{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T21:36:21Z","timestamp":1781732181362,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diffusion\u2010weighted imaging (DWI), a quantitative magnetic resonance imaging (qMRI) technique, has the potential to aid in disease characterization and treatment response monitoring. MR\u2010Linacs (MRLs) enable simultaneous DWI acquisitions during radiotherapy, uniquely aiding in the collection of large\u2010scale datasets for imaging biomarkers, such as the DWI\u2010derived apparent diffusion coefficient (ADC), without additional patient burden. However, the limited data reporting on variability in MRL scanner performance characteristics, and a lack of established clinical trial quality assurance (QA) procedures, are barriers to this route for biomarker validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aims to quantify the accuracy, intra\u2010scanner repeatability, and inter\u2010scanner reproducibility of ADC measurements across three MRLs in Australia in both a phantom and in vivo. These measurements will inform the feasibility of carrying out prospective multi\u2010center studies in Australia investigating ADC as a biomarker and form a core set of QA procedures and baselines to assess biomarker and sequence suitability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An isotropic diffusion phantom (at 0\u00b0C) and one healthy volunteer were scanned on three Unity MRLs (Elekta AB, Stockholm, Sweden). Standardized (QIBA Diffusion Profile) and anatomy\u2010specific DWI sequences, including sequences recommended by the MR\u2010Linac Consortium Imaging Biomarker Working Group, were used to image the phantom and volunteer. ADC maps generated using the MRL scanner software (inline ADC) and diffusion\u2010weighted (\n                      <jats:italic>b<\/jats:italic>\n                      \u2010value) images were exported from the scanner console. The latter was used to generate ADC maps using commercial software (offline ADC) for a separate comparative analysis. Performance metrics were computed for each sequence, including a coefficient of variation to assess between\u2010session intra\u2010scanner repeatability (CV\n                      <jats:sub>BS<\/jats:sub>\n                      ) and inter\u2010scanner reproducibility (CV), for each phantom vial and contoured organ. Additionally, using the phantoms\u2019 known ADC vial values, a percentage bias (bias) was calculated to determine ADC accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Phantom\u2010based measurements for the standardized QIBA sequence had intra\u2010 and inter\u2010scanner CV and bias well within recommended guideline (QIBA Diffusion Profile) tolerance limits of 2.2% and\u00a0\u00b13.6%, respectively. All anatomy\u2010specific phantom DWI sequences were also within these tolerances, except for the cervix sequence at one site which showed an average intra\u2010scanner bias of +4.5%. Both accuracy and reproducibility for all sequences were worse for lower diffusivity vials measured in the phantom. Additionally, inline and offline ADC maps had high similarity with average percent differences of +0.2%. Volunteer\u2010based results had worse reproducibility, with the average inter\u2010scanner CV for the brain and pancreas sequences within 9.0%, however, reaching up to 27.1% for pelvis and abdomen sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated accuracy, intra\u2010scanner repeatability, and inter\u2010scanner reproducibility comparable to metrics reported in the literature, using both the phantom and volunteer datasets. The cervix sequence had the largest variability in both phantom and volunteer results and was recommended for further investigation. This study suggests that qMRI techniques utilizing DWI could be a viable option for future multi\u2010centered patient\u2010based studies utilizing Australian MRLs, with phantom\u2010based quality assurance recommended alongside patient imaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.17739","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T07:41:42Z","timestamp":1741851702000},"page":"4120-4133","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Quantifying multi\u2010institutional ADC measurement variability of 1.5 T MR\u2010Linacs: A phantom and in vivo study"],"prefix":"10.1002","volume":"52","author":[{"given":"Madeline E.","family":"Carr","sequence":"first","affiliation":[{"name":"GenesisCare  Sydney New South Wales Australia"},{"name":"Centre for Medical Radiation Physics University of Wollongong  Wollongong New South Wales Australia"},{"name":"Liverpool and Macarthur Cancer Therapy Centres\/Ingham Institute for Applied Medical Research  Liverpool Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Keenan","sequence":"additional","affiliation":[{"name":"National Institute of Standards and Technology  Boulder Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Beavan","sequence":"additional","affiliation":[{"name":"Liverpool and Macarthur Cancer Therapy Centres\/Ingham Institute for Applied Medical Research  Liverpool Australia"},{"name":"School of Clinical Medicine, Medicine and Health University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Byrne","sequence":"additional","affiliation":[{"name":"GenesisCare  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Higuchi","sequence":"additional","affiliation":[{"name":"GenesisCare  Sydney New South Wales Australia"},{"name":"School of Mathematical and Physical Sciences University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Walker","sequence":"additional","affiliation":[{"name":"Centre for Medical Radiation Physics University of Wollongong  Wollongong New South Wales Australia"},{"name":"Liverpool and Macarthur Cancer Therapy Centres\/Ingham Institute for Applied Medical Research  Liverpool Australia"},{"name":"School of Clinical Medicine, Medicine and Health University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Olivia Newton\u2010John Cancer Wellness and Research Centre Austin Health  Heidelberg Australia"},{"name":"Department of Physical Sciences Peter MacCallum Cancer Centre  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Baines","sequence":"additional","affiliation":[{"name":"Townsville Cancer Centre Townsville University Hospital  Townsville Australia"},{"name":"College of Science and Engineering James Cook University  Townsville City Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikneswary","family":"Batumalai","sequence":"additional","affiliation":[{"name":"GenesisCare  Sydney New South Wales Australia"},{"name":"School of Clinical Medicine, Medicine and Health University of New South Wales  Sydney New South Wales Australia"},{"name":"The George Institute for Global Health University of New South Wales  Barangaroo New South Wales 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