Glenda Longoria

QA Assignment
Fall 2016

Daily QA1
Procedure

Tolerance
Conventional Non-IMRT

IMRT

SBRT/SRS

In-room lasers

2 mm

1.5 mm

1 mm

ODI at isocenter

2mm

2 mm

2 mm

Collimator size

2 mm

2 mm

1 mm

Energy output - all energies

3%

Electron output constancy

3%

Door interlocks

N/A

Functional

Functional

Audio/visual monitors

N/A

Functional

Functional

Stereotactic interlocks

N/A

N/A

Functional

Radiation area monitor

N/A

Functional

Functional

Beam on indicator

N/A

Functional

Functional

Mechanical

Dosimetry

Safety

Glenda Longoria
QA Assignment
Fall 2016

Monthly QA1
Tolerance
Procedure

Conventional Non-
IMRT

IMRT

SBRT/SRS

X-ray output constancy

Electron output constancy

2%

Backup monitor chamber constancy

Typical dose rate output constancy

N/A

2% (@ stereo dose
rate, MU)

Dosimetry

Photon beam profile constancy

2% (@ IMRT dose
rate)
1%

Electron beam profile constancy

1%

Electron beam energy constancy

2% /2 mm

Mechanical
Light/radiation field coincidence
Light/radiation field coincidence
(asymmetric)
Distance check device for lasers compared
with front pointer
Gantry/collimator angle indicators

2 mm or 1% on a
side
1 mm or 1% on a
side

1 mm

Accessory trays

2 mm

Jaw position indicators (symmetric)

2 mm

Jaw position indicators (asymmetric)

1 mm

Cross-hair centering (walkout)

1 mm

2 mm / 1

2 mm / 1

1 mm / 0.5

Wedge placement accuracy

2 mm

Compensator placement accuracy

1 mm

Latching of wedges, blocking tray

Functional

2 mm

1 mm

< 1 mm

Functional

Beam output constancy

2%

Phase, amplitude beam control

Functional

In-room respiratory monitoring system

Functional

Gating interlock

Functional

Treatment couch position indicators

Localizing lasers
Safety
Laser guard-interlock test
Respiratory Gating

Glenda Longoria
QA Assignment
Fall 2016

Annual QA1
Tolerance
Procedure

Conventional
Non-IMRT

IMRT

SBRT/SRS

1%

1%

1%

1%

N/A

N/A

Monitor units set vs. delivered: 1

MU or 2% (whichever is greater).
Gantry arc set vs. delivered: 1 or
2% (whichever is greater)

1% (absolute)

2% for f.s. < 4 x 4

cm, 1% to 4 x 4
cm

2% from
baseline

Dosimetry
X-ray flatness change from
baseline
X-ray Symmetry change from
baseline
Electron flatness change from
baseline
Electron symmetry change
from baseline
SRS arc rotation mode
X-ray/electron output
calibration (TG 51)
Spot check of field size
dependent output factors for
x-ray (two or more FSs)
Output factors for electron
applicators (spot check of one
applicator/energy)
X-ray beam quality

Electron Beam Quality (R50)

Physical wedge transmission
factor constancy
X-ray monitor unit linearity
(output constancy)
Electron monitor unit linearity
(output constancy)
X-ray output constancy vs.
dose rate
X-ray output constancy vs.
gantry angle
Electron output constancy vs.
gantry angle
Electron and x-ray off-axis
factor constancy vs. gantry
angle
Arc mode (expected MU,
degrees)

1% from
baseline
1 mm

2%

2% to 5 MU

5% (2-4MU),
2% to 5 MU

5% (2-4MU), 2% to 5 MU

2% to 5 MU

2% from
baseline
1% from
baseline
1% from
baseline

1% from
baseline

1% from
baseline

Glenda Longoria
QA Assignment
Fall 2016

TBI/TSET mode

Functional
1% (TBI) or 1 mm
PDD shift (TSET)
from baseline
2% from baseline

PDD or TMR and OAF

constancy

TBI/TSET output calibration

TBI/TSET accessories

2% from baseline

Mechanical

Collimator Rotation isocenter

Gantry rotation isocenter

Couch rotation isocenter

Electron applicator interlocks

1mm from
baseline
1mm from
baseline
1mm from
baseline
Functional

Coincidence of radiation and

mechanical isocenter

2mm from
baseline

2mm from
baseline

1mm from baseline

Table top sag

Table angle

2mm from
baseline
1

Table travel maximum range

movement in all directions

2mm

N/A

N/A

Functional

Functional

Beam energy constancy

Temporal accuracy of
phase/amplitude gate on
Calibration of surrogate for
respirator phase/amplitude

2%
100 ms of
expected
100 ms of
expected

Interlock testing

Functional

Stereotactic accessories,
lockouts, etc.
Safety
Follow manufacturer's test
procedures
Respiratory Gating

