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Gamma analysis dependence on specified low-dose thresholds for VMAT QA.

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The study evaluated how low-dose thresholds affect gamma analysis in patient-specific QA for radiation therapy. Results show low-dose thresholds have minimal impact with global normalization but significantly influence local normalization, requiring careful selection.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Quality Assurance

Background:

  • The American Association of Physicists in Medicine (AAPM) Task Group 119 recommends specific low-dose thresholds for gamma analysis in quality assurance (QA).
  • However, the clinical impact of these low-dose thresholds on gamma index calculations remains quantitatively undemonstrated.

Purpose of the Study:

  • To quantitatively assess the impact of varying low-dose thresholds on gamma analysis for patient-specific QA in radiation therapy.
  • To compare the effects of global versus local normalization methods on gamma passing rates across different low-dose thresholds and acceptance criteria.

Main Methods:

  • Gamma analysis was performed on 30 treatment plans (head and neck, brain, prostate) using Varian Eclipse Treatment Planning System (TPS).
  • Calculated and measured portal images were analyzed using Portal Dosimetry software with low-dose thresholds ranging from 0% to 15%.
  • Analyses were conducted using both global and local normalization with acceptance criteria of 3%/3 mm, 2%/2 mm, and 1%/1 mm.

Main Results:

  • Gamma passing rates (%GP) decreased with increasing low-dose thresholds under global normalization, consistently exceeding 95% for 3%/3 mm and 2%/2 mm criteria.
  • Under local normalization, a 10% low-dose threshold increased %GP by 7.47% (head and neck), 10.23% (brain), and 6.71% (prostate) compared to 0% for the 3%/3 mm criterion.
  • The impact of low-dose thresholds varied significantly between global and local normalization methods.

Conclusions:

  • Applying low-dose thresholds in global normalization shows minimal impact on patient-specific QA results.
  • Careful selection of low-dose thresholds is crucial for local normalization, as excluded low-dose points can artificially inflate the average %GP.