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Estimation of the dosimetric uncertainty could potentially have impact in the process of comparing and selecting volumetric modulated arc therapy (VMAT) plans. In this study, different measures for estimation of dosimetric uncertainty based on treatment plan parameters for plans with similar dose distributions were evaluated.<\/jats:p><jats:p>VMAT plans with similar dose distributions but with different treatment plan designs were created using three different optimization methods for each of ten patient cases (tonsil and prostate cancer). Two plans were optimized in Eclipse, one with and one without the use of aperture shape controller, and one plan was optimized in RayStation.<\/jats:p><jats:p>The studied measures related to dosimetric uncertainty of treatment plans were aperture\u2010based complexity metric analysis, investigation of modulation level of multi leaf collimator leaves, gantry speed and dose rate, quasi\u20103D measurements and evaluation of simulations of realistic delivery variations.<\/jats:p><jats:p>The results showed that there can be variations in dosimetric uncertainty for treatment plans with similar dose distributions. Dosimetric uncertainty assessment could therefore have impact on the choice of plan to be used for treatment and lead to a decrease in the uncertainty level of the delivered absorbed dose distribution. This study showed that aperture shape complexity had a larger impact on dosimetric uncertainty compared to modulation level of MLC, gantry speed and dose rate.<\/jats:p>","DOI":"10.1002\/acm2.13862","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T11:20:46Z","timestamp":1671103246000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Evaluation of measures related to dosimetric uncertainty of VMAT plans"],"prefix":"10.1002","volume":"24","author":[{"given":"Julia","family":"G\u00f6tstedt","sequence":"first","affiliation":[{"name":"Department of Radiation Physics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Therapeutic Radiation Physics Medical Physics and Biomedical Engineering Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Karlsson","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Therapeutic Radiation Physics Medical Physics and Biomedical Engineering Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"B\u00e4ck","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Therapeutic Radiation Physics Medical Physics and Biomedical Engineering Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2818738"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2011.11.012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2016.04.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4921733"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/56\/6\/020"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3005481"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2815356"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4963219"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598381"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.06.013"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/59\/23\/7315"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","unstructured":"NilssonJ KarlssonA B\u00e4ckA IMRT patient\u2010specific QA using the Delta4 dosimetry system and evaluation based on ICRU 83 recommendations.7th International Conference on 3D Radiation Dosimetry.2013; IC3DDose 2012.","DOI":"10.1088\/1742-6596\/444\/1\/012048"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3544657"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3633904"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3425781"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.04.036"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.09.038"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.599000"},{"key":"e_1_2_10_20_1","unstructured":"Varian Medical Systems. 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