QA checklist

Please review the table below. For the QA that your clinic performs, you need to at least observe
the procedure. If you are able to assist or perform any of the 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.

Type of QA Observed Assisted

Daily Warm-up QA for Linac

Daily Warm-up QA for CT Simulator

Monthly Linac

Monthly CT Simulator

IMRT

SRS

Brachytherapy

Respiratory Gating*

IGRT system

Treatment Planning System

Preceptor signature Date

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