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Install ReShade https://reshade.me/ (Pro Tip: Railworks uses DirectX 9)
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Download MartinsEffects.ini and put it into the same folder as Railworks.exe
Depth Buffer Issues:
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To allow MXAO to access the depth buffer you will have to set Railwork's anti-aliasing setting to FXAA or Disabled. I recommend using something like Nvidia's DSR feature (https://www.geforce.com/hardware/technology/dsr/technology) to further reduce any jagged edges. I personally use DSR 2.25x (3440x1440 to 5160x2160) with 33% smoothness.
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You may need to change RESHADE_DEPTH_INPUT_IS_REVERSED to 0 in the ReShade settings (not the config file!)