ArticleStrahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]2026
Evaluation of a merging-based approach for improving patient-specific quality assurance in proton and carbon-ion radiotherapy: a comparative study with conventional single-isocentre experience.
Article in Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeIonization chamber arrays are inherently limited in spatial resolution, which can lead to the underdetection of potential clinical errors in particle therapy. The study aimed to validate the clinical efficacy of a multi-position dose merging approach, evaluating its capacity to enhance spatial resolution and improve error detection sensitivity relative to conventional single-isocentre quality assurance (QA) protocols.
methodsDose distributions were measured using PTW 729
resultsThe single-isocentre cohort showed higher mean gamma pass rates (n = 2616) than the merged cohort (P < 0.05). The merging method resulted in a greater reduction in gamma passing rates for carbon-ion and pencil beam scanning (PBS) dose verification compared to proton and uniform scanning dose verification (3.85% for carbon-ion versus 1.93% for proton; 3.49% for PBS versus 1.69% for uniform scanning). Bland-Altman analysis revealed a 95% limits of agreement (LoA) width of 5.28% between the two methods under 3%/2 mm gamma criteria with global normalization. ROC analysis demonstrated that the merging method yielded greater sensitivity for detecting 1 and 2 mm range errors than the single-isocentre approach, improving sensitivity for detecting 2 mm errors by 19.06% in carbon-ion therapy versus 6.69% in proton therapy.
conclusionThe spatial resolution limitations of conventional detector arrays may artificially inflate gamma pass rates, introducing a risk of false-negative approval for clinically unacceptable treatment plans. The multi-position dose merging approach mitigates this limitation by enhancing spatial resolution, supporting its clinical utility as a practical, workflow-integratable strategy to improve the accuracy and effectiveness of proton and carbon-ion radiotherapy QA protocols.
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