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      Longitudinal assessment of quality assurance measurements in a 1.5T MR‐linac: Part I—Linear accelerator


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          To describe and report longitudinal quality assurance (QA) measurements for the mechanical and dosimetric performance of an Elekta Unity MR‐linac during the first year of clinical use in our institution.

          Materials and methods

          The mechanical and dosimetric performance of the MR‐linac was evaluated with daily, weekly, monthly, and annual QA testing. The measurements monitor the size of the radiation isocenter, the MR‐to‐MV isocenter concordance, MLC and jaw position, the accuracy and reproducibility of step‐and‐shoot delivery, radiation output and beam profile constancy, and patient‐specific QA for the first 50 treatments in our institution. Results from end‐to‐end QA using anthropomorphic phantoms are also included as a reference for baseline comparisons. Measurements were performed in water or water‐equivalent plastic using ion chambers of various sizes, an ion chamber array, MR‐compatible 2D/3D diode array, portal imager, MRI, and radiochromic film.


          The diameter of the radiation isocenter and the distance between the MR/MV isocenters was ( μ ± σ) 0.39 ± 0.01 mm and 0.89 ± 0.05 mm, respectively. Trend analysis shows both measurements to be well within the tolerance of 1.0 mm. MLC and jaw positional accuracy was within 1.0 mm while the dosimetric performance of step‐and‐shoot delivery was within 2.0%, irrespective of gantry angle. Radiation output and beam profile constancy were within 2.0% and 1.0%, respectively. End‐to‐end testing performed with ion‐chamber and radiochromic film showed excellent agreement with treatment plan. Patient‐specific QA using a 3D diode array identified gantry angles with low‐pass rates allowing for improvements in plan quality after necessary adjustments.


          The MR‐linac operates within the guidelines of current recommendations for linear accelerator performance, stability, and safety. The analysis of the data supports the recently published guidance in establishing clinically acceptable tolerance levels for relative and absolute measurements.

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          Most cited references36

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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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            IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119.

            AAPM Task Group 119 has produced quantitative confidence limits as baseline expectation values for IMRT commissioning. A set of test cases was developed to assess the overall accuracy of planning and delivery of IMRT treatments. Each test uses contours of targets and avoidance structures drawn within rectangular phantoms. These tests were planned, delivered, measured, and analyzed by nine facilities using a variety of IMRT planning and delivery systems. Each facility had passed the Radiological Physics Center credentialing tests for IMRT. The agreement between the planned and measured doses was determined using ion chamber dosimetry in high and low dose regions, film dosimetry on coronal planes in the phantom with all fields delivered, and planar dosimetry for each field measured perpendicular to the central axis. The planar dose distributions were assessed using gamma criteria of 3%/3 mm. The mean values and standard deviations were used to develop confidence limits for the test results using the concept confidence limit = /mean/ + 1.96sigma. Other facilities can use the test protocol and results as a basis for comparison to this group. Locally derived confidence limits that substantially exceed these baseline values may indicate the need for improved IMRT commissioning.
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              The ViewRay system: magnetic resonance-guided and controlled radiotherapy.

              A description of the first commercially available magnetic resonance imaging (MRI)-guided radiation therapy (RT) system is provided. The system consists of a split 0.35-T MR scanner straddling 3 (60)Co heads mounted on a ring gantry, each head equipped with independent doubly focused multileaf collimators. The MR and RT systems share a common isocenter, enabling simultaneous and continuous MRI during RT delivery. An on-couch adaptive RT treatment-planning system and integrated MRI-guided RT control system allow for rapid adaptive planning and beam delivery control based on the visualization of soft tissues. Treatment of patients with this system commenced at Washington University in January 2014. Copyright © 2014 Elsevier Inc. All rights reserved.

                Author and article information

                J Appl Clin Med Phys
                J Appl Clin Med Phys
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                10 September 2021
                October 2021
                : 22
                : 10 ( doiID: 10.1002/acm2.v22.10 )
                : 190-201
                [ 1 ] Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York
                [ 2 ] Elekta Limited Stockholm Sweden
                Author notes
                [*] [* ] Correspondence

                Ergys Subashi, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065.

                Email: subashie@ 123456mskcc.org

                Author information
                © 2021 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.

                : 16 August 2021
                : 23 June 2021
                : 29 August 2021
                Page count
                Figures: 12, Tables: 2, Pages: 12, Words: 6159
                Funded by: NIH/NCI Cancer Center
                Award ID: P30 CA008748
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                October 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.8 mode:remove_FC converted:11.10.2021

                longitudinal,mr‐linac,1.5t,quality assurance
                longitudinal, mr‐linac, 1.5t, quality assurance


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