Longitudinal assessment of quality assurance measurements in a 1.5 T MR-linac: Part II-Magnetic resonance imaging

Purpose To describe and report longitudinal quality assurance (QA) measurements for the magnetic resonance imaging (MRI) component of the Elekta Unity MR-linac during the first year of clinical use in our institution. Materials and methods The performance of the MRI component of Unity was evaluated with daily, weekly, monthly, and annual QA testing. The measurements monitor image uniformity, signal-to-noise ratio (SNR), resolution/detectability, slice position/thickness, linearity, central frequency, and geometric accuracy. In anticipation of routine use of quantitative imaging (qMRI), we characterize B0/B1 uniformity and the bias/reproducibility of longitudinal/transverse relaxation times (T1/T2) and apparent diffusion coefficient (ADC). Tolerance levels for QA measurements of qMRI biomarkers are derived from weekly monitoring of T1, T2, and ADC. Results The 1-year assessment of QA measurements shows that daily variations in each MR quality metric are well below the threshold for failure. Routine testing procedures can reproducibly identify machine issues. The longitudinal three-dimensional (3D) geometric analysis reveals that the maximum distortion in a diameter of spherical volume (DSV) of 20, 30, 40, and 50 cm is 0.4, 0.6, 1.0, and 3.1 mm, respectively. The main source of distortion is gradient nonlinearity. Maximum peak-to-peak B0 inhomogeneity is 3.05 ppm, with gantry induced B0 inhomogeneities an order of magnitude smaller. The average deviation from the nominal B1 is within 2%, with minimal dependence on gantry angle. Mean ADC, T1, and T2 values are measured with high reproducibility. The median coefficient of variation for ADC, T1, and T2 is 1.3%, 1.1%, and 0.5%, respectively. The median bias for ADC, T1, and T2 is -0.8%, -0.1%, and 3.9%, respectively. Conclusion The MRI component of Unity operates within the guidelines and recommendations for scanner performance and stability. Our findings support the recently published guidance in establishing clinically acceptable tolerance levels for image quality. Highly reproducible qMRI measurements are feasible in Unity.