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PURPOSE The purpose of this study is to evaluate the prediction and classification performances of the gamma passing rate (GPR) for different machine learning models and to select the best model for achieving machine learning-based patient-specific quality assurance (PSQA). METHODS The measurement verification of 356 head-and-neck volumetric modulated arc therapy plans was performed using a diode array phantom (Delta4 Phantom), and GPR values at 2%/2 mm with global normalization and 3%/2 mm with local normalization were calculated. Machine learning models, including ridge regression (RIDGE), random forest (RF), support vector regression (SVR), and stacked generalization (STACKING), were used to predict the GPR. Each machine learning model was trained using 260 plans, and the prediction accuracy was evaluated using the remaining 96 plans. The prediction error between the measured and predicted GPR was evaluated. For the classification evaluation, the lower control limit for the measured GPR and lower control limit for predicted GPR (LCLp ) was defined to identify whether the GPR values represent a "pass" or a "fail." LCLp values with 99% and 99.9% confidence levels were calculated as the upper prediction limits for the GPR estimated from the linear regression between the measured and predicted GPR. RESULTS There was an overestimation trend of the low measured GPR. The maximum prediction errors for RIDGE, RF, SVR, and STACKING were 3.2%, 2.9%, 2.3%, and 2.2% at global 2%/2 mm and 6.3%, 6.6%, 6.1%, and 5.5% at the local 3%/2 mm, respectively. In the global 2%/2 mm, the sensitivity was 100% for all the machine learning models except RIDGE when using 99% LCLp . The specificity was 76.1% for RIDGE, RF, and SVR and 66.3% for STACKING, however, the specificity decreased dramatically when 99.9% LCLp was used. In the local 3%/2 mm, however, only STACKING showed 100% sensitivity when using 99% LCLp . The decrease in the specificity using 99.9% LCLp was smaller than that in the global 2%/2mm, and the specificity for RIDGE, RF, SVR, and STACKING was 61.3%, 61.3%, 72.0%, and 66.8%, respectively. CONCLUSIONS STACKING had better prediction accuracy for low GPR values than other machine learning models. Applying LCLp to a regression model enabled the consistent evaluation of quantitative and qualitative GPR predictions. Adjusting the confidence level of the LCLp helped improve the balance between the sensitivity and specificity. We suggest that STACKING can assist the safe and efficient operation of PSQA. This article is protected by copyright. All rights reserved.

Purpose We analyzed interfractional robustness of scanning carbon ion radiotherapy (CIRT) for prostate cancer based on the dose distribution using daily in‐room computed tomography (CT) images. Materials and Methods We analyzed 11 consecutive patients treated with scanning CIRT for localized prostate cancer in our hospital between December 2015 and January 2016. In‐room CT images were taken under treatment conditions in every treatment session. The dose distribution on each in‐room CT image was recalculated, while retaining the pencil beam arrangement of the initial treatment plan. Then, the dose–volume histogram (DVH) parameters including the percentage of the clinical target volume (CTV) with 95% and 90% of the prescribed dose area (V95% of CTV, V90% of CTV) and V80% of rectum were calculated. The acceptance criteria for the CTV and rectum were set at V95% of CTV ≥95%, V90% of CTV ≥98%, and V80% of rectum < 10 ml. Results V95% of CTV, V90% of CTV, and V80% of rectum for the reproduced plans were 98.8 ± 3.49%, 99.5 ± 2.15%, and 4.39 ± 3.96 ml, respectively. Acceptance of V95% of CTV, V90% of CTV, and V80% of rectum was obtained in 123 (94%), 125 (95%) and 117 sessions (89%), respectively. Acceptance of the mean dose of V95% of CTV, V90% of CTV, and V80% of rectum for each patient was obtained in 10 (91%), 10 (91%), and 11 patients (100%), respectively. Conclusions We demonstrated acceptable interfractional robustness based on the dose distribution in scanning CIRT for prostate cancer.

Background/aim The present study aimed to compare the radiation dose distribution of carbon-ion radiotherapy (CIRT) for stage I esophageal cancer with three-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT). Patients and methods Fifteen patients with cT1bN0M0 esophageal cancer who received 3DCRT at Kanagawa Cancer Center between January 2014 and April 2019 were enrolled. The dose-volume histogram parameters of the target volume and normal organs planned with CIRT, 3DCRT, and VMAT were evaluated. Results The homogeneity index for the target volume of CIRT was significantly lower than that of 3DCRT and VMAT. In addition, the radiation dose of CIRT to the heart, lungs, spinal cord, and skin was significantly lower than that of 3DCRT and VMAT. Conclusion Favorable dose distributions with CIRT were demonstrated compared with 3DCRT and VMAT for esophageal cancer.

