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 X Daily Warm-up QA for CT Simulator x Monthly Linac xX x 7 Monthly CT Simulator x IMRT x SRS x Brachytherapy x Respiratory Gating* Serer IGRT system x ‘Treatment Planning System \ L_ memes | A LX *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.Amanda Lisher QA Checklist: Respiratory Gating October 2015 Respiratory gating refers to a variety of methods utilized in radiation oncology simulation and treatment to reduce and account for differences in patient anatomy as a result of respiratory motion. Respiratory motion can be a significant planning factor for patients with thoracic, abdominal, and some pelvic tumors.! Respiratory gating involves matching the radiation beam- on time to phases of the patient's breathing cycle. Types of respiratory gating include motion- encompassing methods, respiratory-gated techniques, breath-hold techniques, forced-shallow breathing methods, and respiration-synchronized techniques.’ According to TG-76', gating techniques are recommended when the target moves more than 5 mm due to respiratory motion, and when gating can reduce normal tissue radiation doses. Regular QA of the respiratory gating system is necessary to ensure both radiographic and mechanical components are operating appropriately. Safety interlocks should be tested prior to each use. Monitoring systems should be checked monthly at minimum. Tests for beam energy and output constancy should be performed monthly and annually. Accuracy of the phase and amplitude gate on should be performed annually to verify the beam is only exposing in the correct phase of respiration. Calibration of the surrogate, which represents the position of the target, should be done annually to verify the actual position of the surrogate matches the recorded position, A summary of TG-142? recommendations and tolerances is presented in Table 1. Additional QA testing should be completed after any hardware or software changes, after service or changes to respiratory management devices, and may be performed until the staff is familiar with the equipment.' Table 1. ee f ee Procedure Type Frequency & Tolerance Daily Monthly Annually Beam energy/output constancy 2% 2% Phase, amplitude beam control Funetional In-room respiratory Functional monitoring system Gating interlock Fanctional ‘Temporal accuracy of 100 ms of expected phase/amplitude gate on Calibration of surrogate for 100 ms of expected respiratory phase/amplitude Interlock testing Functional 1.Keall PJ, Mageras GS, Balter JM, et al. TG-76: The management of respiratory motion in radiation oncology. Med Phys. 2006;33(10):3874-3900. http://dx.doi.org/10.1118/1.2349696 2.Klein EE, Hanley J, Bayouth J, et al. TG-142: Quality assurance of medical accelerators. Med Phys. 2009;36(9):4 197-4212. http://dx.doi.org/10.1118/1.3190392