{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:25:20Z","timestamp":1782289520270,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Volumetric modulated arc therapy (VMAT) requires an accurate patient\u2010specific quality assurance (PSQA) program. In clinical practice, this is usually performed using the \u03b3\u2010index and the two\u2010dimensional gamma passing rate (2D %GP). A three\u2010dimensional (3D) index incorporating the patient anatomy could be more useful for the 3D dose distribution verification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The current study demonstrates a thorough investigation of VMAT PSQA treatment plans by examining the correlation between 3D Gamma passing rate (%GP) and 2D %GP. The aim was to establish the tolerance limits (TL) and action limits (AL) that could be adopted in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>PSQA was performed for 67 head and neck (H&amp;N) and 69 prostate treatment plans, using an appropriate phantom and the \u03b3\u2010index method. The 3%\/2\u00a0\u00a0mm acceptance criterion was used. Treatment plans\u2019 2D% GP and 3D %GP values were collected and correlated with individual 3D %GP values of planning target volume (PTV) and organs at risk (OARs). Institutional TL and AL of both 2D %GP and 3D %GP were established using 30 prostate and 30 H&amp;N treatment plans, as per recommendations proposed by AAPM TG\u2010218.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A moderate correlation was observed between 2D %GP and 3D %GP of the treatment plans. \u03a4he correlations demonstrated a stronger association for the 3D %GP than for the 2D %GP with respect to the 3D %GP of the individual structures considered. The TL for the 3D %GP (both plan and individual) and the plans\u2019 2D %GP were generally more stringent, while the AL showed a wider range compared to the corresponding limits suggested by the TG\u2010218 protocol for plan 2D %GP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Institution\u2010specific 3D %GP as well as TL and AL for treatment plan, PTV and OARs could be incorporated in the PSQA procedure in synergy with the 2D evaluation, as they can provide a more\u2010in\u2010depth\u2010view of the treatment quality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70025","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T07:49:42Z","timestamp":1739951382000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["From 2D to 3D gamma passing rate tolerance and action limits for patient\u2010specific quality assurance in volumetric\u2010modulated arc therapy"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9614-5962","authenticated-orcid":false,"given":"Christos","family":"Zarros","sequence":"first","affiliation":[{"name":"Medical Physics Unit, Second Department of Radiology, Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Patatoukas","sequence":"additional","affiliation":[{"name":"Medical Physics Unit, Second Department of Radiology, Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Kollaros","sequence":"additional","affiliation":[{"name":"Medical Physics Unit, Second Department of Radiology, Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7796-6001","authenticated-orcid":false,"given":"Marina","family":"Chalkia","sequence":"additional","affiliation":[{"name":"Medical Physics Unit, Second Department of Radiology, Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andromachi","family":"Kougioumtzopoulou","sequence":"additional","affiliation":[{"name":"Radiation Therapy Unit, Second Department of Radiology Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Kouloulias","sequence":"additional","affiliation":[{"name":"Radiation Therapy Unit, Second Department of Radiology Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-7895","authenticated-orcid":false,"given":"Kalliopi","family":"Platoni","sequence":"additional","affiliation":[{"name":"Medical Physics Unit, Second Department of Radiology, Medical School National and Kapodistrian University of Athens Attikon General University Hospital  Haidari Athens 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