Sadie Wilhite

DOS 542

Linear Accelerator Daily QA1,2

Tolerance
Procedure
Non-IMRT IMRT SRS
Safety Door interlock
Door closing safety
Functional
Beam on light/indicator operation
Patient monitoring equipment
Radiation area monitor
Stereotactic interlocks (lockout) N/A Functional
Mechanical Laser localization 2mm 1.5mm 1mm
Distance indicator (ODI) at ISO 2mm
Collimator size indicator 2mm 1mm
Dosimetry X-ray output constancy (all
3%
energies)
Electron output constancy
Sadie Wilhite
DOS 542

Linear Accelerator Monthly QA1,2

Tolerance
Procedure Non-
IMRT SRS
IMRT
Safety Laser guard-interlock test Functional
Mechanical Light/radiation field coincidence 2mm or 1% on a side
Light/radiation field coincidence
1mm or 1% on a side
(asymmetric)
Distance check device for lasers
1mm
compared with front pointer
Gantry/Collimator angle indicators 1.0
Accessory trays 2mm
Jaw position indicators (symmetric) 2mm
Jaw position indicators (asymmetric) 1mm
Crosshair centering (walkout) 1mm
Treatment couch position indicators 2mm/1.0 1mm/0.5
Wedge placement accuracy 2mm
Compensator placement accuracy 1mm
Latching of wedges, blocking tray Functional
Localizing lasers 2mm 1mm <1mm
Dosimetry X-ray output constancy
Electron output constancy 2%
Backup monitor chamber constancy
Typical dose rate output constancy 2% (stereo
2% (IMRT
N/A dose rate,
dose rate)
MU)
Photon beam profile constancy 1%
Electron beam profile constancy 1%
Electron beam energy constancy 2%/2mm
Respiratory Beam output constancy 2%
Gating Phase, amplitude beam control
Functional
In-room respiratory monitory system
Gating interlock

Linear Accelerator Annual QA1,2

Tolerance
Procedure Non-
IMRT SRS
IMRT
Safety Follow manufacturers test
Functional
procedures
Mechanical Collimator rotation isocenter 1mm from baseline
Gantry rotation isocenter 1mm from baseline
Couch rotation isocenter 1mm from baseline
Electron applicator interlocks Functional
Sadie Wilhite
DOS 542

Coincidence of radiation and 1mm

mechanical isocenter 2mm from baseline from
baseline
Table top sag 2mm from baseline
Table angle 1
Table travel maximum range
2mm
movement in all directions
Stereotactic accessories, lockouts,
N/A Functional
etc.
Dosimetry X-ray flatness change from baseline 1%
X-ray symmetry change from
1%
baseline
Electron flatness change from
1%
baseline
Electron symmetry change from
1%
baseline
SRS arc rotation mode (range: 0.5- 1.0 MU or
10 MU/deg) N/A 2%
MU set vs. delivered
SRS arc rotation mode (range: 0.5-
10 MU/deg) N/A 1.0 or 2%
Gantry set vs. delivered
X-ray/electron output calibration 1% (absolute)
Spot check of field size dependent
output factors for x-ray (2 or more 2% for FS <4x4 cm2, 1% 4x4 cm2
FSs)
Output factors for electron
applicators (spot check of one 2% from baseline
applicator/energy)
X-ray beam quality (PDD10 or
1% from baseline
TMR2010)
Electron beam quality 1mm
Physical wedge transmission factor
2%
constancy
X-ray monitor unit linearity (output 2% 5 5% (2-4 MU), 2% 5
constancy) MU MU
Electron monitor unit linearity
2% 5 MU
(output constancy)
X-ray output constancy vs. dose rate 2% from baseline
X-ray output constancy vs. gantry
1% from baseline
angle
Electron output constancy vs. gantry
1% from baseline
angle
Electron and x-ray off-axis factor
1% from baseline
constancy vs. gantry angle
Sadie Wilhite
DOS 542

Arc mode (expected MU, degrees) 1% from baseline

TBI/TSET mode Functional
PDD or TMR and OAF constancy 1% (TBI) or 1mm PDD shift (TSET)
from baseline
TBI/TSET output calibration 2% from baseline
TBI/TSET accessories 2% from baseline
Respiratory Beam energy constancy 2%
Gating Temporal accuracy of
100ms of expected
phase/amplitude gate on
Calibration of surrogate for
100ms of expected
respiratory phase/amplitude
Interlock testing Functional
MLC Setting vs. light vs radiation field for
patterns over range of gantry and 1mm
collimator angles
Water scan of set patterns 50% radiation edge within 1mm
Film scans to evaluate interleaf
Interleaf leakage <3%, abutted leakage
leakage and abutted leaf
<25%
transmission
Review of procedures and in-service All operators must fully understand
with therapists operation and procedures
Sadie Wilhite
DOS 542

