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      A virtual phantom for patient‐specific QA On A 1.5 T MR‐linac

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          Abstract

          Create a virtual ArcCHECK‐MR phantom, customized for a 1.5 T MR‐linac, with consideration of the different density regions within the quality assurance (QA) phantom, aiming to streamline the utilization of this specialized QA device. A virtual phantom was constructed in the treatment planning system (TPS) to replicate the ArcCHECK‐MR's composition, consisting of five distinct layers: “Outer” (representing the outer PMMA ring), “Complex” (simulating the printed circuit boards), “Detectors” (encompassing the detector area), “Inner” (signifying the inner PMMA ring) and “Insert” (representing the PMMA insert). These layers were defined based on geometric data and represented as contour points on a set of dummy CT images. Additionally, a setup platform was integrated as contoured structures. To determine the relative electron density (RED) values of the external and internal PMMA components, measurements were taken at 25 points in the insert using an ion chamber. A novel method for establishing the exit/entrance dose ratio (EEDR) for ArcCHECK‐MR was introduced. The RED of higher density region was derived by evaluating the local gamma index passing rate results with criteria of 2% dose difference and 2 mm distance‐to‐agreement. The performance of the virtual phantom was assessed for Unity 7 FFF beams with a 1.5 T magnetic field. The radii of the five ring structures within the virtual phantom measured 133.0  mm, 110.0  mm, 103.4  mm, 100.0  mm, and 75.0  mm for the “Outer,” “Complex,” “Detectors,” “Inner” and “Insert” regions, respectively. The RED values were as follows: ArcCHECK‐MR PMMA had a RED of 1.130, “Detectors” were assumed to have a RED of 1.000, “Complex” had a RED of 1.200, and the setup QA phantom justified a RED of 1.350. Early validation results demonstrate that the 5‐layer virtual phantom, when compared to the commonly used bulk overridden phantom, offers improved capability in MR‐linac environments. This enhancement led to an increase in passing rates for the local gamma index by approximately 5 ∼ 6%, when applying the criteria of 2%, 2  mm. We have successfully generated a virtual representation of the distinct regions within the ArcCHECK‐MR using a TPS, addressing the challenges associated with its use in conjunction with a 1.5 T MR‐linac. We consistently observed favorable local gamma index passing rates across two 1.5 T MR‐linac and ArcCHECK‐MR unit combinations. This approach has the potential to minimize uncertainties in the creation of the QA phantom for ArcCHECK‐MR across various institutions.

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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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            Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218.

            Patient-specific IMRT QA measurements are important components of processes designed to identify discrepancies between calculated and delivered radiation doses. Discrepancy tolerance limits are neither well defined nor consistently applied across centers. The AAPM TG-218 report provides a comprehensive review aimed at improving the understanding and consistency of these processes as well as recommendations for methodologies and tolerance limits in patient-specific IMRT QA.
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              Medical physics challenges in clinical MR-guided radiotherapy

              The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART. Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation. Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing. The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization.
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                Author and article information

                Contributors
                Matthew.Ji@Elekta.com
                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
                22 January 2024
                May 2024
                : 25
                : 5 ( doiID: 10.1002/acm2.v25.5 )
                : e14264
                Affiliations
                [ 1 ] Elekta, Inc. Atlanta Georgia USA
                [ 2 ] Department of Radiation Oncology Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences (SDCH) Jinan China
                [ 3 ] Department of Radiation Oncology National Cancer Center/National Clinical Research Center for Cancer Cancer Hospital Chinese Academy of, Medical Sciences and Peking Union Medical College, (CAMS) Beijing Beijing China
                [ 4 ] Elekta Ltd. Asia Pacific Hongkong China
                Author notes
                [*] [* ] Correspondence

                Mingshuo Ji, Elekta, Inc. Atlanta, Georgia, USA.

                Email: Matthew.Ji@ 123456Elekta.com

                Author information
                https://orcid.org/0009-0008-6819-9761
                https://orcid.org/0000-0002-9977-4166
                Article
                ACM214264
                10.1002/acm2.14264
                11087164
                38252813
                b5c21b20-3d7d-47bc-a76a-40f541f3f1cb
                © 2024 The Authors. Journal of Applied Clinical Medical Physics is published by Wiley Periodicals, Inc. 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
                : 19 December 2023
                : 14 March 2023
                : 22 December 2023
                Page count
                Figures: 13, Tables: 3, Pages: 18, Words: 10493
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                May 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.2 mode:remove_FC converted:10.05.2024

                arccheck‐mr,mr‐linac,patient‐specific quality assurance,plan verification,radiotherapy

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