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Table 1 Daily
Procedure
Non-IMRT
IMRT Tolerance
Tolerance
SRS/SBRT
Tolerance
X-ray output
constancy
Electron output
3%
constancy
Laser localization
2mm
ODI at isocenter
2mm
1.5mm
1mm
Functional
IMRT Tolerance
SRS/SBRT
Collimator size
indicator
Door Interlock
Functional
(beam off)
Door closing safety
AV system
Stereotactic
interlocks
Radiation Area
Functional
Monitor
Beam on indicator
Table 2 Monthly
Procedure
Non-IMRT
Tolerance
X-ray output
2%
constancy
Ekectron output
constancy
Backup monitor
chamber constancy
Typiacal dose rate
output constancy
Photon beam profile
1%
profile constancy
Electron beam
2%/2mm
energy constancy
Light/radiation field
2mm or 1% on a side
coincidence
Light/radiation field
1mm or 1% on a side
coincidence
1mm
1 degree
angle indicators (@
cardinal angles)
(digital only)
Accessory Tray (i.e.
2mm
2% at SRS dose
rate,MU
constancy
Electron beam
(asymmetric)
Distance check
1mm
Cross-hair centering
(walkout)
Treatment couch
2mm/1 deg
position indicators
Wedge placement
2mm
accuracy
Compensator
1mm
placement accuracy
Latching of wedges,
Functional
blocking tray
Localizing lasers
Laser Guard
+/-2mm
Functional
Interlock Test
Beam Output
2%
2mm/1 deg
1mm/0.5 deg
+/-1mm
<+/-1mm
IMRT Tolerance
SRS/SBRT
constancy
(Respiratory Gating)
In-room respiratory
Functional
monitoring system
Phase, amplitude
beam control
(Respiratory Gating)
Gating Interlock
Table 3 Annual
Procedure
Non-IMRT
Tolerance
X-ray flatness
change from
baseline
X-ray symmetry
change from
baseline
Electron flatness
change from
+/-1%
Tolerance
baseline
SRS arc rotation
mode
delivered 1.0 MU or
2%
Gantry arc set vs
delivered: 1 deg or
2% whichever is
greater
x-ray/electron
+/-1%
output calibrations
TG-51
Spot check of field
size dependent
output factors for xray (two or more
FSs)
Output factors for
+/- 2% baseline
electron applicators
x-ray beam quality
+/- 1mm
Physical Wedge
+/-2%
Transmission
x-ray monitor unit
+/-2%
linearity
Electron monitor
+/-5%(2-4MU), +/2%>/= 5%
+/-2%>/=5MU
unit linearity
X ray constancy vs
Dose rate
X-ray constancy vs
+/- 1% baseline
gantry angle
Electron output
constancy vs gantry
angle
Electron output off
axis factor constancy
+/-5%(2-4 MU)
vs gantry angle
Arc mode
PDD or TMOR and
OAF constancy
TBI/TSET output
2% from baseline
calibration
TBI/TSET output
calibration
Collimator rotation
isocenter
Gantry Rotation
Isocenter
Couch rotation
isocenter
Electron applicator
interlocks
Coincidence of
Functional
+/-2mm baseline
radiation and
baseline
baseline
Functional
mechanical isocenter
Table Top Sag
2mm from baseline
Table angle
1 deg
+/-2mm
range
Stereotactic
accessories,
lockouts, etc
Follow
Functional
manufacturers test
procedures
Beam Energy
2%
Constancy(Gating)
Temporal accuracy
100 ms of expected
of phase/amplitude
gate on
Calibration of
surrogate for
repiratory
phase/amplitude
Interlock testing
Functional
Feature
Elekta XVI
Image Configuration
Kv-CBCT
Varian
Siemens
OBI
Artiste
Kv-CBCT Mv-CBCT
TomoTherapy
Siemens
Primato
MVCT
m
kvCT-on
45x45x17
40x40x27.
40
rails
50
Automati
4
Automatic
Automatic in 2
Manual
couch motion
c couch
couch
directions
couch
Rotation
Geometric accuracy
Optional
motion
None
motion
None
Optional
Submillimeter
motion
Optional
Dose (cGy)
Image acquisition and
0.1-3.5
2 mins
0.2-2.0
1.5mins
3-10
1.5mins
0.05-1
3 s per
Field of view
Correctio
50x50x25.6
Translation Automatic
n Method
reconstruction time
0.7-3.0
5 s per slice
slice
Table 5: Summary of QC test recommended for CT-based IGRT systems. Tolerances may change according to
expectations, experience, and performance.