Simulator QA2,3
Daily
Procedure Tolerance
Electromechanical Components
Localizing Lasers
Alignment of gantry lasers with center of imaging plane 2mm
Distance indicator (ODI)
Image Performance
CT number accuracy (for water) For water, 0 5 HU
Image noise Manufacturer specifications
In plane spatial integrity X or Y direction 1mm
Monthly
Procedure Tolerance
Electromechanical Components
Field Size Indicator 2mm
Gantry/Collimator angle indicators 1
Cross-hair centering 2mm diameter
Focal spot-axis indicator 2mm
Fluoroscopic image quality Baseline
Emergency/collision avoidance Functional
Light/radiation field coincidence 2mm or 1%
Film processor sensitometry Baseline
Orientation of gantry lasers with respect to imaging plane 2mm
Spacing of lateral wall lasers with respect to lateral gantry
2mm
lasers and scan plane
Orientation of wall lasers with respect to the imaging plane 2mm
Orientation of the ceiling laser with respect to the imaging
2mm
place
Orientation of the CT scanner tabletop with respect to the
2mm
imaging plane
Table vertical and longitudinal motion 1mm
Image Performance
CT number accuracy 4-5 different materials Baseline
In plane spatial integrity both directions 1mm
Field uniformity most commonly used kVp Within 5 HU
Annual
Procedure Tolerance
Mechanical
Collimator, Gantry, Couch rotation isocenter 2mm diameter
Coincidence of collimator, gantry, couch axes, and isocenter
Tabletop sag 2mm
Vertical travel of couch
Radiographic
Exposure rate
Sadie Wilhite
DOS 542

Tabletop exposure with fluoroscopy Baseline

kVp and mAs calibration
High- and low-contrast resolution
Electromechanical Components
Table indexing and position 1mm
Gantry tilt accuracy 1
Gantry tilt position accuracy 1 or 1mm
Scan localization 1mm
Radiation profile width Manufacturer specifications
Sensitivity profile width *semiannual* 1mm of nominal value
Generator tests Manufacturer specifications (or
Report No. 39)
Image Performance
CT number accuracy electron density phantom Baseline
Field uniformity other used kVp settings Within 5 HU
Electron density to CT number conversion
Spatial resolution Manufacturer specifications
Contrast resolution

Imaging QA1,4
Daily
Tolerance
Procedure Non-
SRS/SBRT
SRS/SBRT
Planar kV Collision interlocks Functional
and MV Positioning/repositioning 2mm 1mm
(EPID) Imaging and treatment coordinate
2mm 1mm
coincidence (single gantry angle)
CBCT Collision interlocks Functional
(kV and MV) Positioning/repositioning 2mm 1mm
Imaging and treatment coordinate 1mm
coincidence
Monthly
Tolerance
Procedure Non-
SRS/SBRT
SRS/SBRT
Planar MV Imaging & treatment coordinate
2mm 1mm
(EPID) coincidence (4 cardinal angles)
Scaling 2mm
Spatial resolution
Contrast Baseline
Uniformity & noise
Planar kV Imaging & treatment coordinate
2mm 1mm
imaging coincidence (4 cardinal angles)
Sadie Wilhite
DOS 542

Scaling 2mm 1mm

Spatial resolution
Contrast Baseline
Uniformity & noise
CBCT Geometric distortion 2mm 1mm
(kV and MV) Spatial resolution
Contrast
Baseline
HU constancy
Uniformity & noise
Annual
Tolerance
Procedure Non-
SRS/SBRT
SRS/SBRT
Planar MV Full range of travel SDD 5mm
(EPID) Imaging dose
Planar kV Beam quality/energy
imaging Imaging dose Baseline
CBCT (kV Imaging dose
and MV)

Instrument QA5
Procedure Tolerance/Frequency
Ionization chamber & electrometer
Every 2 years
submitted to ADCL for calibration
Thermometers & barometers Time of purchase, semi-annually, whenever
intercomparisons device gives suspicious reading
Diodes & MOSFETs Initial use, monthly
TLD Initially, monthly/frequently depending on use
Film Initially, dependent on use
Survey meters Yearly calibration, battery & constancy check
day of measurements
Sadie Wilhite
DOS 542