Glenda Longoria
QA Assignment
Fall 2016

Daily QA of Imaging Systems2

Procedure

non-SRS/SBRT

Planar kV and MV (EPID) imaging

Functional

Functional

Positioning/repositioning

2mm

1mm

Imaging and treatment Coordinate

coincidence (single gantry angle)

2mm

1mm

Collision interlocks

Cone-beam CT (kV and MV)

Functional

Functional

Imaging and treatment coordinate

coincidence

2mm

1mm

Positioning/repositioning

1mm

1mm

Collision interlocks

Monthly QA of Imaging Systems2

Procedure
non-SRS/SBRT
Planar kV and MV (EPID) imaging

SRT/SBRT

Imaging and treatment coordinate

coincidence (4 cardinal angles)

2mm

1mm

Scaling

2mm

2mm

Spatial resolution

Baseline

Baseline

Contrast

Baseline

Baseline

Uniformity and noise

Baseline

Baseline

Planar kV imaging

Imaging and treatment coordinate

coincidence (4 cardinal angles)

2mm

1mm

Scaling

2mm

1mm

Spatial resolution

Baseline

Baseline

Contrast

Baseline

Baseline

Uniformity and noise

Baseline

Baseline

Cone-beam CT (kV and MV)

SRT/SBRT

Geometric distortion

2mm

1mm

Spatial resolution

Baseline

Baseline

Contrast

Baseline

Baseline

HU constancy

Baseline

Baseline

Uniformity and noise

Baseline

Baseline

Glenda Longoria
QA Assignment
Fall 2016

Annual QA of Imaging Systems2

Procedure
non-SRS/SBRT
Planar MV (EPID) imaging

SRT/SBRT

Full range of travel SDD

5 mm

5 mm

Imaging dose

Baseline

Baseline

Planar kV imaging
Beam quality/energy

Baseline

Baseline

Imaging dose

Baseline

Baseline

Cone-beam CT (kV and MV)

Baseline

Imaging dose

Baseline

Respiratory Gating QA2
Tolerance

Monthly

2%

Beam output constancy

Functional

Phase, amplitude beam control

Functional

In-room respiratory monitoring system

Functional

Gating interlock

Annual
Beam Energy Constancy
Temporal accuracy of phase/amplitude
Calibration of surrogate for respiratory
phase/amplitude
Interlock testing

2%
100 ms of expected
100 ms of expected
Functional

Glenda Longoria
QA Assignment
Fall 2016

CT Simulator: Electromechanical Components Testing1

Frequency

Tolerance

Alignment of gantry lasers with

the center of imaging plane

Daily

2mm

Orientation of gantry lasers with

respect to the imaging plane

Monthly and after

laser adjustments

2mm over the length of

laser projection

Spacing of lateral wall lasers

with respect of lateral gantry
lasers and scan plane

Monthly and after

laser adjustments

2mm

Orientation of wall lasers with

respect to the imaging plane

Monthly and after

laser adjustments

2mm over the length of

laser projection

Orientation of the ceiling laser

with respect to the imaging
plane

Monthly and after

laser adjustments

2mm over the length of

laser projection

Orientation of the CT scanner

tabletop with respect to the
imaging plane

Monthly or when
daily laser quality
assurance tests
reveal rotational
problems

2mm over the length and

width of the tabletop

Table vertical and longitudinal

motion

Monthly

1mm over the range of

table motion

Table indexing and position

Annually

1mm over the scan range

Gantry tilt accuracy

Annually

1mm over the gantry tilt

range

Gantry tilt position accuracy

Annually

1 or 1 mm from
nominal position

Scan localization

Annually

1 mm over scan range

Radiation profile width

Annually [this test is

optional if the
Communications Test
Design Inc. (CTDI)
accuracy has been
verified]

Manufacturer
specifications

Sensitivity profile width

Semiannually

1 mm of nominal value

After replacement of
major generator
component

Manufacturer
specifications or Report
No. 39

Generator tests

Glenda Longoria
QA Assignment
Fall 2016

CT Simulator: Image Performance Evaluation1

Frequency

Tolerance

CT number accuracy

Daily - CT # for water,

Monthly - 4-5 diff materials,
Annually - electron density
phantom

For water, 0 5 HU

Image Noise

Daily

Manufacturer
Specifications

In plane spatial integrity

Daily - X or Y direction,
Monthly - both directions

1 mm

Field uniformity

Monthly - Most Commonly

used kVp, Annually - other
used kVp settings

within 5 HU

Electron density to CT
number conversion

Annually - or after scanner

calibration

Consistent with
Commissioning
results and test
phantom
manufacturer
specifications

