Dosimetric evaluation of off-axis fields and angular transmission for the 1.5 T MR-linac.

Objective.GPU-oriented Monte Carlo dose (GPUMCD) is a fast dose calculation algorithm used for treatment planning on the Unity MR-linac. Treatments for the MR-linac must be calculated quickly and accurately, and must account for two important MR-linac aspects: off-axis positions and angular transmission through the cryostat, couch and MR-coils. Therefore, the aim of this research is to quantify the system-related errors for GPUMCD calculations over the range of clinically-relevant field configurations and gantry angles.Approach.Dose profiles (crossline, inline and PDD) were measured and calculated for varying field sizes, off-axis positions and depths. Eleven different (off-axis) positions were included. The angular transmission was investigated by measuring and calculating the transmission for multiple angles, taking the cryostat, couch and coils into account.Main results.Differences between absolute point doses were found to be within 1.7% for field sizes 2 × 2 cm2and larger. The relative dose profiles in the crossline, inline and PDD direction illustrated maximum mean dose differences of 0.9pp, 0.8pp and 0.7pp ofDmaxin the central region for field sizes 2 × 2 cm2and larger. The 1 × 1 cm2field size showed larger dosimetric errors for absolute point doses and relative dose profiles. The maximum mean DTA in the penumbra was 0.7 mm. The mean difference in angular transmission ranged from -0.33% ± 0.60% to 0.27% ± 0.91% using three treatment machines. Additionally, 77.1%-93.7% of the datapoints remained within 1% transmission difference. The largest transmission differences were present at the edges of the table.Significance.This research showed that the GPUMCD algorithm provides reliable dose calculations with a low uncertainty for field sizes 2 × 2 cm2and larger, focusing on off-axis fields and angular transmission.

Characterization of a prototype MR-compatible Delta4 QA system in a 1.5 tesla MR-linac.

To perform patient plan quality assurance (QA) on a newly installed MR-linac (MRL) it is necessary to have an MR-compatible QA device. An MR compatible device (MR-Delta4) has been developed together with Scandidos AB (Uppsala, Sweden). The basic characteristics of the detector response, such as short-term reproducibility, dose linearity, field size dependency, dose rate dependency, dose-per-pulse dependency and angular dependency, were investigated for the clinical Delta4-PT as well as for the MR compatible version. All tests were performed with both devices on a conventional linac and the MR compatible device was tested on the MRL as well. No statistically significant differences were found in the short-term reproducibility (<0.1%), dose linearity (⩽0.5%), field size dependency (<2.0% for field sizes larger than 5 × 5 cm2), dose rate dependency (<1.0%) or angular dependency for any phantom/linac combination. The dose-per-pulse dependency (<0.8%) was found to be significantly different between the two devices. This difference can be explained by the fact that the diodes in the clinical Delta4-PT were irradiated with a much larger dose than the MR-Delta4-PT ones. The absolute difference between the devices (<0.5%) was found to be small, so no clinical impact is expected. For both devices, the results were consistent with the characteristics of the Delta4-PT device reported in the literature (Bedford et al 2009 Phys. Med. Biol. 54 N167-76; Sadagopan et al 2009 J. Appl. Clin. Med. Phys. 10 2928). We found that the characteristics of the MR compatible Delta4 phantom were found to be comparable to the clinically used one. Also, the found characteristics do not differ from the previously reported characteristics of the commercially available non-MR compatible Delta4-PT phantom. Therefore, the MR compatible Delta4 prototype was found to be safe and effective for use in the 1.5 tesla magnetic field of the Elekta MR-linac.

Performance of a PTW 60019 microDiamond detector in a 1.5 T MRI-linac.

Accurate small-field dosimetry is critical for a magnetic resonance linac (MRI-linac). The PTW 60019 microDiamond is close to an ideal detector for small field dosimetry due to its small physical size, high signal-to-noise ratio and approximate water equivalence. It is important to fully characterise the performance of the detector in a 1.5 T magnetic field prior to its use for MRI-linac commissioning and quality assurance. Standard techniques of detector testing have been implemented, or adapted where necessary to suit the capabilities of the MRI-linac. Detector warmup, constancy, dose linearity, dose rate linearity, field size dependence and leakage were within tolerance. Measurements with the detector were consistent with ion chamber measurements for medium sized fields. The effective point of measurement of the detector when used within a 1.5 T magnetic field was determined to be 0.80 ± 0.23 mm below the top surface of the device, consistent with the existing vendor recommendation and alignment mark at 1.0 mm. The angular dependence was assessed. Variations of up to 9.7% were observed, which are significantly greater than in a 0 T environment. Within the expected range of use, the maximum effect is approximately 0.6% which is within tolerance. However for large beams within a magnetic field, the divergence and consequent variation in angle of photon incidence means that the microDiamond would not be ideal for characterising the profiles and it would not be suitable for determining large-field beam parameters such as symmetry. It would also require a correction factor prior to use for patient-specific QA measurements where radiation is delivered from different gantry angles. The results of this study demonstrate that the PTW 60019 microDiamond detector is suitable for measuring small radiation fields within a 1.5 T magnetic field and thus is suitable for use in MRI-linac commissioning and quality assurance.

