Comparison of global and local gamma evaluation results using isodose levels

The aim of this study is to evaluate the behaviour of global and local gamma analyses with isodose levels. Global and local gamma evaluation were performed on patient-specific quality assurance (PSQA) data from 100 volumetric modulated arc therapy (VMAT) arcs and 100 helical tomotherapy (HT) plans, using an in-house gamma code. Gamma pass rates versus isodose levels were plotted and evaluated. Other than a slightly increased skew towards higher pass rates for the global gamma evaluation, minimal differences were observed between the results of evaluating all VMAT arcs separately and the results of evaluating over VMAT treatment plans by combining arcs from each plan. Generally, the VMAT results showed average pass rates that increase with decreasing isodose level, for both global and local gamma evaluations. The HT results differed systematically from the VMAT results, with the results of performing global and local gamma evaluations agreeing more closely at all isodose levels and with the highest gamma pass rates being achieved at intermediate dose levels, between the 40 and 70% isodose levels. These results demonstrate the complex of relationships between global and local gamma evaluation results that can arise when clinical PSQA data are analysed and exemplify how the local gamma evaluation does not necessarily produce disproportionately reduced gamma pass rates in low dose regions. Performing gamma evaluation with different isodose levels is suggested as a useful method to improve understanding of specific PSQA data and as well as the broader features of gamma evaluation results.