Patient Specific QA Research Articles

Analysis of delivery and recalculation of dose using DICOM treatment records

ObjectiveA procedure has been proposed for patient-specific QA that, instead of comparing a measurement to the planned dose, compares the dose calculated by an independent system to the dose calculated by the planning system. It is still prudent, however, to check the accuracy of the beam delivery. For this purpose, the DICOM records from the first treatment fraction can be compared to the planned treatment using an in-house developed planning system. MethodsTotally 1,398 patient portals were subjected to the new QA procedure. The dose distribution for each portal was first recalculated on a water phantom by two treatment planning systems and the dose distributions were compared. When agreement was observed, the patient was allowed to start treatment without a measurement. The record from the first day was imported into an in-house planning system which was used to evaluate the delivery for errors and calculate the delivered dose distribution and compare it to the planned dose distribution. ResultsA total of 266 portals passed a strict comparison between the clinical and QA dose calculations and directly used for treatment without measurements. For those portals, the comparison of the delivery records to the plan showed that 99% of spot positions deviated less than 0.2 ​mm and 99.7% of spot metersets deviated by less than 0.3%. On the other hand, 64 portals showed spot size deviations greater than the tolerance of ± 15% with some as large as ±25%. For 32 portals in which the record was used to calculate the delivered dose distribution, the Gamma passing rates between the planned and delivered distributions were always above 95% using a 2% dose difference and 2 ​mm distance-to-agreement criteria. ConclusionsThe new QA process has been implemented slowly with strict constraints. The amount of beam time required has been reduced while maintaining safety.

Design and fabrication of indigenous multi-rotational thorax phantom for patient-specific quality assurance of IMRT and VMAT

Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are commonly used treatment modalities in external beam radiotherapy. Precise quality assurance is required for the clinical implementation of IMRT and VMAT to ensure the correct treatment delivery. Square slab phantom is used commonly in developing countries to measure the pre-treatment point dose measurements. The limitation of the slab phantom was that the detector was positioned on the central axis of the beam which caused difficulty in positioning of the chamber at off-axis of the beam and peripheral regions. The new indigenously multi-purpose multi-rotational phantom was fabricated with various chamber provisions in order to address the above challenge. Innovative devices always play a crucial role in radiotherapy to bring significant technological advancement to the field. The quality assurance Multi-Rotational Thorax (MRT) Phantom designing involved slice-wise modelling of an average adult thorax using Poly-methyl methacrylate (PMMA) to perform point dose absolute dosimetry using an ionization chamber and Radio-Photo-Luminescence Glass Dosimeter (RPLGD). The phantom consisted of 35 slices of PMMA material in an axial direction. Each slice had a dimension of 1 cm thickness, 35 cm length and 20 cm height. The phantom had provisions in the target region and multiple provisions in the lungs, heart, surface and spine. The unique manual rotation system was provided on the lungs as well as in the heart. The provisions were capable of holding the detectors such as ionization chambers and RPLGD. The response of the phantom to open the beam in various gantry angles was initially accessed with multiple gantry angles and then pre-treatment verification of IMRT and VMAT plans was also checked. The results showed that the MRT phantom had good capabilities for absolute point dosimetry. In the case of an open beam, multiple gantry angles, the maximum variations for both the detectors were within −1.9% when compared with the TPS dose. The maximum percentage variation on isocentre (T) for IMRT and VMAT between TPS and Semiflex chamber was 1.85%. Similarly, the maximum percentage variation was 1.92% between TPS and RPLGD on isocentre. For Semiflex chamber, maximum percentage variation on peripheral region was 2.68%. Similarly, for RPLGD maximum percentage variation was 2.76%. The overall difference between the measured values for both the detectors were less than 3%. The present dosimetric study concluded that the MRT phantom with a RPLGD and Semiflex chamber was suitable for routine IMRT and VMAT patient-specific QA purposes.

Predicting gamma evaluation results of patient-specific head and neck volumetric-modulated arc therapy quality assurance based on multileaf collimator patterns and fluence map features: A feasibility study.

