Scholars@Duke publication: TU-C-BRE-05: Clinical Implications of AAA Commissioning Errors and Ability of Common Commissioning ' Credentialing Procedures to Detect Them.

TU-C-BRE-05: Clinical Implications of AAA Commissioning Errors and Ability of Common Commissioning ' Credentialing Procedures to Detect Them.

Publication , Journal Article

McVicker, A; Oldham, M; Yin, F; Adamson, J

Published in: Med Phys

June 2014

PURPOSE: To test the ability of the TG-119 commissioning process and RPC credentialing to detect errors in the commissioning process for a commercial Treatment Planning System (TPS). METHODS: We introduced commissioning errors into the commissioning process for the Anisotropic Analytical Algorithm (AAA) within the Eclipse TPS. We included errors in Dosimetric Leaf Gap (DLG), electron contamination, flattening filter material, and beam profile measurement with an inappropriately large farmer chamber (simulated using sliding window smoothing of profiles). We then evaluated the clinical impact of these errors on clinical intensity modulated radiation therapy (IMRT) plans (head and neck, low and intermediate risk prostate, mesothelioma, and scalp) by looking at PTV D99, and mean and max OAR dose. Finally, for errors with substantial clinical impact we determined sensitivity of the RPC IMRT film analysis at the midpoint between PTV and OAR using a 4mm distance to agreement metric, and of a 7% TLD dose comparison. We also determined sensitivity of the 3 dose planes of the TG-119 C-shape IMRT phantom using gamma criteria of 3% 3mm. RESULTS: The largest clinical impact came from large changes in the DLG with a change of 1mm resulting in up to a 5% change in the primary PTV D99. This resulted in a discrepancy in the RPC TLDs in the PTVs and OARs of 7.1% and 13.6% respectively, which would have resulted in detection. While use of incorrect flattening filter caused only subtle errors (<1%) in clinical plans, the effect was most pronounced for the RPC TLDs in the OARs (>6%). CONCLUSION: The AAA commissioning process within the Eclipse TPS is surprisingly robust to user error. When errors do occur, the RPC and TG-119 commissioning credentialing criteria are effective at detecting them; however OAR TLDs are the most sensitive despite the RPC currently excluding them from analysis.