Linear Accelerator QA

Daily
Procedure Non-IMRT IMRT SRS/SBRT
Dosimetry
X-ray Output Constancy 3%
Electron Output Constancy 3%
Mechanical
Laser Localization 2 mm 1.5 mm 1 mm
Distance Indicator (ODI) @ Iso 2 mm 2 mm 2 mm
Collimator Size Indicator 2 mm 2 mm 1 mm
Safety
Door Interlock (Beam Off) Functional
Door Closing Safety Functional
Audiovisual Monitor Functional
Stereotactic Interlocks NA NA Functional
Radiation Area Monitor Functional

Beam On Indicator Functional

Monthly
Dosimetry
X-ray Output Constancy 2%
Electron Output Constancy 2%
Backup Monitor Chamber Constancy 2%
Typical Dose Rate Output Constancy NA 2%(@ IMRT Dose Rate)
Photon Beam Profile Constancy 1%
Electron Beam Profile Constancy 1%
Electron Beam Energy Constancy 2%/2 mm
Mechanical
Light/Radiation field Coincidence 2 mm or 1% on a side
Light/Radiation field Coincidence (Asymmetric) 1 mm or 1% on a side
Distance Check Device for Lasers
1 mm
Compared with Front Pointer
Gantry/Collimator Angle Indicators
1 Degree
(@ Cardinal Angles)
Accessory Trays 2 mm
Jaw Position Indicators (Symmetric) 2 mm
Jaw Position Indicators (Asymmetric) 1 mm
Cross-Hair Centering 1 mm
Treatment Couch Position Indicators 2 mm/1 Degree 2 mm/1 Degree
Wedge Placement Accuracy 2 mm
Compensator Placement Accuracy 1 mm
Latching of Wedges, Blocking Tray Functional
Localizing Lasers 2 mm 1 mm <1 mm
Safety
Laser Guard-Interlock Test Functional
Respiratory Gating
Beam Output Constancy 2%
Phase, Amplitude Beam Control Functional
In-Room Respiratory Monitoring System Functional

Gating Interlock
 Annual
Dosimetry
X-ray Output Flatness Change from Baseline 1%
X-Ray Symmetry Change from Baseline 1%
Electron Flatness Change from Baseline 1%
Electron Symmetry Change from Baseline 1%
SRS Arc Rotation Mode NA NA Monitor Units Set vs Delivered:
(Range: .5-1.0 MU/Deg) 1 MU or 2% (Whichever greater)
Gantry Arc Set vs Delivered:
1.0 Degree or 2% (Whichever greater)
X-ray/electron Output Calibration (TG-51) 1% (Absolute)
Spot Check of Field Size Dependent 2% for Field Size 4x4 cm,
Output Factors for X-Ray (2 or more FSs) 1% 4x4 cm
Output Factors for Electron Applicators 2% From Baseline
(Spot Check for 1 Applicator/Energy)
X-Ray Beam Quality 1% From Baseline
Electron Beam Quality 1 mm
Physical Wedge Transmission Factor Constancy 2%
X-Ray Monitor Unit Linearity (Output Constancy) 2% 5 MU 5% (2-4 MU), 2% 5 MU 5% (2-4 MU), 2% 5 MU
Electron Monitor Unit Linearity (Output Constancy) 2% 5 MU
X-Ray Output Constancy vs Dose Rate 2% From Baseline
X-Ray Output Constancy vs Gantry Angle 1% From Baseline
Electron Output Constancy vs Gantry Angle 1% From Baseline
Electron and X-ray Off-Axis Factor Constancy 1% From Baseline
vs Gantry Angle
Arc Mode (expected MU, Degree) 1% From Baseline
TBI/TSET Mode Functional
PDD or TMR and OAF Constancy 1% (TBI) or 1 mm PDD Shift (TSET) From Baseline
TBI/TSET Output Calibration 2% From Baseline
TBI/TSET Accessories 2% From Baseline
Mechanical
Collimator Rotation Isocenter 1 mm From Baseline
Gantry Rotation Isocenter 1 mm From Baseline
Couch Rotation Isocenter 1 mm From Baseline
Electron Applicator Interlocks Functional
Coincidence of Radiation and 2 mm From 2 mm From Baseline 1 mm From Baseline
Mechanical Isocenter Baseline
Table Top Sag 2 mm From Baseline
Table Angle 1 Degree
Travel Maximum Range 2 mm
Movement in all Directions
Stereotactic Accessories, Lockouts, Etc. NA NA Functional
Safety
Follow Manufacturer's Test Procedures Functional
Respiratory Gating
Beam Energy Constancy 2%
Temporal Accuracy of Phase/Amplitude Gate On 100 ms of Expected
Calibration of Surrogate for Respiratory Phase/Amplitude 100 ms of Expected
Interlock Testing Functional
 Imaging QA
Daily
Procedure non-SRS/SBRT SRS/SBRT
Planar kV and MV (EPID) imaging
Collision interlocks Functional
Positioning/repositioning
2mm 1mm
Imaging and treatment coordinate coincidence (single gantry angle)
Cone-beam CT (kV and MV)
Collision interlocks Functional
Imaging and treatment coordinate coincidence 2mm
1mm
Positioning/repositioning 1mm

