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JennyKouri
DOS542
10/14/15
TreatmentPlanningSystem(TPS)QualityAssurance(QA)
AttheVAMedicalCenterinMinneapolis,Minnesota,themedicalphysicistandmedical
dosimetristbothplayasignificantrollintheQATPSprocess.EventhoughtheVAdoesnot
haveaformalprocedure,theyfollowtheAAPMReportTG62toguidethroughthe
uncertaintiesofthecomplextreatmentplanningsystem.Withmuchterritorytocover,suchas
patientlocalization,imaging,contouring,beamgeography,dosecalculation,dosedisplayand
plansevaluation,acceptancetestingispreformedinitially,afteranyupgrade,orchangeinthe
systembythemedicalphysicist.1Thecommissioningprocessinvolvesanalyzingdatainput,
output,anddosealgorithms.ThemedicaldosimetristpreformsquarterlyQA.Thisinvolves
runningpreplannedtreatments(forQA)andcalculatingthedosetocheckforvarianceindata
output.ARANDOphantomisusedscannedtocreateaCTdatasetfortheQAplans.ARANDO
phantomismanufacturedtomimicthedifferentdensitiesofabodywithgridsasanoptionfor
dosimeteruse.Thephantomisequivalenttosofttissue,whichismadeupofnaturalskeletoncast
material.2AttheVA,ourdosimetristdesignedQAplansforH/N,lung/mediastinum,and
prostrateforbothofourtreatmentmachines(Varianixlinearaccelerators),bothenergies(6MV,
18MV),alltechniques(3D,IMRT,VMAT,andelectrons)anddifferentwedging.Thetheory
behindthisistohaveQAplansthatwewouldtypicallyuseforanyscenarioinrealtime
planning.GranteditisalmostimpossibleandtimeconsumingtocreateQAplansforALL
scenarios,buttheQAplansattheVAcoveralotofground.Ifanydiscrepanciesoccurwhen
comparingtheRANDOphantomQAplanstotherealtreatmentplans,thephysicsteamwill
thoroughlyanalyzetheTPS.Figures15demonstratetheRANDO phantomQAplansusedto
comparetotreatmentplanscreatedforpatients.

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Inaddition,themachinefluenceiscomparedtotheplannedfluencetoverifyan
agreement.Acceptabletoleranceisa97%comparabletreatmentdelivery.Ifbelow97%,then
treatmentplanswillberedone.Secondarychecksarepreformedtoverifytheconsistencyofthe
monitorunitsoftheTPSviaMuCheck.IMRTplansmustagreewithin5%and3DCRT,3%.

References
1. Fraass,DoppkeK,HuntM,KutcherG,etal.AmericanAssociationofPhysicistin
Medicineradiationtherapycommitteetaskgroup53:qualityassuranceforclinical
radiotherapytreatmentplanning.MedPhys.1998;25(10);17731829.
2. RANDOPhantoms.ThePhantomLaboratorywebsite.
http://www.phantomlab.com/products/rando.php.Updated20102015.AccessedOctober
14,2015.

Figures

Figure 1. This is the QA plan for a 3D H/N case. Three fields are used, 2
photons and an electron. This plan was designed with different trials to test
the calculations of different electron energies, 9Mev and 12Mev (our most
commonly used), and all the different degrees of wedging. I found this 3D
plan particularly interesting because the electron and photon mixed energies
and blocked field edge created the isodose lines to curve around the spinal
cord. The electron field was used to create superficial coverage to not allow
dose to accumulate deep into the spinal cord. This pattern of dose is similar
to current IMRT planning with a curvature of dose around the cord. Our
physicist always talks about building your IMRT plans off of conventional 3D
fields based from historical data of dose uptake by surrounding critical
structures.

Figure 2. This is a QA plan of the lung/mediastinum that was designed with

4 fields: anterior, posterior, and parallel obliques. The fields can be tested for
6MV and 18MV.

Figure 3. The QA plan for the prostrate involves beam orientation for both,
7 (initial) and 8 (boost) fields.