Abstract
BACKGROUND: The traditional gamma evaluation method combines dose difference (DD) and distance-to-agreement (DTA) to assess the agreement between two dose distributions. However, while gamma evaluation can identify the location of errors, it does not provide information about the type of errors. PURPOSE: The purpose of this study is to optimize and apply the structural similarity (SSIM) index algorithm as a supplementary metric for the quality evaluation of radiation therapy plans alongside gamma evaluation. By addressing the limitations of gamma evaluation, this study aims to establish clinically meaningful SSIM criteria to enhance the accuracy of patient-specific quality assurance (PSQA). METHODS: We analyzed the relationship between the gamma passing rate (GPR) and the SSIM index with respect to distance and dose errors. For SSIM analysis corresponding to gamma evaluation criteria of 3%/2 mm, we introduce the concept of SSIM passing rate (SPR). We determined a valid SSIM index that met the gamma evaluation criteria and applied it. Evaluations performed for 40 fields measured with an electronic portal imaging device (EPID) were analyzed using the GPR and the applied SPR. RESULTS: The study results showed that distance errors significantly affected both the GPR and the SSIM index, whereas dose errors had some influence on the GPR but little impact on the SSIM index. The SPR was 100% for distance error of 2 mm but began to decrease for distance errors of 3 mm or more. An optimal SSIM index threshold of 0.65 was established, indicating that SPR fell below 100% when distance errors exceeded 2 mm. CONCLUSIONS: This study demonstrates that the SSIM algorithm can be effectively applied for the quality evaluation of radiation therapy plans. The SPR can serve as a supplementary metric to gamma evaluation, offering a more precise identification of distance errors. Future research should further validate the efficacy of SSIM algorithm across a broader range of clinical cases.