Monthly
Planar MV imaging (EPID)
Imaging and treatment coordinate coincidence (4 cardinal angles) 1mm
2mm
Scaling ' 2mm
Spatial resolution
Contrast Baseline
Uniformity and noise
Planar kV imaging (EPID)
Imaging and treatment coordinate coincidence (4 cardinal angles)
2mm 1mm
Scaling
Spatial resolution
Contrast Baseline
Uniformity and noise
Cone-beam CT (kV and MV)
Geometric distortion 2mm 1mm
Spatial resolution
Contrast
Baseline
HU constancy
Uniformity and noise

Annual
Planar MV imaging (EPID)
Full range of travel SSD +/-5mm +/-5mm
Imaging dose Baseline
Planar kV imaging
Beam quality/energy
Baseline
Imaging dose
Cone-beam CT (kV and MV)
Imaging dose Baseline
 Simulator QA
Daily QA
Electromechanical Components
Door Interlock, Patient Viewing, Audio Communication
Functional
Alignment of fantry lasers with center of imaging
+/- 2mm
plane--verify laser identification
Distance Indicator (ODI) +/- 2mm
Image Performance
CT number accuracy for water 0+/- 5 HU
Image Noise Manufacturer specs
Spatial Intergrity in X or Y direction +/- 1mm

Monthly QA
Electromechanical Components
Door Interlock, Equipment Limit Switches, BeamFunctional
on Lights
Orientation of gantry lasers to imaging plane--verify
+/- 2mmlaser projection
Spaicng and orientation of wall/ceiling lasers+/-
to 2mm
scan plane--verify laser projection
Table top orientation and levelness +/- 2mm
Table top vertical and longitudinal motions--compare
+/- 1mm to digital readout
Field Size Indicator +/- 2mm
Gantry/Collimator Angle Indicator +/-1 degree
Cross Hair Centering 2mm diameter
Focla Spot Axis Indicator 2mm
Light/Radiation Field Coincidence 2mm or 1%
Image Performance
CT number accurac for 4-5 different materials
Baseline
Spatial Intergrit in X and Y direction +/- 1mm
Field Uniformity--most common kVp used Within '+/- 5 HU