Spatial resolution

Annually

Manufacturer
specifications

Contrast resolution

Annually

Manufacturer
specifications

Glenda Longoria
QA Assignment
Fall 2016

Periodic Quality Assurance of Radiographic Simulators1

Procedure
Frequency
Tolerance
Localizing lasers
ODI
Field size indicator
Gantry/collimator angle indicators
Cross-hair centering
Focal spot-axis indicator
Fluouroscopic image quality
Emergency/collision avoidance
Light/radiation field coincidence
Film processor sensitometry
Mechanical Checks
Collimator rotation isocenter
Gantry rotation isocenter
Couch rotation isocenter
Coincidence of collimator, gantry,
couch axes, and isocenter
Tabletop sag
Vertical travel of couch
Radiographic checks
Exposure rate
Tabletop exposure with
fluoroscopy
kVp and mAs calibration
High-and low-contrast resolution

Daily
Daily
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly

Annually
Annually
Annually

2 mm
2 mm
2 mm
1
2 mm diameter
2 mm
Baseline
Functional
2 mm or 1%
Baseline

2 mm diameter
2 mm diameter
2 mm diameter

Annually

2 mm diameter

Annually
Annually

Annually

2 mm
2 mm

Baseline

Annually

Baseline

Annually
Annually

Baseline
Baseline

Instrumentation QA3
Instrument
Frequency
Ion chambers & electrometers
Diodes & MOSFETs
TLD

Film
Survey meters
Beam scanning system
Barometers & thermometers

Every 2 years
Monthly
Monthly or more
frequently depending
on use
Dependent on
frequency of use
Annually
At time of purchase,
and prior to use
At time of purchase
and semi-annually

Glenda Longoria
QA Assignment
Fall 2016

Frequency
Daily

10

Item

Periodic RTP Process QA Checks4

Comments/Details

Error log
Change log
Digitizer
Hardcopy output

Weekly

Computer files
Review clinical planning
CT data input into RTP
system

Monthly

Problem review
Review of RTP system
Dose Calculations

Annual

Data and I/O devices

Critical software tools

Variable

Review report log listing system failures, error messages, hardware

malfunctions, and other problems. Triage list and remedy any
serious problems that occur during the day.
Keep log of hardware/software changes.
Review digitizer accuracy
Review all hardcopy output, including scaling for plotter and other
graphics-type output.
Verify integrity of all RTP system data files and executables using
checksums or other simple software checks. Checking software
should be provided by the vendor
Review clinical treatment planning activity. Discuss errors,
problems, complications, difficulties. Resolve problems.
Review the CT data within the planning system for geometrical
accuracy, CT number consistency (also dependent on the QA and
use of the scanner), and derived electron density.
Review all RTP problems (both for RTP system and clinical treatment
planning) and prioritize problems to be resolved.
Review current configuration and status of all RTP system software,
hardware, and data files.
Annual Checks. Review acceptability of agreement between
measured and calculated doses for each beam/source
Review functioning and accuracy of digitizer tablet, video/laser
digitizer, CT input, MR input, printers, plotters, and other imaging
output devices.
Review BEV/DRR generation and plot accuracy, CT geometry,
density conversions, DVH calculations, other critical tools, machine-
specific conversions, data files, and other critical data.

Beam Parameterization

Checks and/or recommissioning may be required due to machine

changes or problems.

Software changes,
including operating
system

Checks and/or recommissioning may be required due to changes in

the TRP software, any support/additional software such as image
transfer software, or the operating system.

Glenda Longoria
QA Assignment
Fall 2016

11

TPS Acceptance Test Features4

Topic

Tests

CT input

Create an anatomical description based on a standard set of CT scans provided by the

vendor, in the format which will be employed by the user

Anatomical
description

Create a patient model based on the standard CT data discussed above. Contour the
external surface, internal anatomy, etc. Create 3-D objects and display.

Beam description

Verify that all beam technique functions work, using a standard beam description
provided by the vendor.

Photon beam dose

calculations
Electron beam dose
calculations
Brachytherapy dose
calculations
Dose display, DVH
Hardcopy output

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 dataset. Include open
fields, different SSDs, shaped fields, inhomogeneity test cases, surface irregularity test
cases, and 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 and ovoids, two-plane breast implant, etc.
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
may also be used for additional tests.
Print out all hardcopy documentation for a given series of plans, and confirm that all
textual and graphical information is output correctly

Brachytherapy Applicators5
Type of applicator

Test

Frequency

Tolerance

Source location

Initial use, yearly

Documented

Coincidence of dummy
and active sources

Initial use

1 mm

Intracavitary
Location of shields

Interstitial

Coincidence of dummy
and active sources

Initial use, location of shields should

be verified by radiograph before the
first use. Before every use the
applicator may be shaken to listen for
loose parts
Initial use or after repair, visual
inspection