The purpose of this study was to develop a predictive model for patient‐specific VMAT QA results using multileaf collimator (MLC) effect and texture analysis. The MLC speed, acceleration and texture analysis features were extracted from 106 VMAT plans as predictors. Gamma passing rate (GPR) was collected as a response class with gamma criteria of 2%/2 mm and 3%/2 mm. The model was trained using two machine learning methods: AdaBoost classification and bagged regression trees model. GPR was classified into the “PASS” and “FAIL” for the classification model using the institutional warning level. The accuracy of the model was assessed using sensitivity and specificity. In addition, the accuracy of the regression model was determined using the difference between predicted and measured GPR. For the AdaBoost classification model, the sensitivity/specificity was 94.12%/100% and 63.63%/53.13% at gamma criteria of 2%/2 mm and 3%/2 mm, respectively. For the bagged regression trees model, the sensitivity/specificity was 94.12%/91.89% and 61.18%/68.75% at gamma criteria of 2%/2 mm and 3%/2 mm, respectively. The root mean square error (RMSE) of difference between predicted and measured GPR was found at 2.44 and 1.22 for gamma criteria of 2%/2 mm and 3%/2 mm, respectively. The promising result was found at tighter gamma criteria 2%/2 mm with 94.12% sensitivity (both bagged regression trees and AdaBoost classification model) and 100% specificity (AdaBoost classification model).

Virtual patient-specific QA with DVH-based metrics.

We demonstrate a virtual pretreatment patient-specific QA (PSQA) procedure that is capable of quantifying dosimetric effect on patient anatomy for both intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). A machine learning prediction model was developed to use linear accelerator parameters derived from the DICOM-RT plan to predict delivery discrepancies at treatment delivery (defined as the difference between trajectory log file and DICOM-RT) and was coupled with an independent Monte Carlo dose calculation algorithm for dosimetric analysis. Machine learning models for IMRT and VMAT were trained and validated using 120 IMRT and 206 VMAT fields of prior patients, with 80% assigned for iterative training and testing, and 20% for post-training validation. Various prediction models were trained and validated, with the final models selected for clinical implementation being a boosted tree and bagged tree for IMRT and VMAT, respectively. After validation, these models were then applied clinically to predict the machine parameters at treatment delivery for 7 IMRT plans from various sites (61 fields) and 10 VMAT multi-target intracranial radiosurgery plans (35 arcs) and compared to the dosimetric effect calculated directly from trajectory log files. Dose indices tracked for targets and organs at risk included dose received by 99%, 95%, and 1% of the volume, mean dose, percent of volume receiving 25%-100% of the prescription dose. The average coefficient of determination (r2 ) when comparing intra-field predicted and actual delivery error was 0.987±0.012 for IMRT and 0.895±0.095 for VMAT, whereas r2 when comparing inter-field predicted versus actual delivery error was 0.982 for IMRT and 0.989 for VMAT. Regarding dosimetric analysis, r2 when comparing predicted versus actual dosimetric changes for all dose indices was 0.966 for IMRT and 0.907 for VMAT. Prediction models can be used to anticipate the dosimetric effect calculated from trajectory files and have potential as a "delivery-free" pretreatment analysis to enhance PSQA.

PD-0898 Clinical gains through log file based automated patient specific QA in Proton Therapy

PD-0898 Clinical gains through log file based automated patient specific QA in Proton Therapy

PO-1555 Error detection thresholds of diode detector arrays in SRT patient specific QA

PO-1555 Error detection thresholds of diode detector arrays in SRT patient specific QA

PO-1639 A pre-treatment patient specific QA alternative approach for HyperArc treatments.

PO-1639 A pre-treatment patient specific QA alternative approach for HyperArc treatments.

