Validation of a diode-based phantom for high temporal and spatial measurements in a 1.5 T MR-linac.

Background: For the development and validation of dynamic treatment modalities and processes on the MR-linac, independent measurements should be performed that validate dose delivery and linac behavior at a high temporal resolution. To achieve this, a detector with both high temporal and spatial resolution is necessary.

Purpose: This study investigates the suitability of a Delta4 Phantom+ MR (Delta4) detector array for time-resolved dosimetry in the 1.

Quantifying the spatial distribution of the accumulated dose uncertainty using the novel delta index.

Inter- and intra-fractional anatomical changes during a radiotherapy treatment can cause differences between the initially planned dose and the delivered dose. The total delivered dose can be accumulated over all fractions by using deformable image registration (DIR). However, there is uncertainty in this process which should be accounted for.

3D gel dosimeter assessment for end-to-end geometric accuracy determination of the online adaptive workflow on the 1.5 T MR-linac.

Background And Purpose: During an end-to-end (E2E) test on the online workflow of the MR-linac, the performance of the treatment starting from the acquisition of pre-treatment MRI scans and ending with dose delivery is quantified. In such a test, the geometrical accuracy of the entire workflow is assessed. Ideally, the 3D geometrical accuracy of dose delivery on an MR-linac should be assessed using dosimeters that provide 3D dose distributions.

An improved calibration procedure for accurate plastic scintillation dosimetry on an MR-linac.

Plastic scintillation dosimeters (PSDs) are highly suitable for real-time dosimetry on the MR-linac. For optimal performance, the primary signal (scintillation) needs to be separated from secondary optical effects (Cerenkov, fluorescence and optical fiber attenuation). This requires a spectral separation approach and careful calibration.

Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium.

Purpose: STereotactic Arrhythmia Radioablation (STAR) showed promising results in patients with refractory ventricular tachycardia. However, clinical data are scarce and heterogeneous. The STOPSTORM.

Treatment planning evaluation and experimental validation of the magnetic resonance-based intrafraction drift correction.

Background And Purpose: MRI-guided online adaptive treatments can account for interfractional variations, however intrafraction motion reduces treatment accuracy. Intrafraction plan adaptation methods, such as the Intrafraction Drift Correction (IDC) or sub-fractionation, are needed. IDC uses real-time automatic monitoring of the tumor position to initiate plan adaptations by repositioning segments.

Experimental validation of multi-fraction online adaptations in magnetic resonance guided radiotherapy.

Background And Purpose: Radiotherapy plan verification is generally performed on the reference plan based on the pre-treatment anatomy. However, the introduction of online adaptive treatments demands a new approach, as plans are created daily on different anatomies. The aim of this study was to experimentally validate the accuracy of total doses of multi-fraction plan adaptations in magnetic resonance imaging guided radiotherapy in a phantom study, isolated from the uncertainty of deformable image registration.

Influence of magnetic field on a novel scintillation dosimeter in a 1.5 T MR-linac.

For commissioning and quality assurance for adaptive workflows on the MR-linac, a dosimeter which can measure time-resolved dose during MR image acquisition is desired. The Blue Physics model 10 scintillation dosimeter is potentially an ideal detector for such measurements. However, some detectors can be influenced by the magnetic field of the MR-linac.

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

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.

Dynamic Contrast-enhanced and Diffusion-weighted Magnetic Resonance Imaging for Response Evaluation After Single-Dose Ablative Neoadjuvant Partial Breast Irradiation.

Purpose: We aimed to evaluate changes in dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance imaging (MRI) scans acquired before and after single-dose ablative neoadjuvant partial breast irradiation (NA-PBI), and explore the relation between semiquantitative MRI parameters and radiologic and pathologic responses.

Methods And Materials: We analyzed 3.0T DCE and DW-MRI of 36 patients with low-risk breast cancer who were treated with single-dose NA-PBI, followed by breast-conserving surgery 6 or 8 months later.

First experimental exploration of real-time cardiorespiratory motion management for future stereotactic arrhythmia radioablation treatments on the MR-linac.

Stereotactic arrhythmia radioablation (STAR) is a novel, non-invasive treatment for refractory ventricular tachycardia (VT). The VT isthmus is subject to both respiratory and cardiac motion. Rapid cardiac motion presents a unique challenge.

Acceptance procedure for the linear accelerator component of the 1.5 T MRI-linac.

Purpose: To develop and implement an acceptance procedure for the new Elekta Unity 1.5 T MRI-linac.

Methods: Tests were adopted and, where necessary adapted, from AAPM TG106 and TG142, IEC 60976 and NCS 9 and NCS 22 guidelines.

Sarcoma of the Heart Treated with Stereotactic MR-Guided Online Adaptive Radiation Therapy.

We present the first case in the literature of a patient with a histology-proven intimal sarcoma of the heart, recurrent after surgery, treated with stereotactic MR-guided online adaptive radiation therapy on an MR-Linac machine. The treatment was feasible and well tolerated. The CT scan 6 months after the last treatment showed stable disease.

Synthetic CT for single-fraction neoadjuvant partial breast irradiation on an MRI-linac.

A synthetic computed tomography (sCT) is required for daily plan optimization on an MRI-linac. Yet, only limited information is available on the accuracy of dose calculations on sCT for breast radiotherapy. This work aimed to (1) evaluate dosimetric accuracy of treatment plans for single-fraction neoadjuvant partial breast irradiation (PBI) on a 1.

