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Igrt Qa Discussion

Daily QA is performed on the clinic's cone beam CT scanner and linear accelerator to check collision interlocks and imaging accuracy within 1mm. Monthly QA uses a CAT Phan phantom to check parameters including geometric distortion, spatial resolution, and Hounsfield units are within specifications. Annual testing measures the travel SSD at multiple distances to ensure it is correct. This comprehensive QA plan follows Task Group 142 guidelines for precise stereotactic radiosurgery treatments. While IGRT improves accuracy, it adds approximately 1-2% extra cumulative dose to the patient over their treatment course.

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59 views4 pages

Igrt Qa Discussion

Daily QA is performed on the clinic's cone beam CT scanner and linear accelerator to check collision interlocks and imaging accuracy within 1mm. Monthly QA uses a CAT Phan phantom to check parameters including geometric distortion, spatial resolution, and Hounsfield units are within specifications. Annual testing measures the travel SSD at multiple distances to ensure it is correct. This comprehensive QA plan follows Task Group 142 guidelines for precise stereotactic radiosurgery treatments. While IGRT improves accuracy, it adds approximately 1-2% extra cumulative dose to the patient over their treatment course.

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IGRT QA is done daily, monthly, and annually at my clinical site.

The
therapists do daily QA on our Cone beam CT (CBCT) with their daily warm-up
for our Varian Trilogy linear accelerator. The therapists start by checking
collision interlocks by applying light pressure to the portal and KV imaging
devices to ensure the interlocks are working appropriately and the machine
will alarm when there is a collision. The phantom shown below is used to
verify planar KV and CBCT imaging. The imaging and treatment coordinate
coincidence as well as the positioning and repositioning of the device to
ensure parameters are within 1mm since the equipment is utilized for
stereotactic radiosurgery (SRS) treatments.1

A device called a CAT Phan is used for monthly QA and can be seen below.
This device is imaged and checks geometric distortion, spatial resolution,
contrast, Hounsfield units, and uniformity and noise. For MV imaging, the
scaling, spatial resolution, contrast, and uniformity and noise must be within
2 mm of the baseline established during commissioning and treatment
coordinate coincidence must be within 1mm. For CBCT and KV imaging, all
parameters including HU for CBCT imaging must be within 1mm.
Annual testing done for our imaging equipment checks the travel SSD to
ensure that distances are correct. Our physicists will set multiple distances
such as 100, 105, 110, etc and then measure these distances manually to
ensure that the travel SSD is appropriate.
This QA plan was established in our department because it follows what is
recommended by Task Group 142 and our parameters are set to comply with
SRS treatments because our Varian Trilogy linear accelerator is the machine
all of our SRS patients are treated on. Below I have included tables from the
Task Group 142 report showing appropriate values for daily, monthly, and
annual QA.
Using IGRT improves patient alignment but does increases dose to the
patient. As a therapist I have heard others ask how much “extra” dose
patients receive due to their daily imaging, and in doing research for this
discussion I came across a source stating that a patient who has daily IGRT
and a prescription of 70-80Gy will receive a cumulative extra dose of about 1-
2%.2

1. Klein EE, Hanley J, Bayouth J, et al. Task group 142 report: quality
assurance of medical accelerators. Med Phys. 2009;36(9):4197-4212.
http://dx.doi.org/10.1118/1.3190392

2. Verellen DM, Deridder K, Tournel KM, et al. An overview of volumetric


imaging technologies and their quality assurance for IGRT. Acta Oncol.
2008;47:1271-1278. http://dx.doi.org/10.1080/02841860802244182

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