SEAFARER – A new concept for validating radiotherapy patient specific QA for clinical trials and clinical practice

BackgroundThe quality of radiotherapy delivery has been shown to significantly impact clinical outcomes including patient survival. To identify errors, institutions perform Patient Specific Quality Assurance (PSQA) assessing each individual radiotherapy plan prior to starting patient treatments. Externally administered Dosimetry Audits have found problems despite institutions passing their own PSQA. Hence a new audit concept which assesses the institution’s ability to detect errors with their routine PSQA is needed. MethodsPurposefully introduced edits which simulated treatment delivery errors were embedded into radiation treatment plans of participating institutions. These were designed to produce clinically significant changes yet were mostly within treatment delivery specifications. Actual impact was centrally assessed for each plan. Institutions performed PSQA on each plan, without knowing which contained errors. ResultsSeventeen institutions using six radiation treatment planning systems and two delivery systems performed PSQA on twelve plans each. Seventeen erroneous plans (across seven institutions) passed PSQA despite causing >5% increase in spinal cord dose relative to the original plans. Six plans (from four institutions) passed despite a >10% increase. ConclusionsThis novel audit concept evolves beyond testing an institution’s ability to deliver a single test case, to increasing the number of errors caught by institutions themselves, thus increasing quality of radiation therapy and impacting every patient treated. Administered remotely this audit also provides advantages in cost, environmental impact, and logistics.

A polar-coordinate-based pencil beam algorithm for VMAT dose computation with high-resolution gantry angle sampling.

Most commercially available treatment planning systems (TPSs) approximate the continuous delivery of volumetric modulated arc therapy (VMAT) plans with a series of discretized static beams for treatment planning, which can make VMAT dose computation extremely inefficient. In this study, we developed a polar-coordinate-based pencil beam (PB) algorithm for efficient VMAT dose computation with high-resolution gantry angle sampling that can improve the computational efficiency and reduce the dose discrepancy due to the angular under-sampling effect. 6 MV pencil beams were simulated on a uniform cylindrical phantom under an EGSnrc Monte Carlo (MC) environment. The MC-generated PB kernels were collected in the polar coordinate system for each bixel on a fluence map and subsequently fitted via a series of Gaussians. The fluence was calculated using a detectors' eye view with off-axis and MLC transmission factors corrected. Doses of VMAT arc on the phantom were computed by summing the convolution results between the corresponding PB kernels and fluence for each bixel in the polar coordinate system. The convolution was performed using fast Fourier transform to expedite the computing speed. The calculated doses were converted to the Cartesian coordinate system and compared with the reference dose computed by a collapsed cone convolution (CCC) algorithm of the TPS. A heterogeneous phantom was created to study the heterogeneity corrections using the proposed algorithm. Ten VMAT arcs were included to evaluate the algorithm performance. Gamma analysis and computation complexity theory were used to measure the dosimetric accuracy and computational efficiency, respectively. The dosimetric comparisons on the homogeneous phantom between the proposed PB algorithm and the CCC algorithm for 10 VMAT arcs demonstrate that the proposed algorithm can achieve a dosimetric accuracy comparable to that of the CCC algorithm with average gamma passing rates of 96% (2%/2mm) and 98% (3%/3mm). In addition, the proposed algorithm can provide better computational efficiency for VMAT dose computation using a PC equipped with a 4-core processor, compared to the CCC algorithm utilizing a dual 10-core server. Moreover, the computation complexity theory reveals that the proposed algorithm has a great advantage with regard to computational efficiency for VMAT dose computation on homogeneous medium, especially when a fine angular sampling rate is applied. This can support a reduction in dose errors from the angular under-sampling effect by using a finer angular sampling rate, while still preserving a practical computing speed. For dose calculation on the heterogeneous phantom, the proposed algorithm with heterogeneity corrections can still offer a reasonable dosimetric accuracy with comparable computational efficiency to that of the CCC algorithm. We proposed a novel polar-coordinate-based pencil beam algorithm for VMAT dose computation that enables a better computational efficiency while maintaining clinically acceptable dosimetric accuracy and reducing dose error caused by the angular under-sampling effect. It also provides a flexible VMAT dose computation structure that allows adjustable sampling rates and direct dose computation in regions of interest, which makes the algorithm potentially useful for clinical applications such as independent dose verification for VMAT patient-specific QA.