Background/Aim The efficacy and safety of carbon-ion radiotherapy (CIRT) for prostate cancer have already been demonstrated. The number of hemodialysis (HD) patients is increasing. Although the toxicity of CIRT in HD patients may be more severe, it has been insufficiently investigated. Therefore, we retrospectively analyzed the safety of CIRT for HD patients with prostate cancer in the present study. Materials and Methods Five HD patients with prostate cancer who underwent CIRT at the Kanagawa Cancer Center during November 2015–2020 were included in this study. CIRT was delivered by the raster scanning method (sCIRT). Adverse events were assessed using the CTCAE v5.0. The dose-volume histogram (DVH) parameters of the target volume and normal organs were evaluated between initial planning computed tomography (CT) and in-room CT images. Results In the acute phase, Grade 1 genitourinary toxicity was recorded in 1 patient. In the late phase, Grade 1 genitourinary toxicity was recorded in 2 patients. No gastrointestinal toxicities were noted during the follow-up period. In-room CT analysis revealed no significant differences among all DVH parameters of the target volume and normal organs when compared with the treatment plan dose. Conclusions The safety of sCIRT for prostate cancer in HD patients was investigated in the present study. In-room CT analysis suggested the robustness of the treatment plan. According to the present results, sCIRT for prostate cancer can be safely performed in HD patients.

From August 2019 to August 2020, we inserted polyglycolic acid (PGA) spacers and administered carbon ion radiotherapy (CIRT) to three cases of retroperitoneal sarcoma at our hospital. We aimed to investigate its utility and safety for retroperitoneal sarcoma. We analyzed changes in PGA spacer volume and corresponding computed tomography (CT) values in addition to the dose distribution using in-room CT images that were obtained during treatment. We assessed adverse events and investigated the suitability, safety and effectivity of PGA spacer insertion. During treatment, changes in PGA spacer volumes and CT values were confirmed. Volumes increased in patients with a folded PGA spacer, and it increased 1.6-fold by the end of irradiation compared with planning CT. The CT values decreased by 20–50 Hounsfield units at the end of irradiation compared to the planning CT. Dose distribution evaluation showed that the dose to the gastrointestinal tract adjacent to the tumor was maintained below the tolerable dose, and a sufficient dose was delivered to the target by PGA spacer insertion. One case of subileus caused during abdominal surgery for PGA spacer insertion occurred. No other adverse events, such as digestive disorders, were observed. CIRT with PGA spacer insertion for retroperitoneal sarcomas is safe and effective. For cases in which there is no option but to perform irradiation using a PGA spacer, precautionary measures such as verification of dose distributions using CT images are necessary.

Background/aim The purpose of this study was to compare the dose distribution between scanning carbon-ion radiotherapy (sCIRT) and volumetric-modulated arc therapy with stereotactic body radiation therapy (VMAT-SBRT) for stage I non-small cell lung cancer (NSCLC). Patients and methods Fifteen patients with early-stage NSCLC who underwent sCIRT at Kanagawa Cancer Center between 2018-2020 were enrolled. Dose-volume histogram parameters of the planned target volume and normal organs for sCIRT and VMAT-SBRT were evaluated. Results The homogeneity index of the target volume of sCIRT was significantly lower than that of VMAT-SBRT. The dose of sCIRT was significantly lower than that of VMAT-SBRT at low volumes in the lung, heart, spinal cord, and esophagus. Conclusion The dose distribution of sCIRT for early-stage NSCLC was better than that of VMAT-SBRT.

To evaluate the contribution of indirect action mediated by OH radicals in biological effects of high LET radiations, we examined the production of 8-hydroxy-2′-deoxyguanosine (8-OHdG) in 2′-deoxyguanosine aqueous solution using various ion species with an LET range from 20 to 300 keV/μm. The 8-OHdG yield decreased with increasing LET. In the hypoxic irradiation condition, the yield showed constant or rather increasing tendency above about 100 keV/μm, which is consistent with an oxygen-in-the-track hypothesis to explain the diminishment of oxygen effect.

