Volumetric-modulated arc therapy: effective and efficient end-to-end patient-specific quality assurance.

To explore an effective and efficient end-to-end patient-specific quality-assurance (QA) protocol for volumetric modulated arc radiotherapy (VMAT) and to evaluate the suitability of a stationary radiotherapy QA device (two-dimensional [2D] ion chamber array) for VMAT QA. Three methods were used to analyze 39 VMAT treatment plans for brain, spine, and prostate: ion chamber (one-dimensional absolute, n = 39), film (2D relative, coronal/sagittal, n = 8), and 2D ion chamber array (ICA, 2D absolute, coronal/sagittal, n = 39) measurements. All measurements were compared with the treatment planning system dose calculation either via gamma analysis (3%, 3- to 4-mm distance-to-agreement criteria) or absolute point dose comparison. The film and ion chamber results were similarly compared with the ICA measurements. Absolute point dose measurements agreed well with treatment planning system computed doses (ion chamber: median deviation, 1.2%, range, -0.6% to 3.3%; ICA: median deviation, 0.6%, range, -1.8% to 2.9%). The relative 2D dose measurements also showed good agreement with computed doses (>93% of pixels in all films passing gamma, >90% of pixels in all ICA measurements passing gamma). The ICA relative dose results were highly similar to those of film (>90% of pixels passing gamma). The coronal and sagittal ICA measurements were statistically indistinguishable by the paired t test with a hypothesized mean difference of 0.1%. The ion chamber and ICA absolute dose measurements showed a similar trend but had disparities of 2-3% in 18% of plans. After validating the new VMAT implementation with ion chamber, film, and ICA, we were able to maintain an effective yet efficient patient-specific VMAT QA protocol by reducing from five (ion chamber, film, and ICA) to two measurements (ion chamber and single ICA) per plan. The ICA (Matrixx®, IBA Dosimetry) was validated for VMAT QA, but ion chamber measurements are recommended for absolute dose comparison until future developments correct the ICA angular dependence.

O'Daniel J ，Das S ，Wu QJ ，Yin FF ... -  《-》

Patient-specific 3D pretreatment and potential 3D online dose verification of Monte Carlo-calculated IMRT prostate treatment plans.

Fast and reliable comprehensive quality assurance tools are required to validate the safety and accuracy of complex intensity-modulated radiotherapy (IMRT) plans for prostate treatment. In this study, we evaluated the performance of the COMPASS system for both off-line and potential online procedures for the verification of IMRT treatment plans. COMPASS has a dedicated beam model and dose engine, it can reconstruct three-dimensional dose distributions on the patient anatomy based on measured fluences using either the MatriXX two-dimensional (2D) array (offline) or a 2D transmission detector (T2D) (online). For benchmarking the COMPASS dose calculation, various dose-volume indices were compared against Monte Carlo-calculated dose distributions for five prostate patient treatment plans. Gamma index evaluation and absolute point dose measurements were also performed in an inhomogeneous pelvis phantom using extended dose range films and ion chamber for five additional treatment plans. MatriXX-based dose reconstruction showed excellent agreement with the ion chamber (<0.5%, except for one treatment plan, which showed 1.5%), film (∼100% pixels passing gamma criteria 3%/3 mm) and mean dose-volume indices (<2%). The T2D based dose reconstruction showed good agreement as well with ion chamber (<2%), film (∼99% pixels passing gamma criteria 3%/3 mm), and mean dose-volume indices (<5.5%). The COMPASS system qualifies for routine prostate IMRT pretreatment verification with the MatriXX detector and has the potential for on-line verification of treatment delivery using T2D.

Boggula R ，Jahnke L ，Wertz H ，Lohr F ，Wenz F ... -  《-》

A retrospective analysis for patient-specific quality assurance of volumetric-modulated arc therapy plans.

Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters, such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean ± standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% ± 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS.

Li G ，Wu K ，Peng G ，Zhang Y ，Bai S ... -  《-》

Measurement comparison and Monte Carlo analysis for volumetric-modulated arc therapy (VMAT) delivery verification using the ArcCHECK dosimetry system.

Lin MH ，Koren S ，Veltchev I ，Li J ，Wang L ，Price RA ，Ma CM ... -  《Journal of Applied Clinical Medical Physics》

IMRT quality assurance using a second treatment planning system.

We used a second treatment planning system (TPS) for independent verification of the dose calculated by our primary TPS in the context of patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT). QA plans for 24 patients treated with inverse planned dynamic IMRT were generated using the Nomos Corvus TPS. The plans were calculated on a computed tomography scan of our QA phantom that consists of three Solid Water slabs sandwiching radiochromic films, and an ion chamber that is inserted into the center slab of the phantom. For the independent verification, the dose was recalculated using the Varian Eclipse TPS using the multileaf collimator files and beam geometry from the original plan. The data was then compared in terms of absolute dose to the ion chamber volume as well as relative dose on isodoses calculated at the film plane. The calculation results were also compared with measurements performed for each case. When comparing ion chamber doses, the mean ratio was 0.999 (SD 0.010) for Eclipse vs. Corvus, 0.988 (SD 0.020) for the ionization chamber measurements vs. Corvus, and 0.989 (SD 0.017) for the ionization chamber measurements vs. Eclipse. For 2D doses with gamma histogram, the mean value of the percentage of pixels passing the criteria of 3%, 3 mm was 94.4 (SD 5.3) for Eclipse vs. Corvus, 85.1 (SD 10.6) for Corvus vs. film, and 93.7 (SD 4.1) for Eclipse vs. film; and for the criteria of 5%, 3 mm, 98.7 (SD 1.5) for Eclipse vs. Corvus, 93.0 (SD 7.8) for Corvus vs. film, and 98.0 (SD 1.9) for Eclipse vs. film. We feel that the use of the Eclipse TPS as an independent, accurate, robust, and time-efficient method for patient-specific IMRT QA is feasible in clinic.

Anjum MN ，Parker W ，Ruo R ，Aldahlawi I ，Afzal M ... -  《-》