Daily quality assurance checks are performed to ensure that all equipment is working safely and

properly before patients are treated for that day. At the Pluta Cancer center, these checks are
performed for two Varian True beam linacs. The quality assurance and calibration testing at our facility
is based upon the American Association of Physics in Medicine TG-142 and TG-51 guidelines. The
Suncheck software system is used to take the therapists through the necessary daily checks and ensure
that the equipment parameters are within the daily acceptable range. Beginning with the warmup, the
treatment machine uses a 9E energy beam and warms up to 500 monitor units. A digital display that
reads on the control console should match the delivered monitor units.

The Daily QA3 device is used to verify most of the quality testing. It consists of different chambers to
verify the output and diodes to evaluate shifts and deviations. The goal of a QA program for linear
accelerators is to assure that the machine characteristics do not deviate significantly from their baseline
values acquired at the time of acceptance and commissioning. 1 At this facility, we evaluate equipment
consistency from day to day and uphold that these values must remain within a 3% range for the
machine to safely treat. At a 1.5% deviation from the consistency range, a warning is displayed so that
physics can evaluate the variance before it escalates further. The machine is still safe to treat with at a
1.5% deviation.

The morning checks require that all beam energies are checked daily. For this site, this includes 6x,16x,
6x-FFF,10x-FFF,6E,9E,12E,16E, and a check for the electronic dynamic wedge. For each energy the
Output, Axial and Trans symmetry, Flatness, X/Y size, and X/Y shift are tested. A beam profile evaluates
the flattening filter free beams. Beam energies can either be evaluated at two different depths, or by
evaluating the differences in the beam profile, but must be within 3%. The x-ray light field and the area
of irradiation should be coincidence upon each other and can be evaluated by the diodes on the edges
of the QA3. Collimator size, laser localization, and the ODI indicator is tested by aligning the phantom to
the specified coordinates and comparing the readout. This must be within a 2mm tolerance and should
ideally display 97 ODI.
The CRAD system is used for respiratory gating procedures and requires a separate phantom containing
three spheres which are evaluated to see if they have moved in relation to the previous quality
assurance test.

In addition to system testing, a series of safety tests must also be performed. The results of these tests
are either pass or fail. Required safety testing includes checking door locks, visual and audio alerts, beam
on indicators, MV and KV collision checks, and door closure functions.

Failure of the safety system checks to pass will result in an immediate halting of treatments that day
until the issue is resolved. Likewise, failure of the quality and accuracy of the daily checks could also
result in treatment halts, but the level of deviation and type of error are to be brought to the attention
of the physicist who will guide the therapists on whether the treatment unit is safe to use or will require
immediate service.

References

1. Klein E, Hanley J, Bayouth J, Yin F, Simon W, Dresser S, etl. Task Group 142 report: Quality assurance
of medical accelerators. 2009. Med. Phys., 36: 4197-4212. https://doi.org/10.1118/1.3190392