Quality Assurance Results Research Articles

157. Verification of high dose delivery in radiosurgery management of brain functional disorders

Purpose The purpose of this study is to validate the use of an innovative detector (edgeless-diode) [1] to measure the dose delivered in stereotactic radiosurgery for brain functional disorders. Methods Three diodes were inserted in a Rando phantom in ‘trigeminal’, 8 mm cranial and 26 mm caudal positions. In the framework of a dose escalation protocol, a trigeminal target patient’s plan was properly optimized. The diode coincident with the PTV-position was prescribed at doses respectively of 75, 100, 140 and 200 Gy in one single fraction. In the 75 Gy delivery case an EBT3 film was placed in correspondence with the caudal diode position and a prescription dose of 12 Gy was imposed in order to validate the diode’s recorded value. After the escalation of the dose, quality-assurance (QA) verifications were also performed for three patient planes with different prescription doses and placing the central diode in correspondence with the trigeminal target. Finally, the dose values measured by the three diodes were compared to the planned ones. Results The Rando plan and patient QA results are summarized in the following table. Comparison of the dose values from the edgeless-diode with EBT3 film shows a difference of −4.6%. Conclusions The edgeless-diode detectors were employed to measure the dose distribution of a full trigeminal stereotactic treatment; they record values of the dose in the central part of the PTV within 4% of the planned value for seven different plans. The verification of the value corresponding to a caudal position of the Rando-plan scaled at 75 Gy by EBT3 films shows a difference smaller than 5% in comparison with the edgeless-diode. The edgeless-diode employment in functional treatments QA procedures seems promising.

Monte-Carlo Based Total-Body Irradiation Using Linac-Based Volumetric Modulated Arc Therapy

To assess the accuracy, feasibility, and reliability of a total-body irradiation (TBI) technique with linac-based volumetric modulated arc therapy (VMAT) in patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). From 2015-2017, 26 patients (15 men, 11 women) with AML or ALL underwent allogenic stem-cell transplantation following TBI with linac-based VMAT technique, which consisted of three isocenters and three overlapping arcs for head first CT sets. We added one or two more overlapping arcs, depending on the height of the patient for feet first CT sets. Patient age ranged from 6-63 years with a mean and median age of 20.5 and 17.5 years, respectively. TBI dose was prescribed to 90% of the clinical target volume receiving 12 Gy in six fractions, at two fractions per day. Mean lung and kidney doses were restricted less than 10 Gy, and maximum lens dose less than 6 Gy. Dose rate was variable, and mean dose rate was 250 MU/min. Calculation parameters were grid spacing 0.4 cm, minimum segment width 0.5 cm, maximum 180 control points per arc, fluence-smoothing medium, statistical uncertainty 1.0% per calculation, gantry increment of 30°, and calculate dose deposition to medium. Patients were immobilized in supine position using customized thermoplastic masks for head support and a vacuum cushion for body support on an adjustable combined immobilization board. Laser-based optical surface-guided devices were used for patient positioning and intra-fraction motion detection. Quality assurance (QA) comprised the verification of the radiation plans via dose-volume histograms (DVH) based 3D patient QA system. Average mean lung dose was 9.7 ± 0.2 Gy, mean kidney dose 9.6 ± 0.2 Gy, maximum lens dose 4.5 ± 0.4 Gy, mean planning treatment volume (PTV) dose 12.7 ± 0.1 Gy, and heterogenity index of PTV was 1.16 ± 0.02 in all patients. Overall acute toxicity was low with only grade 1 and 2 morbidity: patchy mucositis in 16 (62%), nausea not requiring antiemetics in 12 (46%), headache in 11 (42%), fatigue in 9 (35%), neck pain in 8 (31%), xerostomia in 7 (27%), loss of appetite in 6 (23%), and faint or dull erythema in 4 (15%) patients. Grade 3 and more acute radiation toxicity was not observed. All patients are stil alive. When comparing plan and DVH-based 3D patient QA results, average differences of 3.4% ± 1.3 in mean kidney doses, 1.0% ± 0.7 in mean lung doses, and 0.9% ± 0.4 in mean target doses were observed. Linac-based VMAT simplifies the process of TBI, and is accurate, feasible, and reliable. Partial cone-beam CT and optical surface-guided system assure patient positioning. Moreover, up to 6-mm longitudinal misalignment does not cause an average more than 3.5% mean lung dose enhancement. DVH-based 3D patient dose verification QA was possible with linac-based VMAT showing small differences between planned and delivered doses.

