LAUSR

Abstract Purpose Gamma evaluation is the most commonly used technique for comparison of dose distributions for patient‐specific pretreatment quality assurance in radiation therapy. Alternative dose comparison techniques have been developed but not widely implemented. This study aimed to compare and evaluate the performance of several previously published alternatives to the gamma evaluation technique, by systematically evaluating a large number of patient‐specific quality assurance results. Methods The agreement indices (or pass rates) for global and local gamma evaluation, maximum allowed dose difference (MADD) and divide and conquer (D&C) techniques were calculated using a selection of acceptance criteria for 429 patient‐specific pretreatment quality assurance measurements. Regression analysis was used to quantify the similarity of behavior of each technique, to determine whether possible variations in sensitivity might be present. Results The results demonstrated that the behavior of D&C gamma analysis and MADD box analysis differs from any other dose comparison techniques, whereas MADD gamma analysis exhibits similar performance to the standard global gamma analysis. Local gamma analysis had the least variation in behavior with criteria selection. Agreement indices calculated for 2%/2 mm and 2%/3 mm, and 3%/2 mm and 3%/3 mm were correlated for most comparison techniques. Conclusion Radiation oncology treatment centers looking to compare between different dose comparison techniques, criteria or lower dose thresholds may apply the results of this study to estimate the expected change in calculated agreement indices and possible variation in sensitivity to delivery dose errors.