Kristine Phillips
Quality Assurance Course
Final QA Table
10/19/2016
DAILY LINAC QA:
QA Tests:
X-ray output constancy
Electron output constancy
Laser Localization
ODI @ Iso
Collimatro size indicator
Door interlock
Door closing safety
Audiovisual monitors
Stereotactic interlocks
Radiation Area Monitor
Beam on indicator
3D
Tolerance:
3%
3%
2mm
2mm
2mm
Functional
Functional
Functional
NA
Functional
functional
IMRT
Tolerance:
3%
3%
1.5mm
2mm
2mm
Functional
Functional
Functional
NA
Functional
Functional
SRS/SBRT
Tolerance:
3%
3%
1mm
2mm
1mm
Functional
Functional
Functional
Functional
Functional
functional
MONTHLY LINAC QA:
QA Tests:
3D
IMRT
Tolerance: Tolerance:
X-ray output constancy
Electron output constancy
Backup monitor chamber constancy
Typical dose rate output constancy
Photon beam profile constancy
Electron beam profile constancy
Electron beam energy constancy
Photon beam flatness and symmetry
Electron beam flatness and symmetry
Wedge placement accuracy
Compensator placement accuracy
Latching of wedges and blocking trays
2%
2%
2%
NA
1%
1%
2%/2mm
2%
2%
2mm
1mm
Functional
2%
2%
2%
2%
1%
1%
2%/2mm
2%
2%
2mm
1mm
Functional
Localizing lasers
Light/radiation field coincidence
2mm
2mm or
1% on a
side
1mm
2mm
1mm
2mm or 1%
on a side
Distance check device for lasers
Gantry/collimator angle indicators
1mm
2mm
SRS/SBR
T
Toleranc
e:
2%
2%
2%
2%
1%
1%
2%/2mm
2%
2%
2mm
1mm
Functiona
l
<1mm
2mm or
1% on a
side
1mm
2mm
Accessory Trays
Jaw position indicators (symmetric)
Jaw position indicators (asymmetric)
Treatment couch position indicators
Laser guard-interlock
2mm
2mm
1mm
2mm/1
degree
functional
2mm
2mm
1mm
2mm/1
degree
functional
Beam output constancy
2%
2%
2mm
2mm
1mm
1mm/.5
degree
Functiona
l
2%
Yearly Linac QA:
QA Tests:
X-ray flatness change from
baseline
Light/radiation field coincidence
X-ray symmetry change from
baseline
Electron flatness/symmetry
change from baseline
SRS arc rotation mode, .5-10MU
per degree
X-ray and electron output
calibration
Spot check of field size
dependent output factors for xray
Output factors for electron
applicators
X-ray beam quality
Electron beam quality
Physical wedge transmission
factor constancy
X-ray monitor unit linearity
Electron monitor unit linearity
X-ray output constancy vs. dose
rate
X-ray and electron output
constancy vs. gantry angle
X-ray and electron off-axis
factory constancy vs. gantry
angle
Arc mode (expected MU/degree)
3D
Tolerance:
1%
IMRT
Tolerance:
1%
SRS/SBRT
Tolerance:
1%
2mm
1%
2mm
1%
2mm
1%
1%
1%
1%
NA
NA
1%
1%
Monitor units set
vs. delivered:
1MU or 2%
1%
2%
2%
2%
2%
2%
2%
1mm
2%
2%
1mm
2%
2%
1mm
2%
2%
2%, less
than 5MU
2%, >5MU
2% from
baseline
1% from
baseline
1% from
baseline
5%, 2-4MU
2%, >5MU
2%, >5MU
2% from
baseline
1% from
baseline
1% from
baseline
NA
2% from
baseline
1% from
baseline
1% from
baseline
1% from
baseline
1% from
baseline
1% from
baseline
TBI/TSET mode
TBI/TSET output calibration
PDD or TMR and OAF constancy
TBI/TSET accessories
Collimatory, gantry and couch
rotation
Coincidence of radiation and
mechanical isocenter
Table sag
Table angle
Wedge placement accuracy
Compensator placement
accuracy
Gantry/collimator angle
indicators
Cross-hair centering
Jaw position indicators (sym and
asym)
Accessory trays
Table travel max range
movement in all directions
Electron applicator interlocks
Stereotactic accessories,
lockouts, etc.
