I have split clinical time between Froedtert Hospital and its community affiliate, St.

Josephs Hospital. The facilities mentioned possess a variety of different linear accelerator
models and associated IGRT systems. I observed IGRT QA an Elekta Infinity linear accelerator
several months ago during my clinical rotation at St. Josephs Hospital.
All QA protocols across the Froedtert network have been derived from and based off TG-
142 guidelines. On a daily basis, a single radiation therapist will perform QA on the linear
accelerator and IGRT systems prior to any patient treatment. Using a QUASAR™ Penta-Guide
Phantom seen in Figure 1., the KV-CBCT is checked for accuracy in image localization and
repositioning as well as image and target coincidence. During this portion of morning QA,
collision interlocks and warning lights are tested to ensure the machine faults if it were to come
into contact with the patient or couch.
Monthly QA is a more involved process and is performed by a medical physicist. This
series of checks verifies both MV and KV imaging panel accuracy. To do so, spatial resolution,
contrast QA, CBCT uniformity, CBCT geometry accuracy, CBCT low contrast visibility, and
isocenter registration accuracy are tested using a ball-bearing phantom for isocenter checks and a
Catphan 500 series phantom for all other checks.

Figure 1. The QUASAR™ Penta-Guide Phantom is a great tool used in daily QA to test on-
board imaging accuracy.1

1. Blair. Penta-Guide. Modus Medical Devices Inc. https://modusqa.com/igrt/penta-guide.

Accessed September 12, 2018.