient is on the table are major advances relative to current conventional radiation treatments. These advanced techniques demand efficient coordination and communication between members of the treatment team. MRgRT could fundamentally transform the radiotherapy delivery process within radiation oncology centers through the reorganization of the patient and treatment team workflow process. However, the MRgRT technology currently is limited by accessibility due to the cost of capital investment and the time and personnel allocation needed for each fractional treatment and the unclear clinical benefit compared to conventional radiotherapy platforms. As the technology evolves and becomes more widely available, we present the case that MRgRT has the potential to become a widely utilized treatment platform and transform the radiation oncology treatment process just as earlier disruptive radiation therapy technologies have done.

Prostate cancer is the most common malignant neoplasm in men, with more than 164 000 new cases diagnosed in 2018.¹ With the advent and availability of prostate-specific antigen (PSA) testing enabling earlier detection of prostate cancer, most men are diagnosed as having localized disease. Prostate cancer is stratified as low-, intermediate-, and high-risk disease based on tumor stage, PSA level at diagnosis, and Gleason score.² Treatment options for localized prostate cancer include active surveillance (reserved for low-risk individuals), radical prostatectomy with possible pelvic lymph node dissection, or radiation therapy (RT) entailing brachytherapy, external beam radiation therapy (EBRT), or both.

Radiotherapy can be safely delivered during the coronavirus disease 2019 (COVID-19) pandemic, often through use of hypofractionated regimens, which minimize the number of visits to treatment centres while also avoiding potentially detrimental delays in the delivery of cancer care.