AbstractPurposeDevelop a true real‐time implementation of MR signature matching (MRSIGMA) for free‐breathing 3D MRI with sub‐200 ms latency on the Elekta Unity 1.5T MR‐Linac.MethodsMRSIGMA was implemented on an external computer with a network connection to the MR‐Linac. Stack‐of‐stars with partial k_z sampling was used to accelerate data acquisition and ReconSocket was employed for simultaneous data transmission. Movienet network computed the 4D MRI motion dictionary and correlation analysis was used for signature matching. A programmable 4D MRI phantom was utilized to evaluate MRSIGMA with respect to a ground‐truth translational motion reference. In vivo validation was performed on patients with pancreatic cancer, where 15 patients were employed to train Movienet and 7 patients to test the real‐time implementation of MRSIGMA. Dice coefficients between real‐time MRSIGMA and a retrospectively computed 4D reference were used to evaluate motion tracking performance.ResultsMotion dictionary was computed in under 5 s. Signature acquisition and matching presented 173 ms latency on the phantom and 193 ms on patients. MRSIGMA presented a mean error of 1.3–1.6 mm for all phantom experiments, which was below the 2 mm acquisition resolution along the motion direction. The Dice coefficient over time between MRSIGMA and reference contours was 0.88 ± 0.02 (GTV), 0.87 ± 0.02(duodenum‐stomach), and 0.78 ± 0.02(small bowel), demonstrating high motion tracking performance for both tumor and organs at risk.ConclusionThe real‐time implementation of MRSIGMA enabled true real‐time free‐breathing 3D MRI with sub‐200 ms imaging latency on a clinical MR‐Linac system, which can be used for treatment monitoring, adaptive radiotherapy and dose accumulation mapping in tumors affected by respiratory motion.