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Qa Discussion 2

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30 views4 pages

Qa Discussion 2

Uploaded by

api-633434674
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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The guidelines for IGRT QA are somewhat unclear.

While there are published reports by


the AAPM showing tables of daily, monthly and annual tests, they are often only
representing the minimum required for conducting IGRT. It is recommended and
encouraged for each facility to establish their own QA plan based on factors such as
cost, equipment, quality, etc. What does your facility do for QA of IGRT devices (MV, kV,
CBCT, etc.)? How often is QA performed? Daily? Monthly? How did your department
decide on this QA plan?

Like other radiation oncology treatment sites, the physicists at my clinical site have taken the
IGRT QA recommendations from TG-142 and the published minimum requirements from the
AAPM, and have created their own IGRT QA protocol. I was able to speak with one of our
physicists about how their team decided upon this specific protocol and was able to learn more
about why, how, and when our IGRT QA is performed and evaluated.

Our daily IGRT QA process is performed by the warm-up therapist. They begin by placing the
Varian Morning QA Phantom (pictured below) on the couch and aligning the lasers to a set of
crosshairs on the cube. This crosshair is placed in a known axis point and is aligned to the
lasers in the vertical, longitudinal, and lateral direction. They take a kV image pair. Then they
make a shift to match a DRR which will ensure the center of the internal fiducial aligns to
isocenter. The physicists observe the shift and can tell if there are any issues by the magnitude
of the shift (which is a known distance). After the internal fiducial marker coincides with
isocenter, the therapists will take a CBCT to verify that it aligns with the planar kV images. This
test ensures that the CBCT images processing system is error free. Finally, an AP and lateral
MV image is taken and the center of the graticule and the center of the fiducial marker must
align within 1.5 mm (the actual recommendation is 2 mm but our physicists use 1.5 mm as to
provide a notice before falling out of tolerance). This test ensures the MV and kV images
coincide.

Our monthly IGRT protocols include similar tests to the daily IGRT QA protocols, but they also
include more in-depth tests. In addition to the typical image coincidence tests and mechanical
checks, our physicists use the Phantom Laboratory Catphan (seen below) to evaluate our
CBCT system. This phantom is scanned via on board imaging devices. It consists of multiple
layers to check high and low contrast resolution and linearity, HU consistency and uniformity,
intensities profiles,and 3D geometric accuracy. Our physicists also use the PTW Dosimetry QC
EPID Phantom. This device is used to check the image quality of the MV imager. It provides
data about the high and low contrast resolution, geometric accuracy, and intensity linearity. After
this data has been collected, we use the Radiological Imaging Technology (RIT) software to
interpret and analyze the images. Below, you can see some of the evaluation screens from both
phantoms, what the software searches for, and how it can be used to check the quality of the
imagers compared to their performance at commissioning.
My site’s annual IGRT QA protocols include all the aforementioned tests as well as a test to
check the dose that is given by a particular imaging modality. At commissioning, this data was
collected for each image type and technical imaging protocol. A Saysafe Xi detector is used to
determine the dose given throughout each image. This must be the same as the baseline
measure. This, like all of the QA procedures, is done to protect patients and ensure their
treatment is accurately delivered.

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