4. SIMULATION CHECK LIST

5. IMAGING PROTOCOL

10. TPS - QA Topic Test CT input
Create an anatomical description based on a standard set of CT
scans provided by the vendor, in the format to be employed by the
user.
Anatomical
description
Create a patient model based on the standard CT data discussed
above. Contour the external surface, internal anatomy, etc. Create
3-D objects and display.
Beam description
Verify that all beam technique functions work, using a standard
beam description provided by the vendor.
Photon beam dose
calculations
Perform dose calculations for a standard photon beam data set.
Tests should include various open fields, different SSDs, blocked
fields, MLC shaped fields, inhomogeneity test cases, multibeam
plans, asymmetric jaw fields, wedged fields and others.
Electron beam
dose calculations
Perform a set of dose calculations for a standard electron beam
data set. Include open fields, different SSDs, shaped fields,
inhomogeneity test cases, surface irregularity test cases and others.

11. TPS - QA Topic Test Brachytherapy dose calculations
Perform dose calculations for single sources of each type, as well as
several multisource implant calculations, including standard
implant techniques such as a gynaecological insertion with tandem
and ovoids, two plane breast implant, etc.
Dose display,
DVHs
Display dose calculation results. Use a standard dose distribution
provided by the vendor to verify that the DVH code works as
described. User created dose distributions may also be used for
additional tests.
Hard copy output
Print out all hard copy documentation for a given series of plans,
and confirm that all textual and graphical information is output
correctly.

12. Telecobalt– Daily QA Procedure Tolerance Safety Mechanical
 Door interlock
Functional
 Radiation room monitor
 Audiovisual monitor
Mechanical
Lasers
2 mm
   Distance indicator (ODI)
Source position to be checked weekly

13. Telecobalt – Monthly QA
Procedure
Tolerance
Dosimetry
   Output constancy 2%
Mechanical checks
Light/radiation field coincidence
3 mm
   Field size indicator (collimator setting)
2 mm
   Gantry and collimator angle indicator 1°
   Cross-hair centering
1 mm
Latching of wedges, trays
Functional
Safety interlocks
   Emergency off
Wedge interlocks

14. Telecobalt – Annual QA Procedure Tolerance Dosimetry Safety interlocks
 Output constancy 2%
 Field size dependence of output constancy
Central axis dosimetry parameter constancy (PDD/TAR)
Transmission factor constancy for all standard accessories
Wedge transmission factor constancy
Timer linearity and error 1%
Output constancy vs. gantry angle
Beam uniformity vs. gantry angle 3%
Safety interlocks
Follow test procedures of manufacturers
Functional

15. Telecobalt – Annual QA Procedure Tolerance Mechanical checks
   Collimator rotation isocenter
2 mm diameter
   Gantry rotation isocenter
   Couch rotation isocenter
   Coincidence of collimator, gantry, couch axis with isocenter
   Coincidence of radiation and mechanical isocenter
   Tabletop sag
2 mm
   Vertical travel of table
   Field-light intensity
Functional

16. Linac – Daily QA Procedure Tolerance Dosimetry Mechanical Safety
   X-ray output constancy 3%
   Electron output constancyb
Mechanical
   Localizing lasers
2 mm
   Distance indicator (ODI)
Safety
   Door interlock
Functional
   Audiovisual monitor

17. Linac – Monthly QA Procedure Tolerance Dosimetry Safety interlocks
X-ray output constancy 2%
Electron output constancy
Backup monitor constancy
X-ray central axis dosimetry parameter (PDD, TAR) constancy
Electron central axis dosimetry parameter constancy (PDD)
2 mm at therapeutic depth
X-ray beam flatness constancy
Electron beam flatness constancy 3%
X-ray and electron symmetry
Safety interlocks
Emergency off switches
Functional
Wedge, electron cone interlocks

18. Linac – Monthly QA Procedure Tolerance Mechanical checks
   Light/radiation field coincidence
2 mm or 1% on a sided
   Gantry/collimator angle indicators 1°
   Wedge position
2 mm (or 2% change in transmission factor)
   Tray position
2 mm
   Applicator position
   Field size indicators
   Cross-hair centering
2 mm diameter
   Treatment couch position indicators
2 mm/1°
   Latching of wedges, blocking tray
Functional
   Jaw symmetrye
   Field light intensity

