The use of a Treatment planning system QA is very important to ensuring the treatment

planning system is providing consistent and reliable monitor units, DVHs, and isodose
distributions. An important aspect to ensuring all of these components is to understand how the
treatment planning system calculates those factors. That is why treatment planning system
consistency and CT data geometric accuracy should be tested.
I have been working with Vijeshwar Sharma, senior medical physicist at McLaren-Flint,
on the process of commissioning a treatment planning system quality assurance in accordance
with the American Association of Physicists in Medicine Radiation Therapy Committee Task
Group 53: Quality assurance for clinical radiotherapy treatment planning (AAPM TG53). The
first part of the process has been creating plans that encompass every machine, energy, and
technique separately.
1
To ensure consistency a standard pelvic phantom was used. This includes:
Trubeam Stx:
Calculation models: AAA, Acuros
Energies: 6x,15x,6FFF, and 10FFF
Techniques: IMRT, RapidArc, & 3D
Flint, Owosso, and Lapeer 21ex
Calculation moderls: AAA, Acuros
Energies: 6x, 18x, 6e,9e,12e,16e, and 20e
Techniques: IMRT and 3D
These energies were also tested with a 40x40cm water phantom and measured at two different
depths (10cm and 20cm). The calculated plans were exported to RadCalc second check and the
Eclipse monitor units, RadCalc monitor units, and percent difference between the two were
placed into spreadsheet that will be compared in future treatment planning QA assessments. The
second portion we are still working on is the accuracy of the treatment planning CT Hounsfield
unit (HU) calculation that relays correct structural volumes and geometry. This will be
established by using a Cheese phantom scan that has known simulated bone, water, and tissue
volumes and relate those known volumes to the calculated volume that the Varian treatment
planning system communicates.
The treatment planning system QA is a very complicated and tedious process that ensures
various energies, techniques, calculation models, and accurate monitor units are being utilized.
This is a lengthy process, but in the end it helps assure that there is no gap in patient treatment
safety. The treatment planning process is a crucial key to ensuring every plan will have a smaller
margin for systematic error.



1
Fraass B, Doppke K, Hunt M, et al. American Association of Physicists in Medicine Radiation Therapy Committee
Task Group 53: Quality assurance for clinical radiotherapy treatment planning. Med Phys. October 1998; 25(10):
1773-1829.