MO-F-CAMPUS-T-03: Data Driven Approaches for Determination of Treatment Table Tolerance Values for Record and Verification Systems
Purpose: To determine appropriate couch tolerance values for modern radiotherapy linac R&V systems with indexed patient setup. Methods: Treatment table tolerance values have been the most difficult to lower, due to many factors including variations in patient positioning and differences in table tops between machines. We recently installed nine linacs with similar tables and started indexing every patient in our clinic. In this study we queried our R&V database and analyzed the deviation of couch position values from the acquired values at verification simulation for all patients treated with indexed positioning. Mean and standard deviations of daily setup deviations were computed in the longitudinal, lateral and vertical direction for 343 patient plans. The mean, median and standard error of the standard deviations across the whole patient population and for some disease sites were computed to determine tolerance values. Results: The plot of our couch deviation values showed a gaussian distribution, with some small deviations, corresponding to setup uncertainties on non-imaging days, and SRS/SRT/SBRT patients, as well as some large deviations which were spot checked and found to be corresponding to indexing errors that were overriden. Setting our tolerance values based on the median + 1 standard error resulted in tolerance values of 1cm lateral and longitudinal, and 0.5 cm vertical for all non- SRS/SRT/SBRT cases. Re-analizing the data, we found that about 92% of the treated fractions would be within these tolerance values (ignoring the mis-indexed patients). We also analyzed data for disease site based subpopulations and found no difference in the tolerance values that needed to be used. Conclusion: With the use of automation, auto-setup and other workflow efficiency tools being introduced into radiotherapy workflow, it is very essential to set table tolerances that allow safe treatments, but flag setup errors that need to be reassessed before treatments.