Treatment plan prescreening for patient-specific quality assurance measurements using independent Monte Carlo dose calculations

PURPOSE: This study proposes a method to identify plans that failed patient-specific quality assurance (QA) and attempts to establish a criterion to prescreen treatment plans for patient-specific QA measurements with independent Monte Carlo dose calculations. MATERIALS AND METHODS: Patient-specific QA results measured with an ArcCHECK diode array of 207 patients (head and neck: 25; thorax: 61; abdomen: 121) were retrospectively analyzed. All patients were treated with the volumetric modulated arc therapy (VMAT) technique and plans were optimized with a Pinnacle v16.2 treatment planning system using an analytical algorithm-based dose engine. Afterwards, phantom verification plans were designed and recalculated by an independent GPU-accelerated Monte Carlo (MC) dose engine, ArcherQA. Moreover, sensitivity and specificity analyzes of gamma passing rates between measurements and MC calculations were carried out to show the ability of MC to monitor failing plans (ArcCHECK 3%/3 mm,<90%), and attempt to determine the appropriate threshold and gamma passing rate criterion utilized by ArcherQA to prescreen treatment plans for ArcCHECK measurements. The receiver operator characteristic (ROC) curve was also utilized to characterize the performance of different gamma passing rate criterion used by ArcherQA. RESULTS: The thresholds for 100% sensitivity to detect plans that failed patient-specific QA by independent calculation were 97.0%, 95.4%, and 91.0% for criterion 3%/3 mm, 3%/2 mm, and 2%/2 mm, respectively, which corresponded to specificities of 0.720, 0.528, and 0.585, respectively. It was shown that the 3%/3 mm criterion with 97% threshold for ArcherQA demonstrated perfect sensitivity and the highest specificity compared with other criteria, which may be suitable for prescreening treatment plans treated with the investigated machine to implement measurement-based patient-specific QA of patient plans. In addition, the area under the curve (AUC) calculated from ROC analysis for criterion 3%/3 mm, 3%/2 mm, and 2%/2 mm used by ArcherQA were 0.948, 0.924, and 0.929, respectively. CONCLUSIONS: Independent dose calculation with the MC-based program ArcherQA has potential as a prescreen treatment for measurement-based patient-specific QA. AUC values (>0.9) showed excellent classification accuracy for monitoring failing plans with independent MC calculations.