Doris Chen

DOS 524: Week 4

Quality Assurance Charts

LINEAR ACCELERATOR QA1

Procedure

Daily

Monthly
DOSIMETRY

x-ray/electron flatness
x-ray/electron symmetry
SRS arc rotation*
(range: 0.5 10 MU/deg)

x-ray/electron output calibration

Spot check of field size dependent
output factors for x-rays (2 or
more fields)
Output factors for electron
applicators (spot check of one
applicator/energy)
x-ray beam quality (PDD10 or
TMR1020)
Electron beam quality (R50)
Physical wedge transmission factor
constancy
x-ray /electron MU linearity
3%
(output constancy)
x-ray output constancy vs dose rate
x-ray/electron output constancy vs
gantry angle
Electron/x-ray off-axis factor

Annually
1%
+ or 1%
MU set vs delivered:
1MU or 2% (whichever is
greater)
Gantry arc set vs delivered:
1 or 2% depending on which is
greater
Within 1% deviation (absolute)
2% for field size < 4x4 cm2
1% 4x4 cm2
Within 2% deviation from
baseline
Within 1% deviation from
baseline
Within 1mm deviation
+ or 2%

2%

+ or 2% 5 MU
+ or 2% from baseline
+ or 1% from baseline
+ or 1% from baseline

constancy vs gantry angle

Backup monitor chamber
constancy
Typical dose rate output constancy
Photon/electron beam profile
constancy
Electron beam energy constancy
Collimator, gantry, and couch
rotation isocenter
Electron applicator interlocks
Coincidence of radiation and
mechanical isocenter
Table top sag
Table angle
Table travel max range movement
in all directions
Stereotactic accessories, lockouts,
etc.
Light/radiation field coincidence
Distance check device for lasers
compared within front pointer
Gantry/collimator angle indicators
(@ cardinal angles)
Accessory trays
Jaw position indicator
Cross-hair centering (walkout)
Treatment couch position indicator

2%
2% for both IMRT and
SRS/SBRT*
1%
2% or 2 mm
MECHANICAL
Within 1mm deviation
Functional
Within 2mm deviation
1mm deviation*
Within 2mm deviation
1
Within 2mm deviation
Functional
2 mm or 1% on a side
1mm or 1% on a side for
asymmetric fields
1 mm
1
2mm
2mm (symmetric)
1mm (asymmetric)
1mm
2mm/1

Wedge placement accuracy

Compensatory placement accuracy
Latching of wedges, blocking tray
Localizing lasers
Laser localization

Distance indicator (ODI) @ iso

Collimator size indicator

1mm/0.5*
2mm
1mm
Functional
+ or 1mm
2mm (non-IMRT)
1.5mm (IMRT)
1mm*
2mm (all techniques)
2mm
1mm*
SAFETY

Door interlock (beam off)

Door closing safety
Audiovisual monitor(s)
Stereotactic interlocks (lockout)*
Radiation area monitor
Beam on indicator
Laser guard-interlock test
Follow manufacturers test
procedures
Beam output constancy
Phase, amplitude beam control
In-room respiratory monitoring
system
Gating interlock
Temporal accuracy of
phase/amplitude gate on
Calibration of surrogate for

Functional
Functional
Functional
Functional*
Functional
Functional
Functional
Functional
RESPIRATORY GATING
2%
Functional
Functional
Functional

2%

Functional
100 ms of expected
100 ms of expected

respiratory phase/amplitude
*Applies to SRS/SBRT procedures

IMAGING FOR LINEAR ACCELERATOR QA1

Procedures

Daily

Monthly
PLANAR KV AND MV (EPID) IMAGING
Collision interlocks
Functional
Functional
Functional*
Functional*
Positioning/repositioning
2mm
1mm*
Imaging and treatment
2mm
coordinate coincidence (single 1mm*
gantry angle)
Imaging and treatment
2mm
coordinate coincidence (four
1mm*
cardinal angles)
Scaling
2mm
2mm*
Spatial resolution
Baseline
Baseline*
Contrast
Baseline
Baseline*
Uniformity and noise
Baseline
Baseline*
Full range of travel SSF
Imaging dose
Beam quality/energy
CONE-BEAM CT (KV AND MV)

Annual

Within 5mm deviation

Within 5mm deviation
Baseline
Baseline*
Baseline
Baseline*

Collision interlocks
Imaging and treatment
coordinate coincidence
Positioning/repositioning

