The aim of this work was to determine magnetic field correction factors that are needed for dosimetry in hybrid devices for MR-guided radiotherapy for Farmer-type ionization chambers for different magnetic field strengths and field orientations. The response of six custom-built Farmer-type chambers irradiated at a 6 MV linac was measured in a water tank positioned in a magnet with magnetic field strengths between 0.0 T and 1.1 T. Chamber axis, beam and magnetic field were perpendicular to each other and both magnetic field directions were investigated. EGSnrc Monte Carlo simulations were compared to the measurements and simulations with different field orientations were performed. For all geometries, magnetic field correction factors, [Formula: see text], and perturbation factors were calculated. A maximum increase of 8.8% in chamber response was measured for the magnetic field perpendicular to chamber and beam axis. The measured chamber response could be reproduced by adjusting the dead volume layer near the chamber stem in the Monte Carlo simulations. For the magnetic field parallel to the chamber axis or parallel to the beam, the simulated response increased by 1.1% at maximum for field strengths up to 1.1 T. A complex dependence of the response was found on chamber radius, magnetic field strength and orientation of beam, chamber axis and magnetic field direction. Especially for magnetic fields perpendicular to beam and chamber axis, the exact sensitive volume has to be considered in the simulations. To minimize magnetic field correction factors and the influence of dead volumes on the response of Farmer chambers, a measurement set-up with the magnetic field parallel to the chamber axis or parallel to the beam is recommended for dosimetry.

Background and Purpose The clinical introduction of on-table adaptive radiotherapy with Magnetic Resonance (MR)-guided linear accelerators (Linacs) yields new challenges and potential risks. Since the adapted plan is created within a highly interdisciplinary workflow with the patient in treatment position, time pressure or erroneous communication may lead to various possibly hazardous situations. To identify risks and implement a safe workflow, a proactive risk analysis has been conducted. Materials and Methods A process failure mode, effects and criticality analysis (P-FMECA) was performed within a group of radiation therapy technologists, physicians and physicists together with an external moderator. The workflow for on-table adaptive MR-guided treatments was defined and for each step potentially hazardous situations were identified. The risks were evaluated within the team in order to homogenize risk assessment. The team elaborated and discussed possible mitigation strategies and carried out their implementation. Results In total, 89 risks were identified for the entire MR-guided online adaptive workflow. After mitigation, all risks could be minimized to an acceptable level. Overall, the need for a standardized workflow, clear-defined protocols together with the need for checklists to ensure protocol adherence were identified among the most important mitigation measures. Moreover, additional quality assurance processes and automated plan checks were developed. Conclusions Despite additional workload and beyond the fulfilment of legal requirements, execution of the P-FMECA within an interdisciplinary team helped all involved occupational groups to develop and foster an open culture of safety and to ensure a consensus for an efficient and safe online adaptive radiotherapy workflow.

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