A new approach is developed for intrafractional motion management in radiation therapy (RT) that accounts for respiratory-induced motion using a prior simultaneous MR-ultrasound acquisition to provide “virtual” real-time MR image guidance during the RT procedure. This proposed solution first acquires simultaneous MR and ultrasound to link MR images to different respiratory states that are determined from 4D ultrasound images. During the RT procedure, the hands-free 4D ultrasound determines the respiratory state from displacement of endogenous fiducial markers. MR images corresponding to each respiratory state are displayed to provide an indication of the tumor target relative to the radiation beam.
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