KEY POINTS
- A structured literature review screened 185 records published between 2010 and August 2025 but identified no comprehensive guideline specifically addressing patient-specific quality assurance for stereotactic radiotherapy.
- A survey of 43 users from Germany, Austria, and Switzerland showed that detector arrays and electronic portal imaging devices were the most common measurement tools. Most centres relied on gamma analysis, frequently applying the same 1%–3% dose-difference and 1–3 mm distance-to-agreement criteria to stereotactic radiosurgery and stereotactic body radiotherapy.
- Vendor surveys evaluated 19 measurement devices and 10 analysis tools from nine vendors, alongside secondary dose-calculation systems from 10 vendors. Measurement systems varied in resolution and coverage, while independent recalculation provided three-dimensional dose information but could not verify the mechanical delivery chain.
- The working group defined 12 quality assurance characteristics covering treatment-planning systems, treatment machines, patient positioning and motion, verification-equipment capabilities, and workflow demands. The method matrix in Table 5 maps how different verification approaches address these characteristics.
- No single method covered all relevant error sources. The authors recommend combining complementary measurement-based verification, independent dose calculation, imaging, motion monitoring, and machine quality assurance rather than relying on a gamma passing rate alone.
CLINICAL TAKEAWAY
Stereotactic radiotherapy programmes should treat patient-specific quality assurance as a layered process rather than a single pre-treatment measurement or gamma threshold. The toolkit provides a practical framework for identifying local blind spots, but its ratings reflect expert judgment, regional practice surveys, and evolving technology rather than prospective clinical validation.