title: Comparison of three commercial dosimetric systems in detecting clinically significant VMAT delivery errors.
abstract: OBJECTIVE
  To study the sensitivity of three commercial dosimetric systems, Delta4, Multicube and Octavius4D, in detecting Volumetric Modulated Arc Therapy (VMAT) delivery errors.
  
  
  METHODS
  Fourteen prostate and head and neck (H&N) VMAT plans were considered for this study. Three types of errors were introduced into the original plans: gantry angle independent and dependent MLC errors, and gantry angle dependent dose errors. The dose matrix measured by each detector system for the no-error and error introduced delivery were compared with the reference Treatment Planning System (TPS) calculated dose matrix for no-error plans using gamma (γ) analysis with 2%/2mm tolerance criteria. The ability of the detector system in identifying the minimum error in each scenario was assessed by analysing the gamma pass rates of no error delivery and error delivery using a Wilcoxon signed-rank test. The relative sensitivity of the system was assessed by determining the slope of the gamma pass line for studied error magnitude in each error scenario.
  
  
  RESULTS
  In the gantry angle independent and dependent MLC error scenario the Delta4, Multicube and Octavius4D systems detected a minimum 2mm error. In the gantry angle dependent dose error scenario all studied systems detected a minimum 3% and 2% error in prostate and H&N plans respectively. In the studied detector systems Multicube showed relatively less sensitivity to the errors in the majority of error scenarios.
  
  
  CONCLUSIONS
  The studied systems identified the same magnitude of minimum errors in all considered error scenarios.
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia. Electronic address: Sankar.Arumugam@sswahs.nsw.gov.au.
authors.forename: Sankar
authors.initials: S
authors.lastname: Arumugam
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Aitang
authors.initials: A
authors.lastname: Xing
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Young
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Thwaites
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
authors.forename: Lois
authors.initials: L
authors.lastname: Holloway
mesh_terms: D000465:Algorithms; D055592:Biophysical Phenomena; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D019047:Phantoms, Imaging; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011874:Radiometry / Q000295:instrumentation / Q000706:statistics & numerical data; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity
keywords: Delivery error; Dosimetric systems; VMAT