Assessing the correlation between Gamma passing rate and clinical dosimetric variations in breast cancer IMRT plans with multi-leaf collimator errors: perspectives from the ArcCHECK QA system.

This study aimed to comprehensively investigate the influence of multi-leaf collimator (MLC) position errors on both the clinical absolute dose distribution and Gamma passing rate (%GP) in intensity-modulated radiation therapy (IMRT) plans for breast cancer. Additionally, the correlation between %GP and the clinical absolute dose relative difference (%DE) caused by MLC position errors was analysed. Ten IMRT plans for breast cancer were randomly selected. Systematic and random MLC position errors were introduced into DICOM files representing the investigated treatment plans by modifying the plan files and adjusting the MLC positions. Systematic errors were categorized as MLC opening errors, closing errors, and shift errors. The %DE in the tumour planning target volume (PTV) and organs at risk (OARs) caused by MLC errors were statistically analyzed using dose-volume histogram (DVH) analysis. The ArcCHECK quality assurance (QA) system was used to detect the %GP differences between baseline plans and plans with MLC errors. The correlation between %GP and %DE was obtained using linear regression methods. The results of this study indicate that MLC opening and closing errors have a significant impact on %DE and %GP in IMRT plans for breast cancer. Opening and closing errors can be detected at a gamma level of 3%/2 mm, if error values are greater than or equal to 0.5 mm, and %GP can predict DVH dosimetric changes caused by MLC opening and closing errors. It is concluded that DVH-based verification of IMRT plans can serve as an adjunct method to Gamma analysis to improve QA accuracy for breast cancer cases. Additionally, it is concluded that greater attention should be given to MLC leaf opening and closing errors in clinical practice.