Explain what is checked daily, how it is checked (the instrumentation) and the tolerances of what

they are checking. Explain the process to follow if the tolerances are exceeding the
recommended limits. (This will require reviewing current AAPM reports and then scheduling
with the designated individuals to observe, review and discuss each of the tests performed so that
you may summarize them without excluding the required components for the discussion).

Daily Quality Control procedures are performed by the Radiation Therapist (RTT)
I. Mechanical/Digital Indicator/Laser Alignment Accuracy – TrueBeam Linear Accelerator
***USING SUN NUCLEAR DQA3 AS QA DEVICE***
A. Gantry Angle Indicator(s)
1. Set the gantry to 0° (Beam Down) as determined with a bubble level placed against the
collimator frame.
2. Ensure that the level is placed directly on the smooth portion of the collimator frame
and not on top of screws or screw holes (this could cause a false level reading).
3. Adjust the gantry position until the air bubble in the level is centered.
4. Note: to ensure that the level is reading correctly, it is important to turn it around and
read it in its “turned around” position.
Test: Verify that the digital gantry angle display on the in-room monitor agrees with the
bubble level.
Criteria: 1°
B. Collimator Angle Readout
1. Rotate the gantry to 90° or 270° true angular position, as set with a bubble level placed
against the collimator frame.
2. Set the collimator to 0° true angular position as determined with a bubble level placed
against the collimator frame.
Test: Verify that the digital collimator angle display on the in-room monitor agrees with
bubble level.
Criteria: 1°
C. Light Field Size Indicators
1. Ensure that the gantry angle is set to 0° (Beam Down) as determined with a bubble
level placed against the collimator frame.
2. Ensure the collimator is set to 0° (see above for directions on how to make it “true”
0°).
 3. Place the Sun Nuclear DQA3 on the Treatment table, with the cable oriented away
from the gantry (i.e., toward the feet end of a patient set up as head-first supine).
4. Using the level, ensure the DQA3 is level in the SUP-INF and LT-RT directions,
adjusting the leveling feet as necessary. Note that the level is placed in the CENTER of
the device for each direction. DO NOT USE THE LEVEL RESIDENT ON THE
DEVICE (if so equipped – the DQA3 device in the images does have a level resident on
it).
SUP-INF Direction:
LT-RT Direction:
Leveling Feet:
5. Insert the holder for the Mechanical Front Pointer into the head of the gantry.
6. Insert the Mechanical Front Pointer into its holder assembly.
7. Set the distance for the Mechanical Front Pointer to slightly more than 100 SSD.
8. Raise the couch until the top surface of the DQA3 is at 100 cm SSD, as determined by
the Mechanical Front Pointer.
9. Align the DQA3’s crosshairs with the treatment unit’s optically projected crosshairs.
10. Set the field size indicators to 20.0 cm x 20.0 cm.
a. Note that a QA patient is set up for each linear accelerator for Daily Output,
Flatness, and Symmetry checks.
b. The QA patient includes fields that automatically set field size to 20.0 cm x
20.0 cm to test the field size indicators.
Test: Verify that the light field edges are coincident with the 20 x 20 cm field outlined on
the DQA3, i.e., the digital field size indicators are accurate.
Criteria: 2 mm on each edge (limits indicated on DQA3 surface).
D. Optical Distance Indicator
Test: Activate the ODI light. Verify that the ODI reading agrees with distance set by the
mechanical front pointer.
Criteria: 2 mm.
E. Laser Alignment with Isocenter
Align the DQA3’s crosshairs with the treatment unit’s optically projected crosshairs.
Verify the following:
a. Sagittal Laser
 Test: Verify that the Sagittal laser is aligned with the DQA3 crosshairs.
Criteria: 2 mm.
Left Lateral Laser
Test: Verify that the Left Lateral Laser is aligned with the DQA3 side crosshairs
and the horizontal portion of the lateral laser skims across the surface of the
DQA3.
Criteria: 2 mm.

Right Lateral Laser

Test: Verify that the Right Lateral Laser is aligned with the DQA3 side crosshairs
and the horizontal portion of the lateral laser skims across the surface of the
DQA3.
Criteria: 2 mm.
Ceiling Laser
Rotate the gantry to 90° as set with a bubble level placed against the collimator
frame.
Test: Verify that the ceiling laser is aligned with the DQA3 crosshair.
Criteria: 2 mm.

After all of these items are checked when then run the output of each energy level checking for
flatness symmetry and output using Sun Nuclear DQA3 QA device. The device is able to
categorize the energy delivery as either a "pass" or "fail," which is usually around 2%. The Qa
device assesses factors such as the evenness and symmetry of the energy beam and its dosage
output. Additionally, we conducted checks on specific treatment fields, including the electronic
dynamic wedge (EDW) field and an ARC field, as part of our routine quality assurance for
patient care.
We also ensured the safe and precise functioning of the radiation therapy machine by testing
various interlocks and mechanical components. This involved verifying laser alignment on a
phantom, checking the door interlock system during beam delivery, testing the "beam off"
button, ensuring the functionality of audio and visual systems, and confirming that all radiation
monitors and "beam on" indicators were operational. We also evaluated the OBI/Kv images by
aligning them with a designated target within a phantom, confirming the alignment on the
phantom, and performing cone-beam computed tomography (CBCT) imaging to validate shifts
and alignment accuracy.
Our policy is “ONE OF THE PHYSICISTS MUST BE INFORMED AS SOON AS POSSIBLE
IF THE TREATMENT UNIT FAILS TO PASS THE TESTS DESCRIBED BELOW;
HOWEVER, TREATMENTS MAY COMMENCE UNLESS EITHER PATIENT
MONITORING TEST FAILS. THEN IT (THEY) MUST BE REPAIRED PRIOR TO
COMMENCING TREATMENTS.”