Machine Learning for Patient-Specific Quality Assurance of VMAT: Prediction and Classification Accuracy.

Purpose: To assess the accuracy of machine learning to predict and classify quality assurance (QA) results for volumetric modulated arc therapy (VMAT) plans.
Methods and Materials: Three hundred three VMAT plans, including 176 gynecologic cancer and 127 head and neck cancer plans, were chosen in this study. Fifty-four complexity metrics were extracted from the QA plans and considered as inputs. Patient-specific QA was performed, and gamma passing rates (GPRs) were used as outputs. One Poisson lasso (PL) regression model was developed, aiming to predict individual GPR, and 1 random forest (RF) classification model was developed to classify QA results as "pass" or "fail." Both technical validation (TV) and clinical validation (CV) were used to evaluate the model reliability. GPR prediction accuracy of PL and classification performance of PL and RF were evaluated.
Results: In TV, the mean prediction error of PL was 1.81%, 2.39%, and 4.18% at 3%/3 mm, 3%/2 mm, and 2%/2 mm, respectively. No significant differences in prediction errors between TV and CV were observed. In QA results classification, PL had a higher specificity (accurately identifying plans that can pass QA), whereas RF had a higher sensitivity (accurately identifying plans that may fail QA). By using 90% as the action limit at a 3%/2 mm criterion, the specificity of PL and RF was 97.5% and 87.7% in TV and 100% and 71.4% in CV, respectively. The sensitivity of PL and RF was 31.6% and 100% in TV and 33.3% and 100% in CV, respectively. With 100% sensitivity, the QA workload of 81.2% of plans in TV and 62.5% of plans in CV could be reduced by RF.
Conclusions: The PL model could accurately predict GPR for most VMAT plans. The RF model with 100% sensitivity was preferred for QA results classification. Machine learning can be a useful tool to assist VMAT QA and reduce QA workload.
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