West Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter. Asian Pacific Journal of Cancer Prevention 1513-7368 25 9 2024 09 01 Impact of Reference Selection on Gamma Analysis in Patient-Specific Quality Assurance for Monte Carlo-Based Treatment Planning Systems 3283 3291 91319 10.31557/APJCP.2024.25.9.3283 EN Arun Krishnan M P School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India. MVR Cancer Centre and Research Institute, Kozhikode 693601, India. Ummal Momeen M School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India. Journal Article 2024 05 27 Objective: Our study aimed to establish a standardized methodology for selecting “reference” and “evaluated” distributions in gamma analysis for Monte Carlo (MC) based intensity modulated treatment plans. Evaluation of importance of reference selection in MC based and non MC based treatment planning systems were analysed using a study classification. Methods: Three categories were utilized to analyzed gamma passing rates across using different treatment planning systems (TPS) and detectors for thirty five patients. Category 1 utilized MC-based Monaco TPS plans and a 2 dimensional(2D) I’mRTMatriXX detector. Category 2 employed non-MC-based Eclipse TPS plans, assessed with a 2D I’mRTMatriXX detector. In Category 3, MC-based Monaco TPS plans were validated using a Dolphin detector. All plans were subjected to analysis using gamma criteria, which considered a dose difference of 3% and a distance to agreement of 3mm. Additionally, another set of gamma criteria was employed, with a dose difference of 3% and a distance to agreement of 2mm. An introduced Asymmetric factors in both 2D and 3D analysis will quantify the asymmetric nature of gamma based on the choice of “reference” distribution. Result: For 2D Gamma analysis, MC-based Monaco TPS and I’mRTMatriXX showed a consistent positive Zk2D trend for all patients, with significant p-values below 0.01 for both gamma passing criteria. In contrast, non-MC based Eclipse TPS exhibited varied Zk2D results, with non-significant p-values. In 3D Gamma analysis, all patients exhibited positive Zk3D values with significant p-values below 0.01 when “references” were swapped. The Pearson correlation between asymmetricity and isodose volumes was notably high at 0.99 for both gamma criteria. Conclusion: Our study highlights the imperative of using MC-based TPS as the definitive “reference” in gamma analysis for patient specific quality assurance of intensity modulated radiation therapy, emphasizing that variations can mislead results, especially given gamma analysis’s sensitivity to MC calculation noise. https://journal.waocp.org/article_91319_30517e25a6c8cec2e296a966354669dc.pdf