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Figure 1. Unfeasibility results from the interaction of four dimensions: Technical Feasibility (including patient-related technical factors, institutional factors, and temporal factors), Resources, Equity, and Values and Acceptability. These dimensions capture barriers to treatment realisation that emerge after a patient has been deemed clinically eligible through MTH criteria (Unfitness, Liver dysfunction, Critical tumour features). This integrative construct adapts the five GRADE EtD domains to individual-level clinical decision-making (see Supplementary Materials, Supplementary Table 1 for the complete mapping and Supplementary Table 2 for the expanded Technical Feasibility domain). This image was created by the authors with Canva. MTH: Multiparametric Therapeutic Hierarchy; GRADE: Grading of Recommendations Assessment, Development and Evaluation; EtD: Evidence-to-Decision.