QA checklist

Please review the table below. For the QA that your clinic performs, you need to at least observe
the procedure. Ifyou are able to assist or perform any ofthe following procedures, that's even
better! At the completion of the Fall QA course, submit the table below leaving an "x" in the
boxes that apply to the procedures that you have observed or participated in and have your
preceptor sign the form. Submit this table to the dropbox by the last day of the course in Fall
Semester. Make sure you mention this assignment to your preceptor or physicist prior to the
beginning of the QA course, so they are able to help get you involved in as much QA as possible.

Tvpe of OA Observed Assisted

/
Daily Warm-up QA for Linac 1fr*f.t t
?('^ l'q

Daily Warm-up QA for CT Simulator ?1,"f ,<

Monthly Linac
Tl'"1 "t
Monthly CT Simulator </t=/,t f ,/ lrll *t
IMRT vlrln
rt
SRS
ft Irr
Brachytherapy elr{ l,',

Respiratory Gating* a.\tr lr't

IGRT system al'r=t\dt

Treatment Planning System aptl(

signature
Preceptor signature Date

*If Respiratory gating is not performed in your clinic, research this topic and provide a short
suflrmary of the QA to be performed along with the current tolerances.