Frequency
Daily
Quality Metric
Safety
Quality Check
Collision and other
Tolerance
Functional
interlocks
Warning lights
Laser/image/treatment
accuracy
isocentre coincidence
Phantom localization
+/-2mm
Geometric
upgrade
couch shift
Geometric calibration
maps
kV/MV/laser
alignment
Couch shifts:
Image quality
If used for
calculation
Annual
Replace/refresh
+/-1mm
accuracy of motions
Scale, distance, and
orientation accuracy
Uniformity. Noise
High contrast spatial
Baseline
<=2mm (or 51p/cm)
resolution
Low contrast
Baseline
Image quality
detectability
CT number accuracy
Baseline
Dose
Imaging system
and stability
Imaging dose
x-ray generator
performance
Performance (kv
systems only)
Tube potential, mA,
Baseline
ms accuracy, and
Geometric
linearity
Anteroposterior,
mediolateral, and
craniocaudal
Accurate
orientations are
maintained (upon
upgrade from CT to
System operation
Section
Image Input Tests
Topic
Image Geometry
IGRT system)
Long and short term
planning of resources
(disk space,
policies and
manpower etc)
procedures
Test
Document and verify
Reasons
Vendor and scanner-specific
converted
thickness.)
Document and verify
converted
is correctly transferred
sequence identification
Text Information
scans
Wrong grayscale data may
cause incorrect
conversion of CT number to
identification of anatomy or
electron density
misinterpretation of the
Image unwarping
scans
Methodologies which
(removing distortions)
place
inhomogeneity) and
structure
Imaging Data
Anatomical
Structure Tests
Structure attributes
on that type
Verify that correct definition
definition
calculations
implementation.
Display errors can cause
misinterpretations.
Auto-segmentation
structure.
Check parameters for auto-
parameters
each structure.
likely to be defined
Display characteristics
separately
Structure created from
contours
used?
structures.
limited?
to
corners in contours?
systematic errors in
contours?
large number
of patients.
between contours?
Does algorithm handle
Structure constructed by
bifurcated structures?
Resolve issues such as:
expansion or contraction
expansion algorithm?
target volume (
D, verification must be
CTV). Errors
implications should be
understood.
definition
structure?.)
Test should include same
Numerous independent
dependent on
the underlying 3-
orientations.
structures and
structure is based on
contours)
are understood.
structure.
Verify basic surface
simple contours.
Contour Tests
Manual Contour
algorithm.
Define standard procedures
Acquisition
manual
contours to prevent
lateral
specific
integrity of digitization.
errors.
related
accuracy.
from position-dependent
distortions. Digitizer
behavior
the entire
Contouring on 2-D
Contouring on CT images is
images
image
display.
lead
systems in
on image type or
calculates dose.
orientation.
Digitization process
parameters.
Verify proper response of the
image
contour.
Misunderstandings of
artifacts).
lead to
phantoms or simulated
improper contours.
grayscale
phantoms as described above.
Partial volume effects
probably
are most easily sorted out
using images which model the
effects
of slice thickness changes on
Bifurcated structures
slice for a
particular structure?
Does it form the 3-D
structure correctly? Check 3-D
surfaces
Contours on projection
Incorrect handling of
contours on projection
misinterpretation of plan
displays
projected
correctly when viewed in full
3-D displays.
Check intersection of such
contours with various axial,
sagittal,
Contours on CT
scannograms
CT scannograms have
significant divergence in the
axial direction but typically
negligible divergence in the
sagittal direction
Contour extraction onto
surfaces
the
or reconstructions provides
implementation:
description of anatomical
structures
single slice?
Verify that the system creates
Tests
representation
density representation.
modified.
Verify that the CT number to
density-corrected
calculations
dependent.
Verify the proper operation of
of contrast or image
artifacts, leading to
incorrect derived relative
electron densities
Incorrect information may
density
Verify that the density in the
bolus
to incorrect density-
corrected calcs.
Measurement tools
Bolus Tests
image
Verify that tools read the
tools
makes verification of
Verify that:
to wrong design or
Bolus information is
implementation of bolus.
calculation results.
calculation results.
or patient set up
Possible incorrect bolus
displays
treatment.
Beam Assignment
Dose calculation
display tests
level settings
interpretation
of imaging data.
reformatted images
oblique reconstructions is
image.
an
of
in
treatment planning.
original images.
Verify the capability to remove
Use of CT information
which
will not be present during
dose delivery will cause
dose
distribution to not be
representative of the real
dose
Geometrical accuracy of
distribution.
Inaccuracies in geometry
images
visualization and in
ROI analysis
planning
CT numbers and electron
when
of situations.
Verify point coordinates,
display type
Positional measurements
identifying anatomical
Confirm color and other
markers
Incorrect rendering may
rendering functions
misrepresent the
geometrical situation
Inconsistencies could lead
use
to incorrect planning
decisions
session proceeds
Verify that the library of
is
and
monitor units.
3D object rendering
Beam configuration
tests
Machine library
be segregated from
research or other beams.
Machine/beam
accessories
incorrect, or misleading.
Parameter limitations
Readouts
collimator!, etc.
Verify correct use and display
Incorrect numbering/names
numbers.
documentation.
Lack of agreement between
systematic machine
treatment
readouts
errors.
Wedges
limitations.
Verify correct functionality of
Incorrect functioning of
internal
mistakes in planning.
This can lead to incorrect
characterizations such as
coding,
treatment.
correct.
Verify correct use and display.
important
System readout
General system
dosimetric errors.