Impact of the Use of Homogeneous and Heterogeneous Phantoms in Pretreatment Verification for Volumetric Modulated Arc Radiotherapy

The purpose of this study was to investigate the impact of quality assurance (QA) phantoms designed with different material to verify the accuracy of dose distribution for volumetric modulated arc radiotherapy (VMAT). Homogeneous and heterogeneous QA phantoms are developed to compare the pretreatment verification according to the different materials made in the phantom for routine VMAT of lung cancer. These phantoms have a quadrature rectangular shape with horizontal and vertical lengths of 300 mm and 315 mm, respectively, and with inserts of various slabs. The homogeneous QA phantom was constructed using only polymethyl methacrylate (ρ = 1.19 g/cm3). The heterogeneous QA phantom was constructed using a ceramic fiber board with a density of 0.3 g/cm3, which is similar to that of the lung in human thorax. Overall, the average gamma agreement values for the homogeneous and the heterogeneous QA phantoms were observed to be higher than 94.9% and 95.4% for two energies and the usual criteria. In addition, this study showed that the gamma agreement values obtained for both the homogeneous and the heterogeneous QA phantom agreed to within 2% for both the 2%/2 mm and the 3%/3 mm criteria. Furthermore, no statistically significant difference was observed in the gamma agreement values obtained using the homogeneous and the heterogeneous QA phantoms for both energies and the usual criteria (p > 0.05). Consequentially, this study found that patient specific QA results were not affected by phantoms made of the different materials.

Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability

PurposeTo report the feasibility, accuracy, and reliability of volumetric modulated arc therapy (VMAT)-based total-body irradiation (TBI) treatment in patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). Materials and methodsFrom 2015 to 2018, 30 patients with AML or ALL were planned and treated with VMAT-based TBI, which consisted of three isocenters and three overlapping arcs. TBI dose was prescribed to 90% of the planning treatment volume (PTV) receiving 12 Gy in six fractions, at two fractions per day. Mean lung and kidney doses were restricted less than 10 Gy, and maximum lens dose less than 6 Gy. Quality assurance (QA) comprised the verification of the irradiation plans via dose–volume histogram (DVH) based 3D patient QA system. ResultsAverage mean lung dose was 9.7 ± 0.2 Gy, mean kidney dose 9.6 ± 0.2 Gy, maximum lens dose 4.5 ± 0.4 Gy, mean PTV dose 12.7 ± 0.1 Gy, and heterogeneity index of PTV was 1.16 ± 0.02 in all patients. Grade 3 or more acute radiation toxicity was not observed. When comparing plan and DVH-based 3D patient QA results, average differences of 3.3% ± 1.3 in mean kidney doses, 1.1% ± 0.7 in mean lung doses, and 0.9% ± 0.4 in mean target doses were observed. ConclusionLinac-based VMAT increased the dose homogeneity of TBI treatment more than extended SSD techniques. Partial cone-beam CT and optical surface-guided system assure patient positioning. DVH-based 3D patient dose verification QA was possible with linac-based VMAT showing small differences between planned and delivered doses. It is feasible, accurate, and reliable.

Auditing local methods for quality assurance in radiotherapy using the same set of predefined treatment plans

