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      Measurement validation of treatment planning for a MR‐Linac

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          Abstract

          Purpose

          The magnetic field can cause a nonnegligible dosimetric effect in an MR‐Linac system. This effect should be accurately accounted for by the beam models in treatment planning systems (TPS). The purpose of the study was to verify the beam model and the entire treatment planning and delivery process for a 1.5 T MR‐Linac based on comprehensive dosimetric measurements and end‐to‐end tests.

          Material and methods

          Dosimetry measurements and end‐to‐end tests were performed on a preclinical MR‐Linac (Elekta AB) using a multitude of detectors and were compared to the corresponding beam model calculations from the TPS for the MR‐Linac. Measurement devices included ion chambers (IC), diamond detector, radiochromic film, and MR‐compatible ion chamber array and diode array. The dose in inhomogeneous phantom was also verified. The end‐to‐end tests include the generation, delivery, and comparison of 3D and IMRT plan with measurement.

          Results

          For the depth dose measurements with Farmer IC, micro IC and diamond detector, the absolute difference between most measurement points and beam model calculation beyond the buildup region were <1%, at most 2% for a few measurement points. For the beam profile measurements, the absolute differences were no more than 1% outside the penumbra region and no more than 2.5% inside the penumbra region. Results of end‐to‐end tests demonstrated that three 3D static plans with single 5 × 10 cm 2 fields (at gantry angle 0°, 90° and 270°) and two IMRT plans successfully passed gamma analysis with clinical criteria. The dose difference in the inhomogeneous phantom between the calculation and measurement was within 1.0%.

          Conclusions

          Both relative and absolute dosimetry measurements agreed well with the TPS calculation, indicating that the beam model for MR‐Linac properly accounts for the magnetic field effect. The end‐to‐end tests verified the entire treatment planning process.

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          Most cited references25

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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.
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            A new formalism for reference dosimetry of small and nonstandard fields.

            The use of small fields in radiotherapy techniques has increased substantially, in particular in stereotactic treatments and large uniform or nonuniform fields that are composed of small fields such as for intensity modulated radiation therapy (IMRT). This has been facilitated by the increased availability of standard and add-on multileaf collimators and a variety of new treatment units. For these fields, dosimetric errors have become considerably larger than in conventional beams mostly due to two reasons; (i) the reference conditions recommended by conventional Codes of Practice (CoPs) cannot be established in some machines and (ii) the measurement of absorbed dose to water in composite fields is not standardized. In order to develop standardized recommendations for dosimetry procedures and detectors, an international working group on reference dosimetry of small and nonstandard fields has been established by the International Atomic Energy Agency (IAEA) in cooperation with the American Association of Physicists in Medicine (AAPM) Therapy Physics Committee. This paper outlines a new formalism for the dosimetry of small and composite fields with the intention to extend recommendations given in conventional CoPs for clinical reference dosimetry based on absorbed dose to water. This formalism introduces the concept of two new intermediate calibration fields: (i) a static machine-specific reference field for those modalities that cannot establish conventional reference conditions and (ii) a plan-class specific reference field closer to the patient-specific clinical fields thereby facilitating standardization of composite field dosimetry. Prior to progressing with developing a CoP or other form of recommendation, the members of this IAEA working group welcome comments from the international medical physics community on the formalism presented here.
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              The Australian magnetic resonance imaging-linac program.

              The Australian magnetic resonance imaging (MRI)-Linac program is a $16-million government-funded project to advance the science and clinical practice of exquisite real-time anatomical and physiological adaptive cancer therapy. The centerpiece of the program is a specifically designed 1-T open-bore MRI/6-MV linac system that is planned for delivery and completion of installation in 2014. Current scientific endeavors include engineering discovery in MRI component design, quantifying MRI and linac interactions, and developing image guidance and adaptation strategies.
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                Author and article information

                Contributors
                ali@mcw.edu
                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
                29 June 2019
                July 2019
                : 20
                : 7 ( doiID: 10.1002/acm2.2019.20.issue-7 )
                : 28-38
                Affiliations
                [ 1 ] Department of Radiation Oncology Medical College of Wisconsin Milwaukee WI USA
                Author notes
                [*] [* ] Author to whom correspondence should be addressed. X. Allen Li

                E‐mail: ali@ 123456mcw.edu ; Telephone: 414‐805‐4362; Fax: 414‐805‐4369.

                Article
                ACM212651
                10.1002/acm2.12651
                6612768
                31254376
                bf9a57c9-9741-43e9-ab98-b2fea7031549
                © 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of 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
                : 10 April 2018
                : 11 March 2019
                : 02 May 2019
                Page count
                Figures: 8, Tables: 4, Pages: 11, Words: 5878
                Funding
                Funded by: MCW Cancer Fotsch and Meinerz Foundations
                Funded by: Elekta AB
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                acm212651
                July 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:08.07.2019

                beam model verification,electron returning effect,mr‐guided rt,mr‐linac,treatment planning system

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