Daily QA

Dosimetry Procedures
X-ray output constancy
Electron output constancy

Non-IMRT

IMRT

SRS/SBRT

3%
3%

3%
3%

3%
3%

Mechanical Procedures
Laser localization
Distance indicator
Collimator size indicator

Non-IMRT

IMRT

SRS/SBRT

2 mm
2 mm
2 mm

1.5 mm
2 mm
2 mm

1 mm
2 mm
1 mm

Safety Procedures
Door Interlock
Door closing safety
Audiovisual monitor
Sterotactic interlocks
Radiation area monitor
Beam on indicator

Non-IMRT

IMRT

SRS/SBRT

N/A
N/A
N/A
N/A
N/A
N/A

Functional
Functional
Functional
N/A
Functional
Functional

Functional
Functional
Functional
Functional
Functional
Functional

Imaging Procedures
Planar kV and MV (EPID) Imaging
Collision interlocks
Position/repositioning
Imaging and treatment coordinate coincidence
Cone-beam CT (kV and MV)
Collision interlocks
Position/repositioning
Imaging and treatment coordinate coincidence

Non-SRS/SBRT
Functional
2 mm
2 mm
Functional
2 mm

1 mm

SRS/SBRT
Functional
1 mm
1 mm
Functional
1 mm

1 mm

Monthly QA
Dosimetry Procedures
X-ray output constancy
Electron output constancy
Backup monitor chamber constancy
Typical dose rate output constancy
Photon beam profile constancy
Electron beam profile constancy
Electron beam energy constancy
Mechanical Procedures
Light/radiation field coincidence
Light/radiation field coincidence (asymmetric)
Distance check device for lasers compared with front pointer
Gantry/collimator angle indicators
Accessory trays
Jaw position indicators (symmetric)
Jaw position indicators (asymmetric)
Cross-hair centering
Treatment couch position indicators
Wedge placement accuracy
Compensator placement accuracy
Latching of wedges, blocking tray
Localizing lasers
Safety Procedure
Laser guard-interlock test
Respiratory Gating Procedures
Beam output constancy
Phase, amplitude beam control
In-room respiratory monitoring system
Gating interlock

Non-IMRT

IMRT

SRS/SBRT

N/A
N/A
N/A
N/A
N/A
N/A
N/A

2%
2%
2%
2% (@ IMRT dose rate)
1%
1%
2%/2mm

Non-IMRT

IMRT

SRS/SBRT

2 mm or 1% on a side
1 mm or 1% on a side
1 mm
1 degree
2 mm
2 mm
1 mm
1 mm
2 mm/ 1 degree
2 mm
1 mm
Functional
2 mm

2 mm or 1% on a side
1 mm or 1% on a side
1 mm
1 degree
2 mm
2 mm
1 mm
1 mm
2 mm/ 1 degree
2 mm
1 mm
Functional
2 mm

2 mm or 1% on a side
1 mm or 1% on a side
1 mm
1 degree
2 mm
2 mm
1 mm
1 mm
2 mm/ 1 degree
2 mm
1 mm
Functional
2 mm

Non-IMRT

IMRT

SRS/SBRT

Functional

Functional

Functional

Non-IMRT

IMRT

SRS/SBRT

2%
Functional
Functional
Functional

2%
Functional
Functional
Functional

2%
Functional
Functional
Functional

2%
2%
2%
2%
2%
2%
2%

(@
(@
(@
(@
(@
(@
(@

stereo
stereo
stereo
stereo
stereo
stereo
stereo

dose
dose
dose
dose
dose
dose
dose

rate,
rate,
rate,
rate,
rate,
rate,
rate,

MU)
MU)
MU)
MU)
MU)
MU)
MU)

Imaging Procedures
Non-SRS/SBRT
Planar MV Imaging (EPID)
Imaging and treatment coordinate coincidence
2 mm
Scaling
2 mm
Spatial resolution
Baseline
Contrast
Baseline
Unifromity and noise
Baseline
Planar kV Imaging
Imaging and treatment coordinate coincidence
2 mm
Scaling
2 mm
Spatial resolution
Baseline
Contrast
Baseline
Unifromity and noise
Baseline
Cone-beam CT (kV and MV)
Geometric distortion
2 mm
Spatial resolution
Baseline
Contrast
Baseline
HU constancy
Baseline
Unifromity and noise
Baseline

