Daily QA for Elekta Agility

Item Name

Base

Units

Tolerance

Water Pressure
Water Temperature
SF6 Pressure
Walk Through
LINAC Movements
Treatment Couch Brakes
Switches Pendant
Switches Table
Test Imager
Door Interlock
Bean ON/OFF light
Beam Interrupt
Monitor / Intercom
XVI kV Imager Tube Warm-Up
kV Imaging Test
PentaGuide Table Correction Lat.
Value
PentaGuide Table Correction Long.
Value
PentaGuide Table Correction Vert.
Value
PentaGuide Laser Alignment after
Table Correction
PentaGuide ODI reading
PentaGuide Light Field Size and
Coincidence
Daily Monitor Test

11.5
29.5
0.8

lbs
C
Bar

2.5
2.5
0.2

X-ray output constancy (all

energies)
Electron output constancy (all
energies)
X-ray flatness and symmetry
constancy (all energies)
Electron flatness and symmetry
constancy (all energies)

%/
Absolute
Absolute
Absolute
Absolute

Functional
Functional
Functional
Functional
Functional
Functional
Functional
Functional
Functional
-1

cm

0.1

Absolute

1.4

cm

0.1

Absolute

-1.2

cm

0.1

Absolute

cm

0.1

Absolute

cm
cm

0.2
0.2

Absolute
Absolute

Low
Warning
3

High
Warning
5

Monthly QA for Elekta Agility

____ Review logbook
____ Review Daily QA
Items
Mechanical
Gantry / collimator Angle Accuracy

Tolerance

Notes

1o

Cross hair stability (run-out) (isocentricity by

light field)

1 mm

@cardinal
angles
Gantry,
collimator,
and couch

Light/radiation field coincidence

Jaw position indicators (symmetric)
Treatment couch position indicators
Jaw position indicators (asymmetric)
XVI kV Image Tests / LASERS
Side lasers (alignment with wall marks)
Overlap between opposing side lasers away
from isocenter
Laser Coincidence with Radiation Isocenter
Dosimetry
X ray output constancy
Electron output constancy
Backup monitor chamber constancy
Photon beam profile constancy
Electron beam profile constancy
Electron beam energy constancy

2 mm or 1% on a side
2 mm or 1% on a side
2 mm / 1o
1 mm
2 mm
2 mm at 50 cm
1 mm
2%
2%
2%
1%
1%
1%

Annual QA for Elekta Agility

____ Review logbook
Procedure

Tolerance

Dosimetry
X-ray flatness change from baseline
X-ray symmetry change from baseline

1%
1%

Electron flatness change from baseline

1%
Electron symmetry change from baseline
1%
SRS arc rotation mode (range .5-10MU/deg) MU set vs. delivered: 1MU or 2%
(whichever is greater),
Gantry arc set vs. delivered: 1 or 2%
(Whichever is greater)
X-ray/electron output calibration (TG-51)

1% absolute

Field size dependent output factors for Xrays

Output factors for electron applicators
X-ray beam quality PDD10x
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

2% for field size<4x4cm2; 1% for field size>= 4x4cm

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% from baseline

TMR constancy
Mechanical

1 mm PDD shift from baseline

Collimator rotation isocenter

Gantry rotation isocenter
Couch rotation isocenter

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

2% from baseline
1% from baseline
1mm
2%
5%(2-4MU); 2%>=5MU
2%>=5MU
2% from baseline
1% from baseline

1% from baseline

Electron applicator interlocks

1 mm from baseline

Coincidence of radiation and mechanical

isocenter
Table top sag
Table angle
Table travel max range movement in all
directions
Safety

1 mm from baseline

Follow manufacturer's test procedures

Functional

2 mm from baseline
1
2 mm

CT-based IGRT QA
Daily

Tolerance

Safety
Collision and other interlocks
Warning lights
System operation and accuracy
Laser/imager/treatment isocenter
coincidence
Phantom localization and repositioning with
couch shift
Monthly or upon upgrade
Geometric
Geometric calibration maps
kV/MV/laser alignment
Couch shifts: accuracy of motions
Image quality
Scale, distance, and orientation accuracy
Uniformity, noise
High contrast spatial resolution
Low contrast detectability
If used for calculation / Annual
Image quality: CT number accuracy and
stability
Imaging system performance: X-ray
generator performance (kV systems only):
tube potential, mA, ms accuracy, and
linearity
Geometric: Anteroposterior, mediolateral,
and craniocaudal orientations are
maintained (upon upgrade from CT to IGRT
system)
System operation: Long and short term
planning of resources (disk space,
manpower, etc.)

Functional
Functional
2mm
2mm
Tolerance
Replace/refresh
1mm
1mm
Baseline
Baseline
2mm or 5 lp/cm
Baseline
Tolerance
Baseline
Baseline

Accurate

Support clinical use and current

imaging policies and procedures

Treatment Planning System QA

Daily

Comments/Details

Error log

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.

Change log

Keep log of hardware/software

changes.
Comments/Details

Weekly
Digitizer
Hardcopy output

Review digitizer accuracy.

Review all hardcopy output, including
scaling for plotter and other
graphics-type output.

