Jessica Ezelle

QA Tolerance Table

Daily QA
Procedure IMRT SRS/SBRT
Dosimetry1
X-ray Output Constancy 3%
Electron Output Constancy 3%
Mechanical1
Laser localization 1.5mm 1mm
Optical Distance Indicator at Iso 2mm 2mm
Collimator Size Indicator 2mm 1mm
Safety1
Door Interlock- Beam off Functional
Door Closes Safely Functional
Audiovisual Monitors Functional
Stereotactic Interlocks n/a Functional
Radiation Area Monitors Functional
Beam on Indicator Functional
Imaging1
Collision Interlocks and Warning Lights Functional
KV/MV Portal Positioning 2mm 1mm
CBCT Positioning 1mm 1mm
Imaging and Treatment Coordinate Coincidence 2mm 1mm
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Monthly QA
Procedure IMRT SRS/SBRT
Dosimetry1
X-ray Output Constancy 2%
Electron Output Constancy 2%
Back-up Monitor Chamber Constancy 2%
Typical Dose Rate Output Constancy 2%
Photon Beam Profile Constancy 1%
Electron Beam Profile Beam Profile Constancy 1%
Electron Beam Energy Constancy 2% and 2mm at therapeutic depth
X-ray Symmetry and Flatness Constancy 1%
Electron Symmetry and Flatness Constancy 1%
Mechanical1
Light/Radiation Field Coincidence- Symmetric 2mm or 1% per side
Light/ Radiation Field Coincidence- Asymmetric 1mm or 1% per side
Distance check of Lasers with Front Pointer 1mm
Gantry/Collimator Angle Indicators Specific Angles, 1
Digital Readout Only
Accessory Tray 2mm
Jaw Symmetry 2mm
Cross-Hair Centering 2mm Diameter/1 1mm
Diameter/0.5
Wedge and Tray Position Accuracy 2mm
Treatment Couch Position Indicator 2mm/1
Field Size indicator 1mm per side
Latching of Wedges/Block Tray Functional
Localizing Laser +/- 1mm <+/- 1mm
Field Light Intensity Functional
Safety1
Laser Guard-Interlock Test Functional
Respiratory Gating1
Beam Output Constancy 2%
Phase, Amplitude Beam Control Functional
In-Room Respiratory Monitoring System Functional
Gating Interlock Functional
Imaging1
KV, MV Imaging and Treatment Coordinate Coincidence 2mm 1mm
KV and MV Scaling 2mm 1mm
CBCT Geometric Distortion 2mm 1mm
KV, MV, CBCT Spatial Resolution Baseline
KV, MV, CBCT uniformity and Noise Contrast Baseline
Couch Shifts Accuracy Motion +/- 1mm
CBCT HU Constancy Baseline
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Annual QA
Procedure IMRT SRS/SBRT
Dosimetry1
X-ray and Electron Flatness 1%
X-ray and Electron Symmetry +/- 1%
SRS Arc Rotation Mode n/a 1.0 MU or 2%
1 or 2%
X-ray and Electron Output Calibration +/- 1%
X-ray Output Field Size Spot Check 2% for field size < 4x4
1% for field size 4x4
Electron Applicator Output Factors +/-2% from Baseline
X-ray Beam Quality- PDD or TMR +/-1% from Baseline
Electron Beam Quality +/- 1mm
Hard Wedge Transmission Factor Constancy +/- 2%
X-ray MU Output Constancy +/- 5% 2-4MU
+/- 2% 5MU
Electron MU Output Constancy +/- 2% 5MU
X-ray Output vs. Dose Rate +/- 2% from Baseline
X-ray or Electron Output vs. Gantry Angle +/- 1% from Baseline
X-ray or Electron OAF Constancy vs. Gantry Angle +/- 1% from Baseline
Arc Mode- Expected MU/Degrees +/- !% from Baseline
TBI/TSET Mode Functional
PDD/TMR and OAF Constancy (TBI) 1% From Baseline
1mm PDD shift from Baseline (TSET)
TBI/TSET Output Calibration +/- 2% from Baseline
TBI/TSET Accessories +/- from Baseline
Mechanical1
Collimator, Couch, or Gantry Rotation Isocenter +/- 1mm from Baseline
2mm Diameter
Collimator, Couch, Gantry axes Isocenter Coincidence 2mm Diameter
Coincidence of Mechanical/ Rotational Isocenter 2mm Diameter
Electron Applicator- Interlock System Functional
Radiation/ Isocenter Coincidence +/- 2mm diameter +/- 1mm Diameter
from Baseline from Baseline
Table Sag 2mm from Baseline
Table Angle 1
Table Travel- All Directions +/-2mm
Stereotactic Accessories/ Interlocks n/a Functional
Safety1
Manufacturer Guidelines Functional
Respiratory Gating1
Beam Energy Constancy 2%
Phase/Amplitude Gate On Accuracy 100 ms Expected
Interlock Testing Functional
MLC
MLC Transmission- Average of Leaf/Interleaf leakage +/- 0.5% from
Baseline
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Laser Position Repeatability +/- 1.0mm

