A.J.

Kressin
Week 3 Discussion
Quality assurance (QA) procedures are vital to ensuring that patients are receiving the best intended
care from a radiation oncology department. Quality assurance of treatment planning systems is no
exception. Brilliant plans can be developed on the computer, but if the plan delivered does not
correspond to the plan created in the treatment planning system, the effort put forth to produce such a
plan is meaningless.
At Gundersen Health System of La Crosse, WI 2 different treatment planning systems are used for
external beam radiation therapy planning. Both Varian Eclipse version 11 and Philips Pinnacle version 8
are used. The QA for these systems is completed annually by one of the physicists. The first test that is
done requires a phantom of known size that contains several different plugs of known densities.
1
This
phantom is scanned using a General Electric computed tomography (CT) scanner and the CT data set is
exported to each of the treatment planning systems. Within each planning system the geometry of the
phantom must agree within 2 mm of the known dimensions and the Hounsfield units (HU) of the
phantom plugs must agree within a few percent of the known densities.
The other test that is done checks the accuracy of the monitor units in both the Eclipse and Pinnacle
treatment planning systems. A similar plan is made in both systems that delivers 200 cGy at 100 source-
to-axis distance (SAD). This is done for all photon energies and also for all electron energies. For the
photon energies, several different field sizes are used for each energy at a constant depth. Plans are also
calculated to a point on the central axis and then at a constant off axis point. Plans with and without
wedges calculated to the central axis and also calculated to a constant off axis point are made. For the
electron energies, various cone sizes are used for each energy and the plans are calculated to a point at
the maximum depth (dmax) of the specified energy. The monitor unit outputs for both treatment
planning systems are compared to each other and also compared to the monitor units calculated by
MUcheck, which is our facilitys independent monitor unit verification software. The monitor units for
each plan should agree within 2% across all 3 systems.
1. Discussion with John Wochos, Senior Medical Physicist, Gundersen Health System, La Crosse,
WI. October 7, 2014.