Implementation of volumetric-modulated arc therapy for locally advanced breast cancer patients: Dosimetric comparison with deliverability consideration of planning techniques and predictions of patient-specific QA results via supervised machine learning

PurposeThe aim of this study was to implement a clinically deliverable VMAT planning technique dedicated to advanced breast cancer, and to predict failed QA using a machine learning (ML) model to optimize the QA workload. MethodsFor three planning methods (2A: 2-partial arc, 2AS: 2-partial arc with splitting, 4A: 4-partial arc), dosimetric results were compared with patient-specific QA performed with the electronic portal imaging device of the linac. A dataset was built with the pass/fail status of the plans and complexity metrics. It was divided into training and testing sets. An ML metamodel combining predictions from six base classifiers was trained on the training set to predict plans as ‘pass’ or ‘fail’. The predictive performances were evaluated using the unseen data of the testing set. ResultsThe dosimetric comparison highlighted that 4A was the highest dosimetric performant method but also the poorest performant in the QA process. 2AS spared the best heart, but provided the highest dose to the contralateral breast and lowest node coverage. 2A provides a dosimetric compromise between organ at risk sparing and PTV coverage with satisfactory QA results. The metamodel had a median predictive sensitivity of 73% and a median specificity of 91%. ConclusionsThe 2A method was selected to calculate clinically deliverable VMAT plans; however, the 2AS method was maintained when the heart was of particular importance and breath-hold techniques were not applicable. The metamodel provides promising predictive performance, and it is intended to be improved as a larger dataset becomes available.

A method for time-independent film dosimetry: Can we obtain accurate patient-specific QA results at any time postirradiation?

AimThe aim of this work was twofold. (1) To investigate and present a comparison between EBT3 and EBT‐XD in terms of postirradiation color changes. (2) Create an automated workflow to allow radiochromic film (EBT3/XD) to be scanned and converted to dose accurately at any postirradiation time.Materials and MethodsTen GafChromic EBT‐XD calibration films were exposed in 2 Gy increments up to 18 Gy. Calibrates were then scanned at 5‐min intervals postirradiation over 24 h using an AutoHotKey script, resulting in 288 TIFF images. Following the 24‐h scanning period, a MATLAB script was used to automatically read the tiff images and create a series of 288 calibration curves distinct in time which is termed as the “Temporal Calibration Model” (TCM). The model is saved as a series of polynomial fit coefficients to net optical density as a function of dose, timestamped in 5‐min increments. Ten patient‐specific film measurements (5 × EBT‐XD and 5 × EBT3) were then carried out and scanned using the same 5‐min scan intervals from 5 min postirradiation to 24 h postirradiation. The TCM was then automatically applied using eFilmQA software to convert the patient‐specific QA films to dose by applying the relevant calibration curve from the TCM, corresponding to the arbitrary postirradiation time that the film was scanned. Each dose plane at postirradiation scan intervals of 5 min up to 20 h was then compared to the ground‐truth dose plane using gamma analysis.ResultsGamma pass rates using the TCM at time t, normalized to the pass rate after 20 h postirradiation, were found to have a maximum coefficient of variation of 3% over any postirradiation time. Conversely, not using the TCM resulted in coefficients of variation of up to 39%. Clinical implementation of this method showed an average accuracy of 2.8% when comparing the clinical result to the TCM result.ConclusionsWe have developed a methodology that allows radiochromic film to be accurately used as a dosimeter at any arbitrary scan postirradiation time, whereas previously, waiting periods of 16–24 h before readout were needed to ensure the postirradiation changes had stabilized. The creation of a TCM can enable results from radiochromic film measurements to be obtained quickly postirradiation. Using a conventional single calibration curve generated at 20 h postirradiation can result in gamma pass‐rate difference of up to 75% for measurement films scanned at a much shorter postirradiation time.

