Abstract
The main objectives of this study are to (1) analyze the sensitivity of various gamma index passing rates using different types of detectors having different resolutions and (2) investigate the sensitivity of various gamma criteria in intensity-modulated radiation therapy (IMRT) and volumetrically modulated arc therapy (VMAT) quality assurance (QA) for the detection of systematic multileaf collimator (MLC) errors using an electronic portal imaging device (EPID) and planar (MapCheck2) and cylindrical (ArcCheck) diode arrays. We also evaluated whether the correlation between the gamma passing rate (%GP) and the percentage dose error (%DE) of the dose-volume histogram (DVH) metrics was affected by the finite spatial resolution of the array detectors. We deliberately simulated systematic MLC errors of 0.25 mm, 0.50 mm, 0.75 mm, and 1 mm in five clinical nasopharyngeal carcinoma cases, thus creating 40 plans with systematic MLC errors. All measurements were analyzed field by field using gamma criteria of 3%/3 mm, 3%/2 mm, 3%/1 mm, and 2%/2 mm, with a passing rate of 90% applied as the action level. Our results showed that 3%/1 mm is the most sensitive criterion for the detection of systematic MLC errors when using EPID, with the steepest slope from the best-fit line and an area under the receiver operating characteristic (ROC) curve >0.95. With respect to the 3%/1 mm criterion, a strong correlation between %GP and %DE of the DVH metrics was observed only when using the EPID. However, with respect to the same criteria, a 0.75 mm systematic MLC error can go undetected when using MapCheck2 and ArcCheck, with an area under the ROC curve <0.75. Furthermore, a lack of correlation between %GP and %DE of the DVH metrics was observed in MapCheck2 and ArcCheck. In conclusion, low-spatial resolution detectors can affect the results of a per-field gamma analysis and render the analysis unable to accurately separate erroneous and non-erroneous plans. Meeting these new sensitive criteria is expected to ensure clinically acceptable dose errors.