A multi-layer ionization chamber (MLIC) which consists of a stack of parallel plate-type ionization chambers in which the parallel configuration is in the depth direction was developed at the National Institute of Radiological Science (NIRS) and has been used as a field dosimeter for MU calibration since 2002. Although the MLIC can measure depth dose distributions at one time, a correction is needed to obtain an accurate dose at the center of the spread-out Bragg peak (SOBP) in a water phantom. We attributed the observed difference between the correct dose at the center of the SOBP and the measured dose to the lack of water equivalence of the MLIC. In order to overcome this problem, a new MLIC was developed. It consists of polymethyl-methacrylate (PMMA) plates and graphite electrodes instead of flame retardant type 4 (FR4) and copper electrodes. The calibration coefficients of the MLICs were obtained by 160 MeV proton beam irradiation. For carbon-ion beams, the PMMA type MLIC has the capability to measure depth dose distributions in the water phantom with less than 2% error, including the fragment tail region.

INTRODUCTION: \nThe characteristics of a glass dosimeter were investigated for its potential use as a tool for postal dose audits. Reproducibility, energy dependence, field size and depth dependence were compared to those of a thermoluminescence dosimeter (TLD), which has been the major tool for postal dose audits worldwide. \nMATERIALS AND METHODS: \nA glass dosimeter, GD-302M (Asahi Techno Glass Co.) and a TLD, TLD-100 chip (Harshaw Co.) were irradiated with gamma-rays from a (60)Co unit and X-rays from a medical linear accelerator (4, 6, 10 and 20 MV). \nRESULTS: \nThe dosimetric characteristics of the glass dosimeter were almost equivalent to those of the TLD, in terms of utility for dosimetry under the reference condition, which is a 10 x 10 cm(2) field and 10 cm depth. Because of its reduced fading, compared to the TLD, and easy quality control with the ID number, the glass dosimeter proved to be a suitable tool for postal dose audits. Then, we conducted postal dose surveys of over 100 facilities and got good agreement, with a standard deviation of about 1.3%. \nCONCLUSIONS: \nBased on this study, postal dose audits throughout Japan will be carried out using a glass dosimeter.

The Kanagawa Cancer Center (KCC) is the core facility for cancer care in Kanagawa Prefecture. It serves a population of more than 9 million people. Planning for the ionbeam Radiation Oncology Center in Kanagawa (i-ROCK) started in 2015. The basic framework and design of i-ROCK was established in 2010, and it is the first cancercenter-based carbon ion radiation therapy facility in the world and the fifth carbon ion radiation therapy facility in Japan. The building was completed in August 2014 (Figure 1). The installation of beam delivery equipment has been completed. The start of clinical operation is planned for December 2015. An overview of i-ROCK is presented in this report.

To estimate the physical dose at the center of spread-out Bragg peaks (SOBP) for various conditions of the irradiation system, a semiempirical approach was applied. The dose at the center of the SOBP depends on the field size because of large-angle scattering particles in the water phantom. For a small field of 5x5 cm{sup 2}, the dose was reduced to 99.2%, 97.5%, and 96.5% of the dose used for the open field in the case of 290, 350, and 400 MeV/n carbon beams, respectively. Based on the three-Gaussian form of the lateral dose distributions of the carbon pencil beam, which has previously been shown to be effective for describing scattered carbon beams, we reconstructed the dose distributions of the SOBP beam. The reconstructed lateral dose distribution reproduced the measured lateral dose distributions very well. The field-size dependencies calculated using the reconstructed lateral dose distribution of the therapeutic carbon beam agreed with the measured dose dependency very well. The reconstructed beam was also used for irregularly shaped fields. The resultant dose distribution agreed with the measured dose distribution. The reconstructed beams were found to be applicable to the treatment-planning system.

