A multi-institutional initiative on patient-related quality assurance: Independent computational dose verification of fluence-modulated treatment techniques.

PURPOSE: This multi-institutional study investigates whether computational verification of fluence-modulated treatment plans using independent software with its own Strahlerkopfmodel is an appropriate method for patient-related quality assurance (PRQA) in the context of various combinations of linear accelerators (linacs), treatment techniques and treatment planning systems (TPS). MATERIALS AND METHODS: The PRQA-software's (Mobius3D) recalculations of 9 institutions' treatment plans were analyzed for a horseshoe-shaped planning target volume (PTV) inside a phantom. The recomputed dose distributions were compared to a) the dose distributions as calculated by all TPS's and b) the measured dose distributions, which were acquired using the same independent measuring system for all institutions. Furthermore, dose volume histograms were examined. The penumbra deviations and mean gamma values were quantified using Verisoft (PTW). Additionally, workflow requirements for computational verification were discussed. RESULTS: Mobius3D is compatible with all examined TPSs, treatment techniques and linacs. The mean PTV dose differences (Mobius3D-TPS, <3.0%) and 3D gamma passing rates (>95.0%) led to a positive plan acceptance result in all cases. These results are similar to the outcome of the dosimetric measurements with one exception. The mean gamma values (<0.5) show a good agreement between Mobius3D and the TPS dose distributions. CONCLUSION: Using Mobius3D was proven to be an appropriate computational PRQA method for the tested combinations of linacs, treatment techniques and TPS's. The clinical use of Mobius3D has to be complemented with regular dosimetric measurements and thorough linac and TPS QA. Mobius3D's computational verification reduced measurement effort and personnel needs in comparison to dosimetric verifications.

Patient-related quality assurance with different combinations of treatment planning systems, techniques, and machines : A multi-institutional survey.

PURPOSE: This project compares the different patient-related quality assurance systems for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques currently used in the central Germany area with an independent measuring system. MATERIALS AND METHODS: The participating institutions generated 21 treatment plans with different combinations of treatment planning systems (TPS) and linear accelerators (LINAC) for the QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology) patient model. The plans were exposed to the ArcCHECK measuring system (Sun Nuclear Corporation, Melbourne, FL, USA). The dose distributions were analyzed using the corresponding software and a point dose measured at the isocenter with an ionization chamber. RESULTS: According to the generally used criteria of a 10 % threshold, 3 % difference, and 3 mm distance, the majority of plans investigated showed a gamma index exceeding 95 %. Only one plan did not fulfill the criteria and three of the plans did not comply with the commonly accepted tolerance level of ±3 % in point dose measurement. CONCLUSION: Using only one of the two examined methods for patient-related quality assurance is not sufficiently significant in all cases.