functional
2% from
baseline
2%
2% from
baseline
1mm
functional
2% from
baseline
2%
2% from
baseline
1mm
Functional
2% from
baseline
NA
2% from
baseline
1mm
2mm
2mm
1mm
1 degree
2mm
2mm
1mm
1 degree
2mm
2mm
1mm
1 degree
2mm
2mm
1mm
1 degree
1 degree
1 degree
1mm
2mm (sym),
1mm
(asym)
2mm
2mm
1mm
2mm (sym),
1mm
(asym)
2mm
2mm
1mm
2mm (sym),
1mm (asym)
functional
NA
functional
NA
functional
functional
2mm
2mm
Respiratory Gating checks:
QA Tests:
Phase, amplitude beam
control
In-room respiratory
monitoring system
Gating interlock
Beam energy constancy
Temporal accuracy of
phase/amplitude gate
on
Calibration of surrogate
for respiratory
phase/amplitude
3D
Tolerance
:
Functional
IMRT
Tolerance
:
Functional
SRS/SBRT
Tolerance
:
Functional
Frequency:
Functional
Functional
Functional
Monthly
Functional
2%
100ms of
expected
Functional
2%
100ms of
expected
Functional
2%
100ms of
expected
Monthly
Annual
Annual
100ms of
expected
100ms of
expected
100ms of
expected
Annual
Monthly
Interlock testing
functional
functional
functional
Annual
KV Imaging Tests:
Planar kV Imaging
Tolerance:
NonSRS/SBRT
Frequenc
y
functional
2mm
2mm
Toleranc
e:
SRS/SBR
T
functional
1mm
1mm
Collision interlocks
Positioning/repositioning
Imaging and treatment coordinate
coincidence (single gantry angle)
Imaging and treatment coordinate
coincidence (cardinal angles)
Scaling
Spatial resolution
Contrast
Uniformity and noise
Beam Quality/energy
Imaging dose
2mm
1mm
Monthly
2mm
baseline
baseline
baseline
baseline
baseline
1mm
baseline
baseline
baseline
baseline
baseline
Monthly
Monthly
Monthly
Monthly
Annual
Annual
Daily
Daily
Daily
MV Imaging Tests:
Planar MV Imaging Tests:
Tolerance:
Non-SRS/SBRT
functional
2mm
2mm
Tolerance:
SRS/SBRT
functional
1mm
1mm
Frequen
cy:
Daily
Daily
Daily
2mm
1mm
Monthly
2mm
2mm
Monthly
Spatial resolution
baseline
baseline
Monthly
Contrast
Uniformity and Noise
Full range of travel SDD
Imaging Dose
baseline
baseline
5mm
baseline
baseline
baseline
5mm
baseline
Monthly
Monthly
Annual
Annual
Collision interlocks
Positioning/re-positioning
Imaging and treatment coordinate
coincidence
Imaging and treatment coordinate
coincidence (cardinal angles)
Scaling
CBCT Imaging Tests:
Cone-beam CT
Tolerance:
Tolerance:
Frequen
Collision interlocks
Imaging and treatment coordinate
coincidence
Positioning/repositioning
Geometric distortion
Spatial resolution
Contrast
HU constancy
Uniformity and noise
Imaging noise
Imaging noise
NonSRS/SBRT
functional
2mm
SRS/SBRT
cy
functional
1mm
Daily
Daily
1mm
2mm
baseline
baseline
baseline
baseline
baseline
baseline
1mm
1mm
baseline
baseline
baseline
baseline
baseline
baseline
Daily
Monthly
Monthly
Monthly
Monthly
Monthly
Annual
Annual
MLC QA Tests:
MLC QA Tests:
Tolerance:
Frequency:
Check of MLC-generated field vs.
simulation film (DRR) before each tx
Double check of MLC field by
therapists for each fraction
On-line imaging verifcation for patient
on each fraction
Port film approval before second
fraction
Setting vs. light field vs. radiation field
for two designated patterns
Testing of network systems
2mm
Patient Specific
Expected Field
Patient Specific
Physician Discretion
Patient Specific
Physician Discretion
Patient Specific
1mm
Quarterly
Expected fields over
network
Must be operational
1mm
Quarterly
50% radiation edge
within 1mm
Interleaf leakage
<3%, abutted
leakage <25%
All operators must
understand
operation/procedure
s
Annually
Check of interlocks
Setting vs. light vs. radiation field for
patterns over range of gantry and
collimator angles
Water scan of set parameters
Film scans to evaluate interleaf
leakage and abutted leaf transmission
Review of procedures and in-service
with therapists
Quarterly
Annually
Annually
Annually
CT Simulator Tests: Image Performance
CT QA Tests:
CT number
accuracy
Tolerance:
Daily- CT number
for water
Monthly- 4-5
different materials
Annual- electron
density phantom
Daily
Frequency:
For water: 05
HU
In plane spatial
integrity
Daily- x or y
direction
Monthly- both
directions
1mm
Field uniformity
Monthly- most
commonly used kVp
Annual- other kVp
settings
Consistent with
commissioning
results and test
phantom.
Manufacturer
Specifications
Within 5 HU
Spatial resolution
Manufacturer
Specifications
Annual
Contrast
resolution
Manufacturer
Specifications
Annual
Image noise
Electron density
to CT number
conversion
Manufacturer
Specifications
Annually or
after scanner
calibration
Notes:
Ideally, a CT scan of
uniform phantom
would have uniform
pixel values (CT
numbers) throughout
phantom image.
