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Tolerance
Frequency Procedure Non-IMRT IMRT SRS/SBRT
Dosimetry
x-ray output constancy 3%
A
Mechanical
Laser localization 2 mm 1.5 mm 1 mm
M Mechanical
L
Cross-hair centering 1 mm
Treatment couch position indicators 2 mm/1 2 mm/1 1 mm/0.5
Y
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
Imaging QA2
Tolerance
Frequency Procedure Non-SRS/SBRT SRS/SBRT
Planar kV and MV (EPID) imaging
D Collison interlocks Functional Functional
Positioning/repositioning 2 mm 1mm
A Imaging and treatment coordinate coincidence (single 2 mm 1 mm
I gantry angle)
Cone-beam CT (kV and MV)
L Collison interlocks Functional Functional
Y Imaging and treatment coordinate coincidence
Positioning/repositioning
2 mm
1 mm
1mm
1 mm
H Orientation of CT-scanner
tabletop with respect to imaging
To verify that the CT-scanner tabletop is level
and orthogonal with the imaging plane
2 mm over the
length and width of
plane table top
L Table vertical and To verify the table longitudinal motion 1 mm over the range
longitudinal motion according to digital indicators is accurate and of table motion
Y reproducible
Image performance
CT number accuracy Test 4-5 different materials 5 HU
In plane spatial integrity (both x 1 mm
and y directions)
Field uniformity (most 5 HU
common used kVp)
Electromechanical
Table indexing and position To verify table indexing & position accuracy 1 mm over the scan
under scanner control range
Gantry tilt accuracy To verify accuracy of gantry tilt indicators 1 degree over the
A Gantry tilt position accuracy To verify that the gantry accurately returns to
gantry tilt range
1 degree or 1 mm
N Scan localization
nominal position after tilting
To verify accuracy of scan localization from
from nominal position
1 mm over the scan
N Radiation profile width
pilot images
To verify that the radiation profile width
range
Manufacturer
A CT number accuracy
Field uniformity (other used
Electron density phantom 5 HU
5 HU
L kVp settings)
Electron density to CT Consistent with
number conversion commissioning results
and test phantom
manufacturer
specifications
Spatial Resolution Manufacturer
specifications
Contrast resolution Manufacturer
specifications
SEMI- Electromechanical
ANNUAL Sensitivity profile width To verify that the radiation profile width 1mm of nominal
meets manufacturer specs value
D
Correct function of dedicated fluoroscopy/imaging system if present HDR
Correct function: door interlock HDR/PDR
A
Correct function: area radiation monitor HDR/PDR
Correct function: Audio/visual system communication HDR/PDR
patient/public
/staff safety Correct function: Portable survey meter all
all
Y verify
positional
response placed near a programmed dwell position, multiple-channel
autoradiograph of every active dwell position used in the patient treatment
and compare programmed position to expected, visually check that relative
position of source tip in a ruled catheter reproduces from day-to-day.
accuracy
within 1 mm Autoradiograph patient-specific configuration of sources loaded into All fixed and
intermediate safe of device programmable
source-train units
time duration of source ejected light, perform a spot check of radiation HDR/PDR
output for a timed interval using tertiary calibration standard jig, compare
temporal source arrival and departure times on printed treatment documentation with a
accuracy clock or stop watch
subtract treatment interruptions from overall treatment time and compare to LDR (optional)
programmed time
Remote afterloading facility QA (continued)5
Frequency General endpoint Specific tests/endpoints System type
Personnel safety Head/machine survey with source retracted all
Important interlocks and emergency response systems function: all
obstructed applicator, missing applicator, door, unlocked indexer
Patient safety ring, displacement, power/air pressure loss, backup battery system.
Emergency source handling tools, shielded storage container, and all
supplies for emergency applicator removal available and functioning.
Q
Calibration of optical and
pneumatic source
position/status detection As specified by vendor all
systems; any other
U
preventive maintenance
or inspections
correct operation of all Examine all dummies for kinks or bends that may shorten their axial all
A
applicators, transfer displacement through applicator assembly. Check integrity of all
tubes and source transfer tube-applicator interfaces
localization dummies
Verify that radioactive source position agrees with dummy marker
R positional accuracy:
within 0.5 mm previously tested against dwell position markers used
in simulation
Confirm check cable operation All HDR/PDR
T
single stepping source Obtain multiple channel autoradiograph with unique dwell sequence single stepping
in each channel: verify that dwell position spacing, assignment of source devices
dwell sequence to programmed channel, and relative indexer length
to dwell 1 are correct within 1 mm.
L
multiple-source Source trains correctly sorted and composed Programmable
machines source train
Source inventory correct all
Y
Source trains stored in correct locations in user accessible storage Fixed source
location train devices
source calibration Measure source air kerma strength using a secondary standard HDR/PDR
Difference between measured and vendor-specified air kerma
redundant source strength is within expected margin
calibration checks Use tertiary source strength standard (e.g., daily/monthly output HDR/PDR
checking system) to confirm primary calibration within 5%. Different
electrometer and detector to be used
spot check of absolute Various techniques available All LDR
timer accuracy
timer accuracy and Various techniques available HDR/PDR
linearity measurement
Update source strength in treatment planning computer initialization all
miscellaneous file, treatment unit and quarterly inventory
Have a second physicist independently review the quarterly report HDR/PDR
Remote afterloading facility QA (continued)5
Frequency Test endpoint Test methodology System type
Personnel and Review workload and annualized unrestricted area/personnel exposures all
public safety Perform facility survey if occupancy/building structure revised. all
Intercompare secondary standard used for quarterly calibration against HDR/PDR
dose delivery another departmental substandard. Obtain new calibration from ADCL if
accuracy calibration more than two years old. Perform Table III tests for re-entrant
chamber if used.
A
Verify air kerma strength calibration and other annual Table I checks. LDR
Verify accuracy of any jigs or autoradiography cassettes used for all
daily/monthly positional accuracy verification
N positional
accuracy
Verify construction/spacing of all simulation markers (dummy sources)
Verify position of simulation markers agrees with radioactive source for all
applicator types. Verify simulation source localization procedure
all
all
U temporal
accuracy
Verify timer linearity and absolute accuracy
Verify transit dose/source velocity
all
all
A
Verify pulse sequencing PDR
Additional Verify that unit detects simulated detached source capsule HDR/PDR
interlock/ Verify emergency retraction buttons in room and manual source retraction HDR/PDR
Check that treatment unit correctly decays source strengths and corrects all
dwell times for decay
miscellaneous Review accuracy of all standard treatment configurations stored in treatment all
unit
Review quality assurance manual and update if necessary all
SRS QA6
Guidelines to follow
Linear Accelerator
Follow guidelines from AAPM TG-42 Stereotactic Radiosurgery from 1995
Gamma Knife
Follow guidelines from AAPM TG-42 Stereotactic Radiosurgery from 1995
Cyberknife
Follow guidelines from AAPM TG-135 QA for Robotic Radiosurgery from 2011
References
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