Abstract
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.
Zusammenfassung
Ziel
Im Rahmen des Projekts sollten die verschiedenen derzeit im mitteldeutschen Raum eingesetzten patientenbezogenen Qualitätssicherungssysteme zur intensitätsmodulierten Radiotherapie (IMRT) und volumenmodulierten Arc-Radiotherapie (VMAT) mit einem unabhängigen Messsystem verglichen werden.
Material und Methoden
Die teilnehmenden Einrichtungen berechneten insgesamt 21 Bestrahlungspläne mit verschiedenen Planungssystemen (TPS) und Linearbeschleunigern (LINAC) für das Patientenmodell QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology), die dann auf das ArcCHECK-Phantom (Sun Nuclear Corporation, Melbourne, FL, USA) übertragen und abgestrahlt wurden. Zur Auswertung wurde sowohl eine Punktmessung im Isozentrum als auch die Dosisverteilung in der Diodenebene des Messphantoms betrachtet.
Ergebnisse
Nach den allgemein üblichen Kriterien von 10 %-Schwellenwert, 3 %-Abweichung und 3‑mm-Abstand zeigten die meisten Pläne dieser Studie einen Gamma-Index größer 95 %, lediglich ein Plan erfüllte diese Kriterien nicht. Bei der Dosispunktmessung lagen drei Pläne außerhalb der üblichen Toleranz der 3 %-Abweichung.
Schlussfolgerung
Für die patientenbezogene Qualitätssicherung ist die Punktmessung der Dosis oder die alleinige Gammaanalyse zur Planverifizierung nicht in allen Fällen ausreichend signifikant.
Similar content being viewed by others
References
Feygelman V, Zhang G, Stevens C, Nelms BE (2011) Evaluation of a new VMAT QA device, or the “X” and “O” array geometries. J Appl Clin Med Phys 12(2):3346
Nelms BE, Simon JA (2007) A survey on planar IMRT QA analysis. J Appl Clin Med Phys 8(3):2448
Ezzell GA, Burmeister JW, Dogan N, LoSasso TJ, Mechalakos JG, Mihailidis D, Molineu A, Palta JR, Ramsey CR, Salter BJ, Shi J, Xia P, Yue NJ, Xiao Y (2009) IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Med Phys 36(11):5359–5373
Hussein M, Rowshanfarzad P, Ebert MA, Nisbet A, Clark CH (2013) A comparison of the gamma index analysis in various commercial IMRT/VMAT QA systems. Radiother Oncol 109(3):370–376. doi:10.1016/j.radonc.2013.08.048
Low DA, Moran JM, Dempsey JF, Dong L, Oldham M (2011) Dosimetry tools and techniques for IMRT. Med Phys 38(3):1313–1338
DIN 6875-3:2008-03 Spezielle Bestrahlungseinrichtungen – Teil 3: Fluenzmodulierte Strahlentherapie – Kennmerkmale, Prüfmethoden und Regeln für den klinischen Einsatz.
DIN 6875-4:2011-10 Spezielle Bestrahlungseinrichtungen – Teil 4: Fluenzmodulierte Strahlentherapie – Konstanzprüfungen.
DIN 6800-2:2008-03 Dosismessverfahren nach der Sondenmethode für Photonen- und Elektronenstrahlung – Teil 2: Dosimetrie hochenergetischer Photonen- und Elektronenstrahlung mit Ionisationskammern.
Ibbott GS, Haworth A, Followill DS (2013) Quality assurance for clinical trials. Front Oncol 3:311. doi:10.3389/fonc.2013.00311
Jornet N, Carrasco P, Beltran M, Calvo JF, Escude L, Hernandez V, Quera J, Saez J (2014) Multicentre validation of IMRT pre-treatment verification: comparison of in-house and external audit. Radiother Oncol 112(3):381–388. doi:10.1016/j.radonc.2014.06.016
Kry SF, Molineu A, Kerns JR, Faught AM, Huang JY, Pulliam KB, Tonigan J, Alvarez P, Stingo F, Followill DS (2014) Institutional patient-specific IMRT QA does not predict unacceptable plan delivery. Int J Radiat Oncol Biol Phys 90(5):1195–1201. doi:10.1016/j.ijrobp.2014.08.334
McKenzie EM, Balter PA, Stingo FC, Jones J, Followill DS, Kry SF (2014) Reproducibility in patient-specific IMRT QA. J Appl Clin Med Phys 15(3):4741. doi:10.1120/jacmp.v15i3.4741
Bohsung J, Gillis S, Arrans R, Bakai A, De Wagter C, Knoos T, Mijnheer BJ, Paiusco M, Perrin BA, Welleweerd H, Williams P (2005) IMRT treatment planning: a comparative inter-system and inter-centre planning exercise of the ESTRO QUASIMODO group. Radiother Oncol 76(3):354–361. doi:10.1016/j.radonc.2005.08.003
Followill DS, Urie M, Galvin JM, Ulin K, Xiao Y, Fitzgerald TJ (2012) Credentialing for participation in clinical trials. Front Oncol 2:198. doi:10.3389/fonc.2012.00198
Li G, Bai S, Chen N, Henderson L, Wu K, Xiao J, Zhang Y, Jiang Q, Jiang X (2013) Evaluation of the sensitivity of two 3D diode array dosimetry systems to setup error for quality assurance (QA) of volumetric-modulated arc therapy (VMAT). J Appl Clin Med Phys 14(5):13–24. doi:10.1120/jacmp.v14i5.3828
Chaswal V, Weldon M, Gupta N, Chakravarti A, Rong Y (2014) Commissioning and comprehensive evaluation of the ArcCHECK cylindrical diode array for VMAT pretreatment delivery QA. J Appl Clin Med Phys 15(4):4832. doi:10.1120/jacmp.v15i4.4832
Li G, Zhang Y, Jiang X, Bai S, Peng G, Wu K, Jiang Q (2013) Evaluation of the ArcCHECK QA system for IMRT and VMAT verification. Phys Med 29(3):295–303. doi:10.1016/j.ejmp.2012.04.005
Neilson C, Klein M, Barnett R, Yartsev S (2013) Delivery quality assurance with ArcCHECK. Med Dosim 38(1):77–80. doi:10.1016/j.meddos.2012.07.004
Vieillevigne L, Molinier J, Brun T, Ferrand R (2015) Gamma index comparison of three VMAT QA systems and evaluation of their sensitivity to delivery errors. Phys Med 31(7):720–725. doi:10.1016/j.ejmp.2015.05.016
Sun Nuclear Corporation (2012) ArcCHECK Reference Guide.
