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Purpose: As clinics begin to use 3D metrics for intensity-modulated radiation therapy (IMRT) quality assurance; these metrics will often produce results different from those produced by their 2D counterparts. 3D and 2D gamma analyses would be expected to produce different values, because of the different search space available. We compared the results of 2D and 3D gamma analysis (where both datasets were generated the same way) for clinical treatment plans. Methods : 50 IMRT plans were selected from our database and recalculated using Monte Carlo. Treatment planning system-calculated (“evaluated”) and Monte Carlo-recalculated (“reference”) dose distributions were compared using 2D and 3D gamma analysis. This analysis was performed using a variety of dose-difference (5%, 3%, 2%, and 1%) and distance-to-agreement (5, 3, 2, and 1 mm) acceptance criteria, low-dose thresholds (5%, 10%, and 15% of the prescription dose), and data grid sizes (1.0, 1.5, and 3.0 mm). Each comparison was evaluated to determine the average 2D and 3D gamma and percentage of pixels passing gamma. Results: Average gamma and percentage of passing pixels for each acceptance criterion demonstrated better agreement for 3D than for 2D analysis for every plan comparison. Average difference in the percentage of passing pixels between the 2D and 3D analyses with no low-dose threshold ranged from 0.9% to 2.1%. Similarly, using a low-dose threshold resulted in a differences ranging from 0.8% to 1.5%. No appreciable differences in gamma with changes in the data density (constant difference: 0.8% for 2D vs. 3D) were observed. Conclusion : We found that 3D gamma analysis resulted in up to 2.9% more pixels passing than 2D analysis.  Factors such as inherent dosimeter differences may be an important additional consideration to the extra dimension of available data that was evaluated in this study.  Cite this article as: Pulliam KB, Huang JY, Bosca R, Followill D, Kry SF. 2D vs. 3D gamma analysis: Establishment of comparable clinical action limits. Int J Cancer Ther Oncol 2014; 2(2):020231. DOI: 10.14319/ijcto.0202.31

2D vs 3D gamma analysis: Establishment of comparable clinical action limits