Background and purposeLocal implementation of plan-specific quality assurance (QA) methods for intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment plans may vary because of dissimilarities in procedures, equipment and software. The purpose of this work is detecting possible differences between local QA findings and those of an audit, using the same set of treatment plans.MethodsA pre-defined set of clinical plans was devised and imported in the participating institute’s treatment planning system for dose computation. The dose distribution was measured using an ionisation chamber, radiochromic film and an ionisation chamber array. The centres performed their own QA, which was compared to the audit findings. The agreement/disagreement between the audit and the institute QA results were assessed along with the differences between the dose distributions measured by the audit team and computed by the institute.ResultsFor the majority of the cases the results of the audit were in agreement with the institute QA findings: ionisation chamber: 92%, array: 88%, film: 76% of the total measurements. In only a few of these cases the evaluated measurements failed for both: ionisation chamber: 2%, array: 4%, film: 0% of the total measurements.ConclusionUsing predefined treatment plans, we found that in approximately 80% of the evaluated measurements the results of local QA of IMRT and VMAT plans were in line with the findings of the audit. However, the percentage of agreement/disagreement depended on the characteristics of the measurement equipment used and on the analysis metric.

20. Pre-treatment quality assurance for flattening filter free dynamic arcs: A detector comparison

Introduction Pre-treatment quality assurance (QA) with flattening filter free (FFF) beams is challenging because of the high dose rate and the required spatial resolution as small field are usually used. Our current clinical practice is to perform pre-treatment QA with a diode array in a rotational phantom. This study investigates the replacement of this process by an electronic portal imager (EPI) measurement without a phantom in place in order to shorten the QA time on the machine. Methods Pre-treatment QA was performed with PTW Octavius 4D phantom equipped with SRS1000 diode array and with Varian aS1000 EPI. Diode array measurements were compared with the dose calculated in Octavius phantom with Varian Eclipse 13.7. EPI measurements was converted to water measurement and compared with water calculation performed in Dosisoft EPIBEAM (ThinkQA 1.0.2.2ALPHA). QA results were compared for Varian Truebeam 10 FFF dynamic arcs of 10 liver stereotactic radiotherapy plans and for plans with dose and MLC errors voluntarily introduced during beam delivery. Results Clinical plans covered a wide range of PTV size (average = 129.5 cm3, minimum = 9.8 cm3, maximum = 327.5 cm3) and dose prescription (average = 11.8 Gy, minimum = 6 Gy, maximum = 18 Gy) resulting in 1866 MU on average (minimum = 806 MU, maximum = 3072). Diode array and portal imager QA process gave both gamma values higher than 97% for 2%-2 mm criteria (10% threshold). Analysis of plans with errors is pending. Conclusions EPI QA process for FFF beams is achievable. It is much faster than diode array process as there is no need for a phantom setup and it provides similar results.

Three-dimensional dose prediction and validation with the radiobiological gamma index based on a relative seriality model for head-and-neck IMRT.

ABSTRACTThis study proposes a quality assurance (QA) method incorporating radiobiological factors based on the QUANTEC-determined tumor control probability and the normal tissue complication probability (NTCP) of head-and-neck intensity-modulated radiation therapy (HN-IMRT). Per-beam measurements were conducted for 20 cases using a 2D detector array. Three-dimensional predicted dose distributions within targets and organs at risk were reconstructed based on the per-beam QA results derived from differences between planned and measured doses. Under the predicted dose distributions, the differences between the physical and radiobiological gamma indices (PGI and RGI, respectively) based on the relative seriality (RS) model were evaluated. The NTCP values in the RS and Niemierko models were compared. The dose covers 98% (D98%) of the clinical target volume (CTV) decreased by 3.2% (P < 0.001), and the mean dose of the ipsilateral parotid increased by 6.3% (P < 0.001) compared with the original dose. RGI passing rates in the CTV and brain stem were greater than PGI ones by 5.8% (P < 0.001) and 2.0% (P < 0.001), respectively. The RS model’s average NTCP values for the ipsilateral and contralateral parotids under the original dose were smaller than those of the Niemierko model by 9.0% (P < 0.001) and 7.0% (P < 0.001), respectively. The 3D predicted dose evaluation with RGI based on the RS model was introduced for QA of HN-IMRT, leading to dose evaluation for each organ with consideration of the radiobiological effect. This method constitutes a rational way to perform QA of HN-IMRT in clinical practice.

Effect of beam profile measurement on arc therapy plan quality assurance: a case study.

