Evaluating AAPM-TG-218 recommendations: Gamma index tolerance and action limits in IMRT and VMAT quality assurance using SunCHECK

Jia Deng; ShengYan Liu; Yun Huang; Xiuquan Li; Xiangyang Wu

doi:10.1002/acm2.14277

Evaluating AAPM-TG-218 recommendations: Gamma index tolerance and action limits in IMRT and VMAT quality assurance using SunCHECK

J Appl Clin Med Phys. 2024 Jan 19:e14277. doi: 10.1002/acm2.14277. Online ahead of print.

Authors

Jia Deng^{1

2}, ShengYan Liu³, Yun Huang⁴, Xiuquan Li⁵, Xiangyang Wu¹

Affiliations

¹ Department of Radiation Oncology, Shaanxi Provincial Tumor Hospital, Xian, Shaanxi, China.
² School of Nuclear Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
³ Department of Radiation Oncology, Yulin Xingyuan Hospital, Xi'an, China.
⁴ Department of Oncology, Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China.
⁵ Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

PMID: 38243604
DOI: 10.1002/acm2.14277

Abstract

Purpose: This study aimed to improve the safety and accuracy of radiotherapy by establishing tolerance (TL) and action (AL) limits for the gamma index in patient-specific quality assurance (PSQA) for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) using SunCHECK software, as per AAPM TG-218 report recommendations.

Methods: The study included 125 patients divided into six groups by treatment regions (H&N, thoracic and pelvic) and techniques (VMAT, IMRT). SunCHECK was used to calculate the gamma passing rate (%GP) and dose error (%DE) for each patient, for the planning target volume and organs at risk (OARs). The TL and AL were then determined for each group according to TG-218 recommendations. We conducted a comprehensive analysis to compare %DE among different groups and examined the relationship between %GP and %DE.

Results: The TL and AL of all groups were more stringent than the common standard as defined by the TG218 report. The TL and AL values of the groups differed significantly, and the values for the thoracic groups were lower for both VMAT and IMRT. The %DE of the parameters D_95% , D_90% , and D_mean in the planning target volume, and D_mean and D_max in OARs were significantly different. The dose deviation of VMAT was larger than IMRT, especially in the thoracic group. A %GP and %DE correlation analysis showed a strong correlation for the planning target volume, but a weak correlation for the OARs. Additionally, a significant correlation existed between %GP of SunCHECK and Delta4.

Conclusion: The study established TL and AL values tailored to various anatomical regions and treatment techniques at our institution. Establishing PSQA workflows for VMAT and IMRT offers valuable clinical insights and guidance. We also suggest developing a standard combining clinically relevant metrics with %GP to evaluate PSQA results comprehensively.

Keywords: IMRT QA; VMAT QA; action limits; gamma passing rate.