Sources of out-of-field dose in MRgRT: an inter-comparison of measured and Monaco treatment planning system doses for...

With the clinical introduction of MR-linacs, out-of-field dose (OFD) associated with head leakage/scatter (HLS), spiralling contaminant electrons (SCE) and the electron streaming effect (ESE) is of interest. To investigate HLS and SCE, EBT3 film on solid water 5.0 cm beyond each edge of a 10.0 × 10.0 cm² field was used to determine depth-dose for 0 T and 1.5 T, in the isocentric plane. Additionally, ESE induced by the anterior imaging coil was quantified and the experimental arrangements to measure SCE and ESE were modelled using Monaco. For a clinical treatment of supraclavicular nodal disease, Monaco OFD was compared to in vivo measurements. For 0 T, depth-dose was isotropic and surface dose was approximately 4.4% of D_max. With 1.5 T surface doses were approximately 3.8% of D_max at ± Y (IEC61217), compared to 2.6% and 0.6% of D_max at - X and X, respectively. For both field strengths, the TPS depth-dose variation was consistent with experimental trends; however, near surface doses calculated at ± Y differed significantly from measurements. For the field sizes investigated, measured coil ESE dose was between 9.0 and 28.0% of D_max and Monaco coil ESE was less than measured by up to 13.0%. OFD in 0 T and 1.5 T are comparable at ± Y, inconsistent with previous work. Anterior coil ESE should be mitigated during treatment and for the clinical case investigated, in vivo OFD was within 2σ of TPS calculations. Monaco overestimates near surface SCE and underestimates coil ESE.