Linear Accelerator Daily, Monthly and Annually Quality Assurance

Daily
IMRT

SRS

3%

3%

3%

Laser localization

2mm

1.5m
m

1mm

Optical distance indicator

2mm

2mm

2mm

Collimator size indicator

2mm

2mm

1mm

Procedure

Tolerance

Machine output constancy

Door interlock
Door closing safety
Audiovisual monitor
Beam on indicator

Functional
Functional
Functional
Functional

Monthly
X-ray and Electron output
constancy
Backup monitor chamber constancy
Photon & E. beam profile constancy
Light/radiation field coincidence
Distance for lasers compared with
front pointer
Gantry/collimator angle indicators
Accessory trays
Jaw position indicators- Symmetric
Jaw position indicatorsAsymmetric
Cross-hair centering
Wedge placement accuracy
Compensator placement accuracy
Localizing lasers
Laser guard-interlock test
Beam output constancy Gating

2%
2%
1%
2mm/
SRS 1mm
1mm
1 degree
2mm
2mm
1mm
1mm
2mm
1mm
1mm
Functiona
l
2%

Gating interlock

Functiona
l

Annually
X-ray flatness change from baseline
X-ray symmetry change from baseline
Electron flatness change from baseline
Electron symmetry change from baseline
X-ray/electron output calibration
Output factors for electron applicators
X-ray beam quality
Electron beam quality (R50)
Physical wedge transmission
X-ray/ Electron monitor unit output constancy
X-ray output constancy vs dose rate
X-ray/ Electron output constancy vs gantry
angle
Arc mode (expected MU, degrees)
PDD or TMR and OAF constancy
Collimator, Gantry, Couch rotation
Electron applicator interlocks
Radiation isocenter
Table top sag
Table angle
Table travel maximum range
Beam energy constancy/Gating
Interlock testing
MLC transmission

1%
1%
1%
1%
1%
2%
1%
1mm
2%
2%
2%
1%
1%
1mm
1mm
Functional
2mm
2mm
1 degree/
SRS 0.5
degree
2mm
2%
Functional
0.50%

SIMULATOR Daily, Monthly and Annually Quality Assurance

Daily
Procedure

Tolerance

Alignment of gantry Lasers

2 mm

CT number for water

Image noise
plane spatial integrity X & Y
Isocenter distance indicator
Collimator size indicator
kVp Accuracy

5 HU
Manufacturer specifications
1 mm
2mm
2mm
5kVp
Exposure rate increase
proportionally
5%
2mm
Functional
Functional
Functional
Functional

mA Linearity
Timer accuracy and linearity
TAD to ODI (rangefinder)
Fluoroscopic System QA
Door beam off.
Audiovisual Monitors
Beam on indicator

Monthly
Target to axis distance (SAD)
Image intensifier radial position
Light radiation field coincidence
X-ray energy constancy
Optical distance indicator
Door switches
Field size indicators (Symmetric)
Field size indicators (Asymmetric)
Gantry angle indicator

2mm
2mm
2mm
2%
2mm / SRS 1mm
Functional
2mm
2mm
1 degree

Collimator angle indicator

Cross hair centering
Accessory tray
Couth position indicator

1 degree
1mm
2mm
2mm/ 1 degree

Annually
Target to axis distance (SAD)
Image intensifier radial position
Tube leakage
Safety interlock
Collimator rotation isocenter
Gantry rotation isocenter
Couth rotation isocenter
Electron applicator interlock
Coincidence of isocenter
Table top sagging
Table angle
Table travel max range in all
directions

2mm
2mm
0.1R/hr at 1mm
Functional
1mm
1mm
1mm
Functional
2mm
2mm
1 degree
2mm

Imaging Devices Daily, Monthly and Annually Quality Assurance

Frequency
Daily

KV

Monthly

Annually
Daily

M
V

Monthly

Annually

Procedure
Collision interlock
Positioning & repositioning
Coincidence of imaging and
treatment coordinates
Coincidence of imaging and
coordinates
Scaling
Spatial resolution
Contrast
Uniformity and noise
Beam quality/ energy
Image dose
Collision interlocks
Positioning & repositioning
Coincidence of imaging and
treatment coordinates
Coincidence of imaging and
coordinates
Scaling
Spatial resolution
Contrast
Uniformity and noise
Beam quality/ energy
Image dose

Tolerance
Non SRS/SBRT

SRS/SBRT

Functional
2mm

Functional
1mm

2mm

1mm

2mm

1mm

2mm
Baseline
Baseline
Baseline
Baseline
Baseline
Functional
2mm

1mm
Baseline
Baseline
Baseline
Baseline
Baseline
Functional
1mm

2mm

1mm

2mm

1mm

2mm
Baseline
Baseline
Baseline
5mm
Baseline

2mm
Baseline
Baseline
Baseline
5mm
Baseline

CBC
T

Daily

Collision interlocks

Functional

Functional

<1mm

<1mm

<2mm

<1mm

Monthly

Positioning & Repositioning

accuracy tests
Coincidence of imaging and
treatment coordinates
Geometric distortion

<2mm

<1mm

Spatial Resolution

Baseline

Baseline

Hounsfield unit (HU) consistency Baseline

Baseline

Contrast

Baseline

Baseline

Uniformity and Noise

Baseline

Baseline

Image dose

Baseline

Baseline

Annuall
y

Brachytherapy QA
Procedure
Applicator
Radioactive Sources
leakage
Cesium source leak testing
Remote After-loader
source inventory
source preparation area
measure applicator
dimension

Tolerance
Initial use / Before
treatment
when received / 6 month
3 years
Prior to patient treatment /
Monthly
Quarterly
As needed
Initially, annually

source calibration

Initially, each use

Treatment Planning QA:

Frequency / Procedure
Daily
Weekly
Monthly
Annual
Variable
Measurement of Beam Data
Inaccuracies of Data
Entry/weekly
Inaccuracies of Data
Output/weekly
Algorithm Inaccuracy

Item / Tolerance
Error logs / Hardware/software change logs
Digitizer/Hardcopy output/Computer files
CT data input/Review hardware, software and data files
Dose Calculations/
Review BEV/DRR accuracy/CT geometry/DVH
Recommissioning due to machine changes/Software
upgrade
Before treatment/3%
2mm
2mm
2%