User’s Guide

Vol. 3

myQA Machines
SW Version: 2.12 | Release: 2019-002
Notice
This manual is an integral part of the myQA® system and should always be kept at hand. If the manual
is missing, immediately contact the IBA Dosimetry GmbH for a copy.
Observance of the manual instructions is required for proper performance and correct operation of the
myQA® system. The myQA® system and its accessories must not be used for any other purpose than
what is described in the accompanying documentation (intended use). Violation will result in loss of
warranty.
IBA Dosimetry GmbH does not accept liability for injury to personnel or damage to equipment that may
result from misuse of this equipment, failure to observe the hazard notices contained in this manual, or
failure to observe local health and safety regulations.
Under no circumstances shall IBA Dosimetry GmbH be liable for incidental or coincidental damage
arising from use of the equipment described in this document.
No part of the accompanying documentation may be translated or reproduced without written
permission of IBA Dosimetry, unless reproduction is carried out for the sole purpose of being used by
several people in the same department.
The user must treat the accompanying documentation like any other copyrighted material. If part of the
accompanying documentation is provided in electronic form, these files shall not be modified in any
way. IBA Dosimetry and its suppliers retain title and all ownership rights to the accompanying
documentation (in either electronic or printed form).

IBA Dosimetry GmbH

Bahnhofstrasse 5
DE-90592 Schwarzenbruck
Germany

Phone: +49 9128 607-0

Fax: +49 9128 607-10
www.iba-dosimetry.com

Last update: 2019-11-06

Documentation ID: P-19-002-510-003 01
© 2019 IBA Dosimetry GmbH, Schwarzenbruck

myQA User's Guide – Vol. 3. myQA Machines | Notice | i

Table of Contents

1. Introduction ..................................................................................... 1
1.1. Intended Use ............................................................................................................................ 1
1.2. General Product Description.................................................................................................. 1
1.2.1. Generic Tests and Plugin Tests ............................................................................................ 2
1.2.2. Supported Measurement Devices ......................................................................................... 2
1.3. Scope of Delivery .................................................................................................................... 2
1.4. Related Documents................................................................................................................. 3
2. Getting Started with the Software .................................................. 4
2.1. Step 1 – Set up the Equipment ............................................................................................. 4
2.2. Step 2 – Create a Protocol Template ................................................................................... 5
2.3. Step 3 – Create a Machine Protocol .................................................................................... 6
2.4. Step 4 – Execute the Tests .................................................................................................... 7
2.5. Step 5 – Print a Report ........................................................................................................... 8
3. Software Description ....................................................................... 9
3.1. myQA Machines User Interface Overview........................................................................... 9
3.2. General Description of a Protocol Template and Device Protocol ................................ 10
3.3. Test Setup .............................................................................................................................. 10
Test Setup Ribbon and Context Menu ................................................................................ 11
Machines & Templates Panel ............................................................................................. 14
Protocol Tree Panel ............................................................................................................ 14
Template / Definition panel ................................................................................................. 17
Error Indication .................................................................................................................... 28
3.4. Test Run ................................................................................................................................. 29
Test Run Ribbon and Context Menu ................................................................................... 29
Agenda Panel ...................................................................................................................... 31
Task View Panel ................................................................................................................. 33
Task/Test Info Panel ........................................................................................................... 35
Skip a Task.......................................................................................................................... 36
Finish a Task ....................................................................................................................... 37
3.5. Run an Imported Excel Spreadsheet Test......................................................................... 39
Create a Machine Protocol .................................................................................................. 39
Map the Excel Template to the Acceptance Criteria ........................................................... 40
Performing a Test ................................................................................................................ 43
3.6. Test Repository Page ........................................................................................................... 45
Ribbon and Context Menu .................................................................................................. 45
Sorting the Listed Items ...................................................................................................... 46
Display Filter........................................................................................................................ 46
Print a Report ...................................................................................................................... 47

4. Dosimetry QA Plugin ..................................................................... 49

ii | Table of Contents | myQA User's Guide - Vol.3. myQA Machines

 4.1. General Description of Dosimetry QA Tests ..................................................................... 50
Profile Constancy ................................................................................................................ 50
Principle of Energy Constancy Analysis ............................................................................. 51
Output Constancy Check .................................................................................................... 52
Wedge Constancy Check ................................................................................................... 52
4.2. Setting Up the Measurement Devices ............................................................................... 53
Installing the Measurement Devices ................................................................................... 53
Using Energy Verification Plate .......................................................................................... 54
A Device Setup Example .................................................................................................... 55
Configure the Measurement Device in the Software .......................................................... 56
4.3. General Steps for Dosimetry QA ........................................................................................ 57
4.4. Create a Protocol Template for Dosimetry QA ................................................................. 58
4.5. Create a Machine Protocol for Dosimetry QA .................................................................. 60
Create Baselines for Dosimetry QA .................................................................................... 60
Copy/Paste Machine Protocols ........................................................................................... 69
4.6. Perform Dosimetry QA Tests .............................................................................................. 75
Share Measurements.......................................................................................................... 76
Import of Profiles into the Compare Page ........................................................................... 76

