Acceptance Testing and Quality Assurance Procedures for Magnetic Resonance Imaging Facilities

Purpose: To present lessons learned from magnetic resonance imaging (MRI) quality control (QC) tests for low-field MRI-guided radiation therapy (MR-IGRT) systems.Methods: MRI QC programs were established for low-field MRI-60 Co and MRI-Linac systems. A retrospective analysis of MRI subsystem performance covered system commissioning, operations, maintenance, and quality control. Performance issues were classified into three groups: (a) Image noise and artifact; (b) Magnetic field homogeneity and linearity; and (c) System reliability and stability.Results: Image noise and artifacts were attributed to room noise sources, unsatisfactory system cabling, and broken RF receiver coils. Gantry angle-dependent magnetic field inhomogeneities were more prominent on the MRI-Linac due to the high volume of steel shielding in the gantry. B 0 inhomogeneities measured in a 24-cm spherical phantom were <5 ppm for both MR-IGRT systems after using MRI gradient offset (MRI-GO) compensation on the MRI-Linac. However, significant signal dephasing occurred on the MRI-Linac while the gantry was rotating. Spatial integrity measurements were sensitive to gradient calibration and vulnerable to shimming.The most common causes of MR-IGRT system interruptions were software disconnects between the MRI and radiation therapy delivery subsystems caused by patient table, gantry, and multi-leaf collimator (MLC) faults. The standard deviation (SD) of the receiver coil signal-to-noise ratio was 1.83 for the MRI-60 Co and 1.53 for the MRI-Linac. The SD of the deviation from the mean for the Larmor frequency was 1.41 ppm for the MRI-60 Co and 1.54 ppm for the MRI-Linac. The SD of the deviation from the mean for the transmitter reference amplitude was 0.90% for the MRI-60 Co and 1.68% for the MRI-Linac. High SDs in image stability data corresponded to reports of spike noise.Conclusions: There are significant technological challenges associated with implementing and maintaining MR-IGRT systems. Most of the performance issues were identified and resolved during commissioning.

Section: Discussionmentioning

confidence: 99%

“…Quality assurance (QA) and quality control (QC) guidelines for MRI are addressed by the American College of Radiology (ACR), the American Association of Physicists in Medicine (AAPM), and the National Electrical Manufacturers Association (NEMA) standards . Separate QA guidelines are available for conventional Linacs .…”

Section: Introductionmentioning

confidence: 99%

MRI quality control for low‐field MR‐IGRT systems: Lessons learned

Gach

Curcuru

Wittland

et al. 2019

“…Daily QA guidance has been previously established for conventional linear accelerators and MR imaging systems . The daily QA tests recommended in TG142, TG40, and MPPG 8a are designed to maintain safety, accurate patient localization, and dosimetric output by monitoring parameters which can impact treatment goals .…”

Section: Introductionmentioning

confidence: 99%

Characterization and longitudinal assessment of daily quality assurance for an MR‐guided radiotherapy (MRgRT) linac

Mittauer

Dunkerley

Yadav

et al. 2019

PurposeTo describe and characterize daily machine quality assurance (QA) for an MR‐guided radiotherapy (MRgRT) linac system, in addition to reporting a longitudinal assessment of the dosimetric and mechanical stability over a 7‐month period of clinical operation.MethodsQuality assurance procedures were developed to evaluate MR imaging/radiation isocenter, imaging and patient handling system, and linear accelerator stability. A longitudinal assessment was characterized for safety interlocks, laser and imaging isocenter coincidence, imaging and radiation (RT) isocentricity, radiation dose rate and output, couch motion, and MLC positioning. A cylindrical water phantom and an MR‐compatible A1SL detector were utilized. MR and RT isocentricity and MLC positional accuracy was quantified through dose measured with a 0.40 cm2 x 0.83 cm2 field at each cardinal angle. The relationship between detector response to MR/RT isocentricity and MLC positioning was established through introducing known errors in phantom position.ResultsCorrelation was found between detector response and introduced positional error (N = 27) with coefficients of determination of 0.9996 (IEC‐X), 0.9967 (IEC‐Y), 0.9968 (IEC‐Z) in each respective shift direction. The relationship between dose (DoseMR/RT+MLC) and the vector magnitude of MLC and MR/RT positional error (Errormag) was calculated to be a nonlinear response and resembled a quadratic function: DoseMR/RT+MLC[%] = −0.0253 Errormag [mm]2 − 0.0195 Errormag [mm]. For the temporal assessment (N = 7 months), safety interlocks were functional. Laser coincidence to MR was within ±2.0 mm (99.6%) and ±1.0 mm (86.8%) over the 7‐month assessment. IGRT position–reposition shifts were within ±2.0 mm (99.4%) and ±1.0 mm (92.4%). Output was within ±3% (99.4%). Mean MLC and MR/RT isocenter accuracy was 1.6 mm, averaged across cardinal angles for the 7‐month period.ConclusionsThe linac and IGRT accuracy of an MR‐guided radiotherapy system has been validated and monitored over seven months for daily QA. Longitudinal assessment demonstrated a drift in dose rate, but temporal assessment of output, MLC position, and isocentricity has been stable.

“…Tracking central frequency was sensitive to a change due to machine service, and a slight reduction of central frequency over time was observed, as can be expected due to drifting postinstallation. The AAPM has suggested that one to two months postacceptance, the central frequency change is commonly

< 0.25 ppm / day

, (49) which will guide our new daily QA procedures.…”

Section: Discussionmentioning

confidence: 99%

Initial clinical experience with a radiation oncology dedicated open 1.0T MR‐simulation

Glide-Hurst

Hearshen

Kim

et al. 2015

The purpose of this study was to describe our experience with 1.0T MR‐SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR‐compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT‐SIM and MR‐SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System‐related, in‐plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5–20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude‐triggered 4D MRI was implemented using a motion phantom (2–10 phases, ~2 cm excursion, 3–5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT‐SIM and MR‐SIM volumes, with a mean distance of <0.2 mm between landmarks. Magnetic field inhomogeneity was <2 ppm. 2D distortion was <2 mm over 28.6–33.6 mm of isocenter. Within 5 cm radius of isocenter, mean 3D geometric distortion was 0.59±0.32 mm (maximum=1.65 mm) and increased 10–15 cm from isocenter (mean=1.57±1.06 mm, maximum=6.26 mm). ELPS interference was within the operating frequency of the scanner and was characterized by line patterns and a reduction in signal‐to‐noise ratio (4.6–12.6% for TE=50−150 ms). Image quality checks were within ACR recommendations. UTE/Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p<0.001) and ~ fourfold acquisition time increase was measured for ten‐phase versus two‐phase. Superior–inferior object extent was underestimated 8% (6 mm) for two‐phase as compared to ten‐phase MIPs, although <2% difference was obtained for ≥4 phases. 4D MRI for a patient demonstrated acceptable image quality in ~7 min. MR‐SIM was integrated into our workflow and QA procedures were developed. Clinical applicability was demonstrated for 4D MRI and UTE imaging to support MR‐SIM for single modality treatment planning.PACS numbers: 87.56.Fc, 87.61.‐c, 87.57.cp