Evaluation of a novel secondary check tool for intensity-modulated radiotherapy treatment planning

The purpose of this study was to assess the accuracy and efficacy of an automated treatment plan verification, or "secondary check", tool (Mobius3D), which uses a reference dataset to perform an independent three-dimensional dose verification of the treatment planning system (TPS) dose calculation and assesses plan quality by comparing dose-volume histograms to reference benchmarks. The accuracy of the Mobius3D (M3D) system was evaluated by comparing dose calculations from IMRT and VMAT plans with measurements in phantom geometries and with TPS calculated dose distributions in prostate, lung, and head and neck patients (ten each). For the patient cases, instances of DVH limits exceeding reference values were also recorded. M3D showed agreement with measured point and planar doses that was comparable to the TPS in phantom geometries. No statistically significant differences (p < 0.05) were noted. M3D dose distributions from VMAT plans in patient cases were in good agreement with the TPS, with an average of 99.5% of dose points showing γ5%,3mm < 1. The M3D system also identified several plans that had exceeded dose-volume limits specified by RTOG protocols for those sites. The M3D system showed dosimetric accuracy comparable with the TPS, and identified several plans that exceeded dosimetric benchmarks. The M3D system possesses the potential to enhance the current treatment plan verification paradigm and improve safety in the clinical treatment planning and review process.