R(e)volution in Pre-Treatment Dose QA

Benjamin E. Nelms is the inventor and lead designer for 3DVH (US Patent 7,945,022), a product owned and distributed by Sun Nuclear Corporation, the industry leader in radiation therapy dose QA devices. As early as the year 2000, when commercial IMRT starting finding its way, I found asking myself the question, “Are these conventional 3%/3mm passing rate metrics good enough? Do they really detect and predict meaningful errors? Do they ensure accuracy of these complex calculations and deliveries?” My gut said no, and the growing body of scientific literature supports this (see references below). But we’re all learning, and improving, and thanks to products like 3DVH, medical physicists worldwide have the power of accuracy and analytics at their fingertips to do what’s best for the industry. And for their patients.

Below are links to the applicable dosimeter array product pages (Sun Nuclear Corporation):


3DVH_Image01 3DVH_Image02 3DVH_Image03


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Recent Scientific Publications Featuring 3DVH (no particular order)

Jin X, Yan H, Han C, Zhou Y, Yi J, Xie C. Correlation between gamma index passing rate and clinical dosimetric difference for pre-treatment 2D and 3D volumetric modulated arc therapy dosimetric verification. Br J Radiol 2015;88:20140577.

Infusino et al. Initial experience of ArcCHECK and 3DVH software for RapidArc treatment plan verification. Med Dosim. 2014; 39 (276-281).

Nelms BE, Chan MF, Jarry G, Lemire M, Lowden J, Hampton C, and Feygelman V. Evaluating IMRT and VMAT dose accuracy: Practical examples of failure to detect systematic errors when applying a commonly used metric and action levels. Med Phys. 2013 Nov; 40(11).

Nelms BE, Opp D, Robinson J, Wolf TK, Zhang G, Moros E, Feygelman V. VMAT QA:  measurement-guided 4D dose reconstruction on a patient. Med Phys. 2012 Jul; 39(7).

Feygelman V, Stambaugh C, Zhang G, Hunt D, Opp D, Wolf TK, Nelms BE. Motion as a perturbation: Measurement-guided dose estimates to moving patient voxels during modulated arc deliveries. Med Phys. 2013 Feb ;40(2).

Nelms, BE, Opp D, Zhang G, Moros E, and Feygelman, V. Motion as perturbation. II. Development of the method for dosimetric analysis of motion effects with fixed-gantry IMRT. Med. Phys. 2014 Jun; 41(6).

Feygelman V, Stambaugh C, Opp D, Zhang G, Moros E, and Nelms, BE. Cross-validation of two commercial methods for volumetric high-resolution dose reconstruction on a phantom for non-coplanar VMAT beams. Radiother Oncol. 2014 Mar; 110(3).

Stambaugh C, Nelms BE, Dilling T, Stevens C, Latifi K, Zhang G, Moros E, Feygelman V. Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments. Med Phys. 2013 Sep; 40(9).

Opp D, Nelms BE, Zhang G, Stevens C, Feygelman V. Validation of measurement-guided 3D VMAT dose reconstruction on a heterogeneous anthropomorphic phantom. J Appl Clin Med Phys. 2013 Jul; 14(4).

Chan MF, Li J, Schupak K, Burman C. Using a Novel Dose QA Tool to Quantify the Impact of Systematic Errors Otherwise Undetected by Conventional QA Methods: Clinical Head and Neck Case Studies. Technol Cancer Res Treat. 2013 Jun; 13(1).

Stasi et al. Pretreatment patient-specific IMRT quality assurance: A correlation study between gamma index and patient clinical dose volume histogram. Med Phys. 2012 Dec; 39(12).

Carrasco et al. 3D DVH-based metric analysis versus per-beam planar analysis in IMRT pretreatment verification. Med Phys. 2012 Aug; 39(8).

Olch A. Evaluation of the accuracy of 3DVH software estimates of dose to virtual ion chamber and film in composite IMRT QA. Med Phys. 2012 Jan; 39(1).

Zhen H, Nelms BE, Tome WA. Moving from gamma passing rates to patient DVH-based QA metrics in pretreatment dose QA. Med Phys. 2011 Oct; 38(10).

Nelms BE, Zhen H, Tomé WA. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors. Med Phys. 2011 Feb;38(2).