TU-C-BRE-07: Quantifying the Clinical Impact of VMAT Delivery Errors Relative to Prior Patients’ Plans and Adjusted for Anatomical Differences




There is increased interest in the Radiation Oncology Physics community regarding sensitivity of pre-treatment IMRT/VMAT QA to delivery errors. Consequently, tools mapping pre-treatment QA to the patient DVH have been developed. However, the quantity of plan degradation that is acceptable remains uncertain. Using DVHs adapted from prior patients’ plans, we developed a technique to determine the magnitude of various delivery errors required to degrade a treatment plan to outside the clinically accepted range.


DVHs for relevant organs at risk were adapted from a population of prior patients’ plans using a machine learning algorithm to establish the clinically acceptable DVH range specific to the patient’s anatomy. We applied this technique to six low-risk prostate cancer patients treated with single-arc VMAT and compared error-induced DVH changes to the adapted DVHs to determine the magnitude of error required to push the plan outside of the acceptable range. The procedure follows: (1) Errors (systematic ' random shift of MLCs, gantry-MLC desynchronization, dose rate fluctuations, etc.) were simulated and degraded DVHs calculated using the Varian Eclipse TPS. (2) Adapted DVHs and acceptable ranges for DVHs were established. (3) Relevant dosimetric indices and corresponding acceptable ranges were calculated from the DVHs. Key indices included NTCP (Lyman-Kutcher-Burman Model) and QUANTEC’s dose-volume Objectives: s of V75Gy≤0.15 for the rectum and V75Gy≤0.25 for the bladder.


Degradations to the clinical plan became “unacceptable” for 19±29mm and 1.9±2.0mm systematic outward shifts of a single leaf and leaf bank, respectively. All other simulated errors fell within the acceptable range.


Utilizing machine learning and prior patients’ plans one can predict a clinically acceptable range of DVH degradation for a specific patient. Comparing error-induced DVH degradations to this range, it is shown that single-arc VMAT plans for low-risk prostate are relatively insensitive to many potential delivery errors.