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Patient-related quality assurance with different combinations of treatment planning systems, techniques, and machines

A multi-institutional survey

Patientenbezogene Qualitätssicherung mit unterschiedlichen Kombinationen von Planungssystemen, Techniken und Geräten

Eine multiinstitutionelle Studie

  • Original Article
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Strahlentherapie und Onkologie Aims and scope Submit manuscript



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.


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.


Using only one of the two examined methods for patient-related quality assurance is not sufficiently significant in all cases.



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.


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.


Für die patientenbezogene Qualitätssicherung ist die Punktmessung der Dosis oder die alleinige Gammaanalyse zur Planverifizierung nicht in allen Fällen ausreichend signifikant.

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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.

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Correspondence to Beatrice Steiniger.

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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.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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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).

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