Model refinement increases confidence levels and clinical agreement when commissioning a three-dimensional secondary dose calculation system

Purpose Evaluate custom beam models for a second check dose calculation system using statistically verifiable passing criteria for film analysis, DVH, and 3D gamma metrics. Methods Custom beam models for nine linear accelerators for the Sun Nuclear Dose Calculator algorithm (SDC, Sun Nuclear) were evaluated using the AAPM-TG119 test suite (5 Intensity Modulated Radiation Therapy (IMRT) and 5 Volumetric Modulated Arc Therapy (VMAT) plans) and a set of clinical plans. Where deemed necessary, adjustments to Multileaf Collimator (MLC) parameters were made to improve results. Comparisons to the Analytic Anisotropic Algorithm (AAA), and gafchromic film measurements were performed. Confidence intervals were set to 95% per TG-119. Film gamma criteria were 3%/3 mm (conventional beams) or 3%/1 mm (Stereotactic Radiosurgery [SRS] beams). Dose distributions in solid water phantom were evaluated based on DVH metrics (e.g., D95, V20) and 3D gamma criteria (3%/3 mm or 3%/1 mm). Film passing rates, 3D gamma passing rates, and DVH metrics were reported for HD MLC machines and Millennium MLC Machines. Results For HD MLC machines, SDC gamma film agreement was 98.76% +/- 2.30% (5.74% CL) for 6FFF/6srs (3%/1 mm), and 99.80% +/- 0.32% (0.83% CL) for 6x (3%/3 mm). For Millennium MLC machines, film passing rates were 98.20% +/- 3.14% (7.96% CL), 99.52% +/- 1.14% (2.71% CL), and 99.69% +/- 0.82% (1.91% CL) for 6FFF, 6x, and 10x, respectively. For SDC to AAA comparisons: HD MLC Linear Accelerators (LINACs); DVH point agreement was 0.97% +/- 1.64% (4.18% CL) and 1.05% +/- 2.12% (5.20% CL); 3D gamma agreement was 99.97% +/- 0.14% (0.30% CL) and 100.00% +/- 0.02% (0.05% CL), for 6FFF/6srs and 6x, respectively; Millennium MLC LINACs: DVH point agreement was 0.77% +/- 2.40% (5.47% CL), 0.80% +/- 3.40% (7.47% CL), and 0.07% +/- 2.15% (4.30% CL); 3D gamma agreement was 99.97% +/- 0.13% (0.29% CL), 99.97% +/- 0.17% (0.36% CL), and 99.99% +/- 0.06% (0.12% CL) for 6FFF, 6x, and 10x, respectively. Conclusion SDC shows agreement well within TG119 CLs for film and redundant dose calculation comparisons with AAA. In some models (SRS), this was achieved using stricter criteria. TG119 plans can be used to help guide model adjustments and to establish clinical baselines for DVH and 3D gamma criteria.