Image quality affects
the ability to identify
and delineate target
volumes and
surrounding structures;
performed in
conjunction with
uniformity tests
Image distortions can
cause dosimetric
errors; CT images
should reproduce
anatomy within 1mm
Fields without
streaking and artifacts
Scanner dependent;
each CT image is a 2D
matric of CT #s
corresponding to mean
linear attenuation
coefficients of the
material in each voxel
Characterizes the
imaging systems
ability to distinguish
between two very
small objects placed
close together
CT ability to distinguish
relatively large objects
which differ in density
from background
CT Simulator Tests: Electromechanical
Components
CT Simulator Tests:
Alignment of gantry
lasers with center of
imaging plane
Tolerance:
2mm
Frequency:
Daily
Orientation of gantry
lasers with respect to
imaging plane
2mm over
length of laser
projection
Monthly and
after laser
adjustments
Spacing of lateral wall
lasers
2mm
Monthly and
after laser
adjustments
Orientation of wall
lasers
2mm over
length of laser
projection
Monthly and
after laser
adjustments
Orientation of ceiling
lasers
2mm over
length of laser
projection
2mm over
length and width
of tabletop
Monthly and
after laser
adjustments
Monthly or when
daily laser QA
tests reveal
rotational
problems
Monthly
Orientation of the CT
scanner tabletop
Table vertical and
longitudinal motion
1mm over
range of table
motion
Table indexing and
position
1mm over the
scan range
Gantry tilt accuracy
1 degree over
gantry tilt range
Gantry tilt position
accuracy
1 degree or
mm from
Annually
Annually
Test Objective:
Verify proper
identification of
scan plane with
gantry angles
Verify that the
gantry lasers are
parallel and
orthogonal with
imaging plane
Verify lateral wall
lasers are
accurately spaced
from scan plane
Verify that the
gantry lasers are
parallel and
orthogonal with
imaging plane over
full length of laser
projection
Verify the Ceiling
laser is orthogonal
with imaging plane
Verify CT scanner
tabletop is level
and orthogonal
with imaging plane
Verify the table
longitudinal motion
according to digital
indicators is
accurate/reproduci
ble
Verify table
indexing and
position accuracy
under scanner
controls
Verify accuracy of
gantry tilt
indicators
Verify gantry
accurately returns
nominal position
Scan localization
1mm over scan
range
Annually
Radiation profile width
Manufacturer
specifications
Annually
Sensitivity profile
width
1mm of
nominal value
Semi-annually
Generator tests
Manufacturer
specifications
After
replacement of
major generator
component
to nominal position
after tilting
Verify accuracy of
scan localization
from pilot images
Verify radiation
profile width meets
manufacturer
specs.
Verify the
sensitivity profile
width meets
manufacturer
specs.
Verify proper
operation of X-ray
generator
recommendations.
IMRT QA: each and every IMRT plan must be verified
by measuring dose delivered
Techniques:
Point dose measurements
for a single field
Point dose measurements
for all fields
Planar dose measurements
for a single field
Planar dose measurements
for multiple fields
Explanation:
Measured using film, ion chamber, or diodes
Composite film used to sample dose at specified
point (s) or an ion chamber may be used
Dose is computed at a specified depth in phantom,
perpendicular to CA of beam. May be measured
using film or an array of diodes. Dose profiles or
isodose lines may be compared to tx plan.
Measured using film; dose profiles or isodose lines
may be compared to treatment plan
Remote Afterloading Equipment: mandated by
NRC and this requires safety procedures to avoid
unintended exposure of patient or personnel
QA tests:
Survey meters
Radiation monitors
Door interlockd
Radiation on lights
Proper operation of afterloading equipment
Presence of equipment needed for a stuck or detached
Frequency:
Daily
Daily
Daily
Daily
Daily
Daily
source (large lead pig and long forceps)
Verification of source activity and check against decay
chart
Measurement of source transit time
Timer linearity
Source positioning accuracy
Integrity of applicators used most often; checked for
mechanical damage, ease of coupling, kinks, and
mechanical deformation
Timer checked to verify accuracy and linearity
Power failure test to verify source retracts
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Daily QA/Testing done prior to HDR patient treatment:
1. All monitor and interlocks checked (door interlocks, emergency off buttons,
treatment interrupt buttons, audiovisual monitors, and room radiation monitors)
2. Testing of interlocks that detect missing or misconnected applicators or transfer
tubes
3. Treatment unit displays of time, date, and current source strength should be
verified for accuracy
4. Test of source-position accuracy
5. Dwell-time Accuracy
6. Normal termination of treatment
7. Mechanical integrity of applicator connections to treatment unit
8. Availability and integrity of emergency response equipment
