SU‐E‐T‐197: Comparing Quality Assurance Strategies for Single Isocenter Treatments of Multiple Brain Metastases

Abstract

Purpose:To demonstrate a new quality assurance (QA) technique for single isocenter volumetric modulated arc therapy (VMAT) plans for stereotactic radiosurgery of multiple brain metastases and to compare quantitative QA results using this method with results using a cylindrical diode array and full field coronal films.Methods:This study employs a phantom built of 28 thin slabs to accommodate radiochromic film insertions near all planning target volume (PTV) locations, providing target specific data for individual PTVs. Single isocenter VMAT plans were designed for two patients with 5 and 11 intra‐cranial metastases. Both plans were modified three times to create plans that overdosed a target by 10%, and underdosed a target by 10 % and 20%. Gamma analyses were performed for full field coronal films, the diode array measurements and for individual PTVs with the proposed film stack method using square ROIs centered on the PTVs, measuring twice the length of the PTV's equivalent sphere diameter. Passing gamma criteria was 95% of points passing at 5%/1mm and a threshold of 10% of the prescription dose.Results:Of the 6 introduced errors, 1 was detected by the diode array gamma test (93.1% pass rate). Pass rates for the other 5 ranged from 95.4–98.8%. None of the errors were detected using the full field film gamma test (pass rates: 98.7–99.9%). Using the proposed film stack method, 5 of 6 errors were detected by failed gamma tests (pass rates: 51, 53, 71, 87.3, 93.9 and 97.8%). The two high pass rates were due to attempts to underdose a PTV that measured too high in the original plan.Conclusion:The results suggest that current methods may be lacking quantitative value and rely heavily on challenging qualitative evaluation, while the proposed method offers a much needed practical method for meaningful quantitative results.