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Each morning quality assurance (QA) testing is performed on our Varian Trilogy linear

accelerator. During this process, multiple safety checks are done to ensure that the
machine is operating appropriately. These checks include verification of the lasers,
optical distance indicator (ODI), light field, machine output, imaging, door interlocks,
cameras, and audio. For light field, laser, and dose output checks, our facility uses a QA
tool from Sun Nuclear shown below.

The therapists set the room lasers so that they intersect in the center of the above
phantom. The height of the table is also adjusted so that the lateral lasers aligns with an
additional mark on the side of the QA device. The ODI should read 100 SSD at this
location and a tolerance of 2 mm is allowed. A 20x20 field size is set and the light field is
checked to ensure it falls within the appropriate parameters on the QA tool. A 2 mm
tolerance is acceptable for non IMRT and IMRT treatments; however, if SRS or SBRT is
treated on the machine, the collimator size indicator must be within 1mm. All photon and
electron energies are then verified, and the output constancy must be within 3%. At our
facility, the collimator indicator and laser localization have a tolerance of 1.0 mm since
we utilize the machine for IMRT treatments.1
Imaging is also a necessary portion of the daily QA. Cone beam CT (CBCT) is utilized
where I am doing my training and the phantom shown below is used to verify imaging
and positioning.
For this test, the therapists will line up the phantom to the crosshair that is shown off
center. The cube is then cone beamed and appropriate shifts are made and applied to line
the phantom up to the reference image. After applying the shifts, the therapist checks the
alignment of the phantom, which should now have the lasers crossing the center of the
phantom. This process is repeated with the therapists taking KV and MV ports instead of
the CBCT to verify proper shifts and alignment. The tolerance is not to exceed 1mm for
any of these imaging tests.1 All imaging devices come equipped with collision interlocks
that should also be verified daily as well. These interlocks stop the movement of the
machine in the event of a collision and/or set off an alarm alerting staff of the
collision. To test these interlocks, therapists apply gentle pressure to the device which
sets off the alarm demonstrating that the interlock is functional.
Audio and visual tests are done to ensure that the cameras and speaker system in the
treatment room are functional, so patients can be both seen and heard during
treatments. The door interlock is also tested to ensure that the beam will not turn on if
the door is open. Door interlock testing is done by running beam and opening the
treatment door while the beam is turned on. As soon as the door begins to open, the
beam will terminate if the interlock is working correctly. If any of the morning QA tests
do not fall within their limits or if any of the safety features are not operational, physics
needs to be notified immediately and treatment cannot be delivered until the issue is
Below are tables from the Task Group 142 report showing appropriate values for daily
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.