QA Procedure for SRS

KEVEZO ZANGO CHUZHO

RESIDENT MEDICAL PHYSICIST, TMH

Equipment required:
 Head & Neck Phantom
 Cylindrical Chamber 0.13cc
IBA Model no: CC13
Bias Voltage: 300V
Charge Mode
8
ND,W: 2.639x10 Gy/C
Uncertainty in ND,W: @95% CC ± 1.5%
 Electrometer
1. MECHANICAL QA
1.1 Field Size Verification
1.1a Place the field size template on the treatment couch and align it with the cross wire
of the machine.
1.1b Open field size to 10cm x 10cm and 5cm x 5cm and
check for congruency with the field size on the QA
template and the opened field light. The optical field
edge is aligned first along the point (1,2,3,4 points) of
intersection of cross wire with the field perimeter line.
Next, check for any deviation of field light edge on the
predefined template field size along X1, X2, Y1 & Y2
direction. Note the deviation should be within the
tolerance of ± 1mm (AAPM TG 142 report for QA of
medical accelerators).
1.2 Laser Alignment Check

Place the Laser alignment QA tool on the treatment couch and align the two lateral
and saggital laser line with the laser tool cross line. Tolerance should be within ±
1mm

Laser Alignment
QA Tool
2. DOSIMETRY QA

2.1 FIELD OUTPUT VERIFICATION

2.1.a Put the chamber adapter at 5cm depth from the surface of the head & neck phantom
and placed it on the treatment couch.
2.1.b Align the phantom with the optical cross wire at SSD 95cm. Then placed the
cylindrical chamber at 100cm from the source (Chamber depth from phantom
surface: 5cm), verifying with the optical distance marker on the phantom surface at
SSD 95cm. Connect the Chamber to the electrometer in the control console.
2.1.c Place a thermometer and note the temperature as well as the ambient pressure.
2.1.d In SRS mode, open the field size to 30cm x 30cm, 6MV, 500MU and dose rate 1000
for warm up.
2.1.e Open the field size to 10cm x 10cm, 6MV, 200MU and dose rate 1000 and note the
electrometer reading (MR nC)
2.1.f Formula used:

Output (MU/cGy) = Set MU * TMR

MR * KTP * KQ * NDW

2.1.g Table: [TOLERANCE: ± 3% of the baseline value ]

Machine : Pressure :

Dosimeter : Reference Pressure :

Phantom : Temperature :

SSD/SAD Set up : Reference Temperature :

Dose Rate :

SET ND,W MR (nC) MEASURED OUTPUT IN %

TMR KT,P KQ,Q0
MU (cGy/nC) MEASURED AVERAGE
OUTPUT USE VARIATION

2.1.h The measured output should be less than 3% of the baseline value.
2.2 DOSE VERIFICATION WRT PATIENT PLANNED DOSE (PATIENT SPECIFIC QA)

2.2.a Keeping the gantry and collimator in 0° position, irradiated the chamber with respect
to specific patient planned MU. Note the MR readings for each planned MU.

Machine : Ambient Pressure :

Dosimeter : Reference Pressure :
Phantom : Ambient Temperature :
SSD/SAD Set up : Reference Temperature :
Field Size : KTP :
Energy :

Measured Dose (cGy) : MR * KTP * KQ,Q0* NDW

[TOLERANCE ±5%]
MR (nC) MR (nC) Planned
MU Each Beam Measured Dose % Variation
Cumulative Dose
Independent

2.2.b Verify the measured dose with the planned dose for each M R readings wrt to planned
MU input.

2.2.c The dose variation between planned dose and measured dose should be within ±5%.

2.3 RADIATION ISOCENTER CHECK: WINSTON LUTZ TEST

2.3.a Rotate gantry to 180° and attach Brainlab collimator mount and place Brainlab cone
(dia: 7.5mm/ 5mm/ 2.5mm) into the collimator mount.
Brainlab Collimator Mount Brainlab Cone
2.3.b Rotate the gantry back to 0° position. Fit brainlab couch mount on the couch and
attach lead ball laser alignment tool to the frame.

Frame
Lead Ball
Alignment Tool

Brainlab
Couch Mount

2.3.c Align the lead pointer alignment tool with the laser marking. After alignment, remove
the ball pointer alignment tool and attach the lead ball (5mm) to the frame.

2.3.d Fit vertical film holder to the gantry head. The ball pointer should be placed between
the cone and film holder.
Lead Ball
Vertical Film Holder Pointer

2.4.e Place Gafchromic film on the film holder.

Gafchromic Film
2.4.f Set the field size to 10 cm x 10 cm. Set 1000 MU. Rotate the gantry and couch wrt
planned data and irradiate the film. For each planned MU input, mark the film
accordingly. Shift the Gafchromic film after each irradiation.

Sl No Couch (°) Gantry (°) Set MU

2.4.f Analyzed the irradiated film. The ball should cast within the field diameter of the set
cone.
IRRADIATED FILM AND ANALYSIS