Evaluation of Patient-Specific Quality Assurance for Carbon Ion Radiotherapy Using Full Energy Scanning Method at QST Hospital

Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report the results of PSQA conducted at the QST Hospital during the period from September 2017 to March 2018. Methods: We analyzed PSQA results for 1448 fields for 10 disease sites with various target volumes, target depths and number of energy layers. For the PSQA, all the planned beams were recalculated on a water phantom with treatment planning software. The recalculated dose distributions were compared with the measured distributions using a 2D ionization chamber array at three depths, including 95% of the area of the prescription dose. These recalculated dose distributions were evaluated using the 3%/3mm gamma index with a passing threshold of 90%. Results: The passing rates for prostate, head and neck, and bone and soft tissue were 96.8%, 99.3%, and 91.7%, respectively. Additionally, 94.7% of lung plans with low energy beams passed. Overall, the CIRT in the QST Hospital reached a high passing rate of more than 95%. Although the remaining 5% failed to pass, there was no dependence between measurement depth and disease sites in these failures. Conclusion: Using PSQA measurements, we confirmed consistency between the planned and delivered doses for CIRT using the full energy scanning method.

Double-vertebral segment SBRT via novel ring-mounted Halcyon Linac: Plan quality, delivery efficiency and accuracy.

To evaluate the plan quality, treatment delivery efficiency, and accuracy of single-isocenter/multi-target (SIMT) volumetric modulated arc therapy (VMAT) of double-vertebral segments stereotactic body radiation therapy (SBRT) on Halcyon ring delivery system (RDS). In-house multi-target end-to-end phantom testing and independent dose verification using the MD Anderson's single-isocenter/multi-target (lung/spine targets) thorax phantom were completed. Six previously treated patients with 2-vertebral segments on thoracic and/or lumber spine were replanned on Halcyon RDS with 6MV-FFF beam using a single-isocenter placed between the vertebral segments. Three full VMAT arcs with 0° and ±10° collimator angles and advanced Acuros-based dose engine for heterogeneity corrections were used. Prescription was 35 Gy in 5 fractions to each vertebral-segment, simultaneously. For comparison, Halcyon VMAT-SBRT plans were retrospectively created on SBRT-dedicated Truebeam with a 6MV-FFF beam using identical planning geometry and optimization objectives. Target coverage, conformity index (CI), heterogeneity index (HI), gradient index (GI), dose to 2-cm away from each target (D2-cm), and dose to adjacent organs-at-risk (OAR) were evaluated per NRG-BR002 protocol. Treatment delivery parameters were evaluated for both plans. In-house phantom measurements showed acceptable spatial accuracy (< 1mm within 5-cm from the isocenter) of conebeam CT-guided Halcyon SBRT treatments. The MD Anderson phantom irradiation credentialing results met IROC requirements for protocol patients. Mean isocenter-to-tumor center distance was 3.3 ± 0.6-cm (range 2.4 to 4.3-cm). Mean combined PTV was 57.3 ± 31.3 cc (range 20.1 to 99.9 cc). Both Halcyon and Truebeam SIMT-VMAT plans met NRG-BR002 compliance criteria and show similar CI, HI, GI, D2-cm. Maximal and volumetric doses to adjacent OAR including dose to partial spinal cord were lower with Halcyon RDS. Average total monitor units, modulation, and overall treatment time were lower with Halcyon plans by 130 MU, 0.2, 3.8 min, respectively, with similar beam-on time. Average pre-treatment patient-specific portal-dosimetry QA results on Halcyon showed a high pass rate of 99.6%, compared to SBRT-dedicated Truebeam pass rate of 96.8%, for 2%/2 mm clinical gamma passing criteria, suggesting more accurate treatment delivery on Halcyon RDS. SBRT treatment of double-vertebral segments via SIMT-VMAT plans on Halcyon for selected patients is feasible and dosimetrically superior to Truebeam Linac. Faster treatment delivery (<10 min) of double-vertebral segment SBRT on Halcyon could reduce patient intolerance due to severe back pain, potentially reduce intra-fraction motion errors, and improve patient throughput, and clinic workflow.