Computer files

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 planning

Review clinical treatment planning

activity. Discuss errors, problems,
complications, difficulties. Resolve
problems

Monthly

Comments/Details

CT data input into RTP system

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 erived electron density.

Problem review

Review all RTP problems (both for

RTP system and clinical treatment
planning) and prioritize problems to be
resolved

Review of RTP system

Review current configuration and

status of all RTP system software,
hardware, and data files
Comments/Details

Annual

Dose calculations

Annual checks. Review acceptability

of agreement between measured and
calculated doses for each beam/source.

Data and I/O devices

Review functioning and accuracy of

digitizer tablet, video/laser digitizer,
CT input, MR input, printers, plotters,
and other imaging output devices.

Critical software tools

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.

Variable
Beam parameterization

Comments/Details
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 RTP
software, any support/additional
software such as image transfer
software, or the operating system.

QA of Simulater
Daily

Tolerance

Localizing lasers

2 mm

Distance indicator (ODI)

Monthly

2 mm
Tolerance

Field size indicator

Gantry/collimator angle indicators
Cross-hair centering
Focal spot-axis indicator
Fluoroscopic image quality
Emergency/collision avoidance
Light/radiation field coincidence
Film processor sensitometry
Annual

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

Mechanical Checks
Collimator rotation isocenter
Gantry rotation isocenter
Couch rotation isocenter
Coincidence of collimator, gantry, couch
axes and isocenter
Table top sag
Vertical travel of couch
Radiographic Checks
Exposure rate
Table top exposure with fluoroscopy
Kvp and mAs calibration
High and low contrast resolution

2 mm diameter
2 mm diameter
2 mm diameter
2 mm diameter
2 mm
2 mm
Baseline
Baseline
Baseline
Baseline

Multileaf collimation (with differentiation of IMRT vs nonIMRT machines)

Weekly _IMRT machines_

Tolerance

Qualitative test _i.e., matched segments, aka

picket fence

Visual inspection for discernable

deviations such as an increase in
interleaf transmission
Tolerance

Monthly
Setting vs radiation field for two patterns
(non-IMRT)
Backup diaphragm settings (Elekta only)
Travel speed (IMRT)
Leaf position accuracy (IMRT)

Annual
MLC transmission (average of leaf and
interleaf transmission), all energies
Leaf position repeatability
MLC spoke shot
Coincidence of light field and x-ray field
(all energies)
Segmental IMRT (step and shoot) test

2 mm
2 mm
Loss of leaf speed _0.5 cm/ s
1 mm for leaf positions of an IMRT
field for four cardinal gantry angles.
(Picket fence test may be used,
test depends on clinical planningsegment size)
Tolerance
0.5% from baseline
1.0 mm
1.0 mm radius
2.0 mm

0.35 cm max. error RMS, 95% of

error counts 0.35 cm
Moving window IMRT (four cardinal gantry 0.35 cm max. error RMS, 95% of
angles)
error counts 0.35 cm

QA tests for brachytherapy sources

Initial purchase

Tolerance

Long half-life: description

Physical/chemical form
Source encapsulation

Documented
Documented

Radionuclide distribution and source

uniformity
Location of radionuclide
Long half-life: calibration
Mean of batch
Deviation from mean
Short half-life: description
Physical/chemical form
Source encapsulation
At every use

Documented

Long half-life: calibration

Calibration verification
Short half-life: calibration
Mean of batch
Deviation from mean
Radionuclide distribution and source
uniformity

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

QA of remote afterloading brachytherapy units

Each treatment day

Tolerance

Room safety door interlocks, light, and

alarms
Console functions, switches, batteries,
printer
Visual inspection of source guides

Functional

Verify accuracy of ribbon preparation

Weekly

autoradiograph
Tolerance

Accuracy of source and dummy loading

(dummies used for spacing and/or
simulation/verification)
At each source change or quarterly
Calibration
Timer function
Check accuracy of source guides and
connectors
Mechanical integrity of applicators (by x ray
if appropriate)
Annual
Dose calculation algorithm (at least one
standard source configuration for each
isotope)
Simulate emergency conditions
Verify source inventory

1mm

Functional
Free of kinks and firmly attached

Tolerance
3%
1%
1 mm
Functional
Tolerance
3%, 1 mm

Reference
1. Klein E, Hanley J, Bayouth J, et al. AAPM TG-142 Report: QA of Medical
Accelerators. Med Phys. September 2009;36(9):4197-4212.
2. Bissonnette J, Balter PA, Dong L, et al. Quality assurance for image-guided
radiation therapy utilizing CT-based technologies: A report of the AAPM TG179. Med Phys. April 2012;39(4):1946-1963.
3. Frass B, Doppke K, Hunt M, et al. American aAssociation of Phusiciest in
Medicine Radiation Therapy Committee Task Group 53: Quality Assurance for
clinical radiotherapy treatment planning. Meical Physics, 1998;Vol.25:10.
4. Kutcher GJ, Goia L, Gillin M, et al. Comprehensive QA for radiation oncology:
Report of AAPM Radiation Therapy Committee Task Group 40. Med Phys.
1994;21(4):595. http://dx.doi.org/10.1118/1.597316