Reference dosimetry in MRI-linacs: evaluation of available protocols and data to establish a Code of Practice.

With the rapid increase in clinical treatments with MRI-linacs, a consistent, harmonized and sustainable ground for reference dosimetry in MRI-linacs is needed. Specific for reference dosimetry in MRI-linacs is the presence of a strong magnetic field. Therefore, existing Code of Practices (CoPs) are inadequate.

Tumor Response After Neoadjuvant Magnetic Resonance Guided Single Ablative Dose Partial Breast Irradiation.

Purpose: To assess the pathologic and radiologic response in patients with low-risk breast cancer treated with magnetic resonance (MR) guided neoadjuvant partial breast irradiation (NA-PBI) and to evaluate toxicity and patient-reported outcomes (PROs).

Methods And Materials: For this single-arm prospective trial, women with unifocal, non-lobular tumors with a maximum diameter of 20 mm (age, 50-70 years) or 30 mm (age, ≥70 years) and tumor-negative sentinel node(s) were eligible. Patients were treated with a single ablative dose of NA-PBI followed by breast-conserving surgery after an interval of 6 to 8 months.

Adaptive radiotherapy: The Elekta Unity MR-linac concept.

Background And Purpose: The promise of the MR-linac is that one can visualize all anatomical changes during the course of radiotherapy and hence adapt the treatment plan in order to always have the optimal treatment. Yet, there is a trade-off to be made between the time spent for adapting the treatment plan against the dosimetric gain. In this work, the various daily plan adaptation methods will be presented and applied on a variety of tumour sites.

Technical Note: Consistency of PTW30013 and FC65-G ion chamber magnetic field correction factors.

Purpose: Reference dosimetry in a strong magnetic field is made more complex due to (a) the change in dose deposition and (b) the change in sensitivity of the detector. Potentially it is also influenced by thin air layers, interfaces between media, relative orientations of field, chamber and radiation, and minor variations in ion chamber stem or electrode construction. The PTW30013 and IBA FC65-G detectors are waterproof Farmer-type ion chambers that are suitable for reference dosimetry.

Feasibility of stereotactic radiotherapy using a 1.5 T MR-linac: Multi-fraction treatment of pelvic lymph node oligometastases.

Online adaptive radiotherapy using the 1.5 Tesla MR-linac is feasible for SBRT (5 × 7 Gy) of pelvic lymph node oligometastases. The workflow allows full online planning based on daily anatomy.

Direct measurement of ion chamber correction factors, k and k , in a 7 MV MRI-linac.

The output of MRI-integrated photon therapy (MRgXT) devices is measured in terms of absorbed dose to water, D . Traditionally this is done with reference type ion chambers calibrated in a beam quality Q without magnetic field. To correct the ion chamber response for the application in the magnetic field, a factor needs to be applied that corrects for both beam quality Q and the presence of the magnetic field B, k .

Evaluation of plan adaptation strategies for stereotactic radiotherapy of lymph node oligometastases using online magnetic resonance image guidance.

Background And Purpose: Recent studies have shown that the use of magnetic resonance (MR) guided online plan adaptation yields beneficial dosimetric values and reduces unplanned violations of the dose constraints for stereotactic body radiation therapy (SBRT) of lymph node oligometastases. The purpose of this R-IDEAL stage 0 study was to determine the optimal plan adaptation approach for MR-guided SBRT treatment of lymph node oligometastases.

Materials And Methods: Using pre-treatment computed tomography (CT) and repeated MR data from five patients with in total 17 pathological lymph nodes, six different methods of plan adaptation were performed on the daily MRI and contours.

Monte Carlo simulations of out-of-field surface doses due to the electron streaming effect in orthogonal magnetic fields.

The out-of-field surface dose contribution due to backscattered or ejected electrons, focused by the magnetic field, is evaluated in this work. This electron streaming effect (ESE) can contribute to out-of-field skin doses in orthogonal magnetic resonance guided radiation therapy machines. Using the EGSnrc Monte Carlo package, a phantom is set-up along the central axis of an incident 10 [Formula: see text] 10 cm 7 MV FFF photon beam.

Monte Carlo simulations of out-of-field skin dose due to spiralling contaminant electrons in a perpendicular magnetic field.

Purpose: The purpose of this study was to evaluate the potential skin dose toxicity contribution of spiralling contaminant electrons (SCE) generated in the air in an MR-linac with a 0.35 or 1.5 T magnetic field using the EGSnrc Monte Carlo (MC) code.

Commissioning of a water calorimeter as a primary standard for absorbed dose to water in magnetic fields.

MRI guided radiotherapy devices are currently in clinical use. Detector responses are affected by the magnetic field and need to be characterized in terms of absorbed dose to water, D , against primary standards under these conditions. The aim of this study was to commission a water calorimeter, accepted as the Dutch national standard for D in MV photons and to validate its claimed standard uncertainty of 0.

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy.

Background: In patients diagnosed with rectal cancer, dose escalation is currently being investigated in a large number of studies. Since there is little known on gross tumor volume (GTV) inter-fraction motion for rectal cancer, a wide variety in margins is used. Purpose of this study is to quantify GTV inter-fraction motion statistics on different timescales and to give estimates of planning target volume (PTV) margins.