Documented

1 mm

Glenda Longoria
QA Assignment
Fall 2016

12

QA tests for brachytherapy sources5

Type of Source
Long half-life:
description

Long half-life:
calibration

Short half-life:
description

Short half-life:
calibration

Test
Physical/chemical form
Source encapsulation
Radionuclide distribution and source
uniformity
Location of radionuclide
Mean of batch
Deviation from mean

Frequency
Initial purchase
Initial purchase

Tolerance
Documented
Documented

Initial purchase

Documented

Initial purchase
Initial purchase
Initial purchase

Calibration verification

At every use

1 mm
3%
5%, Documented
Visual check of source color
code or measurement in a
calibrator

Physical/Chemical form

Initial purchase

Documented

Source encapsulation
Mean of batch
Deviation from mean for short half-life
sources this may not always be
practical
Radionuclide distribution and source
uniformity

Initial purchase
At every use

Documented
3%%

At every use

5%

At every use

Visual check , autoradiograph, or

ionometric check

Acceptance Testing Procedures for Remote Afterloaders1

Timer

Main power, battery power, source on/off, door

open/close, etc.
Source dwell time and source retraction at the end of
preset time, unplanned interruption, or emergency
shutoff
Adequacy of battery voltage under load conditions and
functional performance under battery power
Timer accuracy and end-time effects

Decay correction
Multichannel indexer

Accuracy of computer-calculated decay corrections

Proper source sequencing and channel selection

Console functions
Source Control

Functional Performance

Battery voltage

Backup systems
Radiation detectors

Proper functioning
Proper functioning
Source retracts when the door is opened; the unit does
Door interlocks
not start until the door is closed and the interlock is reset
Radiation warning lights
Proper functioning
Patient
V
iewing
a
nd
Facility Check and Survey
Proper functioning
communication
Exposure rates outside the radiation facility should meet
Radiation survey
the NRC regulations and the leakage radiation rates
around the unit should be acceptable

Glenda Longoria
QA Assignment
Fall 2016

13

QA of remote afterloading brachytherapy units5

Frequency

Test
Room safety door interlocks, lights, and alarms
Console functions, switches, batteries, printer

Each Treatment day

Visual inspection of source guides

Verify accuracy of ribbon preparation
Accuracy of source and dummy loading (dummies used for
spacing and/or simulation/verification)
Source positioning

Weekly

Tolerance
Functional
Functional
Free of kinks and firmly
attached
Autoradiograph
1 mm
1 mm

Calibration (it is worthwhile at source change to calibrate

both new and old sources to establish and document
reproducibility of calibration method)

At each source change

or quarterly

3%

Timer function
Check accuracy of source guides and connectors
Mechanical integrity of applicators (by x-ray if appropriate)
Dose calculation algorithm (at least one standard source
configuration for each isotope)
Simulate emergency conditions
Verify source inventory

Annual

1%
1 mm
Functional
3%, 1 mm

QA tests for brachytherapy source calibrator5
Instrument type

Test
ADCL calibration
Precision
Linearity

Well Ionization chamber

In-air calibration
chamber and external
source holder

Frequency
Initial use, source
specific
Initial use
Initial use/after repair,
2 year

Tolerance
Documented
2%
1%

Collection Efficiency

Initial use/after repair

1%

Geometrical/length
dependence

Initial use/after repair

Documented

Energy dependence

Initial use/after repair

Documented

Source wall dependence

Initial use/after repair

Documented

Venting

Initial use/after repair

Documented

Redundant check

Each use

2%

Leakage

Each use
Initial use, source
specific

Documented

1 year, source specific

1%, Documented

Each use

Documented

ADCL calibration
Accuracy of source
chamber distance
Redundancy

Documented

Glenda Longoria
QA Assignment
Fall 2016

14

References:
1. Kahn, F, Gibbons J P. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014.
2. Thomason C, Vann A M, Hilsendager L. QA of Imaging Systems. [SoftChalk]. La Crosse,
WI: UW-L Medical Dosimetry Program; 2016.
3. Thomason C, Lenards N. QA of Physics Instruments. [SoftChalk]. La Crosse, WI: UW-L
Medical Dosimetry Program; 2016.
4. Fraass B, Doppke K, Hunt M, et al. American Association of Physicists in Medicine
Radiation Therapy Committee Task Group 53: Quality assurance for clinical
radiotherapy treatment planning. Med Phys. 1998;25(10):1773-1829.
http://dx.doi.org/10.1118/1.598373
5. Kutcher GJ, Coia L, Gillin M, et al. Comprehensive QA for radiation oncology: Report of
AAPM Radiation Therapy Committee Task Group 40. Med Phys. 1994;21(4):581-618.