The use of Perspex-based devices in patient specific quality assurance of Acuros XB plans

The use of Perspex-based devices in patient specific quality assurance of Acuros XB plans | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The use of Perspex-based devices in patient specific quality assurance of Acuros XB plans Ali N. Noon, Daniel Truant, Izabela Junis, Jeffrey Barber This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7802957/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Purpose: A transition from the dose-to-water algorithm AAA to the dose-to-medium algorithm Acuros XB (AXB) presents challenges for comparison with measurements made in the dose-to-water calibrated ArcCHECK. This study evaluates the implications of this transition on patient-specific quality assurance (PSQA) measurements. A modified dose-to-medium calibration for the ArcCHECK to was introduced to address these limitations, by developing a formalism to compare ionisation chamber measurements to water-like plastics such as Perspex to AXB dose-to-medium calculations. Methods: A retrospective analysis was conducted on 40 VMAT plans: 5 prostate, 5 cervix, 10 head/neck (HN), 10 lung (5 standard VMAT, 5 SBRT), and 10 breast. Plans were recalculated in AXB using a Perspex-assigned ArcCHECK phantom and compared with dose-to-water and dose-to-medium calibrated ArcCHECK measurements with a γ (3%,2 mm) criteria. Result s: Only one of 35 non-SBRT AXB dose-to-medium plans was within clinical tolerance during dose-to-water calibrated ArcCHECK comparisons, compared to 33 of 35 AAA dose-to-water plans. Applying the proposed dose-to-medium calibration improved results, with 30 of 35 AXB plans performing within tolerance. In the SBRT lung cases, no AXB dose-to-medium plans passed ArcCHECK gamma comparisons, compared to four out of five AAA plans. Applying the dose-to-medium calibration to the ArcCHECK did not improve the passing rates, suggesting limitations of AXB calculations on the ArcCHECK device. Conclusion: This study highlights the inadequacy of dose-to-water calibrated PSQA devices for verifying AXB dose-to-medium calculations and demonstrates practical solutions, including applying a dose-to-medium calibration for the ArcCHECK for AXB PSQA applications. Acuros XB ArcCHECK patient-specific quality assurance dose-to-medium Figures Figure 1 Figure 2 Figure 3 Figure 4 Full Text Additional Declarations No competing interests reported. Tables 1 to 3 are available in the Supplementary Files section. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 02 Dec, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers invited by journal 04 Nov, 2025 Editor assigned by journal 11 Oct, 2025 Submission checks completed at journal 11 Oct, 2025 First submitted to journal 07 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7802957","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":543137188,"identity":"51808722-f390-49bc-a84b-5af6de1dd15c","order_by":0,"name":"Ali N. Noon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIie2SMUvDQBTHXzioy0nWBGr8CieFqhDxq9xRuCm1g0vGQiEugut9jIDgHDlol5OuB3ZoKThHdMjYF+vQoalxE7nf8Pgf3I//Gx6Aw/EH6Rx5Y0Ix+AGOJRQ/Kz5B5R5DqHBw3kIJJwDEYGC2rcI0GROTxje918lzKaoFnPuGeZ+pBl/xBgUXS4y87S+mg4DzN7hUCSNdoyGwB5RhpsWTTRgqGjc8zkmYSYAG5bpWrlB5VKOP6kuZv2yV00MtJ6jkQdLZthTD3HvPYqxrVnTXSKGs7F9wqSmzo1KDiemZWe5XZnerNU1j8aAGa1vGOmLzqVhVaRBFs/0tNcXuo74E0PQ7tMerfvff4XA4/jcbJTJnE7pcc5wAAAAASUVORK5CYII=","orcid":"","institution":"The University of Sydney","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"N.","lastName":"Noon","suffix":""},{"id":543137189,"identity":"f3890d68-558a-43da-8b7d-e2598e901dea","order_by":1,"name":"Daniel Truant","email":"","orcid":"","institution":"Blacktown \u0026 Mount Druitt 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07:11:43","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25379,"visible":true,"origin":"","legend":"","description":"","filename":"CoverPage.docx","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/e212ca6d87f58225c5ccf0b5.docx"},{"id":95895253,"identity":"d402c05e-44cd-4c82-acb9-75b23b1ae631","added_by":"auto","created_at":"2025-11-14 07:11:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24393,"visible":true,"origin":"","legend":"\u003cp\u003eDose-to-Perspex calibration of the ArcCHECK device.\u003c/p\u003e\n\u003cp\u003eFigure 1. Dose-to-Perspex calibration of the ArcCHECK device (left) based on a Farmer chamber measurement made in Perspex at 2.9 cm depth (right), corresponding to the depth of the diode detectors in the ArcCHECK device. This method is a modified version of the dose-to-water method provided by the manufacturer.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/b5e27eb5df185b0eaf3fa2a9.jpg"},{"id":95895251,"identity":"da1a72ad-e9e7-4506-83e4-e12a062a4b51","added_by":"auto","created_at":"2025-11-14 07:11:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40344,"visible":true,"origin":"","legend":"\u003cp\u003eGamma comparisons between dose-to-water calibrated ArcCHECK measurements and AXB calculations.\u003c/p\u003e\n\u003cp\u003eFigure 2. Gamma comparisons between 35 retrospective ArcCHECK measurements and AXB calculations across various anatomies. The ArcCHECK measurements used the standard dose-to-water calibration outlined in Section 2A. For reference, AAA comparisons with the ArcCHECK and the 95% passing level used in the clinic are also included.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/160771a5f25d96b0bf41485c.png"},{"id":96243775,"identity":"0385b286-eb3d-4936-9087-949ee7949ed4","added_by":"auto","created_at":"2025-11-19 07:17:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45801,"visible":true,"origin":"","legend":"\u003cp\u003eGamma comparisons between dose-to-medium calibrated ArcCHECK measurements and AXB calculations.