Assessment of the modulation degrees of intensity-modulated radiation therapy plans

To evaluate the modulation indices (MIs) for predicting the plan delivery accuracies of intensity-modulated radiation therapy (IMRT) plans.

A total of 100 dynamic IMRT plans that used TrueBeam STx and 102 dynamic IMRT plans that used Trilogy were selected. For each plan, various MIs were calculated, which included the modulation complexity score (MCS), plan-averaged beam area (PA), plan-averaged beam irregularity (PI), plan-averaged beam modulation (PM), MI quantifying multi-leaf collimator (MLC) speeds (MI_s), MI quantifying MLC acceleration (MI_a), and MI quantifying MLC acceleration and segment aperture irregularity (MI_c,IMRT). To determine plan delivery accuracy, global gamma passing rates, MLC errors of log files, and dose-volumetric parameter differences between original and log file-reconstructed IMRT plans were obtained. To assess the ability of each MI for predicting plan delivery accuracy, Spearman’s rank correlation coefficients (r_s) between MIs and plan delivery accuracy measures were calculated.

PI showed moderately strong correlations with gamma passing rates in MapCHECK2 measurements of both TrueBeam STx and Trilogy (r_s = − 0.591 with p <  0.001 and − 0.427 with p <  0.001 to with gamma criterion of 2%/2 mm, respectively). For ArcCHECK measurements, PI also showed moderately strong correlations with the gamma passing rates in the ArcCHECK measurements of TrueBeam STx and Trilogy (r_s = − 0.545 with p <  0.001 and r_s = − 0.581 with p <  0.001 with gamma criterion of 2%/2 mm, respectively). The PI showed the second strongest correlation with MLC errors in both TrueBeam STx and Trilogy (r_s = 0.861 with p <  0.001 and r_s = 0.767 with p <  0.001, respectively). In general, the PI showed moderately strong correlations with every plan delivery accuracy measure.

The PI showed moderately strong correlations with every plan delivery accuracy measure and therefore is a useful predictor of IMRT delivery accuracy.