IAEA (2000) TRS No. 398 Absorbed dose determination in external beam radiotherapy.
Zakaria A, Schuette W, Younan C (2011) Reference dosimetry according to the New German Protocol DIN 6800-2 and comparison with IAEA TRS 398 and AAPM TG 51. Biomed Imaging Interv J 7(2):e15. doi:10.2349/biij.7.2.e15
Munjal RK, Negi PS, Babu AG, Sinha SN, Anand AK, Kataria T (2006) Impact of 6MV photon beam attenuation by carbon fiber couch and immobilization devices in IMRT planning and dose delivery. J Med Phys 31(2):67–71. doi:10.4103/0971-6203.26690
Olch AJ, Gerig L, Li H, Mihaylov I, Morgan A (2014) Dosimetric effects caused by couch tops and immobilization devices: report of AAPM Task Group 176. Med Phys 41(6):061501. doi:10.1118/1.4876299
Pulliam KB, Howell RM, Followill D, Luo D, White RA, Kry SF (2011) The clinical impact of the couch top and rails on IMRT and arc therapy. Phys Med Biol 56(23):7435–7447. doi:10.1088/0031-9155/56/23/007
Pulliam KB, Followill D, Court L, Dong L, Gillin M, Prado K, Kry SF (2014) A six-year review of more than 13,000 patient-specific IMRT QA results from 13 different treatment sites. J Appl Clin Med Phys 15(5):4935. doi:10.1120/jacmp.v15i5.4935
Gillis S, De Wagter C, Bohsung J, Perrin B, Williams P, Mijnheer BJ (2005) An inter-centre quality assurance network for IMRT verification: results of the ESTRO QUASIMODO project. Radiother Oncol 76(3):340–353. doi:10.1016/j.radonc.2005.06.021
Melidis C, Bosch WR, Izewska J, Fidarova E, Zubizarreta E, Ishikura S, Followill D, Galvin J, Xiao Y, Ebert MA, Kron T, Clark CH, Miles EA, Aird EG, Weber DC, Ulin K, Verellen D, Hurkmans CW (2014) Radiation therapy quality assurance in clinical trials – Global Harmonisation Group. Radiother Oncol 111(3):327–329. doi:10.1016/j.radonc.2014.03.023
Stasi M, Bresciani S, Miranti A, Maggio A, Sapino V, Gabriele P (2012) Pretreatment patient-specific IMRT quality assurance: a correlation study between gamma index and patient clinical dose volume histogram. Med Phys 39(12):7626–7634. doi:10.1118/1.4767763
Pasler M, Wirtz H, Lutterbach J (2011) Impact of gantry rotation time on plan quality and dosimetric verification-volumetric modulated arc therapy (VMAT) vs. intensity modulated radiotherapy (IMRT). Strahlenther Onkol 187(12):812–819. doi:10.1007/s00066-011-2263-1
Nelms BE, Zhen H, Tome WA (2011) Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors. Med Phys 38(2):1037–1044. doi:10.1118/1.3544657
Heilemann G, Poppe B, Laub W (2013) On the sensitivity of common gamma-index evaluation methods to MLC misalignments in rapidarc quality assurance. Med Phys 40(3):031702. doi:10.1118/1.4789580
Acknowledgements
BS conceived the study, acquired, analyzed, and interpreted the data, reviewed the literature and wrote the manuscript. RB, SE, CK, KL, TP, CR, JS, DS, SP, MW, and UW created the treatment plans and supported the measurements in the participating institutions. MS and KW were involved in study design; collection, analysis, and interpretation of data; and assisted with drafting the manuscript. TW was responsible for coordinating the study, edited the manuscript, and performed a critical revision of scientific content. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
B. Steiniger, R. Berger, S. Eilzer, C. Kornhuber, K. Lorenz, T. Peil, C. Reiffenstuhl, J. Schilz, D. Schröder, M. Schwedas, S. Pensold, M. Walke, K. Weibert, U. Wolf, and T. Wiezorek declare that they have no competing interests.
Ethical standards
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Steiniger, B., Berger, R., Eilzer, S. et al. Patient-related quality assurance with different combinations of treatment planning systems, techniques, and machines. Strahlenther Onkol 193, 46–54 (2017). https://doi.org/10.1007/s00066-016-1064-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00066-016-1064-y