19. Linac – Annual QA Procedure Tolerance Dosimetry
   X-ray/electron output calibration constancy 2%
   Field size dependence of x-ray output constancy
   Output factor constancy for electron applicators
   Central axis parameter constancy (PDD, TAR)
   Off-axis factor constancy
   Transmission factor constancy for all treatment accessories
   Wedge transmission factor constancyf
   Monitor chamber linearity 1%
   X-ray output constancy vs. gantry angle
   Electron output constancy vs. gantry angle
   Off-axis factor constancy vs. gantry angle
   Arc mode
Manufacturers' specifications

20. Linac – Annual QA Procedure Tolerance Safety interlocks
   Follow manufacturers test procedures
Functional
Mechanical checks
   Collimator rotation isocenter
2 mm diameter
   Gantry rotation isocenter
   Couch rotation isocenter
   Coincidence of collimator, gantry, couch axes with isocenter
   Coincidence of radiation and mechanical isocenter
   Tabletop sag
2 mm
   Vertical travel of table

21. HDR Brachytherapy – QA -
Door interlock
Run a test treatment No
Warning lights
Audio/Visual communication
Check the audio and video systems
Emergency and interrupt buttons
Radiation monitor and/or
personal alarm dosimeter
Check their presence and that the correct threshold
alarm is inserted
Emergency equipment
Check their presence through a list and their ease
to be used (e.g. the lid of the shielded storage
container could be opened)

22. HDR Brachytherapy – QA -
Date and time
Check that it corresponds to the actual date and
time no
Integrity of transfer tubes and
applicators
Tube used for treatment; done by dummy run No
Visual inspection of all transfer tubes and
Source and dummy position
Using a transparent test phantom, a check ruler, or
a film, run a treatment test at different positions
2 mm
Timer absolute accuracy
Run a test treatment
2 %

23. HDR Brachytherapy – QA -
Calibration of the source
Air kerma strength measured with local standard
compared with vendor-supplied value
3 %
This test is optional. Air kerma strength measured
with local standard compared with the value
obtained with the redundancy standard
Source strength
Check that the source strength is correctly
specified
N/A
Treatment plan, first application
Independent calculation
Treatment plan, follow-up
application
Check that dwell times are correctly adjusted for
decay no

24. HDR Brachytherapy – QA -
Control
Type of action
Tolerance
Verification of local standard
Verification by an authorized laboratory
N/A
Stability of the local standard
Measurement with long-life source
0.5 %
Calibration of the redundancy
standard
Calibration of thimble chamber in Co-60 or the
lowest high-energy accelerator X-ray
Stability of the redundancy standard

25. HDR Brachytherapy – QA -
Leakage radiation
Use a dose-rate meter to measure room ambiance
dose rate
10 μSv/h
Applicator too long or too short
Run a test treatment
2 mm
Missing applicator
Do not connect the catheter to the trolley and run a
test treatment
N/A
Device disabled
Check that the source retracts if console is turned
off
Run a test treatment and check if the battery works
when the main switch is turned off
Simulation markers
Verify construction/spacing of all simulation
markers
1 mm

26. HDR Brachytherapy – QA -
Emergency procedure
Review and update if necessary
N/A
Practice emergency procedure
Dry run
Quality assurance manual

27. External beam therapy units - Emergency procedures
External beam therapy units Emergency procedures should be posted at the treatment unit for this event.
In general, the first step is to use the source driving mechanism to return the source to the shielded position.
If this is not immediately successful and there is a patient on the treatment couch, the patient should be removed from the area and the area must be secured from further entry.
Emphasis should be placed on avoiding exposure of the staff to the primary beam.
The RSO is then notified and takes over the control of the situation.

28. Remote after loading Brachytherapy units - Emergency procedures
1) Observation at console of error message and emergency indicators (audible and visible alarms)
2) Recovery from the console (e.g., pressing an “emergency OFF” button)
3) Entry into the room with a portable radiation survey meter (opening the door activates the interlock that retracts the source)
4) Monitoring radiation levels in the room
5) Recovery from the afterloading unit (by pressing an “emergency OFF” button on the remote afterloading unit (RAU)
6) Manual retraction of the source (using a hand crank)
7) Patient survey and RAU survey (confirming source is in the safe)
8) Applicator removal and placement in the emergency container
9) Patient survey and emergency container survey (to confirm source is not in the patient and is in the emergency container)
10) Removal of the patient from the vault (with subsequent survey monitoring).