title: An analysis of confidence limit calculations used in AAPM Task Group No. 119.
abstract: OBJECTIVE
  The report issued by AAPM Task Group No. 119 outlined a procedure for evaluating the effectiveness of IMRT commissioning. The procedure involves measuring gamma pass-rate indices for IMRT plans of standard phantoms and determining if the results fall within a confidence limit set by assuming normally distributed data. As stated in the TG report, the assumption of normally distributed gamma pass rates is a convenient approximation for commissioning purposes, but may not accurately describe the data. Here the authors attempt to better describe gamma pass-rate data by fitting it to different distributions. The authors then calculate updated confidence limits using those distributions and compare them to those derived using TG No. 119 method.
  
  
  METHODS
  Gamma pass-rate data from 111 head and neck patients are fitted using the TG No. 119 normal distribution, a truncated normal distribution, and a Weibull distribution. Confidence limits to 95% are calculated for each and compared. A more general analysis of the expected differences between the TG No. 119 method of determining confidence limits and a more time-consuming curve fitting method is performed.
  
  
  RESULTS
  The TG No. 119 standard normal distribution does not fit the measured data. However, due to the small range of measured data points, the inaccuracy of the fit has only a small effect on the final value of the confidence limits. The confidence limits for the 111 patient plans are within 0.1% of each other for all distributions. The maximum expected difference in confidence limits, calculated using TG No. 119's approximation and a truncated distribution, is 1.2%.
  
  
  CONCLUSIONS
  A three-parameter Weibull probability distribution more accurately fits the clinical gamma index pass-rate data than the normal distribution adopted by TG No. 119. However, the sensitivity of the confidence limit on distribution fit is low outside of exceptional circumstances.
authors.affiliation: Department of Radiation Oncology, Karmanos Cancer Center, Detroit, Michigan 48201, USA. knillcor@gmail.com
authors.forename: Cory
authors.initials: C
authors.lastname: Knill
authors.forename: Michael
authors.initials: M
authors.lastname: Snyder
mesh_terms: D016001:Confidence Intervals; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D010825:Physics; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards*; D012958:Societies, Scientific / Q000592:standards*