Statistical quality control for volumetric modulated arc therapy (VMAT) delivery by using the machine’s log data

The aim of this study is to set up statistical quality control for monitoring the volumetric modulated arc therapy (VMAT) delivery error by using the machine’s log data. Eclipse and a Clinac iX linac with the RapidArc system (Varian Medical Systems, Palo Alto, USA) are used for delivery of the VMAT plan. During the delivery of the RapidArc fields, the machine determines the delivered monitor units (MUs) and the gantry angle’s position accuracy and the standard deviations of the MU (σMU: dosimetric error) and the gantry angle (σGA: geometric error) are displayed on the console monitor after completion of the RapidArc delivery. In the present study, first, the log data were analyzed to confirm its validity and usability; then, statistical process control (SPC) was applied to monitor the σMU and the σGA in a timely manner for all RapidArc fields: a total of 195 arc fields for 99 patients. The MU and the GA were determined twice for all fields, that is, first during the patient-specific plan QA and then again during the first treatment. The sMU and the σGA time series were quite stable irrespective of the treatment site; however, the sGA strongly depended on the gantry’s rotation speed. The σGA of the RapidArc delivery for stereotactic body radiation therapy (SBRT) was smaller than that for the typical VMAT. Therefore, SPC was applied for SBRT cases and general cases respectively. Moreover, the accuracy of the potential meter of the gantry rotation is important because the σGA can change dramatically due to its condition. By applying SPC to the σMU and σGA, we could monitor the delivery error efficiently. However, the upper and the lower limits of SPC need to be determined carefully with full knowledge of the machine and log data.