Annual QA
Electromechanical Components
All Safety and Collision Interlocks, Emergency Functional
Off Switches
Table top indexing and position accuracy '+/- 1mm
Gantry tilt position accuracy--verify gantry returns
+/- 1mm to or
home
1 degree
position after tilting
Scan localization--verify scan localization from
'+/-pilot
1mmimages
Gantry tilt posiiton accuaracy-verify against Manufacturer
manufacturer specs
Gantry, Couch, Collimator Rotation of Isocenter2mm diameter
Gantry, Couch, Collimator Coincidence of Isocenter
2mm diameter
Table Top Sag 2mm
Vertical Travel of Couch 2mm
Image Performance
CT number accuracy using electron density phsnatom
Baseline
Field uniformity--all used kVp settings +/- 5 HU
Electron Density to CT number conversion Manufacturer specs
Spaition and Contrast Resolution Manufacturer specs
 Instrumentation QA
Calibrate upon purchase, semi-annually, or when a device gives a
Barometers and Thermometers deviated reading. TG 40 states to send in for calibration every 3
months. Inspect at each use.
Calibrate with ADL every 2 years. Intercomparison with secondary
Ionization Chamber and Electrometer chamber/electrometer twice annually, and before and after ADCL
calibration. Inspect at each use.
Diodes and MOSFETS QA monthly. Inspect at each use.
TLD, Film QA monthly or based on frequency of usage. Inspect at each use.
Annual calibration--per NRC. Daily battery check. Daily constancy
Survey Meter check with low radioactive source.

TPS QA
Daily
Error Log Review any error messages or hardware malfunctions
Monthly
Review imported CT data into TPS to verify geometrical accuracy, CT
CT data input
number consistency, and electron density
Annual
Verify agreement between measure and calculated dose for each
Dose Calculations beam, compare to commissioned data
Review BEV/DRR images, CT geometry, density conversions, DVH
Critical Software Tools calculations, and machine specific conversions
Acceptance
CT input Ensure CT data input is imported into TPS in the correct format
Anatomical description Evaluate 3D contours created in display window for accuracy
Verify all beam technique functions work properly compared to
Beam description
vendor data
Perform dose calculations on standard data set to check components
Photon and electron beam dose
including SSDs, open fields, blocked fields, MLC, multi-beam plans,
calculations
wedged fields, asymmetric jaws, inhomogeneity tests
Brachytherapy dose calculations Perform dose calculation on different source implants
Use vendor dose distribution and verify that DVH information is
Dose display and DVH
displayed correctly
Verify printed documentation for plans (i.e.. Electrons) are printed
Hardcopy output
scale correctly

Radiation Safety
Treatment Planning
Machine Characteristics
Patient Dose Verification
IMRT QA
Secondary barrier for leakage is and neutron dose when using higher
energies (>10 MV) for treatment
Machine tolerance should be commissioned to meet IMRT limits
Test TPS ability to correctly compute dose to what is delivered in
phantom
Test treatment nit's ability to correctly deliver planned dose
Test point dose or planar measurements for each IMRT patient plan
Point dose: sample dose at different points
Planar dose: evaluate dose profile at specified depth in phantom, can be
paired with specialized software for analysis

Brachytherapy Component QA
Inspect applicator to ensure proper function, take x-ray of applicator
Applicators--Initial Use with dummy markers inside, take x-ray of applicator in afterloading
system to verify positional accuracy
Periodic source inventory and inspection (Quarterly or Annually),
Radioactive Sources source leak testing (Semi-annually or every 3 years depending upon
source type), area survey (annually) or when source exchange occurs
Remote Afterloading Equipment
Daily
Check all interlock systems: Doors, Emergency-Off, Treatment interrupt, A/V monitors, Room monitors,
Applicator malfunction interlocks.
Verify correct display of time, date, source strength
Source Positional Accuracy: dwell-time and normal treatment termination (+/- 1mm)
Mechanical Integrity of applicator: check connection to afterloading system
Ensure emergency removal equipment is near
Monthly/Source Exchange
Source positioning accuracy-check expected versus actual dwell
Source activity agreement between calculated and actual
Equipment integrity-ensure no damage, kinks, malfunctions
Timer: ensure accuracy and linearity
Power failure test: ensure source retracts when power is discontinued