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      Characterization of mechanical and radiation isocenter on an MR‐guided radiotherapy (MRgRT) Linac

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          Abstract

          Background and Purpose

          In the emerging paradigm of stereotactic radiosurgery being proposed for MR‐guided radiotherapy (MRgRT), assessment of mechanical geometric accuracy is critical for the implementation of stereotactic delivery. We benchmarked the mechanical accuracy of an MR Linac system that lacks an onboard detector/array. Our mechanical tests utilize a half beam block (HBB) geometry that takes advantage of the sensitivity of a partially occluded detector.

          Materials and Methods

          Mechanical tests benchmarked the couch, MLC, and gantry geometric accuracy for an MR‐Linac system. An HBB technique was used to irradiate an ionization chamber profiler (ICP) array with partial occlusion of individual detectors for characterization of MLC skew, beam divergence displacement, and RT isocenter localization. The sensitivity of the partially occluded detector's ICP‐X (detector width) and ICP‐Y (detector length) was characterized by displacing the detector relative to radiation isocenter by 0.2 mm increments, introduced through couch motion. The accuracy of the HBB ICP technique was verified with a starshot using radiochromic film, and the reproducibility was verified on a conventional C‐arm Linac and compared to Winston‐Lutz.

          Results

          The sensitivity of the HBB technique as quantified through the dose difference normalized to open field as a function of displacement from RT isocenter was 6.4%/mm and 13.0%/mm for the ICP‐X and ICP‐Y orientation, respectively, due to the oblong detector orientation. Couch positional accuracy and sag was within ±0.1 mm. Maximum MLC positional displacement was 0.7 mm with mean MLC skew at 0.07°. The maximum beam divergence displacement was 0.03 mm. The gantry angle was within 0.1°. Independent verification of the RT isocenter localization procedure produced repeatable results.

          Conclusion

          This work serves for characterizing the mechanical and geometric radiation accuracy for the foundation of an MR‐guided stereotactic radiosurgery program, as demonstrated with high sensitivity and independent validation.

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          Most cited references15

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          Task Group 142 report: quality assurance of medical accelerators.

          The task group (TG) for quality assurance of medical accelerators was constituted by the American Association of Physicists in Medicine's Science Council under the direction of the Radiation Therapy Committee and the Quality Assurance and Outcome Improvement Subcommittee. The task group (TG-142) had two main charges. First to update, as needed, recommendations of Table II of the AAPM TG-40 report on quality assurance and second, to add recommendations for asymmetric jaws, multileaf collimation (MLC), and dynamic/virtual wedges. The TG accomplished the update to TG-40, specifying new test and tolerances, and has added recommendations for not only the new ancillary delivery technologies but also for imaging devices that are part of the linear accelerator. The imaging devices include x-ray imaging, photon portal imaging, and cone-beam CT. The TG report was designed to account for the types of treatments delivered with the particular machine. For example, machines that are used for radiosurgery treatments or intensity-modulated radiotherapy (IMRT) require different tests and/or tolerances. There are specific recommendations for MLC quality assurance for machines performing IMRT. The report also gives recommendations as to action levels for the physicists to implement particular actions, whether they are inspection, scheduled action, or immediate and corrective action. The report is geared to be flexible for the physicist to customize the QA program depending on clinical utility. There are specific tables according to daily, monthly, and annual reviews, along with unique tables for wedge systems, MLC, and imaging checks. The report also gives specific recommendations regarding setup of a QA program by the physicist in regards to building a QA team, establishing procedures, training of personnel, documentation, and end-to-end system checks. The tabulated items of this report have been considerably expanded as compared with the original TG-40 report and the recommended tolerances accommodate differences in the intended use of the machine functionality (non-IMRT, IMRT, and stereotactic delivery).
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            A system for stereotactic radiosurgery with a linear accelerator.

            A small field irradiation technique to deliver high doses of single fraction photon radiation to small, precisely located volumes (0.5 to 8 cm3) within the brain has been developed. Our method uses a modified Brown-Roberts-Wells (BRS), CT-guided, stereotactic system and a 6 MV linear accelerator equipped with a special collimator (diameters of 12.5 mm to 30.0 mm projected to isocenter) located 23 cm from isocenter. Target localization via planar angiography has been added. Treatment consists of a series of arcing beams using both gantry and couch rotations. During treatment, the patient's head is immobilized independently of the radiotherapy couch and is precisely positioned without reference to room lasers or light field. A precise verification of alignment precedes each treatment. Extensive performance tests have shown that a target, localized by CT, can be irradiated with a positional accuracy of 2.4 mm in any direction with 95% confidence. If angiography is used for localization, the results are better. The dose 1.0 cm outside the target volume is less than 20% of the prescribed dose for a medium sized collimator.
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              A procedure to determine the radiation isocenter size in a linear accelerator

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                Author and article information

                Contributors
                Nema.BassiriGharb@baptisthealth.net
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                03 August 2023
                November 2023
                : 24
                : 11 ( doiID: 10.1002/acm2.v24.11 )
                : e14111
                Affiliations
                [ 1 ] Department of Radiation Oncology Miami Cancer Institute Baptist Health South Florida Miami Florida USA
                [ 2 ] Herbert Wertheim College of Medicine Florida International University Miami Florida USA
                [ 3 ] Department of Radiation Medicine Oregon Health and Science University Portland Oregon USA
                Author notes
                [*] [* ] Correspondence

                Nema Bassiri, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Dr., Miami, FL 33176, USA.

                Email: Nema.BassiriGharb@ 123456baptisthealth.net

                Article
                ACM214111
                10.1002/acm2.14111
                10647948
                37535938
                535780ff-a739-4fe7-b63b-5fbbcde333ce
                © 2023 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 July 2023
                : 26 December 2022
                : 18 July 2023
                Page count
                Figures: 6, Tables: 9, Pages: 15, Words: 8078
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                November 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.4 mode:remove_FC converted:15.11.2023

                isocenter,mechanical,mlc,mrgrt,mr‐guidance,mr‐rt qa
                isocenter, mechanical, mlc, mrgrt, mr‐guidance, mr‐rt qa

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