5. CBCT QA Plugins ......................................................................... 78

5.1. Introduction............................................................................................................................. 78
5.2. CBCT Test Algorithms .......................................................................................................... 79
Preparatory Automatic Processing ..................................................................................... 79
Geometric Distortion ........................................................................................................... 80
Spatial Resolution ............................................................................................................... 81
Contrast............................................................................................................................... 82
HU constancy ...................................................................................................................... 83
Uniformity ............................................................................................................................ 83
5.3. Workflows for CBCT QA Plugin Tests ............................................................................... 84
Setting up CBCT QA Baselines in Test Setup .................................................................... 84
Execute CBCT QA Tests in Test Run ................................................................................. 87
myQA - Imaging - Test Setup/Test Run Windows .............................................................. 90
5.4. References ........................................................................................................................... 100
6. EPID Plugin ..................................................................................101
6.1. Introduction........................................................................................................................... 101
6.2. EPID Test Setup and ROIs ................................................................................................ 101
6.3. Supported Phantoms and Automatic-Calculations ........................................................ 102
6.4. EPID Test Calculations ...................................................................................................... 106
Scaling Discrepancy ......................................................................................................... 106
Spatial Resolution ............................................................................................................. 106
Contrast and CNR ............................................................................................................. 107
Minimum uniformity ........................................................................................................... 107
6.5. Workflows for EPID QA Plugin Tests ............................................................................... 107
Setting up Baselines in Test Setup ................................................................................... 107
Executing EPID Tests in Test Run ................................................................................... 111
myQA - Imaging - Test Setup/Test Run EPID Windows .................................................. 114

myQA User's Guide - Vol.3. myQA Machines | Table of Contents | iii

 6.6. References ........................................................................................................................... 115
7. MLC QA Plugin ............................................................................ 116
7.1. Introduction ........................................................................................................................... 116
7.2. MLC Plugin Calculations .................................................................................................... 117
MLC QA Image Handling .................................................................................................. 117
Calculations ....................................................................................................................... 117
7.3. MLC QA Workflows ............................................................................................................. 118
Creating a Test Protocol for MLC QA ............................................................................... 118
Executing MLC QA Test .................................................................................................... 121
Imaging QA –TestSetup / TestRun MLC Window............................................................. 125

8. VMAT QA Plugin .......................................................................... 132

8.1. Data acquisition and analysis ............................................................................................ 132
8.2. Workflow for VMAT/DMLC QA Tests ............................................................................... 133
Setting up Baselines in Test Setup ................................................................................... 133
Executing VMAT Tests in Test Run .................................................................................. 137
myQA - Imaging - TestSetup/TestRun VMAT Windows ................................................... 140
8.3. References ........................................................................................................................... 147
9. IsoTrack Plugin ............................................................................ 148
9.1. General Description ............................................................................................................ 148
9.2. Winston-Lutz Test Workspace .......................................................................................... 149
Table of the Image Parameters......................................................................................... 150
Loading Images ................................................................................................................. 150
Selecting Image for Display .............................................................................................. 151
Perform Analysis ............................................................................................................... 151
9.3. Create a Winston-Lutz Test Protocol ............................................................................... 153
9.4. Example – Winston-Lutz Test on EPID Images ............................................................. 155
Phantom for Winston-Lutz Test......................................................................................... 155
Obtaining Winston-Lutz Images with EPID ....................................................................... 155
Execute Winston-Lutz Image Analysis .............................................................................. 155
9.5. Winston-Lutz Calculation Algorithm.................................................................................. 158
Determining Outer/Inner Contours and Their Centers ...................................................... 158
2D Deviation Calculation ................................................................................................... 158
3D Deviation Calculation ................................................................................................... 159