We present an example when profile measurement and modeling of an Elekta Agility multileaf collimator (MLC) had a large effect specifically on arc therapy plan quality assurance (QA) results using ArcCheck. ArcCheck absolute dose measurements of these plans were systematically lower than planned by 3–10%. Failing QA results were seen even with unmodulated static and conformal arcs. Furthermore, the effect was found to be dependent on collimator angle, with worse results associated with near‐zero collimator angles. In contrast, step‐and‐shoot QA results were not affected. Changing the beam model to match steeper profile measurements obtained using a different measurement device resolved the problem. This case study demonstrates that conventional gamma index analysis can be sensitive to small profile modeling changes.

A management method for the statistical results of patient-specific quality assurance for intensity-modulated radiation therapy.

There are many reports concerning patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT). However, reports about the statistical results of QA are lacking. Management methods for the results of the QA are needed, even though we have the ESTRO group recommendation that a tolerance limit of 1.96 standard deviation (SD) be established in each institution. The purpose of this study was to establish a management method for determining the tolerance limit and to report the statistical results of patient-specific QA. From April 2006 to March 2015, five linacs in the National Cancer Center, Tokyo, Japan, were used to treat 1185 patients with IMRT. Patient-specific QA was performed using an ion chamber, films, and some detectors. To establish a management method for the results, differences between the measured and calculated doses in the ion chamber were analyzed for each linac, each phantom, and each treatment site. The overall mean dose difference was 0.5 ± 1.3%, and the mean dose difference in each linac was 0.6 ± 1.2%, 0.9 ± 1.3%, −0.4 ± 1.4%, −0.1 ± 1.2% and −0.1 ± 0.9%. The difference between linacs and between treatment sites was significant (P < 0.001 and 0.01, respectively). The proportion of the dose difference within ±3% was 97.7%, and that was improved from 2006 to 2014. The results of the patient-specific QA should be managed for each linac and each treatment site in order to decide the suitable tolerance limit. Reports of statistical results will be helped if a new tolerance limit and action level will be considered.

Realização de Interlaboratorial entre Empresas Organizadas em Rede como Alternativa para Comprovação da Garantia da Qualidade de Laboratórios de Análise de Sementes

Conducting interlaboratory is an important tool for proving the quality assurance ofanalyzes. The objective of this technical report is to analyze the effectiveness of the realization of seed analysis of interlaboratory by forming cooperation networks.The method used was Case Study. The initiative came from a laboratory seeds of a pubic company research, which is implementing the ISO / IEC 17025: 2005. This and otherseed laboratories, other subsidiaries of the same company, aims to accreditation by the National Institute of Metrology, Quality and Technology - INMETRO. Together theyformed a network of cooperation and conducted an interlaboratory. The analysis performed was soybean germination test. The methodology used and calculations followed that determine the Rules for Seed Analysis of the Ministry of Agriculture, Livestock and Supply. With the completion of this interlaboratory, laboratories managed to check the conformity of their results and meet the requirements regarding the quality assurance of results. The organization of this interlaboratory has highlighted the possibility of holding other interlaboratory between laboratories organized in a network of cooperation, scope of similarity within the national territory.

SU‐F‐T‐291: Development of Physician‐Driven, Clinically‐Relevant Pass/fail Criteria for a DVH‐Based IMRT Patient Specific QA Program

Purpose:To derive and implement physician driven metrics for dose volume histogram (DVH)‐based patient specific quality assurance (QA) for prostate radiation therapy based on clinically relevant deviations.Methods:An observership study presented 3 radiation oncology physicians from our institution with a series of artificial DVH‐based IMRT QA results, each generated by introducing iteratively larger perturbations from a planned DVH (from our pool of 20 real patient plans) to portions of the bladder, rectum, and planning target volume (PTV) DVHs. Physician responses were quantified by recording acceptable deviations from both in‐house defined clinical goals (e.g. V70Gy &lt; 10cc for rectum, mean dose for bladder) and other accepted dosimetric indices from the literature . The newly defined DVH criteria were used to evaluate 14 clinical IMRT plans measured using ArcCHECK and processed using 3DVH (Sun Nuclear Corporation, Melbourne, FL), all of which passed the standard 3%/3mm 2D‐Γ comparison at &gt;90% (absolute dose). In addition, 4 intentionally perturbed plans were measured, all with close to 90% 2D‐Γ passing rates (relative dose). We compared physician derived constraints against 2D‐Γ results to establish the relationship with an accepted IMRT QA metric.Results:Of the 14 clinical patients measured, 7 were flagged for physician review (i.e. did not pass physician‐derived DVH constraints). The rectum and bladder ΔD0.1cc constraint was the root cause of 5/7 of these QA failures. Of the 4 perturbed plans, 3/4 patients failed multiple DVH criteria in the bladder and rectum. Observership results from one physician‐derived metric (PTV ΔD0.1cc) were found to be too strict and excluded from analysis.Conclusion:We derived clinically relevant physician driven criteria for DVH‐based patient specific QA at our institution. In N=14 patient plans, implementation of these criteria reduced the need for physician review of patient QA results by 50%. Further refinement of PTV D0.1cc constraint is needed.Partially funded by Sun Nuclear Corporation research agreement.

