Predicting deliverability of volumetric-modulated arc therapy (VMAT) plans using aperture complexity analysis.

The purpose of this study was to evaluate the ability of an aperture complexity metric for volumetric-modulated arc therapy (VMAT) plans to predict plan delivery accuracy. We developed a complexity analysis tool as a plug-in script to Varian's Eclipse treatment planning system. This script reports the modulation of plans, arcs, and individual control points for VMAT plans using a previously developed complexity metric. The calculated complexities are compared to that of 649 VMAT plans previously treated at our institution from 2013 to mid-2015. We used the VMAT quality assurance (QA) results from the 649 treated plans, plus 62 plans that failed pretreatment QA, to validate the ability of the complexity metric to predict plan deliverability. We used a receiver operating characteristic (ROC) analysis to determine an appropriate complexity threshold value above which a plan should be considered for reoptimization before it moves further through our planning workflow. The average complexity metric for the 649 treated plans analyzed with the script was 0.132 mm-1 with a standard deviation of 0.036 mm-1. We found that when using a threshold complexity value of 0.180 mm-1, the true positive rate for correctly identifying plans that failed QA was 44%, and the false-positive rate was 7%. Used clinically with this threshold, the script can identify overly modulated plans and thus prevent a significant portion of QA failures. Reducing VMAT plan complexity has a number of important clinical benefits, including improving plan deliverability and reducing treatment time. Use of the complexity metric during both the planning and QA processes can reduce the number of QA failures and improve the quality of VMAT plans used for treatment.

Audit tool for external beam radiation therapy departments.

PURPOSE: Development of a self-contained audit tool for external beam radiation therapy to assess compliance with the major recommendations from professional organizations and generally accepted standards of practice. Intensity modulated radiation therapy, stereotactic body radiation therapy, stereotactic radiosurgery, and volumetric modulated arc therapy were included in this review. METHODS AND MATERIALS: A physics quality working group developed a department vision, distinguished and summarized key references, and condensed important elements of good documentation practices. The results were then compiled in a checklist format and used to perform audits at 3 sites. RESULTS: The final audit tool contains 65 items spanning a wide range of external beam radiation therapy practices. Several of the audit items address issues not commonly identified by other authoritative sources. A total of 48 process improvements were identified at the 3 sites audited. CONCLUSIONS: The enclosed self-inspection list may be useful to a site as an annual review tool, as an aid in preparation for the American College of Radiology-American Society for Therapeutic Radiology and Oncology practice accreditation, or as a catalyst for general quality improvement. Sites can quickly identify opportunities for improvement by concentrating on high importance items and commonly identified areas of noncompliance.

Dosimetric impact of density variations in Solid Water 457 water-equivalent slabs.

The purpose of this study was to determine the dosimetric impact of density variations observed in water-equivalent solid slabs. Measurements were performed using two 30 cm × 30 cm water-equivalent slabs, one being 4 cm think and the other 5 cm thick. The location and extent of density variations were determined by computed tomography (CT) scans. Additional imaging measurements were made with an amorphous silicon megavoltage portal imaging device and an ultrasound unit. Dosimetric measurements were conducted with a 2D ion chamber array, and a scanned diode in water. Additional measurements and calculations were made of small rectilinear void inhomogeneities formed with water-equivalent slabs, using a 2D ion chamber array and the convolution superposition algorithm. Two general types of density variation features were observed on CT images: 1) regions of many centimeters across, but typically only a few millimeters thick, with electron densities a few percent lower than the bulk material, and 2) cylindrical regions roughly 0.2 cm in diameter and up to 20 cm long with electron densities up to 5% lower than the surrounding material. The density variations were not visible on kilovoltage, megavoltage or ultrasound images. The dosimetric impact of the density variations were not detectable to within 0.1% using the 2D ion chamber array or the scanning photon diode at distances 0.4 cm to 2 cm beyond the features. High-resolution dosimetric calculations using the convolution-superposition algorithm with density corrections enabled on CT-based datasets showed no discernable dosimetric impact. Calculations and measurements on simulated voids place the upper limit on possible dosimetric variations from observed density variations at much less than 0.6%. CT imaging of water-equivalent slabs may reveal density variations which are otherwise unobserved with kV, MV, or ultrasound imaging. No dosimetric impact from these features was measureable with an ion chamber array or scanned photon diode. Consequently, they were determined to be acceptable for all clinical use.