IMRT QA6
Radiation Secondary barrier to handle leakage radiation for higher energies.
Safety Increased neutron dose to pt should be considered if using >10MV
Treatment Commissioned so that dose predicted by planning system is accurate
Planning within acceptable limits
Geometric test patterns with predicted/known dose
Machine MLC
Characteristics Dose delivery
Patient specific Point dose or planar dose for individual or all fields
dose Point dose single field measuring using film, ion chamber or
verification diodes
Point dose all fields composite film used to sample dose at
specific points or ion chamber used
Planar dose single field dose computed at point in phantom perp.
to CA using film or array of diodes
Planar dose all fields film typically used

TPS Acceptance Test QA7

Procedure/Topic
CT input
Anatomical description
Beam description
Photon beam dose calculations
Electron beam dose calculations
Brachytherapy dose calculations
Dose display, DVHs
Tests
Create anatomical description based on a standard set of
CT scans provided by the vendor, in the format which will
be employed by the user
Create a patient model based on the standard CT data
discussed above. Contour the external surface, internal
anatomy, etc. Create 3-D objects & display
Verify all beam technique functions work, using a standard
beam description provided by the vendor
Perform dose calculations for a standard photon beam
dataset. Tests should include various open fields, different
SSDs, blocked fields, MLC-shaped fields, inhomogeneity
test cases, multi-beam plans, asymmetric jaw fields,
wedged fields & others
Perform a set of dose calculations for a standard electron
beam dataset. Include open fields, different SSDs, shaped
fields, inhomogeneity test cases, surface irregularity test
cases & others
Perform dose calculations for single sources of each type,
as well as several multi-source implant calculations,
including standard implant techniques such as a GYN
insertion with tandem & ovoids, two-plane breast implant
Display dose calculation results. Use a standard dose
distribution provided by the vendor to verify that the DVH
code works as described. User-created dose distributions
Sadie Wilhite
DOS 542

may also be sued for additional tests.

Hardcopy output Print out all hardcopy documentation for a given series of
plans, & confirm that all textual & graphical information is
output correctly

TPS QA6
Daily Error logs Keep track of any errors/malfunctions
Monthly Data input Errors in manually digitizing plotted data from scanning
system to TPS
Check digitizer accuracy by entering contour & compare
with printed output (often done weekly) (within 2mm)
Data output Graphic isodose plots or numerical print outs
Annual Software Tools BEV/DRR, autocontouring, deformable registration
Algorithm Test for reproducibility repeated standard plan on regular
inaccuracy/ Dose basis (often done monthly)
Calculations Evaluate accuracy of calculations compare calculations
against measured data; use field sizes or measured points not
used in measured data originally stored in computer
Sadie Wilhite
DOS 542

Brachytherapy QA8
Procedure Tolerance/Frequency
Applicators Initial use
All parts fit & work properly
Radiograph with dummy markers
Remote afterloading- autoradiograph to verify
positional accuracy of applicator & understand
geometry of applicator
Location of radioactive sources Tracked at all times, periodic inventory (quarterly-yearly)
Leak testing of sources Before initial use, regular basis after (semi-annually)
Remote Afterloading Equipment
Daily Testing of safety equipment: survey meters, radiation monitors, door
interlocks, radiation on lights, emergency off button, treatment interrupt
button, audiovisual monitors, room radiation monitors
Testing for proper operation of afterloading equipment
Presence of equipment needed for a stuck/detached source (lead pig & long
handled forceps)
Treatment unit displays of time, date, current source strength
Test source-position accuracy, dwell-time accuracy, normal termination of
treatment
Mechanical integrity of applicator connections to treatment unit verified
Availability & integrity of emergency response equipment verified
Availability & integrity of emergency response equipment verified
Monthly Verification of source activity and check against a decay chart
Measurement of source transit time
Measurement of timer linearity
Source positioning accuracy
Source activity checked/verify agreement w/ calculated activity
Integrity of applicators used most often checked for mechanical damage, ease
of coupling, kinks, & mechanical deformation
Transfer tubes inspected & measured to verify proper working condition
Timer checked to verify accuracy & linearity
Power failure test
Treatment Planning
Target coverage Isodose prescription surface covers target volume
Homogeneity Max dose below predefined range
Prescribed dose correspond to protocol for disease & does it
Dose prescription
account for contributions from EBRT
Normal structure doses Within tolerances?
Total strength used correspond to that for dose specified to
Consistency
isodose surface
Duration Calculated correctly?
Independent dose check Check that activity is appropriate
Sadie Wilhite
DOS 542

References
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Lippincott Williams & Wilkins; 2014.
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simulators and the computed-tomography-simulation process: Report of the AAPM
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http://dx.doi.org/10.1118/1.1609271.
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Medical Dosimetry Program; 2017.
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Medical Dosimetry Program; 2017.