SU-G-201-01: An Automated Treatment Plan Quality Assurance Program for High-Dose Rate (HDR) Brachytherapy with a VaginalCylinder Applicator

Purpose: Plan specific quality assurance (QA) is an important step in high dose rate (HDR) brachytherapy to ensure the integrity of a treatment plan. The conventional approach is to assemble a set of plan screen-captures in a document and have an independent plan-checker to verify it. Not only is this approach cumbersome and time-consuming, using a document also limits the items that can be verified, hindering plan quality and patient safety. We have initiated efforts to develop a web-based HDR brachytherapy QA system called AutoBrachy QA, for comprehensive and efficient QA. This abstract reports a new plugin in this system for the QA of a cylinder HDR brachytherapy treatment. Methods: A cylinder plan QA module was developed using Python. It was plugged into our AutoBrachy QA system. This module extracted information from CT images and treatment plan. Image processing techniques were employed to obtain geometric parameters, e.g. cylinder diameter. A comprehensive set of eight geometrical and eight dosimetric features of the plan were validated against user specified planning parameter, such as prescription value, treatment depth and length, etc. A PDF document was generated, consisting of a summary QA sheet with all the QA results, as well as images showing plan details. Results: The cylinder QA program has been implemented in our clinic. To date, it has been used in 11 patient cases and was able to successfully perform QA tests in all of them. The QA program reduced the average plan QA time from 7 min using conventional manual approach to 0.5 min. Conclusion: Being a new module in our AutoBrachy QA system, an automated treatment plan QA module for cylinder HDR brachytherapy has been successfully developed and clinically implemented. This module improved clinical workflow and plan integrity compared to the conventional manual approach.

Investigating ion recombination effects in a liquid-filled ionization chamber array used for IMRT QA measurements.

