Evaluation of patient-specific quality assurance for fractionated stereotactic treatment plans with 6 and 10MV photon beams in beam-matched linacs

Beam-matched linear accelerators (LA's) require accurate and precise dosimetry for fractionated stereotactic treatment. In this study, the beam data were validated by comparing the three-beam-matched LA's measured data and the vendor reference data. Upon its validation, the accuracy of the volumetric dose delivery for eighty patient-specific fractionated stereotactic treatment plans was evaluated. Measurements of the percentage depth dose (PDD), beam profiles, output factors (OFs), absolute output, and dynamic multi-leaf collimator (MLC) transmission factors for 6 MV and 10 MV flattening filter (FF) and flattening filter-free (FFF) photon beams were obtained from three-beam-matched LA's. The patient-specific quality assurance evaluation for all eighty plans was performed using PTW Octavius 1000 SRS™ array detectors for two-dimensional (2D) fluence measurement. The following 2D gamma passing criteria were used: 1%/1 mm, 2%/1 mm, 1%/2 mm, 2%/2 mm and 3%/2 mm. In all three LA's, gamma analysis for PDD and profile were above 97% with gamma criteria of 1%/1 mm. The differences OFs, absolute output, and dynamic MLC transmission factors were less than ± 1% of base value. For all eighty cases, the median passing rates on the three LA's were above 76%, 88%, 92%, 96%, and 98% for the above-mentioned gamma criteria of the three LA's. The beam-matched LA's showed good agreement between the measured and treatment planning system (TPS) calculated values for fractionated stereotactic VMAT plans with 6 MV and 10 MV (FF and FFF) photon beams. Patients can be shifted and treated on any beam-matched linac without the need of re-planning.