Coincidence of Light and Radiation Field +/- 2mm
Imaging1
KV Beam Quality/Energy Baseline
KV, MV, CBCT Imaging Dose Baseline
EPID MV Full Range of Travel-SSD +/- 5mm
*Many of the tolerances for Non-IMRT based liner accelerators are the Same for IMRT linear accelerator
tolerances. Therefore, the Non-IMRT column has been left out for simplicity purposes.
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Simulator QA
Daily QA
Electromechanical Components2
Door interlock, Patient Viewing, Audio Communication Functional
Alignment of gantry lasers with center of imaging plane +/- 2mm
Distance indicator +/- 2mm
Image Performance2
CT Number Accuracy For Water 0 +/- 5 HU
Image Noise Manufacturer Specifications
Spatial Integrity in X or Y Direction +/- 1mm
Monthly QA
Electromechanical Components2
Door Interlock, Equipment Limit Switches, Beam on Lights Functional
Orientation of Gantry lasers to imaging plane/ laser projection +/- 2mm
Spacing and orientation of wall/celling lasers to scan plane- laser +/- 2mm
accuracy
Table top orientation and levelness +/- 2mm
Table top vertical and longitudinal motion- compared to digital readout +/- 2mm
Field Size indicator +/- 2mm
Gantry/Collimator Angle indicator +/- 1
Cross Hair Centering 2mm diameter
Focal Spot Axis Indicator 2mm
Light/Radiation Field Coincidence 2mm or 1%
Image Performance2
CT number accuracy for 4-5 different materials Baseline
Spatial integrity in X and Y direction +/- 1mm
Field Uniformity Within +/- 5HU
Annual QA
Electromechanical Components2
All Safety and Collision Interlocks, Emergency off Switches Functional
Table Top Indexing and position Accuracy +/- 1mm
Gantry tilt position Accuracy +/-1mm or 1
Scan localization-verify from pilot images +/- 1mm
Radiation profile width Manufacture Specifications
Gantry, Couch, Collimator Rotation of Isocenter 2mm Diameter
Gantry, Couch, Collimator Coincidence of isocenter 2mm Diameter
Table Top Sag 2mm
Vertical Travel of Couch 2mm
Image Performance2
CT Number accuracy using electron density phantom Baseline
Field Uniformity +/- 5 HU
Electron Density to CT number conversion Manufacturer Specifications
Spatial and Contrast Resolution Manufacturer Specifications
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Instrumentation QA3
Barometers and Thermometers Calibrate upon purchase, semi-annually, or when deviated
reading occurs
Ionization Chamber and Calibrate with ADCL every 2 Years and with a secondary
Electrometer camber/electrometer twice annually
Diodes and MOSFLTS QA Monthly
TLD, Film QA Monthly or based on frequency of use
Survey Meter Annual Calibration-per NRC
Daily Battery Check
Daily Constancy Check with low radioactive source