In carbon therapy, doses at center of spread-out Bragg peaks depend on field size. For a small field of 5 × 5 cm 2 , the central dose reduces to 96% of the central dose for the open field in case of 400 MeV ∕ n carbon beam. Assuming the broad beam injected to the water phantom is made up of many pencil beams, the transverse dose distribution can be reconstructed by summing the dose distribution of the pencil beams. We estimated dose profiles of this pencil beam through measurements of dose distributions of broad uniform beams blocked half of the irradiation fields. The dose at a distance of a few cm from the edge of the irradiation field reaches up to a few percent of the central dose. From radiation quality measurements of this penumbra, the large-angle scattered particles were found to be secondary fragments which have lower LET than primary carbon beams. Carbon ions break up in beam modifying devices or in water phantom through nuclear interaction with target nuclei. The angular distributions of these fragmented nuclei are much broader than those of primary carbon particles. The transverse dose distribution of the pencil beam can be approximated by a function of the three-Gaussian form. For a simplest case of mono-energetic beam, contributions of the Gaussian components which have large mean deviations become larger as the depth in the water phantom increases.

The contribution of indirect action mediated by OH radicals to cell inactivation by ionizing radiations was evaluated for photons over the energy range from 12.4 keV to 1.25 MeV and for heavy ions over the linear energy transfer (LET) range from 20 keV/microm to 440 keV/microm by applying competition kinetics analysis using the OH radical scavenger DMSO. The maximum level of protection provided by DMSO (the protectable fraction) decreased with decreasing photon energy down to 63% at 12.4 keV. For heavy ions, a protectable fraction of 65% was found for an LET of around 200 keV/microm; above that LET, the value stayed the same. The reaction rate of OH radicals with intracellular molecules responsible for cell inactivation was nearly constant for photon inactivation, while for the heavy ions, the rate increased with increasing LET, suggesting a reaction with the densely produced OH radicals by high-LET ions. Using the protectable fraction, the cell killing was separated into two components, one due to indirect action and the other due to direct action. The inactivation efficiency for indirect action was greater than that for direct action over the photon energy range and the ion LET range tested. A significant contribution of direct action was also found for the increased RBE in the low photon energy region.

The calibration coefficients of a parallel plate ionization chamber are examined by comparing the coefficients obtained through three methods: a calculation from a 60Co calibration coefficient, N(D, omega, 60Co), a cross-calibration of a parallel plate ionization chamber using a cylindrical ionization chamber at the plateau region of a mono-energetic beam and a cross-calibration of the chamber using a cylindrical chamber at the middle of the SOBP of the therapeutic beams. This paper also examines reference conditions for determining absorbed dose to water in the cases of therapeutic carbon and proton beams. In the dose calibration procedure recommended by IAEA, irradiation fields should be larger than 10 cm in diameter and the water phantom should extend by at least 5 cm beyond each side of the field. These recommendations are experimentally verified for proton and carbon beams. For proton beams, the calibration coefficients obtained by these three methods approximately agreed. For carbon beams, the calibration coefficients obtained by the second method were about 1.0% larger than those obtained by the third method, and the calibration coefficients obtained by cross-calibration using 290 MeV/u beams were 0.5% lower than those obtained using 400 MeV/u beams. The calibration coefficient obtained by the first method agreed roughly with the results obtained by SOBP beams.

The purpose of this study was to obtain a set of correction factors of the radiophotoluminescent glass dosimeter (RGD) output for field size changes and wedge insertions.Several linear accelerators were used for irradiation of the RGDs. The field sizes were changed from 5 × 5 cm to 25 × 25 cm for 4, 6, 10, and 15 MV x-ray beams. The wedge angles were 15°, 30°, 45°, and 60°. In addition to physical wedge irradiation, nonphysical (dynamic/virtual) wedge irradiations were performed.The obtained data were fitted with a single line for each energy, and correction factors were determined. Compared with ionization chamber outputs, the RGD outputs gradually increased with increasing field size, because of the higher RGD response to scattered low-energy photons. The output increase was about 1% per 10 cm increase in field size, with a slight difference dependent on the beam energy. For both physical and nonphysical wedged beam irradiation, there were no systematic trends in the RGD outputs, such as monotonic increase or decrease depending on the wedge angle change if the authors consider the uncertainty, which is approximately 0.6% for each set of measured points. Therefore, no correction factor was needed for all inserted wedges. Based on this work, postal dose audits using RGDs for the nonreference condition were initiated in 2010. The postal dose audit results between 2010 and 2012 were analyzed. The mean difference between the measured and stated doses was within 0.5% for all fields with field sizes between 5 × 5 cm and 25 × 25 cm and with wedge angles from 15° to 60°. The standard deviations (SDs) of the difference distribution were within the estimated uncertainty (1SD) except for the 25 × 25 cm field size data, which were not reliable because of poor statistics (n = 16).A set of RGD output correction factors was determined for field size changes and wedge insertions. The results obtained from recent postal dose audits were analyzed, and the mean differences between the measured and stated doses were within 0.5% for every field size and wedge angle. The SDs of the distribution were within the estimated uncertainty, except for one condition that was not reliable because of poor statistics.