PTW's Octavius 1000 SRS array performs IMRT quality assurance (QA) measurements with liquid-filled ionization chambers (LICs) to allow closer detector spacing and higher resolution, compared to air-filled QA devices. However, reduced ion mobility in LICs relative to air leads to increased ion recombination effects and reduced collection efficiencies that are dependent on Linac pulse frequency and pulse dose. These pulse parameters are variable during an IMRT delivery, which affects QA results. In this study, (1) 1000 SRS collection efficiencies were measured as a function of pulse frequency and pulse dose, (2) two methods were developed to correct changes in collection efficiencies during IMRT QA measurements, and the effects of these corrections on QA pass rates were compared. To obtain collection efficiencies, the OCTAVIUS 1000 SRS was used to measure open fields of varying pulse frequency, pulse dose, and beam energy with results normalized to air-filled chamber measurements. Changes in ratios of 1000 SRS to chamber measured dose were attributed to changing collection efficiencies, which were then correlated to pulse parameters using regression analysis. The usefulness of the derived corrections was then evaluated using 6 MV and 10FFF SBRT RapidArc plans delivered to the OCTAVIUS 4D system using a TrueBeam (Varian Medical Systems) linear accelerator equipped with a high definition multileaf collimator. For the first correction, matlab software was developed that calculates pulse frequency and pulse dose for each detector, using measurement and DICOM RT Plan files. Pulse information is converted to collection efficiency, and measurements are corrected by multiplying detector dose by ratios of calibration to measured collection efficiencies. For the second correction the MU/min in the daily 1000 SRS calibration was chosen to match the average MU/min of the volumetric modulated arc therapy plan. Effects of the two corrections on QA results were examined by performing 3D gamma analysis comparing predicted to measured dose, with and without corrections. Collection efficiencies correlated linearly to pulse dose, while correlations with pulse frequency were less defined, generally increasing as pulse frequency decreased. After complex matlab corrections, average 3D gamma pass rates improved by [0.07%,0.40%,1.17%] for 6 MV and [0.29%,1.40%,4.57%] for 10FFF using [3%/3 mm,2%/2 mm,1%/1 mm] criteria. Maximum changes in gamma pass rates were [0.43%,1.63%,3.05%] for 6 MV and [1.00%,4.80%,11.2%] for 10FFF using [3%/3 mm,2%/2 mm,1%/1 mm] criteria. On average, pass rates of simple daily calibration corrections were within 1% of complex matlab corrections. OCTAVIUS 1000 SRS ion recombination effects have little effect on 6 MV measurements. However, the effect could potentially be clinically significant for higher pulse dose unflattened beams when using tighter gamma tolerances, especially when small aperture sizes are used, as is common for SRS/SBRT. In addition, ion recombination effects are strongly correlated to changing MU/min, therefore MU/min used in daily 1000 SRS calibrations should be matched to the expected average MU/min of the IMRT plan.

Commissioning and validation of COMPASS system for VMAT patient specific quality assurance

Pre-treatment patient specific quality assurance (QA) of advanced treatment techniques such as volumetric modulated arc therapy (VMAT) is one of important QA in radiotherapy. The fast and reliable dosimetric device is required. The objective of this study is to commission and validate the performance of COMPASS system for dose verification of VMAT technique. The COMPASS system is composed of an array of ionization detectors (MatriXX) mounted to the gantry using a custom holder and software for the analysis and visualization of QA results. We validated the COMPASS software for basic and advanced clinical application. For the basic clinical study, the simple open field in various field sizes were validated in homogeneous phantom. And the advanced clinical application, the fifteen prostate and fifteen nasopharyngeal cancers VMAT plans were chosen to study. The treatment plans were measured by the MatriXX. The doses and dose-volume histograms (DVHs) reconstructed from the fluence measurements were compared to the TPS calculated plans. And also, the doses and DVHs computed using collapsed cone convolution (CCC) Algorithm were compared with Eclipse TPS calculated plans using Analytical Anisotropic Algorithm (AAA) that according to dose specified in ICRU 83 for PTV.

The determination of elements in herbal teas and medicinal plant formulations and their tisanes

Elemental analysis of herbal teas and their tisanes is aimed at assessing their quality and safety in reference to specific food safety regulations and evaluating their nutritional value. This survey is dedicated to atomic spectroscopy and mass spectrometry element detection methods and sample preparation procedures used in elemental analysis of herbal teas and medicinal plant formulations. Referring to original works from the last 15 years, particular attention has been paid to tisane preparation, sample matrix decomposition, calibration and quality assurance of results in elemental analysis of herbal teas by different atomic and mass spectrometry methods. In addition, possible sources of elements in herbal teas and medicinal plant formulations have been discussed.

Analyzing the performance of ArcCHECK diode array detector for VMAT plan

AimThe aim of this study is to evaluate performance of ArcCHECK diode array detector for the volumetric modulated arc therapy (VMAT) patient specific quality assurance (QA). VMAT patient specific QA results were correlated with ion chamber measurement. Dose response of the ArcCHECK detector was studied. BackgroundVMAT delivery technique improves the dose distribution. It is complex in nature and requires proper QA before its clinical implementation. ArcCHECK is a novel three dimensional dosimetry system. Materials and methodsTwelve retrospective VMAT plans were calculated on ArcCHECK phantom. Point dose and dose map were measured simultaneously with ion chamber (IC-15) and ArcCHECK diode array detector, respectively. These measurements were compared with their respective TPS calculated values. ResultsThe ion chamber measurements are in good agreement with TPS calculated doses. Mean difference between them is 0.50% with standard deviation of 0.51%. Concordance correlation coefficient (CCC) obtained for ion chamber measurements is 0.9996. These results demonstrate a strong correlation between the absolute dose predicted by our TPS and the measured dose. The CCC between ArcCHECK doses and TPS predictions on the CAX was found to be 0.9978. In gamma analysis of dose map, the mean passing rate was 98.53% for 3% dose difference and 3mm distance to agreement. ConclusionsThe VMAT patient specific QA with an ion chamber and ArcCHECK phantom are consistent with the TPS calculated dose. Statistically good agreement was observed between ArcCHECK measured and TPS calculated. Hence, it can be used for routine VMAT QA.