SRS/SBRT
1 mm
2 mm
Baseline
Baseline
Baseline
1 mm
1 mm
Baseline
Baseline
Baseline
1 mm
Baseline
Baseline
Baseline
Baseline

Annual QA
Dosimetry Procedures
X-ray flatness change from baseline
X-ray symmetry change from baseline
Electron flatness change from baseline
Electron symmetry change from baseline
SRS arc rotation mode

X-ray/electron output calibration

Output factors for electron applicators
X-ray beam quality
Electron beam quality
Physical wedge transmisson factor constantcy
X-ray monitor unit linearity
Electron monitor unit linearity
X-ray output constancy vs. dose rate
X-ray output constancy vs. gantry angle
Electon output constancy vs. gantry angle
Electron and x-ray off-axis factor constancy vs. gantry angle
Arc-mode
TBI/TSET mode
TBI/TSET output calibration
TBI/TSET accessories
PDD or TMR and OAF constancy
Spot check of field size dependent output factors for x-ray
Mechanical Procedures
Collimator rotation isocenter
Gantry rotation isocenter
Couch rotation isocenter
Electron applicator interlocks
Coincidence of radiation and mechanical isocenter
Table top sag
Table angle
Table travel maximum range movement in all directions
Stereotactic accessories, lockouts, etc.
Safety Procedure
Follow Manufacturer's test procedures
Respiratory Gating Procedures

Beam energy constancy

Temporal accuracy of phase/amplitude gate on
Calibration of surrogate for respiratory phase/amplitude
Interlock testing

Non-IMRT

IMRT

1%
1%
1%
1%

1%
1%
1%
1%

N/A

N/A

Non-IMRT

IMRT

1% (absolute)
2% from baseline
1% from baseline
1 mm
2%
2% 5 MU
2% 5 MU

1% (absolute)
2% from baseline
1% from baseline
1 mm
2%
5% (2-4 MU), 2% 5 MU
2% 5 MU

Non-IMRT

IMRT

2%
1%
1%
1%
1%

from
from
from
from
from

baseline
baseline
baseline
baseline
baseline

Non-IMRT
Functional
2% from baseline
2% from baseline

2%
1%
1%
1%
1%

from
from
from
from
from

baseline
baseline
baseline
baseline
baseline

IMRT
Functional
2% from baseline
2% from baseline
1% (TBI) or 1 mm PDD shift (TSET) from baseline
2% for field size < 4x4 cm, 1% 4x4 cm

Non-IMRT

IMRT

1 mm from baseline
1 mm from baseline
1 mm from baseline
Functional
2 mm from baseline
2 mm from baseline
1 degree
2 mm
N/A

1 mm from baseline
1 mm from baseline
1 mm from baseline
Functional
2 mm from baseline
2 mm from baseline
1 degree
2 mm
N/A

Non-IMRT

IMRT

Functional

Functional

Non-IMRT

IMRT

2%
100 ms of expected
100 ms of expected
Functional

2%
100 ms of expected
100 ms of expected
Functional

SRS/SBRT
1%
1%
1%
1%
Monitor units set vs. delivered: 1 degree or 2% (whichever
is greater) Gantry arc set vs. delivered: 1.0 degree or 2%
(whichever is greater)

SRS/SBRT
1% (absolute)
2% from baseline
1% from baseline
1 mm
2%
5% (2-4 MU), 2% 5 MU
2% 5 MU

SRS/SBRT

2%
1%
1%
1%
1%

from
from
from
from
from

baseline
baseline
baseline
baseline
baseline

SRS/SBRT

Functional
2% from baseline
2% from baseline
PDD shift (TSET) from baseline
< 4x4 cm, 1% 4x4 cm

SRS/SBRT
1 mm from baseline
1 mm from baseline
1 mm from baseline
Functional
1 mm from baseline
2 mm from baseline
1 degree
2 mm
Functional

