Delta4-based Dosimetric Error Detection in Volumetric-modulated Arc Therapy: Clinical Significance and Implications

Background: Volumetric-modulated arc therapy (VMAT) is an efficient method of administering intensity-modulated radiotherapy beams. The Delta(4) device was employed to examine patient data. Aims and Objectives: The utility of the Delta(4) device in identifying errors for patient-specific quality assurance of VMAT plans was studied in this research. Materials and Methods: Intentional errors were purposely created in the collimator rotation, gantry rotation, multileaf collimator (MLC) position displacement, and increase in the number of monitor units (MU). Results: The results show that when the characteristics of the treatment plans were changed, the gamma passing rate (GPR) decreased. The largest percentage of erroneous detection was seen in the increasing number of MU, with a GPR ranging from 41 to 92. Gamma analysis was used to compare the dose distributions of the original and intentional error designs using the 2%/2 mm criteria. The percentage of dose errors (DEs) in the dose-volume histogram (DVH) was also analyzed, and the statistical association was assessed using logistic regression. A modest association (Pearson's R-values: 0.12-0.67) was seen between the DE and GPR in all intentional plans. The findings indicated a moderate association between DVH and GPR. The data reveal that Delta(4) is effective in detecting mistakes in treatment regimens for head-and-neck cancer as well as lung cancer. Conclusion: The study results also imply that Delta(4) can detect errors in VMAT plans, depending on the details of the defects and the treatment plans employed.