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

The American Association of Physicists in Medicine Task Group 119 instructed institutions to use a low‐dose threshold of 10% or a region of interest determined by the jaw setting when they collected gamma analysis quality assurance (QA) data for the planar dose distribution. However, there are no clinical data to quantitatively demonstrate the impact of the low‐dose threshold on the gamma index. Therefore, we performed a gamma analysis with various low‐dose thresholds in the range of 0% to 15% according to both global and local normalization and different acceptance criteria (3%/3 mm, 2%/2 mm, and 1%/1 mm). A total of 30 treatment plans — 10 head and neck, 10 brain, and 10 prostate cancer cases — were randomly selected from the Varian Eclipse treatment planning system (TPS). For the gamma analysis, a calculated portal image was acquired through a portal dose calculation algorithm in the Eclipse TPS, and a measured portal image was obtained using an electronic portal‐imaging device. Then, the gamma analysis was performed using the Portal Dosimetry software (Varian Medical Systems, Palo Alto, CA). The gamma passing rate (%GP) for the global normalization decreased as the low‐dose threshold increased, and all low‐dose thresholds led to %GP values above 95% for both the 3%/3 mm and 2%/2 mm criteria. However, for the local normalization, %GP for a low‐dose threshold of 10% was 7.47%, 10.23%, and 6.71% greater than the low‐dose threshold of 0% for head and neck, brain, and prostate for the 3%/3 mm criteria, respectively. The results indicate that applying the low‐dose threshold to global normalization does not have a critical impact on patient‐specific QA results. However, in the local normalization, the low‐dose threshold level should be carefully selected because the excluded low‐dose points could cause the average %GP to increase rapidly.PACS number: 87.55.Qr

A comparison of the quality assurance of four dosimetric tools for intensity modulated radiation therapy.

BackgroundThis study was designed to compare the quality assurance (QA) results of four dosimetric tools used for intensity modulated radiation therapy (IMRT) and to suggest universal criteria for the passing rate in QA, irrespective of the dosimetric tool used.Materials and methods.Thirty fields of IMRT plans from five patients were selected, followed by irradiation onto radiochromic film, a diode array (Mapcheck), an ion chamber array (MatriXX) and an electronic portal imaging device (EPID) for patient-specific QA. The measured doses from the four dosimetric tools were compared with the dose calculated by the treatment planning system. The passing rates of the four dosimetric tools were calculated using the gamma index method, using as criteria a dose difference of 3% and a distance-to-agreement of 3 mm.ResultsThe QA results based on Mapcheck, MatriXX and EPID showed good agreement, with average passing rates of 99.61%, 99.04% and 99.29%, respectively. However, the average passing rate based on film measurement was significantly lower, 95.88%. The average uncertainty (1 standard deviation) of passing rates for 6 intensity modulated fields was around 0.31 for film measurement, larger than those of the other three dosimetric tools.ConclusionsQA results and consistencies depend on the choice of dosimetric tool. Universal passing rates should depend on the normalization or inter-comparisons of dosimetric tools if more than one dosimetric tool is used for patient specific QA.

WE-AB-201-00: Treatment Planning System Commissioning and QA

WE-AB-201-00: Treatment Planning System Commissioning and QA

WE-AB-201-02: TPS Commissioning and QA: A Process Orientation and Application of Control Charts

WE-AB-201-02: TPS Commissioning and QA: A Process Orientation and Application of Control Charts