Beam characterisation of the 1.5 T MRI-linac.

As a prerequisite for clinical treatments it was necessary to characterize the Elekta 1.5 T MRI-linac 7 MV FFF radiation beam. Following acceptance testing, beam characterization data were acquired with Semiflex 3D (PTW 31021), microDiamond (PTW 60019), and Farmer-type (PTW 30013 and IBA FC65-G) detectors in an Elekta 3D scanning water phantom and a PTW 1D water phantom. EBT3 Gafchromic film and ion chamber measurements in a buildup cap were also used. Special consideration was given to scan offsets, detector effective points of measurement and avoiding air gaps. Machine performance has been verified and the system satisfied the relevant beam requirements of IEC60976. Beam data were acquired for field sizes between 1 × 1 and 57 × 22 cm2. New techniques were developed to measure percentage depth dose (PDD) curves including the electron return effect at beam exit, which exhibits an electron-type practical range of 1.2 ± 0.1 cm. The Lorentz force acting on the secondary charged particles creates an asymmetry in the crossline profiles with an average shift of +0.24 cm. For a 10 × 10 cm2 beam, scatter from the cryostat contributes 1% of the dose at isocentre. This affects the relative output factors, scatter factors and beam profiles, both in-field and out-of-field. The average 20%-80% penumbral width measured for small fields with a microDiamond detector at 10 cm depth is 0.50 cm. MRI-linac penumbral widths are very similar to that of the Elekta Agility linac MLC, as is the near-surface dose PDD(0.2 cm) = 57%. The entrance surface dose is ∼36% of Dmax. Cryostat transmission is quantified for inclusion within the treatment planning system. As a result, the 1.5 T MRI-linac 7 MV FFF beam has been characterised for the first time and is suitable for clinical use. This was a key step towards the first clinical treatments with the MRI-linac, which were delivered at University Medical Center Utrecht in May 2017 (Raaymakers et al 2017 Phys. Med. Biol. 62 L41-50).

Performance of a cylindrical diode array for use in a 1.5 T MR-linac.

At the UMC Utrecht, a linear accelerator with integrated magnetic resonance imaging (MRI) has been developed, the MR-linac. Patient-specific quality assurance (QA) of treatment plans for MRI-based image guided radiotherapy requires QA equipment compatible with this 1.5 T magnetic field. The purpose of this study was to examine the performance characteristics of the ArcCHECK-MR in a transverse 1.5 T magnetic field. To this end, the short-term reproducibility, dose linearity, dose rate dependence, field size dependence, dose per pulse dependence and inter-diode dose response variation of the ArcCHECK-MR diode array were evaluated on a conventional linac and on the MR-linac. The ArcCHECK-MR diode array performed well for all tests on both linacs, no significant differences in performance characteristics were observed. Differences in the maximum dose deviations between both linacs were less than 1.5%. Therefore, we conclude that the ArcCHECK-MR can be used in a transverse 1.5 T magnetic field.

Minimizing the magnetic field effect in MR-linac specific QA-tests: the use of electron dense materials.

To address the quality assurance (QA) of a MR-linac which is an MRI combined with a linear accelerator (linac), the traditional linac QA-tests need to be redesigned, since the presence of the static magnetic field in the MR-linac alters the electron trajectory. The latter causes the asymmetry in the dose kernel which is introduced by the magnetic field and hinders accurate geometrical QA-tests for the MR-linac. We introduced the use of electron dense materials (e.g. copper) to reduce the size of the dose kernel and thereby the magnetic field effect on the dose deposition. Two examples of QA-tests are presented in which the geometrical accuracy of the MR-linac was addressed; beam profile and star-shot measurements. The introduced setup was compared with a reference setup and both were tested on a conventional and the MR-linac. The results showed that the symmetry of the recorded beam profile was restored in presence of the copper material and that the isocenter size of the MR-linac can be determined accurately with the introduced star-shot setup. The use of electron dense materials is not limited to the presented QA-tests but has a broad application for beam-specific QA-tests in presence of a magnetic field.