SRS/SBRT
Functional

SRS/SBRT

Imaging Procedures
Planar MV Imaging (EPID)
Full range of travel SDD
Imaging dose
Planar kV Imaging
Beam quality/energy
Imaging dose
Cone Beam CT (kV and MV)
Imaging dose

2%
100 ms of expected
100 ms of expected
Functional

Non-SRS/SBRT

SRS/SBRT

5 mm
Baseline

5 mm
Baseline

Baseline

Baseline

Baseline

Baseline

Baseline

Baseline

V and MV)

CT Simulator Quality Assurance

Test Specifications for Radiation and Patient Safety
Performance Parameter
Shielding survey

Patient dose from CT scan, CTDI

Test Specifications for Electromechanical
Components
Perfomance Parameter
Alignment of gantry lasers with the center of the
imaging plane
Orientation of gantry lasers with respect to the
imaging plane
Spacing of lateral wall lasers with respect to
lateral gantry lasers and scan plane
Orientation of wall lasers with respect to the
imaging plane
Orientation of the ceiling laser with respect to the
imaging plane
Orientation of the CT-scanner tabletop with
respect to the imaging plane
Table vertical and longitudinal motion
Table indexing and position
Gantry tilt accuracy
Gantry tilt position accuracy
Scan localization
Radiation profile width

Sensitivity profile width

Generator tests
Test Specifications for Image Performance Eval.
Performance Parameter
CT number and accuracy
Image noise
In plane spatial integrity
Field uniformity

Electron density to CT number conversion

Spatial resolution
Contrast resolution

Test Objective
To verify exposure levels around the CT-scanner room

To verify safe dose delivered from the scanner

Test Objective
To verify proper identification of scan plane with gantry
lasers
To verify that the gantry lasers are parallel and orthogonal
with the imaging plane over the full length of laser
projection
To verify that lateral wall lasers are accurately spaced from
the scan plane. This distance is used for patient localization
marking.
To verify that the wall lasers are parallel and orthogonal with
the imaging plane over the full length of laser projection
To verify that the ceiling laser is orthogonal with the imaging
plane
To verify that the CT-scanner tabletop is level and
orthogonal with the imaging plane
To verify that the table longitudinal motion according to
digital indicators is accurate and reproducible
To verify table indexing and position accuracy under scanner
control
To verify accuracy of gantry tilt indicators
To verify that the gantry accurately returns to nominal
position after tilting
To verify accuracy of scan localization from pilot images
To verify that the radiation profile width meets manufacturer
specification

To verify that the sensitivity profile width meets

manufacturer specification
To verify proper operation of the x-ray generator

Frequency
Daily- CT number for water Monthly - 4 to 5 different
materials Annually - Electron density phantom
Daily
Daily - x or y direction Monthly - both directions
Monthly - most commonly used kVp Annually - Other used
kVp settings
Annually - or after scanner calibration
Annually
Annually

Frequency
Initally

Tolerance
NCRP
recommendations
or applicable
regulatory limits

Annually or after major CT

scanner component
replacement

20% of
manufacturer
specifications

Frequency

Tolerance

Daily

2 mm

Monthly and after laser

adjustments

2 mm ver the
length of laser
projection

Monthly and after laser

adjustments

2 mm

Monthly and after laser

adjustments
Monthly and after laser
adjustments
Monthly or when daily laser
QA tests reveal rotational
problems
Monthly
Annually
Annually
Annually
Annually
Annually (This test is optional
if the CTDI accuracy has
been verified

2 mm over the
length of laser
projection
2 mm over the
length of laser
projection
2 mm over the
length and width
of the tabletop
1 mm over the
range of table
motion
1 mm over the
scan range
1 over the
gantry tilt range
1 or 1 mm
from nominal
position
1 mm over the
scan range
Manufacturer
specifications

 1 mm of
nominal value
Manufacturer
After replacement of major
specifications or
generator component
Report No. 39
recommendations
Semiannually

Tolerance
For water, 5 HU
Manufactuerer specifications
1 mm
Within 5 HU
Consistent with
commissioning results and
test phantom manufacturer
specifications
Manufactuerer specifications
Manufactuerer specifications