Dosimetric comparison of analytical anisotropic algorithm and the two dose reporting modes of Acuros XB dose calculation algorithmin volumetric modulated arc therapy of carcinoma lung and carcinoma prostate.

Volumetric Modulated Arc Therapy (VMAT) is an important modality for radical radiotherapy of all major treatment sites. This study aims to compare Analytical Anisotropic Algorithm (AAA) and the two dose-reporting modes of Acuros XB (AXB) algorithm -the dose to medium option (Dm) and the dose to water option (Dw) in Volumetric Modulated Arc Therapy (VMAT) of carcinoma lung and carcinoma prostate. We also compared the measured dose with Treatment Planning System calculated dose for AAA and the two dose reporting options of Acuros XB using Electronic Portal Imaging Device (EPID) and ArcCHECK phantom. Treatment plans of twenty patients each who have already undergone radiotherapy for cancer of lung and cancer of prostate were selected for the study. Three sets of VMAT plans were generated in Eclipse Treatment Planning System (TPS), one with AAA and two plans with Acuros-Dm and Acuros-Dw options. The Dose Volume Histograms (DVHs) were compared and analyzed for Planning Target Volume (PTV) and critical structures for all the plans. Verification plans were created for each plan and measured doses were compared with TPS calculated doses using EPID and ArcCHECK phantom for all the three algorithms. For lung plans, the mean dose to PTV in the AXB-Dw plans was higher by 1.7% and in the AXB-Dm plans by 0.66% when compared to AAA plans. For prostate plans, the mean dose to PTV in the AXB-Dw plans was higher by 3.0% and in the AXB-Dm plans by 1.6% when compared to AAA plans. There was no difference in the Conformity Index (CI) between AAA and AXB-Dm and between AAA and AXB-Dw plans for both sites. But the homogeneity worsened in AXB-Dw and AXB-Dm plans when compared to AAA plans for both sites. AXB-Dw calculated higher dose values for PTV and all the critical structures with significant differences with one or two exceptions. Point dose measurements in ArcCHECK phantom showed that AXB-Dm and AXB-Dw options showed very small deviations with measured dose distributions than AAA for both sites. Results of EPID QA also showed better pass rates for AXB-Dw and AXB-Dm than AAA for both sites when gamma analysis was done for 3%/3 mm and 2%/2 mm criteria. With reference to the results, it is always better to choose Acuros algorithm for dose calculations if it is available in the TPS. AXB-Dw plans showed very high dose values in the PTV when compared to AAA and AXB-Dm in both sites studied. Also, the volume of PTV receiving 107% dose was significantly high in AXB-Dw plans compared to AXB-Dm plans in sites involving high density bones. Considering the results of dosimetric comparison and QA measurements, it is always better to choose AXB-Dm algorithm for dose calculations for all treatment sites especially when high density bony structures and complex treatment techniques are involved. For patient specific QA purposes, choosing AXB-Dm or AXB-Dw does not make any significant difference between calculated and measured dose distributions.

Comparison between different Dosimetric Tools based on Intensity-modulated Radiotherapy (IMRT): A Phantom Study

This study examined the gamma passing rate (GPR) consistency during applying different kinds of gamma analyses and dosimeters to IMRT. Methods: Import treatment protocols for QA phantom irradiation have been recalculated. A gamma analysis was used for comparing the measured and calculated dose distribution of IMRT for different gamma criteria (2%/2mm, 3%/3mm, 4%/4mm, 3%/5mm, 3%/5mm). These criteria are evaluated when 5%, 10%, or 15% of the dose distribution is suppressed. Measured and calculated dose distribution was evaluated with gamma analysis to dose difference (DD) with DTA criteria (distance to agreement). IMRT QA plans to 25 patients from various sites were formed with the Varian Eclipse treatment planning system. Results: Results indicate different diverse hardware and software combinations show varied levels of agreement with expected analysis for the same pass-rate criterion. For a dosimetry audit of the IMRT technique, an EPID detector is superior to conventional methods comparable to Gafchromic EPT3 film and 2D array due to cost, time-consuming, and set up error to get result analysis. The gamma passing rate (GPR) average is increased by increasing the low-dose threshold for different dosimetric tools. For EPID, regardless of the gamma criterion employed, the %GP does not appear to be dependent on the low-dose threshold values (5%-15%) because it indicates that fulfilment the low-dose threshold to global normalization has little effect on patient-specific QA outcomes. Conclusions: It is concluded that GPRs differ depending on gamma, dosimetric tools, and the suppressing dose ratio. To get the best results of quality assurance, each institution should thus carefully develop its procedure for gamma analysis by defining the gamma index analysis and gamma criterion using its dosimetric tools.

