Daily QA of the CyberKnife using the QA BeamChecker+ Gibbs Cancer Center & Research Institute

Speaker is the owner of Spectrum Medical Physics, LLC, a company which has contracts with; - Standard Imaging, Inc - Siemens Healthcare USA c Gibbs Cancer Center SPECTRUM & Research Institute Medical Physics, LLC SPECTRUM Medical Physics, LLC

Current Clinical Use Varian TrueBeam • Daily — Photon Output (Gantry Mount) — Photon Energy Constancy (Gantry Mount) — Photon Flatness and Symmetry (Gantry Mount) — MV Imaging (Gantry Mount) — kV Imaging (Gantry Mount) • Weekly — Electron Output (Couch-Placed) — Electron Energy Constancy (Couch-Placed) — Electron (Couch-Placed) — EDW (Gantry Mount) — RapidArc (Gantry Mount) • Monthly — Respiratory Gating (Gantry Mount) • Patient-Specific — Electron Cut-out Measurements (Couch-Placed) Gibbs Cancer Center SPECTRUM & Research Institute Medical Physics, LLC

Gibbs Cancer Center & Research Institute Lovable Aspects of the QABC+ • Robust • Simple Hardware Interface • Simple Software Interface • Simple-to-traverse database • Easily Scalable as clinic changes • Stable readings • Easy out-of-tolerance notifications • Very few problems • Excellent Support

• Machine Isocenter matches the Room Isocenter • Room Lasers provide demarcation of machine isocenter • Alignment crosshair • Optical SSD • Can be delivered as an automated clinical beam Gibbs Cancer Center SPECTRUM & Research Institute Medical Physics, LLC

Output Verification (Current Methods) Requires manual manipulation of the robot Beam delivered in a non-clinical mode Requires manual correction for temperature and pressure Requires manual numeric entry for baseline comparison Setup uncertainty associated with setup following Iris QA Gibbs Cancer Center & Research Institute

Output Verification (Current Methods) Machine Isocenter matches the Room Isocenter Room Lasers provide demarcation of machine isocenter Alignment crosshair (Sort of) Optical SSD Can be delivered as an automated clinical beam

• Crosshair used for "rough alignment" • Four fiducial markers for alignment and offset calculation using TLS Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

• Place 5 SINLGE beams (4 peripheral and 1 center) • 500 MU Each Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Readiness Technique ■u XRS A kv I mA | ms I Estimated Imaging Dose (cGy) Exposed 1.0 Expected 1,3 Gibbs Cancer Center & Research Institute c SPECTRUM Medical Physics, LLC

Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Gibbs Cancer Center & Research Institute

Thank You Gibbs Cancer Center & Research Institute