Problems can cause
conventions and
conventions
motion description
testing
used consistently
Internal consistency
errors.
the wedge.
Verify that the planning system
parameters ~transformed
treatment
errors.
information at the
Multi-user environment
Block type
tests
unless
software update.
Establish a procedure to ensure
environments
Verify that the system
distinguishes between
identification of blocked or
island
irradiated
areas.
considered.
Verify correct specification of
transmission or block
thickness
dose
under blocks.
transmission blocks.
Document and test all methods
normal
tissue or missing some of
Electron applicators
the target.
Can lead to plans which
Hardcopy output
electron applicators
Check all output showing
cannot be used
Inappropriate
incorrect fabrication
of the aperture, or
BEV
inappropriate clinical QA
checks.
Manual aperture
Film magnification
displays.
Confirm that film
entry tests
factors
be used in plan.
film
digitization entry.
Check geometrical accuracy of
Number of point in
design
Could lead to incorrect
aperture definition
limitation on number of
aperture shape
Editing apertures
defining points
Evaluate how the algorithm
Defining apertures on
aperture shape.
This could lead to incorrect
BEV/DRR displays
interpretation of planned
aperture.
projections of anatomical
information including
beam
direction.
3D projections
points
Wedge tests
Wedge labeling or
specifications
orientation conventions
specifications are
and
treatment.
treatment
2D display
machine conventions.
Check display of wedges in
prevent
collimator
plan or treatment.
orientations.
Check display of wedges in
differences
May lead to plans which
limitations
cannot be delivered.
combination.
Confirm that the division of a
distribution or monitor
machine)
units.
machine.
Verify that the implementation
wedge possible
Non-axial divergence
BEV/DRR displays
treatment machine.
Test intersection of divergent
axial slices.
sizes or
aperture shape.
Incorrect divergence leads
sizes or
completely
understood.
account.
Verify projection of
contours/structures defined on
axial
shape,
projected in 3-D.
shape,
third direction!.
Verify patient orientation
orientation annotations.
or
Verify correctness of
physicians.
displays.
Evaluate and confirm the
important.
Calculation grid
be calculated.
Evaluate and verify proper
definition
functioning of:
miscalculation, incorrect
display, misalignment,
incorrect
display, misalignment of
Regions to be calculated
points
invalidation of calculations if
grid size, spacing, or
extent is changed
proper alignment of
coordinate system in which
dose
computation points are defined
relative to the image
coordinate system and the
machine coordinate system
~i.e., the collimator system!
Status of density
Misleading dose
corrections
status of corrections.
distributions, incorrect
possible.
documented.
Verify functionality associated
calculation correctly.
system.
Evaluate system rules for
recalculation of dose
resources; or 2! leave an
incorrect interpretation.
Dose calculation
recalculated.
Verify that default algorithm
algorithm selection
Verify that:
purposes.
Point displays used for
Dose points
3-D coordinates
for
investigating dose
distribution behavior.
correctly
Verify that:
correctly
Verify that:
Inconsistency demonstrates
algorithm limitations or
are consistent
problems,
makes evaluations
impossible.
are
Dose grids
2D dose displays
Consistent
Verify that dose is correctly
Interpolations done
points
results,
particularly in penumbra
regions.
74!.
Verify that:
correctly located
coverage of
displays
Verify that:
correctlyparticularly check
target
higher
coverage, or other
misrepresentations of the
dose distribution
other.
surfaces are consistent with
Beam display
correct
entire plan
should be doubted.
orientation is correct
beam edges and apertures are
DVH Tests
VROI identification
shown correctly
Test creation of the voxel
Misidentification of VROI
create
DVHs against structure
Structure identification
description.
Test Boolean combinations of
handled.
Verify accuracy of dose
Structure volume
DVH calculation
inaccuracies.
Structure volume is basis of
Also,
shapes ~particularly
subject to numerous
evaluation
grid-based artifacts.
Verify that appropriate
considerations.
Inappropriate bins and/or
used.
Test DVH calculation
misleading DVH.
Basic calculation must be
distributions.
DVH types
is useful in particular
situations.
distributions.
for
normalization
DVH results.
Review and understand
the DVH.
Grid-based artifacts can
effects
grids.
dose,
the plan.
Comparison of DVHs from
different cases
Non-dosimetric
grids, etc.
For source location entry
brachytherapy tests
geometrical accuracy
orthogonal or
sensitive to exact
source positions.
confirmed.
Verify accuracy of source
development and
optimization.
Incorrect functioning of
evaluation
brachytherapy optimization
tools, such as
tools can
automatic determination of
result in sub-optimal or
incorrect treatment.
References
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 JP, Balter PA, Dong L, et al. Quality assurance for image-guided radiation
therapy utilizing CT-based technologies: A report of the AAPM TG-179. Med Phys. April
2012; 39(4): 1946-1963.
3. Fraass B, Doppke K, Hunt M. American Association of Physicists in Medicine Radiation
Therapy committee Task Group 53: Quality assurance for clinical radiotherapy treatment
planning. Med Phys. October 1998; 25(10): 1773-1829.