We evaluated the CT number accuracy in determining a CT calibration method for treatment planning by use of a 256 multi-slice CT (MSCT) scanner. An electron density phantom, which extends full length in the longitudinal direction, was scanned by the 256 MSCT scanner in a single rotation. We inserted four types of samples (air, 100 % ethanol, 40 wt% aqueous K(2)HPO(4), and water) into the phantom. The regions of interest were set for all image slices, and the average CT number was calculated in the transverse and longitudinal sections. For the transverse image direction, the CT number became lower toward the center of the phantom with almost all samples. The causes of these phenomena might be attributed to the effects of scattered radiation and those of beam hardening due to the high-atomic-number material (40 wt% aqueous K(2)HPO(4)). However, the phenomena were too complicated to allow us to determine their causes only from the present studies. Meanwhile, for increasing the accuracy of the CT number calibration, a single sample should be inserted, and this step should be repeated with different samples. For the longitudinal direction, the CT number for a 40 wt % aqueous K(2)HPO(4) sample increased by 30 HU from the anode to the cathode side due to variations in the X-ray energy caused by the heel effect. The caveat is that the CT number varies in the longitudinal direction when a CT scanner with a wide beam width is used.

The postal dose audit using radio-photoluminescence glass dosimeters was begun in November 2007 in order to improve the quality of radiotherapy in Japan. However, the irradiation conditions are now limited to the reference conditions which are 10×10 cm(2) field and 10 cm depth. The application of the glass dosimeters to non-reference conditions is strongly desired. This study dealt with the field-size dependence of the glass dosimeter outputs in the 6 MV photon beams of a medical linear accelerator (Varian Clinac21EX). We irradiated glass dosimeters with square field sizes of 5, 7, 10, 13, 16, 20, 23 and 25 cm side lengths at the 10 cm depth of the water equivalent phantom (SSD=90 cm). The outputs were compared with ionization chamber outputs. The ratio of the glass dosimeter outputs to the absorbed dose to water obtained with the ionization chamber increased approximately 1.5% between 5×5 cm(2) and 25×25 cm(2). We have to consider this field-size dependence when we apply the glass dosimeters to non-reference conditions.

To estimate the physical dose at the center of spread-out Bragg peaks (SOBP) for various conditions of the irradiation system, a semiempirical approach was applied. The dose at the center of the SOBP depends on the field size because of large-angle scattering particles in the water phantom. For a small field of 5 x 5 cm2, the dose was reduced to 99.2%, 97.5%, and 96.5% of the dose used for the open field in the case of 290, 350, and 400 MeV/n carbon beams, respectively. Based on the three-Gaussian form of the lateral dose distributions of the carbon pencil beam, which has previously been shown to be effective for describing scattered carbon beams, we reconstructed the dose distributions of the SOBP beam. The reconstructed lateral dose distribution reproduced the measured lateral dose distributions very well. The field-size dependencies calculated using the reconstructed lateral dose distribution of the therapeutic carbon beam agreed with the measured dose dependency very well. The reconstructed beam was also used for irregularly shaped fields. The resultant dose distribution agreed with the measured dose distribution. The reconstructed beams were found to be applicable to the treatment-planning system.

In carbon therapy, doses at center of spread-out Bragg peaks depend on field size. For a small field of 5 x 5 cm2, the central dose reduces to 96% of the central dose for the open field in case of 400 MeV/n carbon beam. Assuming the broad beam injected to the water phantom is made up of many pencil beams, the transverse dose distribution can be reconstructed by summing the dose distribution of the pencil beams. We estimated dose profiles of this pencil beam through measurements of dose distributions of broad uniform beams blocked half of the irradiation fields. The dose at a distance of a few cm from the edge of the irradiation field reaches up to a few percent of the central dose. From radiation quality measurements of this penumbra, the large-angle scattered particles were found to be secondary fragments which have lower LET than primary carbon beams. Carbon ions break up in beam modifying devices or in water phantom through nuclear interaction with target nuclei. The angular distributions of these fragmented nuclei are much broader than those of primary carbon particles. The transverse dose distribution of the pencil beam can be approximated by a function of the three-Gaussian form. For a simplest case of mono-energetic beam, contributions of the Gaussian components which have large mean deviations become larger as the depth in the water phantom increases.