Functional
Functional*
2mm
1mm*
1mm
1mm*
2mm
1mm*
Baseline
Baseline*
Baseline
Baseline*
Baseline
Baseline*
Baseline
Baseline*
Baseline
Baseline*

Geometric distortion
Spatial resolution
Contrast
HU constancy
Uniformity and noise
Imaging dose
*Applies to SRS/SBRT procedures

CT-Based IGRT Systems QA2

Procedure

Daily

Collision and other interlocks

Warning lights

Functional
Functional

Monthly
SAFETY

SYSTEM OPERATION
Laser/image/treatment
isocentric coincidence OR
Phantom localization and
repositioning with couch shift

Within 2mm
Within 2mm

Annually

Long and short term

planning of resources (disk
space, manpower, etc.)
Geometric calibration maps
OR
kV/MV/laser alignment
Couch shifts: accuracy of
motions
Anteroposterio, mediolateral,
and craniocaudal orientations
are maintained (upgrade
from CT to IGRT)
Scale, distance, and
orientation accuracy
Uniformity, noise
High contrast spatial
resolution
Low contrast detectability
CT number accuracy and
stability

Support clinical use and current

imaging policies and
procedures
GEOMETRIC
Replace/refresh
Within 1mm
Within 1mm
Accurate

IMAGE QUALITY
Baseline
Baseline
2mm (or 5 lp/cm)
Baseline
Baseline
DOSE

Imaging dose

Baseline
IMAGING SYSTEM PERFORMANCE

X-ray generator performance

(kV systems only): tube
potential, mA, ms accuracy,
and linearity

Baseline

SYSTEM OPERATION
Long and short term
planning of resources (disk

Support clinical use and current

imagining policies and

space, manpower, etc.)

CT SIMULATOR QUALITY ASSURANCE3
Test Specifications for radiation and patient safety:
Performance Parameter
Test Objective
Frequency
Shielding survey
To verify exposure levels
Initially
around the CT-scanner room
Patient dose from CT-scan,
To verify safe dose delivered
Annually or after major CTCTDI
from the scanner
scanner component
replacement
Alignment of gantry lasers
To verify proper identification
Daily
with the center imaging plane of scan plane with gantry lasers
Orientation of gantry lasers
To verify that the gantry lasers Monthly and after laser
with respect to the imaging
are parallel and orthogonal with adjustments
plane
the imaging plane over the full
length of laser projection
Spacing of lateral wall lasers
To verify that lateral wall lasers Monthly and after laser
with respect to lateral gantry are accurately spaced from the
adjustments
lasers and scan plane
scan plane. This distance is
used for patient localization
marking
Orientation of wall lasers
To verify that the wall lasers
Monthly and after laser
with respect to the imagining are parallel and orthogonal with adjustments
plane
the imaging plane over the full
length of laser projection
Orientation of the ceiling
To verify that the ceiling laser
Monthly and after laser
laser with respect to the
is orthogonal with the imaging adjustments
imaging plane
plane
Orientation of the CTTo verify that the CT-scanner
Monthly or when daily laser
scanner tabletop with respect tabletop is level and orthogonal QA tests reveal rotational
to the imaging plane
with the imaging plane
problems
Table vertical and
To verify that the table
Monthly

procedures

Tolerance Limits
NCRP recommendations or
applicable regulatory limits
Within 20% deviation of
manufacturer specifications
Within 2 mm deviation
Within 2mm deviation over the
length of laser projection
Within 2 mm deviation

Within 2mm deviation over the

length of laser projection
Within 2mm deviation over the
length of laser projection
Within 2 mm deviation over the
length and width of the tabletop
Within 1mm deviation over the

longitudinal motion
Table indexing and position
Gantry tilt accuracy
Gantry tilt position accuracy
Scan localization
Radiation profile width
Sensitivity profile width
Generator tests

longitudinal motion according

to digital indicators is accurate
and reproducible
To verify table indexing and
position accuracy under
scanner control
To verify accuracy of gantry tilt
indicators
To verify that the gantry
accurately returns to nominal
position after tilting
To verify accuracy of scan
localization from pilot images
To verify that the radiation
profile width meets
manufacturer specification
To verify that the sensitivity
profile width meets
manufacturer specification
To verify proper operation of
the x-ray generator

Test specifications for image performance evaluation:

