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      A radiotherapy community data‐driven approach to determine which complexity metrics best predict the impact of atypical TPS beam modeling on clinical dose calculation accuracy

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          Abstract

          Purpose

          To quantify the impact of treatment planning system beam model parameters, based on the actual spread in radiotherapy community data, on clinical treatment plans and determine which complexity metrics best describe the impact beam modeling errors have on dose accuracy.

          Methods

          Ten beam modeling parameters for a Varian accelerator were modified in RayStation to match radiotherapy community data at the 2.5, 25, 50, 75, and 97.5 percentile levels. These modifications were evaluated on 25 patient cases, including prostate, non‐small cell lung, H&N, brain, and mesothelioma, generating 1,000 plan perturbations. Differences in the mean planned dose to clinical target volumes (CTV) and organs at risk (OAR) were evaluated with respect to the planned dose using the reference (50th‐percentile) parameter values. Correlation between CTV dose differences, and 18 different complexity metrics were evaluated using linear regression; R‐squared values were used to determine the best metric.

          Results

          Perturbations to MLC offset and transmission parameters demonstrated the greatest changes in dose: up to 5.7% in CTVs and 16.7% for OARs. More complex clinical plans showed greater dose perturbation with atypical beam model parameters. The mean MLC Gap and Tongue & Groove index (TGi) complexity metrics best described the impact of TPS beam modeling variations on clinical dose delivery across all anatomical sites; similar, though not identical, trends between complexity and dose perturbation were observed among all sites.

          Conclusion

          Extreme values for MLC offset and MLC transmission beam modeling parameters were found to most substantially impact the dose distribution of clinical plans and careful attention should be given to these beam modeling parameters. The mean MLC Gap and TGi complexity metrics were best suited to identifying clinical plans most sensitive to beam modeling errors; this could help provide focus for clinical QA in identifying unacceptable plans.

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          Most cited references37

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          A new metric for assessing IMRT modulation complexity and plan deliverability.

          B Sharpe, Mark A. McNiven, Thomas Purdie (2010)
          To evaluate the utility of a new complexity metric, the modulation complexity score (MCS), in the treatment planning and quality assurance processes and to evaluate the relationship of the metric with deliverability. A multisite (breast, rectum, prostate, prostate bed, lung, and head and neck) and site-specific (lung) dosimetric evaluation has been completed. The MCS was calculated for each beam and the overall treatment plan. A 2D diode array (MapCHECK, Sun Nuclear, Melbourne, FL) was used to acquire measurements for each beam. The measured and planned dose (PINNACLE3, Phillips, Madison, WI) was evaluated using different percent differences and distance to agreement (DTA) criteria (3%/ 3 mm and 2%/ 1 mm) and the relationship between the dosimetric results and complexity (as measured by the MCS or simple beam parameters) assessed. For the multisite analysis (243 plans total), the mean MCS scores for each treatment site were breast (0.92), rectum (0.858), prostate (0.837), prostate bed (0.652), lung (0.631), and head and neck (0.356). The MCS allowed for compilation of treatment site-specific statistics, which is useful for comparing different techniques, as well as for comparison of individual treatment plans with the typical complexity levels. For the six plans selected for dosimetry, the average diode percent pass rate was 98.7% (minimum of 96%) for 3%/3 mm evaluation criteria. The average difference in absolute dose measurement between the planned and measured dose was 1.7 cGy. The detailed lung analysis also showed excellent agreement between the measured and planned dose, as all beams had a diode percentage pass rate for 3%/3 mm criteria of greater than 95.9%, with an average pass rate of 99.0%. The average absolute maximum dose difference for the lung plans was 0.7 cGy. There was no direct correlation between the MCS and simple beam parameters which could be used as a surrogate for complexity level (i.e., number of segments or MU). An evaluation criterion of 2%/ 1 mm reliably allowed for the identification of beams that are dosimetrically robust. In this study we defined a robust beam or plan as one that maintained a diode percentage pass rate greater than 90% at 2%/ 1 mm, indicating delivery that was deemed accurate when compared to the planned dose, even under stricter evaluation criterion. MCS and MU threshold criteria were determined by defining a required specificity of 1.0. A MCS threshold of 0.8 allowed for identification of robust deliverability with a sensitivity of 0.36. In contrast, MU had a lower sensitivity of 0.23 for a threshold of 50 MU. The MCS allows for a quantitative assessment of plan complexity, on a fixed scale, that can be applied to all treatment sites and can provide more information related to dose delivery than simple beam parameters. This could prove useful throughout the entire treatment planning and QA process.
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            Evaluating IMRT and VMAT dose accuracy: practical examples of failure to detect systematic errors when applying a commonly used metric and action levels.