In order to support a routine QA of the CT number for treatment planning, we developed a phantom and a sample holder for easy handling. At most particle radiotherapy facilities in Japan, the CT number is calibrated by the poly-binary calibration method using liquid samples of 100% ethanol and 40% K(2)HPO(4) which are set in a cylindrical water phantom. However it is hard to remove air bubbles from the calibration liquid sample and maintain its stable concentration for a long time. So much time is needed for QA of the CT number. The new sample holder, which we developed, was able to keep a stable concentration of the liquid for more than 300 days. Consequently, the CT number of each sample, which was set in a water equivalent solid phantom, was the same as the CT number in a water phantom within 7 HU. In addition, we developed software which could measure the CT number of each sample semi-automatically and could calculate the calibration coefficients between the CT number and water equivalent length (WEL). Using this software, we could check the calibration result instantly at the time of CT data acquisition. These tools should be useful to carry out calibration of the CT-WEL routinely in a short time.

A Japanese code of practice for clinical dosimetry, titled "Standard Dosimetry of Absorbed Dose in External Beam Radiotherapy" was published by the Japan Society of Medical Physics (JSMP) in 2002. It mostly followed IAEA Technical Reports Series No. 398, which was based on N(D,w), i.e., the calibration factor in terms of absorbed dose to water for a dosimeter. The Japanese primary standard dosimetry laboratory, however, has not supplied N(D,w) but N(X), as the calibration factor in terms of exposure. The unique feature of the Japanese code was provision of a data table of calculated conversion factors, N(D,w) / N(X) values, for many types of ionization chambers, excluding new plane-parallel ionization chambers. This paper describes the experimental evaluation of the conversion factors for the new plane-parallel ionization chambers, such as the Roos-type and Advanced Markus chambers. The obtained N(D,w) / N(X) values for PTW 34001, Wellhöfer PPC 40 and PTW 34045 were 37.96 +/- 0.19, 37.85 +/- 0.36 and 37.90 +/- 0.26 (Gy/C kg(-1)), respectively. They agreed with estimations based on Monte Carlo calculations.

Purpose: The purpose of this study was to obtain a set of correction factors of the radiophotoluminescent glass dosimeter (RGD) output for field size changes and wedge insertions. Methods: Several linear accelerators were used for irradiation of the RGDs. The field sizes were changed from 5 × 5 cm to 25 × 25 cm for 4, 6, 10, and 15 MV x-ray beams. The wedge angles were 15°, 30°, 45°, and 60°. In addition to physical wedge irradiation, nonphysical (dynamic/virtual) wedge irradiations were performed. Results: The obtained data were fitted with a single line for each energy, and correction factors were determined. Compared with ionization chamber outputs, the RGD outputs gradually increased with increasing field size, because of the higher RGD response to scattered low-energy photons. The output increase was about 1% per 10 cm increase in field size, with a slight difference dependent on the beam energy. For both physical and nonphysical wedged beam irradiation, there were no systematic trends in the RGD outputs, such as monotonic increase or decrease depending on the wedge angle change if the authors consider the uncertainty, which is approximately 0.6% for each set of measured points. Therefore, no correction factor was needed for all inserted wedges. Based on this work, postal dose audits using RGDs for the nonreference condition were initiated in 2010. The postal dose audit results between 2010 and 2012 were analyzed. The mean difference between the measured and stated doses was within 0.5% for all fields with field sizes between 5 × 5 cm and 25 × 25 cm and with wedge angles from 15° to 60°. The standard deviations (SDs) of the difference distribution were within the estimated uncertainty (1SD) except for the 25 × 25 cm field size data, which were not reliable because of poor statistics (n = 16). Conclusions: A set of RGD output correction factors was determined for field size changes and wedge insertions. The results obtained from recent postal dose audits were analyzed, and the mean differences between the measured and stated doses were within 0.5% for every field size and wedge angle. The SDs of the distribution were within the estimated uncertainty, except for one condition that was not reliable because of poor statistics.