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Published on: May 26, 2019
Multi-institutional comparison of secondary check of treatment planning using computer-based independent dose
Hidenobu Tachibana1, Yukihiro Uchida2, Ryuta Miyakawa3
1Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 277-8577 Chiba, Japan; Radiation Safety and Quality Assurance Division, Hospital East, National Cancer Center, 277-8577 Chiba, Japan.
Purpose:
This report covers the first multi-institutional study of independent monitor unit (MU)/dose calculation verification for the CyberKnife, Vero4DRT, and TomoTherapy radiotherapy delivery systems.
Methods:
A total of 973 clinical treatment plans were collected from 12 institutions. Commercial software employing the Clarkson algorithm was used for verification after a measurement validation study, and the doses from the treatment planning systems (TPSs) and verification programs were compared on the basis of the mean value ± two standard deviations. The impact of heterogeneous conditions was assessed in two types of sites: non-lung and lung.
Results:
The dose difference for all locations was 0.5 ± 7.2%. There was a statistically significant difference (P < 0.01) in dose difference between non-lung (-0.3 ± 4.4%) and lung sites (3.5 ± 6.7%). Inter-institutional comparisons showed that various systematic differences were associated with the proportion of different treatment sites and heterogeneity correction.
Conclusions:
This multi-institutional comparison should help to determine the departmental action levels for CyberKnife, Vero4DRT, and TomoTherapy, as patient populations and treatment sites may vary between the modalities. An action level of ±5% could be considered for intensity-modulated radiation therapy (IMRT), non-IMRT, and volumetric modulated arc radiotherapy using these modalities in homogenous and heterogeneous conditions with a large treatment field applied to a large region of homogeneous media. There were larger systematic differences in heterogeneous conditions with a small treatment field because of differences in heterogeneity correction with the different dose calculation algorithms of the primary TPS and verification program.
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