Suitability of EBT3 GafChromic film for quality assurance in MR-guided radiotherapy at 0.35 T with and without real-time MR imaging.

The 0.35 T Co-60 MRldian system (ViewRay Inc., Mountain View) has been in clinical use in our institution since May 2016. For quality assurance (QA) of dose delivery and end-to-end testing for this machine, a reliable dosimeter is required. However, it is possible that a magnetic field may cause perturbations to dosimetry measurements. For static magnetic fields, there is conflicting information in the literature concerning EBT film behaviour, while for real-time MR imaging such information is not available at all. The purpose of this study was to investigate the suitability of EBT3 GafChromic film for MRldian QA, both with and without real-time MR imaging. EBT3 film sheets were irradiated in water using the MRldian and a conventional linear accelerator (Linac) for reference. Dose calibration measurements were first performed up to 8 Gy for both machines. The MRldian measurements were performed with and without real-time MR imaging. Second, film sheets were irradiated at seven different angles with respect to the B-0-field. Optical density and dose values were analysed for the three colour channels. In both the film dose-response and B-0-field orientation measurements, the mean dose values were within the 1% uncertainty range of prescribed dose values for the red and green channels, for both machines. There were no dose deviations detected between the MRldian and Linac film measurements, nor for different B-0-field orientations. In addition, the film dose-response measurements during real-time imaging were within 1.5% of the reference Linac measurements. EBT3 GafChromic film can be used for absolute dosimetry during real-time MR imaging independent of its orientation in the B-0-field. This makes it a suitable dosimeter for patient-specific QA measurements and end-to-end testing of 0.35 T MRI-radiotherapy devices.