\u003c/p\u003e\n\u003cp\u003eFigure 3. Gamma comparisons between 35 retrospective AXB (calculations and the dose-to-medium calibrated ArcCHECK (termed AXB (D\u003csub\u003em,m\u003c/sub\u003e)\u003csup\u003ecal\u003c/sup\u003e). AAA and AXB comparisons with the standard dose-to-water calibration of the ArcCHECK (from Figure 2), and the 95% passing level are shown for reference\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/548ac518facd26fd7befb6dc.png"},{"id":96242209,"identity":"0c8b9cc3-bbe8-4291-bfae-0224dcc29353","added_by":"auto","created_at":"2025-11-19 07:12:18","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":55409,"visible":true,"origin":"","legend":"\u003cp\u003eGamma comparisons between dose-to-medium calibrated ArcCHECK measurements and AXB calculations in lung SBRT plans.\u003c/p\u003e\n\u003cp\u003eFigure 4. Distribution of five AXB (gamma comparisons with dose-to-medium calibrated ArcCHECK measurements for five SBRT lung plans, denoted as AXB (𝐷𝑚,𝑚)\u003csup\u003ecal\u003c/sup\u003e. Gamma comparisons between AAA and AXB (with the dose-to-water calibrated ArcCHECK, as well as the 95% passing level are shown for reference. The AXB (D\u003csub\u003em,m\u003c/sub\u003e)\u003csub\u003esplit\u003c/sub\u003e\u003csup\u003ecal\u003c/sup\u003e) values are AXB gamma comparisons with the dose-to-calibrated ArcCHECK, calculated using split-arc methods techniques discussed in Section 4.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/34c80049975c7799ade16aca.png"},{"id":96255237,"identity":"e4efdd5e-6103-47fe-bd88-40a56280409e","added_by":"auto","created_at":"2025-11-19 07:48:10","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656404,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1_covered_0df78c49-cc24-4de5-83a7-0c7ef719b3d1.pdf"},{"id":95895250,"identity":"72a2caed-dc1b-470b-9397-a0ea2e229c42","added_by":"auto","created_at":"2025-11-14 07:11:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29601,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7802957/v1/35cd4daba6f5f8ffc570fc3b.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"The use of Perspex-based devices in patient specific quality assurance of Acuros XB plans","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"physical-and-engineering-sciences-in-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"apes","sideBox":"Learn more about [Physical and Engineering Sciences in Medicine](http://link.springer.com/journal/13246)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/apes/default.aspx","title":"Physical and Engineering Sciences in Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acuros XB, ArcCHECK, patient-specific quality assurance, dose-to-medium","lastPublishedDoi":"10.21203/rs.3.rs-7802957/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7802957/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e A transition from the dose-to-water algorithm AAA to the dose-to-medium algorithm Acuros XB (AXB) presents challenges for comparison with measurements made in the dose-to-water calibrated ArcCHECK. This study evaluates the implications of this transition on patient-specific quality assurance (PSQA) measurements. A modified dose-to-medium calibration for the ArcCHECK to was introduced to address these limitations, by developing a formalism to compare ionisation chamber measurements to water-like plastics such as Perspex to AXB dose-to-medium calculations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective analysis was conducted on 40 VMAT plans: 5 prostate, 5 cervix, 10 head/neck (HN), 10 lung (5 standard VMAT, 5 SBRT), and 10 breast. Plans were recalculated in AXB using a Perspex-assigned ArcCHECK phantom and compared with dose-to-water and dose-to-medium calibrated ArcCHECK measurements with a γ (3%,2 mm) criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003es: Only one of 35 non-SBRT AXB dose-to-medium plans was within clinical tolerance during dose-to-water calibrated ArcCHECK comparisons, compared to 33 of 35 AAA dose-to-water plans. Applying the proposed dose-to-medium calibration improved results, with 30 of 35 AXB plans performing within tolerance. In the SBRT lung cases, no AXB dose-to-medium plans passed ArcCHECK gamma comparisons, compared to four out of five AAA plans. Applying the dose-to-medium calibration to the ArcCHECK did not improve the passing rates, suggesting limitations of AXB calculations on the ArcCHECK device.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study highlights the inadequacy of dose-to-water calibrated PSQA devices for verifying AXB dose-to-medium calculations and demonstrates practical solutions, including applying a dose-to-medium calibration for the ArcCHECK for AXB PSQA applications.\u003c/p\u003e","manuscriptTitle":"The use of Perspex-based devices in patient specific quality assurance of Acuros XB plans","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 07:11:38","doi":"10.21203/rs.3.rs-7802957/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-03T02:46:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309229656659828751701821389684308266484","date":"2025-11-06T17:15:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-04T08:26:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-11T07:45:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-11T07:44:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Physical and Engineering Sciences in Medicine","date":"2025-10-07T23:40:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"physical-and-engineering-sciences-in-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"apes","sideBox":"Learn more about [Physical and Engineering Sciences in Medicine](http://link.springer.com/journal/13246)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/apes/default.aspx","title":"Physical and Engineering Sciences in Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"833ab230-a421-463d-bdd4-d44a4fd16cb0","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-14T07:11:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 07:11:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7802957","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7802957","identity":"rs-7802957","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}