CT-Based IGRT
Systems
Frequency
Daily

Monthly

Annual

Quality Metric
Safety
System operation and
accuracy

Geometric

Image quality

Image quality
Dose
Imaging system
performance
Geometric
System operation

Quality Check
Collision and other interlocks
Warning lights
Laser/image/treatment isocentre coincidence OR
Phantom localization and repositioning with couch
shift
Geometric calibration maps
kV/MV/laser alignment
Couch shifts; accuracy of motions
Scale, distance and orientation accuracy
Uniformity, noise
High contrast spatial resolution
Low contrast detectability
CT number accuracy and stability
Imaging dose
X-ray generator Performance (kV systems only) :
tube potential, mA, ms accuracy and linearity
Anteroposterior, mediolateral and craniocaudal
orientations are maintained
Long and short term planning of resources

Tolerance
Functional
Functional
2 mm
2 mm
Replace/refresh
1 mm
1 mm
Baseline
Baseline
2 mm (or 5 lp/cm)
Baseline
Baseline
Baseline
Baseline
Accurate
Support clinical use and
current imaging policies and
procedures

TPS QA Procedures
Acceptance Test Features
CT input
Anatomical description
Beam description
Photon beam dose calculations
Image Input Tests
Image geometry
Text information
Imaging data
Anatomical Structure Tests
Structure attributes
Relative electron density definition
Display characteristics
Auto-segmentation parameters
Structure created from contours
Contour Tests
Manual contour acquisition
Digitization process
Contouring on 2-D images
Autotracking contours
Density Description Tests
Relative electron density representation
CT number conversion
Bolus Tests
Electron density within bolus
Density measurment tools
Automated bolus design
Beam assignment
Image Use and Display Tests
Grayscale window and level settings
Creation and use of reformatted images
Removal of imaging table
Geometrical accuracy of slices associated with images
MLC Parameters
Leaf width
Number of leaves
Distance over midline that can be traveled by a leaf
Movement of the leaf carriage
Leaf transmission
Beam Configuration Tests

Machine library
Machine/beam accessories
Parameter limitations
Beam names and numbers
System Readout Conventions and Motion Descriptions Testing
General system conventions
Internal consistency
Readouts
Field Shape Design Tests
Block type
Block transmissions
MLC leaf fits
Manual Aperture Entry Tests
Film magnification factors
Special drawing aids
Number of points in aperture definition
Wedge Tests
Orientation and angle specifications
2-D display
3-D display
Beam Geometry Display Tests
Axial beam divergence
Non-axial divergence
BEV/DRR displays
Methodology and Algorithm Use Tests
Regions to be calculated
Calculation grid definition
Status of density corrections
Dose Display Tests
Dose points
Interactive point doses
Consistency
Dose grids
DVH Tests
Volume region of interest identification
Structure identification
Voxel dose interpolation
Structure volume
Histogram bins and limits
DVH calculation
Non-Dosimetric Brachytherpay Tests
Sourc input and geometrical accuracy
Source display

Electron beam dose calculations

Brachytherapy dose calculations
Dose display, dose volume histograms
Hardcopy output
Geometric location and orientation of the scan
Image unwarping

Structure constructed by expansion or

contraction from another structure
Structure constructed from non-axial contours
Capping
Structure definition

Bifurcated structures
Contours on porjection images
Contours on CT scannograms
Extracting contours from surfaces
Editing
Measurment tools
Dose calculation
Monitor unit calculation
Output and graphic displays

Region-of-interest analysis
Positional measurments
3-D object rendering
Multiple window display use
Minimum gap between opposing leaves
Leaf labels
Leaf editing capabilities
Dynamic leaf motion

Readouts
Beam technique tools
Wedges
Compensators

iptions Testing
Test frequency
Multi-user environment

Electron applicators
Hardcopy output

Editing apertures
Defining apertures on BEV/DRR displays
3-D projections
Orientation and field size limitations
Autowedges
Dynamic wedge
3-D displays
Patient and beam labels

Reading saved plan information

Calculation validity logic
Dose calculation algorithm selection
2-D dose displays
Isodose surfaces
Beam display

DVH types
DVH plotting and output
Plan and DVH normalization
Dose and VROI grid effects
Use of DVHs from different cases

Optimization and evaluation