Peter Hirschi

QA
Procedure
s
For LINAC
Tolerance
Parameter
Frequency

Procedure

Daily

Dosimetry
Xray output constancy
Electron output constancy
Mechanical
Localizing lasers
Distance indicator
Safety
Door interlock
Audiovisual monitor
Dosimetry
Xray output constancy

Monthly

Electron Constancy
Backup monitor constancy
Xray central axis PDD, TAR

NonIMRT

s
IMRT
3%
3%

2mm
2mm

1.5mm
2mm

2% IMRT

2% SRS

dose rate
2%
2%
2%

Rate

2mm at

dosimetry PDD constancy

X-ray beam flatness

depth
2%

constancy
Electron beam flatness

3%
3%
Functional
Functional

interlocks
Mechanical checks
Light/radiation field

2mm or 1%

coincidence
Gantry/collimator angle

on side
1 degree

indicators

1mm
1mm

Functional
Functional

constancy
Electron central axis

constancy
Xray and electron symmetry
Safety interlocks
Emergency off switches
Wedge, electron cone

SRS SBRT

Wedge position
Tray position
Applicator position
Field size indicators
Cross-hair centering

2mm
2mm
2mm
2mm
2mm

Treatment couch position

2mm/1

diameter
2mm/1

indicators
Wedge and block inspection
Jaw symmetry
Field light intensity
Localizing lasers

degree

+/- 2mm

degree
Functional
2mm
Functional
+/- 1mm

1mm/0.5
degree

Less then
1mm

Annual

Dosimetry
Xray/electron output
calibration constancy

2%
(>5mu)

5% (2-4mu)

5% (2-

2% (>5mu)

4mu)
2%
(<5mu)

Field size dependence of

2%

xray output constancy

Output factor constancy for

2%

electron cones
Central axis parameter

2%

constancy PDD,TAR
Off-axis factor constancy
Transmission factor

2%
2%

constancy for treatment

devices
Wedge transmission factor

2%

constancy
Monitor chamber linearity
Xray output constancy

1%
2%

against gantry angle

Off-axis factor constancy

2%

with gantry angle

Safety interlocks
Mechanical checks
Collimator rotation isocenter
Gantry rotation isocenter

Functional
2mm
diameter
2mm
diameter

Couch rotation isocenter

Coincidence of collimator,
gantry, couch axes with

2mm
2mm

diameter
2mm

1mm

diameter

diameter

diameter

Isocenter
Coincidence of radiation and

2mm

mechanical isocenter
Tabletop Sag
Vertical travel of table
Respiratory Gating
Beam energy constancy
Temporal accuracy of

diameter
2mm
2mm
2%
100 ms

phase/amplitude
Calibration of surrogate

100 ms

phase/amplitude
Interlock testing

Functioning

QA
Procedure
s for OBI
Planar kv and MV imaging

Non-

SRS/SBR

SRS/SB

RT
Daily
Collision interlock

Function

Functiona

Positioning/repositioning
Imaging and treatment

al
2mm
2mm

l
1mm
1mm

2mm

1mm

2mm
Baseline

2mm
Baseline

5mm
Baseline

5mm
Baseline

coordinate coincidence
Monthly
Imaging and treatment
coincidence (4 cardinal
angles)
Scaling
Spatial Resolution, Contrast,
and uniformity
Annual
Full range of travel SDD
Imaging dose, beam
quality/energy
CBCT (kV and MV)
Daily

Collision interlock

Function

Functiona

Positioning/reposiotioning
Imaging and treatment

al
2mm
2mm

l
1mm
1mm

2mm
Baseline

1mm
Baseline

Baseline

Baseline

coordinate coincidence
Monthly
Geometric distortion
Spatial resolution, contrast,
HU constancy, and Uniformity.
Annual
Imaging Dose

QA for CT Simulator Image Performance

Frequency
Procedure
Daily
CT number for water
In plane spatial integrity
Monthly
CT number for 4-5 materials
In plane spatial integrity
Field Uniformity common kVp
Annually
Electron density phantom
Field uniformity with all used kVp
Electron density to CT number
conversion
Spatial Resolution
Contrast resolution

Tolerance Parameters
0 5 HU
X or y direction 1mm
0 5 HU
X and Y direction 1mm
Within 0 5 HU
0 5 HU
Manufacturer Specs
Manufacturer Specs
Manufacturer Specs

Qa for TPS (AAMD TG 52)

Frequency
Daily
Weekly

Record error logs and hardware/software change logs

Digitizer, Hardcopy output, Computer files, and Review

Monthly

clinical treatment planning

CT data input, Problem review, Review hardware and
software data files.

Annual

Dose calculations, Review digitizer, CT/MRI input,

BEV/DRR accuracy, CT geometry, density conversions,
DVH calculation, data files and other critical data.
Recommisioning of machine due to hardware changes

As needed

or software upgrades.
Daily/Morning QA for HDR Afterloader

DATE

TEST CRITERIA
Viewing and intercom systems functional
Emergency container and stopwatch present
TCS self-test successful
All lights on TCS console function
Date and time in TCS correct (to within 1 hr)
Decayed source activity in TCS correct
Survey meter battery OK, meter ON
Door interlocks function, prevent treatment
Source exposure indicators at TCS and door work
Source positioning accuracy (+/-1mm)
Interrupt button functions
Emergency off button functions
Timer ends treatment correctly
Timer accuracy (vs. stopwatch)
Printer Operational

HDR Afterloader Annual QA

Preset
Measured using
Difference (sec)

Acceptable

time

(YES/NO)

(sec)
20
60

stopwatch (sec)

yes
yes

Programmed

Measured source position (mm)

position (cm)
130
125
121
Interlock

Differenc

Offset (YES/NO)

e (mm)
0
0
0
YES/NO

YES/NO

Functions
i) Door Interlock

iv) Area radiation monitors O.K

O.K.
ii) Missing

v) Treatment status indicator

Applicator

O.K.

Interlock O.K.
vi) Emergency Off and Interrupt
button O.K.
HDR Accessories
ii) Transfer tubes checked .OK
ii) Patient monitoring system
O.K.
iii) Audio and visual system O.K.

iv) Applicators checked O.K.

v) X-ray dummies checked O.K.
vi) Emergency
container ready

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010.
2. Klein EE, Hanley J, Bayouth J, et al. Task Group 142 report: quality assurance of medical
accelerators. Med Phys. 2009;36(9):4197-4212. http://dx.doi.org/10.1118/1.3190392