            Benjamin E Nelms, Maria Chan, Geneviève Jarry … (2013)
            This study (1) examines a variety of real-world cases where systematic errors were not detected by widely accepted methods for IMRT/VMAT dosimetric accuracy evaluation, and (2) drills-down to identify failure modes and their corresponding means for detection, diagnosis, and mitigation. The primary goal of detailing these case studies is to explore different, more sensitive methods and metrics that could be used more effectively for evaluating accuracy of dose algorithms, delivery systems, and QA devices.
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              Impact of plan parameters on the dosimetric accuracy of volumetric modulated arc therapy.

              Raffaela Doro, Virginia Favuzza, Samantha Cipressi … (2013)
              To evaluate the effect of plan parameters on volumetric modulated arc therapy (VMAT) dosimetric accuracy, together with the possibility of scoring plan complexity.
              Article 0 comments Cited 71 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Stephen Frasier Kry: sfkry@mdanderson.org
                Journal
                Journal ID (nlm-ta): J Appl Clin Med Phys
                Journal ID (iso-abbrev): J Appl Clin Med Phys
                Journal ID (doi): 10.1002/(ISSN)1526-9914
                Journal ID (publisher-id): ACM2
                Title: Journal of Applied Clinical Medical Physics
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 1526-9914
                Publication date (Electronic): 01 March 2024
                Publication date Collection: May 2024
                Volume: 25
                Issue: 5 ( doiID: 10.1002/acm2.v25.5 )
                Electronic Location Identifier: e14318
                Affiliations
                [ 1 ] University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences Houston Texas USA
                [ 2 ] Department of Radiation Physics University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 3 ] Department of Medical Physics Hospital Sant Joan de Reus, IISPV Tarragona Spain
                [ 4 ] Department of Radiation Oncology Hospital Clinic de Barcelona Barcelona Spain
                [ 5 ] Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 6 ] Department of Radiotherapy Physics University College London Hospital London London UK
                [ 7 ] Department of Medical Physics and Bioengineering University College London London UK
                [ 8 ] Medical Physics Department National Physical Laboratory Teddington UK
                Author notes
                [*] [* ] Correspondence

                Stephen Frasier Kry, University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA.

                Email: sfkry@ 123456mdanderson.org

                Author information
                https://orcid.org/0000-0002-6611-1104
                https://orcid.org/0000-0003-3770-8486
                https://orcid.org/0000-0003-4888-9323
                Article
                Publisher ID: ACM214318
                DOI: 10.1002/acm2.14318
                PMC ID: 11087168
                PubMed ID: 38427776
                SO-VID: 98eddf5b-8bd1-4c65-b708-be2095d11e3e
                Copyright © © 2024 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 20 November 2023
                Date received : 26 May 2023
                Date accepted : 25 January 2024
                Page count
                Figures: 5, Tables: 1, Pages: 11, Words: 6014
                Funding
                Funded by: National Institutes of Health , doi 10.13039/100000002;
                Funded by: National Cancer Institute , doi 10.13039/100000054;
                Award ID: CA180803
                Award ID: CA214526
                Categories
                Subject: Radiation Oncology Physics
                Subject: Radiation Oncology Physics
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2024
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.2 mode:remove_FC converted:10.05.2024

                Keywords: beam modeling,complexity metrics,dose calculation accuracy,imrt,mlc,quality assurance,vmat
                Data availability:
                Keywords: beam modeling, complexity metrics, dose calculation accuracy, imrt, mlc, quality assurance, vmat

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