Performance Parameter
Frequency
CT number accuracy
Daily: CT number for water
Monthly: 4 to 5 different
materials
Annually: Electron density
phantom
Image noise
Daily
In plane spatial integrity
Daily: x or y direction
Monthly: both direction

range of table
Annually

Within 1mm deviation over the

scan range

Annually

Within 1 deviation over the

gantry tilt range
Within 1 or 1mm deviation
from nominal position

Annually
Annually
Annually (This test is optional
if the CTDI accuracy has been
verified)
Semiannually
After replacement of major
generator component

Tolerance limits
For water, 05 HU

Manufacturer specifications
Within 1mm deviations

Within 1mm deviation over the

scan range
Manufacturer specifications
Within 1mm deviation of
nominal value
Manufacturer specification or
Report No. 39
recommendations

Field uniformity

Electron density to CT
number conversion

Monthly: most commonly used

kVp
Annually: other used kVp
settings
Annually: or after scanner
calibration

Spatial resolution
Contrast resolution

Annually
Annually

Within 5 HU

Consistent with commissioning

results and test phantom
manufacturer specifications
Manufacturer specifications
Manufacturer specifications

TREATMENT PLANNING QUALITY ASSURANCE4

CT input
Anatomical description
Beam description
Photon Beam dose calc
Electron bead dose calc
Brachytherapy dose
calculations
Dose display, DVHs
Hardcopy output
Image geometry
Geometric location &
orientation of the scan

Acceptance Test
Create an anatomical description based on a standard set of CT scans
Create a patient model based on the standard CT data discussed above
Verify that 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, and others
Perform a set of dose calculations for a standard electron beam data set
Perform a set of dose calculations for single sources of each type, as well as several multi-source
implant calculations, including standard implant techniques such as GYN insertion tandem &
ovoids
Display dose calculation results. Use a standard dose distribution provided by the vendor to verify
the DVH code works as described
Print out all hardcopy documentation for a given series of plans
Imaging Input Test
Document and verify parameters used to determine geometric description of each image (e.g.,
number of pixels, pixel size, slice thickness)
Left-right and head-foot orientations

Text information
Imaging data
Image unwarping (removing
distortions)
Structure attributes
Relative ED definition
Display characteristics
Capping (how end of structure
is based on contours)
Structure definition

Manual contour acquisition

Contouring on 2D images
Autotracking contours
Contours on projection images
(DRRs, BEVs)
Relative Ed representation
CT number conversion
ED within bolus
Automated bolus design
Beam assignment

Verify that all text information is correctly transferred

Verify accuracy of grayscale values, particularly for conversion of CT number to electron density
(ED)
Assure the original and modified images are correctly identified within the system
Anatomical Structure Tests
Verify type (external surface, internal structure, inhomogeneity) and capabilities that are
dependent on that type
Verify relative ED derived from CT number
Check color, type of rendering, and type of contours to be drawn
Verify that all methods of capping are performed correctly and 3-D implications are understood.
Establish clinical protocols for each 3-D anatomical structure.
Verify basic surface generation functionality using simple contours. Verify surface generation
functionality for extreme cases.
Contour Tests
Check and document separation and SSDs to AP and lateral reference points. Check laser
alignment marks.
Verify accuracy of contour display, 3D location of contour, identification of each contour and its
associated 3D structure, and response of the contouring algorithm
Verify proper response of the tracking algorithm for various situations (e.g. different grayscale
gradients, different image types, markers, contrasts, image artifacts)
Check contours drawn on projection images are projected correctly, and intersection of such
contours with various axial, sagittal, and coronal slices
Density Description Test
Verify that the system creates the correct relative ED representation and it is maintained correctly
when contours are modified
Verify that the CT number to the HU units to relative ED conversion are preformed corrected
Bolus Tests
Verify that the density in the bloused region is set to the assigned value
Verify bolus is designed correctly and information is corrected exported and the physical bolus is
correctly fabricated
Conform whether bolus is accounted for in the dose calc

MU calc
Leaf width
Number of leaves
Distance over midline that can
be traveled by a leaf
Leaf transmission
Minimum gap between
opposing leaves
Leaf labels
Leaf editing capabilities
dMLC
Machine library
Machine/beam accessories
Parameter limitations
Wedges
Compensators
Block type
Block Transmission
MLC leaf fits
Electron applicators
Orientation and angle
specifications
2-D Display

