JennyKouri

DOS542QA
9/30/15
DailyQualityAssurance(QA)
DailymorningQAattheVAMedicalCenterinvolvesdosimetry,mechanical,andsafety
procedures.Documentationofthecontrolproceduresmustbecompletedinordertoidentifythat
thehighqualitystandardsofcarearemetortoaddresstheneedforimprovementbasedoffof
national,state,andinstitutionalhistoricalreportsandprotocols.ThemaingoaloftheVAsQA
programistoassurethelinearacceleratorsnormaloutputdoesnotdeviatefromthedata
collectedduringtheinitialacceptancetestingandcommissioningprocess.
Outputconsistency,flatness,symmetry,dailyoutputandenergychecksarecompleted
withTheraPro,aWindowsbasedinstrumentthatincludesanionchamberarrayandreadoutunit
thatdenotesifbeamenergiesareacceptablefortreatment.1Allenergies(6X,18X,6MeV,
9MeV,12MeV,20MeV)arecheckedwithTheraProandmustbewithinatoleranceof+/3%.If
thebeamenergyislessthen+/5%,thetherapistsmustnotifythephysicistsandcontinuetotreat.
Onlyiftheenergiesexceed+/5%,treatmentcannotbeadministered.TheraProshowsagreen
boxifthebeamenergyiswithintolerance,ayellowboxifbetween+/3%and+/5%,andredif
over+/5%.TheraProisveryuserfriendly,touchscreen,providesyearsofstoragefor
measurements,andautomaticallyappliescorrectedtemperatureandpressureunits.Tosetup
outputconstancyforphotons,a5cmacrylicslabforbuildupisusedandplacedontopofthe
chamberarray.Thechamberarrayisplacedat100SSDwiththegantryandcollimatorat0.
Forelectrons,theacrylicslabisremovedanda20x20cmelectronconeiscentered.The
chamberarrayremainsat100SSDandthegantryandcollimatorat0.100monitorunitsare
givenforeachenergyoutputwithadoserateof400.6MVisruntwice,eachwithadoserateof
400and600.During600,beaminterruptmechanismsarechecked.Figures14displayoutput
constancycheck.
CouchshiftaccuracyproceduresarecompletedwithamarkerphantomtocheckMV,
KV,andCBCTimaging.Themarkerphantomisindexedtothecouchat0.Figure5showcases
themarkerphantom.Forconsistency,thelasersarealwaysfirstmatchedtothecrosshairsonthe
rightsideofthemarkerphantom(yourright,notthepatientsright).MVandKVimagingis

preformed.Theimagetakenisthenmatchedtotheexpectedimage.Theexpectedshift(A)is2
cmvertical,longitudinal,andlateral.Thedailyshift(B)issubtractedfromtheexpectedshift
(A).|AB|<1mm.Shiftsareappliedandrecordedasthenewcouchposition(C).CBCTis
performed.CBCTshifts(D)aresubtractedfromthenewcouchposition(C).|CD|<1mm.
Shiftsareappliedandrecordedasthefinalcouchposition.MV,KV,andCBCTisocenter
accuracyischeckedandmustbewithin1mmsuperiortoinferiorandrighttoleft.Iftheisocenter
BBisoffbymorethan1mmbutlessthan2mminanydirection,thephysicistsmustbenotified
andcontinuetotreatexceptforSBRTcases.IftheisocenterBBexceeds2mm,treatmentcannot
beadministered.Ifthelasersonthecrosshairsofthemarkerphantomaregreaterthan1mm
spherically(lateral,longitudinal,orvertical),physicistsmustbenotified.
Safetychecksincludeaudiovisualmonitoring,doorinterlocks,andbeamonlighting.The
temperature(Celsius)andpressure(mmHg)aretaken.

References
1.TheraProDailyOutputandSymmetryMonitor.RadiationProductsDesign,Inc.website.
http://www.rpdinc.com/theraprodailyoutput1296.html.AccessedSeptember30,2015.

Figures

Figure1:TheraProreadoutunitthatdisplaysbeamoutput,flatness,andsymmetry.

Figure2:TheraProionarraychamberissetto100SSDwiththegantryandcollimatorat0.

Figure3:Forelectronenergies,a20x20coneisplacedinsideofthetrayovertheionchamber
array.

Figure4:Forphotonsenergies,5cmacrylicslabsareusedforbuildup.

Figure5:Themarkerphantomisindexedat0onthetreatmentcouch.Lasersarealignedtothe
rightsideonthephantomscrosshairs.