J Korean Med Sci.  2016 Nov;31(11):1742-1748. 10.3346/jkms.2016.31.11.1742.

Comparison of Dosimetric Performance among Commercial Quality Assurance Systems for Verifying Pretreatment Plans of Stereotactic Body Radiotherapy Using Flattening-Filter-Free Beams

• Chung JB
• Kang SW
• Eom KY
• Song C
• Choi KS
• Suh TS

• KMID: 2470269
• DOI: http://doi.org/10.3346/jkms.2016.31.11.1742

Abstract

The purpose of this study was to compare the performance of different commercial quality assurance (QA) systems for the pretreatment verification plan of stereotactic body radiotherapy (SBRT) with volumetric arc therapy (VMAT) technique using a flattening-filter-free beam. The verification for 20 pretreatment cancer patients (seven lung, six spine, and seven prostate cancers) were tested using three QA systems (EBT3 film, I'mRT MatriXX array, and MapCHECK). All the SBRT-VMAT plans were optimized in the Eclipse (version 11.0.34) treatment planning system (TPS) using the Acuros XB dose calculation algorithm and were delivered to the Varian TrueBeam® accelerator equipped with a high-definition multileaf collimator. Gamma agreement evaluation was analyzed with the criteria of 2% dose difference and 2 mm distance to agreement (2%/2 mm) or 3%/3 mm. The highest passing rate (99.1% for 3%/3 mm) was observed on the MapCHECK system while the lowest passing rate was obtained on the film. The pretreatment verification results depend on the QA systems, treatment sites, and delivery beam energies. However, the delivery QA results for all QA systems based on the TPS calculation showed a good agreement of more than 90% for both the criteria. It is concluded that the three 2D QA systems have sufficient potential for pretreatment verification of the SBRT-VMAT plan.

Keyword

Pretreatment Verification; Delivery Quality Assurance; Stereotactic Body Radiotherapy

MeSH Terms

Algorithms
Bone Neoplasms/radiotherapy
Humans
Lung Neoplasms/radiotherapy
Male
Prostatic Neoplasms/radiotherapy
*Quality Assurance, Health Care
Radiometry/instrumentation/*methods
*Radiosurgery
Radiotherapy Dosage
Retrospective Studies

Figure

• 

  Fig. 1 Three commercial QA systems set up for measuring pretreatment plan of SBRT-VMAT. (A) EBT3 film using cylindrical acryl phantom. (B) I’mRT MatriXX using the MultiCube phantom. (C) MapCHECK using the MapPHAN phantom.

• 

  Fig. 2 Example of gamma evaluation results between the three QA systems and TPS. The measured dose distribution, the calculated dose distribution and the gamma evaluation image for (A) EBT3 film, (B) I’mRT MatriXX, and (C) MapCHECK.

• 

  Fig. 3 Gamma passing rate of MapCHECK and MatriXX for static field of 6-MV FFF beam with various dose rates and different field sizes.

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