Application of TG-218 action limits to SRS and SBRT pre-treatment patient specific QA

AAPM TG-218 provides recommendations for standard IMRT pre-treatment QA without giving specifics for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). In light of this, our purpose is to report our experience with applying TG-218 recommendations to a large multicenter clinical SRS and SBRT program for a range of diverse clinical pre-treatment QA systems. Pre-treatment QA systems included Delta4 (Scandidos), Portal Dosimetry (Varian Medical Systems), ArcCHECK (SunNuclear), and SRS MapCHECK (SunNuclear). Plans were stratified by technique for each QA system, and included intracranial and extracranial IMRT and VMAT (total QA cases n=275). Gamma analysis was re-analyzed with spatial/dose criteria combinations ranging from 1 to 3 mm and 1% to 4%, and action and tolerance limits were calculated per plan type and compared to the "universal" TG-218 action limit of 90%. The analysis indicated that spatial tolerance criteria could be tightened to 1 mm while still maintaining an in-control QA process for all QA systems evaluated.