Comparative study of SRS end‐to‐end QA processes of a diode array device and an anthropomorphic phantom loaded with GafChromic XD film

PURPOSE: End‐to‐end testing (E2E) is a necessary process for assessing the readiness of the stereotactic radiosurgery (SRS) program and annual QA of an SRS system according to the AAPM MPPG 9a. This study investigates the differences between using a new SRS MapCHECK (SRSMC) system and an anthropomorphic phantom film‐based system in a large network with different SRS delivery techniques. METHODS AND MATERIALS: Three SRS capable Linacs (Varian Medical Systems, Palo Alto, CA) at three different regional sites were chosen to represent a hospital network, a Trilogy with an M120 multi‐leaf collimator (MLC), a TrueBeam with an M120 MLC, and a TrueBeam Stx with an HD120 MLC. An anthropomorphic STEEV phantom (CIRS, Norfolk, VA) and a phantom/diode array: StereoPHAN/SRSMC (Sun Nuclear, Melbourne, FL) were CT scanned at each site. The new STV‐PHANTOM EBT‐XD films (Ashland, Bridgewater, NJ) were used. Six plans with various complexities were measured with both films and SRSMC in the StereoPHAN to establish their dosimetric correlations. Three SRS cranial plans with a total of sixteen fields using dynamic conformal arc and volumetric‐modulated arc therapy, with 1–4 targets, were planned with Eclipse v15.5 treatment planning system (TPS) using a custom SRS beam model for each machine. The dosimetric and localization accuracy were compared. The time of analysis for the two systems by three teams of physicists was also compared to assess the throughput efficiency. RESULTS: The correlations between films and SRSMC were found to be 0.84 (p = 0.03) and 0.16 (p = 0.76) for γ (3%, 1 mm) and γ (3%, 2 mm), respectively. With film, the local dose differences (ΔD) relative to the average dose within the 50% isodose line from the three sites were found to be −3.2%–3.7%. The maximum localization errors (E(local)) were found to be within 0.5 ± 0.2 mm. With SRSMC, the ΔD was found to be within 5% of the TPS calculation. E(local) were found to be within 0.7 to 1.1 ± 0.4 mm for TrueBeam and Trilogy, respectively. Comparing with film, an additional uncertainty of 0.7 mm was found with SRSMC. The delivery and analysis times were found to be 6 and 2 h for film and SRSMC, respectively. CONCLUSIONS: The SRS MapCHECK agrees dosimetrically with the films within measurement uncertainties. However, film dosimetry shows superior sub‐millimeter localization resolving power for the MPPG 9a implementation.