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

Purpose 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. Results The diameter of the radiation isocenter and the distance between the MR/MV isocenters was (mu +/- sigma) 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. Conclusion 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.