Confirm the proper method to calculate MUs wen the bolus is used
MLC Parameters
Leaf travel (min, max) field size min and max
Overlap between leaves (the tongue and groove design of most MLC system affect the parameter)
Max extension between leaves
Leaf readout resolution
Jaw algorithm
Leaf end design
Design of the side of leaves
Leaf synchronization for dMLC
Beam Configuration Tests
Verify that the library of available machines and beams is correct
Verify that the availability of machine and beam-specific accessories (electron cone or wedge)
Verify that limitations are correct for jaws, MLC, FS with wedges, compensators and electron
applicators. Verify MU limits, MU/deg limits, angle limits.
Verify that wedge characterizations such as coding, directions, and FS limitations, and availability
are correct
Verify correct use and display
Field Shape Design Test
Verify that the system distinguishes between island blocks, in which the aperture delineates the
block shape, and aperture or conformal blocks.
Verify correct specification of transmission or block thickness for full blocks and partial
transmission blocks
Document and test all methods used to fit the MLC leaves to desired field shape
Verify availability and size of electron applicators
Wedge Tests
Confirm that wedge orientation and angle specifications are consistent throughout the planning
system
Check display of wedge in different 2-D planes (parallel, orthogonal, oblique) for different
directions, collimator rotations, and wedge orientations

3-D Display
Orientation and FS limitations
Autowedges (wedges inside the
head of the machine)
Dynamic wedge

Dose points
Interactive point doses
Consistency
Dose grids
2D dose displays
Isodose Surfaces
Beam display

Volume region of interest

(VROI) identification
Structure identification
Voxel dose interpolation
DVH calculation
DVH types
DVH plotting and output
Plans and DVH normalization
Dose and VROI grid effects
Use of DVHs from different

Check display of wedges in room view 3D displays

Verify that wedge orientations and FS not allowed by the tx machine are not allowed in tps
Confirm that the division of a field into fractional open and wedged fields agrees in the RTP
system and on the tx machine
Verify that the implementation in the RTP system has the same capabilities, limitations, and
naming conventions as the tx machine
Dose Display Tests
Verify that point is defined at the desired 3D coordinates, point is displayed at the correct 3D
position, and dose at point is displayed correctly
Verify that point coordinates correctly correspond to cursor position on display
Verify that doses in intersecting planes are consistent and doses displayed with different display
techniques are consistent
Verify that dose is correctly interpolated between grid points for both small and large spacing
Verify that IDLs are correctly located and that the colorwash display lines up correctly with the
IDLs and agrees with the point dose displays
Verify that surfaces are displayed correctly and surfaces are consistent with isodose lines on
planes
Verify that positions and FS are correct, wedges are shown and orientation is correct, and beam
edges and apertures are shown correctly
DVH Tests
Test creation of voxel VROI description used to create DVHs against structure description
Test Boolean combinations of objects and how voxels which belong to multiple structures are
handled
Verify accuracy of dose interpolated in each voxel
Test DVH calculation algorithm with known dose distributions
Verify that standard (direct), differential, and cumulative histograms are all calculated and
displayed correctly
Test DVH plotting and output using known dose distributions
Verify relationship of plan normalization (dose) values to DVH results
Review and understand relationship of dose and VROI grids
Test correct use of DVHs from different cases with different DVH bin sizes, dose grids, etc.

cases

Source input and geometric

accuracy

Source display

Optimization and evaluation

Non-Dosimetric Brachytherapy Tests

For source location entry using a digitizer and orthogonal or stereo-shift films, checks
should be made of the data entry software, the film acquisition process, source
identification, and other associated activities. 3D seed coordinate representation after
entry should be confirmed
Automatic seed identification and locating software mush be verified
For the source location entry using CT images, other tests should be included
For applicator trajectory identification, the appropriate tests described above should be
performed. In addition, the accuracy of dwell points or source locations along the
trajectory should be confirmed
Verify accuracy of source position display on:
2D slices, including CT and reconstructed images and the arbitrary planes often used in
non-CT brachytherapy
3D views
Special views, such as Probes Eye view used in stereotactic brain implant planning
Dummy sources in phantom can be scanned, DRRs generated to use as a check for
radiograph-based identification and positioning
Test automated brachytherapy optimization tools, such as automatic determination of
dwell positions and times to yield a specified dose distribution with an afterloader unit
Test other standard tools such as DVHs

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