Is a weekly qualitative picket fence test sufficient? A proposed alternate EPID‐based weekly MLC QA program

The purpose of this guideline is to provide a list of critical performance tests to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator. Current recommendations for linac QA were reviewed to determine any changes required to those tests highlighted by the original report as well as considering new components of the treatment process that have become common since its publication. Recommendations are made on the acquisition of reference data, routine establishment of machine isocenter, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance and upgrades. The recommended tests proposed in this guideline were chosen based on consensus of the guideline's committee after assessing necessary changes from the previous report. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test. This guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics.

Section: Mlc 2 Leaf Position Accuracymentioning

confidence: 99%

Section: Mlc 4 Radiation Isocentricity (Mlc Radiation Isocenter With ...mentioning

confidence: 99%

Section: Linac Performance Testsmentioning

confidence: 99%

Section: Linac Performance Testsmentioning

confidence: 99%

Section: Linac Performance Testsmentioning

confidence: 99%

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AAPM Medical Physics Practice Guideline 8.b: Linear accelerator performance tests

Krauss,

Balik,

Cirino

et al. 2023

Is a weekly qualitative picket fence test sufficient? A proposed alternate EPID‐based weekly MLC QA program

Kalavagunta

Zhang

et al. 2022

Purpose Well‐designed routine multileaf collimator (MLC) quality assurance (QA) is important to assure external‐beam radiation treatment delivery accuracy. This study evaluates the clinical necessity of a comprehensive weekly (C‐Weekly) MLC QA program compared to the American Association of Physics in Medicinerecommended weekly picket fence test (PF‐Weekly), based on our seven‐year experience with weekly MLC QA. Methods The C‐Weekly MLC QA program used in this study includes 5 tests to analyze: (1) absolute MLC leaf position; (2) interdigitation MLC leaf position; (3) picket fence MLC leaf positions at static gantry angle; (4) minimum leaf‐gap setting; and (5) volumetric‐modulated arc therapy delivery. A total of 20,226 QA images from 16,855 tests (3,371 tests × 5) for 11 linacs at 5 photon clinical sites from May 2014 to June 2021 were analyzed. Failure mode and effects analysis was performed with 5 failure modes related to the 5 tests. For each failure mode, a risk probability number (RPN) was calculated for a C‐Weekly and a PF‐Weekly MLC QA program. The probability of occurrence was evaluated from statistical analyses of the C‐Weekly MLC QA. Results The total number of failures for these 16,855 tests was 143 (0.9%): 39 (27.3%) for absolute MLC leaf position, 13 (9.1%) for interdigitation position, 9 (6.3%) for static gantry picket fence, 2 (1.4%) for minimum leaf‐gap setting, and 80 (55.9%) for VMAT delivery. RPN scores for PF‐Weekly MLC QA ranged from 60 to 192 and from 48 to 96 for C‐Weekly MLC QA. Conclusion RPNs for the 5 failure modes of MLC QA tests were quantitatively determined and analyzed. A comprehensive weekly MLC QA is imperative to lower the RPNs of the 5 failure modes to the desired level (<125); those from the PF‐Weekly MLC QA program were found to be higher (>125). This supports the clinical necessity for comprehensive weekly MLC QA.

Assessing quality assurance of multi‐leaf collimator using the structural similarity index

Zhang,

Lasio

et al. 2024

Self Cite

PurposeThis study aims to evaluate the viability of utilizing the Structural Similarity Index (SSI*) as an innovative imaging metric for quality assurance (QA) of the multi‐leaf collimator (MLC). Additionally, we compared the results obtained through SSI* with those derived from a conventional Gamma index test for three types of Varian machines (Trilogy, Truebeam, and Edge) over a 12‐week period of MLC QA in our clinic.MethodTo assess sensitivity to MLC positioning errors, we designed a 1 cm slit on the reference MLC, subsequently shifted by 0.5–5 mm on the target MLC. For evaluating sensitivity to output error, we irradiated five 25 cm × 25 cm open fields on the portal image with varying Monitor Units (MUs) of 96–100. We compared SSI* and Gamma index tests using three linear accelerator (LINAC) machines: Varian Trilogy, Truebeam, and Edge, with MLC leaf widths of 1, 0.5, and 0.25 mm. Weekly QA included VMAT and static field modes, with Picket fence test images acquired. Mechanical uncertainties related to the LINAC head, electronic portal imaging device (EPID), and MLC during gantry rotation and leaf motion were monitored.ResultsThe Gamma index test started detecting the MLC shift at a threshold of 4 mm, whereas the SSI* metric showed sensitivity to shifts as small as 2 mm. Moreover, the Gamma index test identified dose changes at 95MUs, indicating a 5% dose difference based on the distance to agreement (DTA)/dose difference (DD) criteria of 1 mm/3%. In contrast, the SSI* metric alerted to dose differences starting from 97MUs, corresponding to a 3% dose difference. The Gamma index test passed all measurements conducted on each machine. However, the SSI* metric rejected all measurements from the Edge and Trilogy machines and two from the Truebeam.ConclusionsOur findings demonstrate that the SSI* exhibits greater sensitivity than the Gamma index test in detecting MLC positioning errors and dose changes between static and VMAT modes. The SSI* metric outperformed the Gamma index test regarding sensitivity across these parameters.