The effect of MV image spatial resolution on the patient positioning and patient specific QA

Electronic portal imaging device (EPID) is a common part of almost each radiotherapy treatment unit. It is a quick and simple tool for various clinical procedures, e.g. verification of patient positioning or patient specific QA. Currently available EPIDs have usually the spatial resolution below 0.5 mm. As EPIDs are not primarily designed for diagnostics, even lower spatial resolution might be acceptable. This work assesses the effect of MV image spatial resolution on clinical routines which employ the EPID and addresses the minimal technical requirements of such devices. The aim is to determine if EPIDs with poorer spatial resolution are able to reach the same clinical quality as currently used EPIDs. The effects of MV image spatial resolution on the imaging performance, patient positioning and patient specific QA were studied. The lower spatial resolution was simulated by manually downsampling the original images down to 4× poorer spatial resolution. The study includes an analysis of 96 images used for the patient positioning verification and 61 treatment field images used for the patient specific QA.

P89 - Tolerance and action limits determination for tighter patient specific QA acceptance criteria and comparison of the clinical relevance of 2D versus 3D gamma passing rates

P89 - Tolerance and action limits determination for tighter patient specific QA acceptance criteria and comparison of the clinical relevance of 2D versus 3D gamma passing rates

P24 - A novel isodose surface-based method for patient specific QA analysis

P24 - A novel isodose surface-based method for patient specific QA analysis

P52 - Evaluation of a planar diode matrix for SRS patient-specific QA in comparison with GAFchromic films

P52 - Evaluation of a planar diode matrix for SRS patient-specific QA in comparison with GAFchromic films

Comparative performance analysis of 2D and 3D gamma metrics for patient specific QA in VMAT using Octavius 4D with 2D-Array 1500.

Gamma pass percentage (GPP) is the predominant metric used for Patient Specific Quality Assurance (PSQA) in radiation therapy. The dimensionality of the measurement geometry in PSQA has evolved from 2D planar to 3D planar, and presently to state-of-the-art 3D volumetric geometry. We aim to critically examine the performance of the three-dimensional gammas vis-à-vis the older gamma metrics of lower dimensionality to determine their mutual fungibility in PSQA, using clinically approved Volumetric Arc Therapy (VMAT) plans. Gamma pass percentages derived from PSQA for VMAT plans using Octavius 4D phantom with 2D-Array 1500 and its proprietary software were recorded. 2D planar, 3D planar, and 3D volumetric gamma pass percentages were retrospectively extracted for multiple treatment plans at three sites, using three acceptance limits, and for two modes of normalization. The differences in mean pass percentages, and the pairwise correlation between geometries were calculated within limits of statistical significance. A significant increase in mean pass rates was observed from 2D planar to 3D planar geometries. The difference was less pronounced from 3D planar to 3D volumetric. 2D planar v/s 3D planar showed a significant degree of correlation among themselves, which was not seen against most of the 3D volumetric pass rates. The mean gamma pass rates show conclusive evidence of the benefits of shifting from 2D planar to higher dimensions measurement geometries, but the benefits of using 3D volumetric compared to 3D planar is not always unequivocal. The correlations show mixed results regarding the interdependence of pass percentages at different geometries.