Acceptance Testing of Treatment Planning Systems4

CT Input Ensure CT Data is imported to TPS in the correct format
Anatomical Description Evaluate 3D contours created for accuracy
Beam Description Verify All beam technique functions work properly as compared to the
vendors data
Photon and Electron Beam Perform dose calculations on standard data sets including SSDs, open
Dose Calculations fields, blocked fields, MLC, multi-beam plans, wedged fields,
asymmetric jaws and inhomogeneity tests.
Brachytherapy Dose Perform Dose calculations on various source implants
Calculations
Dose Display and DVH Use given vendor dose distribution to verify the DVH information is
displayed accurately
Hardcopy Output Verify printed documentation for plans are printed to the correct scale,
such as electron blocks

Treatment Planning System QA

4
Daily
Error Log Review error messages and hardware malfunctions
Monthly4
CT Data Input Review imported CT data to verify the geometrical accuracy, CT
number consistency and electron density
Annual4
Dose Calculations Verify measured and calculated dose for each beam is in agreement,
then compare the data against the commissioned data
Critical Software Tools Review BEV/DRR images, CT geometry, density conversion, DVH
calculations and machine specific conversions
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Radiation Safety
Treatment planning
Machine Characteristics
Patient Dose Verification
IMRT QA5
Secondary Barrier for leakage is and neutron dose when using higher
energies for treatment
Machine tolerance commissioned to meet IMRT limits. Test TPS to
correctly compute dose to what is delivered in phantom
Test the treatment machines ability to correctly deliver the planned
dose
Test point dose or planer measurement for each IMRT patient plan

Brachytherapy Component QA5

Applicator- initial use Inspect to ensure proper function
X-ray with dummy markers inside
X-ray in afterloading system to verify positional accuracy
Radioactive Sources Periodic source inventory and inspection (either Quarterly or Annually)
Source Leak Testing (semi-annual or every 3 years source depending)
Area Survey (annually or when source is exchanged)
Remote Afterloading Equipment
Daily Check all interlock system (Door, Emergency-off, Interrupt button etc.)
Verify correct time, date and source strength
Source Positional Accuracy: dwell-time and normal treatment
termination (+/-1mm)
Mechanical Integrity of Applicator and its connection to the
Afterloader
Ensure emergency removal equipment is near-by
Monthly/Source Exchange Source Positioning accuracy- expected vs. actual dwell positions
Source Activity- calculated vs actual
Equipment integrity no damage, kinks or malfunction
Timer: ensure accuracy and linearity
Power Failure: if power disconnects ensure source retracts

Remote Afterloader Acceptance Testing6

Functional Console Functionality: power, battery, source on/off
Performance Source control: dwell time accuracy, source retraction, unplanned interruptions
Battery: ensure it is functioning properly in battery mode
Decay Correction: does the computer correctly calculate the decay
Multichannel indexer: dose it select the correct channel
Back-up system functionality
Radiation Area Detector Functionality
Facility Check Interlock Functionality: Door, warning lights, A/V monitors
Radiation Survey
Source Leak Testing
Calibration Determine Dose Anisotropy
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Reference
1. Klein E, Hanley J, Baymouth J. Task Group 142 report: Quality assurance of medical
accelerators. Med. Phys. 2009;36(9):4197-4212. http://dx.doi.org/10.1118/1.3190392.
2. Mutic S, Palta J, Butker E, et al. Quality assurance for computed-tomography simulators and the
computed-tomography-simulation process: report of the AAPM radiation therapy committee task
group No. 66. Med Phys. 2003;30(10):2762-2792. http://dx.doi.org/10.118/1.1609271.
3. Thomason C, Lenards N. QA of Instruments. [SoftChalk]. La Crosse, WI: UW-L Medical
Dosimetry Program; 2017
4. Fraass B, Doppke K, Hunt M, et al. 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. Thomason C, Vann AM, Lenards N. Quality Assurance:QA of TPS, IMRT, SRS. [SoftChalk]. La
Crosse, WI: WU-L Medical Dosimetry Program; 2016
6. Khan F. Khans the Physics of Radiaiton Therapy. 5th ed. Philadelphia, PA: Lippincott Williams
& Wilkins;2014.