10. Sphinx Plug-In ............................................................................. 160

10.1. Product Description ............................................................................................................. 160
10.2. Setting up for Measurements ............................................................................................ 160
Setting up the PTS Communication .................................................................................. 160
Setting up the Device in a Proton Treatment Unit............................................................. 161
Baseline Measurements .................................................................................................... 162
10.3. Workflow for Sphinx QA Tests .......................................................................................... 163
Creating a Sphinx Protocol Template ............................................................................... 163
Creating a Machine Protocol ............................................................................................. 172
Test Run ............................................................................................................................ 173
10.4. Review and Report the Performed Tests......................................................................... 184

iv | Table of Contents | myQA User's Guide - Vol.3. myQA Machines

 10.5. Sphinx Plugin Calculation Algorithms .............................................................................. 185
Energy Calculation Algorithm............................................................................................ 185
Spot Parameters Calculation Algorithm ............................................................................ 187
Coincidence Calculation Algorithm ................................................................................... 187
Homogeneity Calculation Algorithm .................................................................................. 188

11. Appendix ......................................................................................190

11.1. DICOM Image Import ......................................................................................................... 190
Browsing for DICOM Images ............................................................................................ 190
Loading DICOM Images ................................................................................................... 191
11.2. Applying kTp Correction Workflow in myQA Machines ................................................. 192
12. Glossary .......................................................................................194

myQA User's Guide - Vol.3. myQA Machines | Table of Contents | v

1. Introduction
1.1. Intended Use
The intended use of the Machine QA workspace is to perform and document quality assurance
activities of treatment units, imaging devices and their accessories in the field of radiation therapy and
medical imaging.
Note: For Non-Intended Use, Intended Users, and Expected Service Lifetime of the Hardware, see
Sections 1.2, 1.3, and 1.4, Vol.1, myQA Platform and Devices User’s Guide, respectively.

1.2. General Product Description

The Machine QA workspace is an optional module of the myQA® software package. It is called myQA
Machines in the software. It provides a complete set of functions to plan, perform, analyze, and
document quality assurance of machines, imaging devices and their accessories.
All QA activities are based on customizable protocols. The software provides a pre-configured protocol
according to AAPM TG-142 (thereafter called TG-142). Other protocols such as IEC, DIN etc. can be
created, imported or exchanged by users.
Generic tests of different categories can be replaced by specific tests (e.g. CBCT QA) if the specific
license is available. Tests can be planned and executed by manually entering results, importing data, or
measuring data. Test results are archived in SQL databases and can be accessed from different clients
and users.
The main features of the myQA Machines module are:
■ Scalable solution that covers complete machine QA requirements
■ Protocol based applications, covering dosimetry and imaging
■ Default protocol templates:
 TG-142 General (TG-142 generic tests)
 TG-142 + PlugIn (TG-142 generic tests and Plugin tests provided by the myQA Machines)
■ Customizable protocols and generic tests, including file upload to the test description (e.g. work
instruction, photos of the measurement setup)
■ Copy/paste of QA tests between different machines
■ Fully software and hardware integrated, fast, and accurate dosimetry
■ Fully integrated, advanced imaging QA for CBCT and EPID (software and phantoms)
■ Support of EPID images for several categories (EPID, MLC, etc.)
■ IsoTrack Plugin for isocenter position check
■ Sphinx Plugin for Pencil Beam Scanning (PBS) daily QA
■ Automated archiving on database server:
 Easy data share through network
 Simple data exchange, compatible with other modules in the myQA® software package, OmniPro
software family and MS Excel
 Connecting to web based dashboard: traffic lights, review data, trend analysis anytime and
anywhere (Requires access to clinic network through LAN, VPN etc.)
■ Comprehensive reporting according to standards including PDF exports.

myQA User's Guide - Vol. 3 myQA Machines | Introduction | 1

1.2.1. Generic Tests and Plugin Tests
In myQA Machines, there are two types of tests depending on how the measurements are performed:
■ Generic tests
The measurements are carried out without the myQA Machines software. The test results are
manually entered into the protocol in the myQA Machines software.
■ Plugin tests
The complete QA procedure is performed with the myQA Machines software. The Plugin includes:
 Dosimetry QA
o Energy Constancy
o Output Constancy
o Profile Constancy
o Wedge Constancy
 MLC QA Tests
 CBCT QA
 EPID QA
 Isocenter position QA
 PBS daily QA

1.2.2. Supported Measurement Devices

The description and operating instruction of the supported measurement devices are described in Vol.
1. myQA Platform and Devices, of the myQA User’s Guide. Please ensure that the safety precautions
are taken note of.

1.3. Scope of Delivery

Delivered main items
■ myQA® software including myQA Platform and myQA Machines
■ StarTrack detector or MatriXX (I’mRT MatriXX/MatriXXEvolution/MatriXXFFF) detector

Available Accessories
■ Energy Verification plates for photons and electrons
■ Build-up plates
■ Primus L phantom
■ miniPhantom
■ Gantry mounts for the Elekta or Varian linear accelerators
■ Sphinx V1 or Sphinx Compact device
■ Other QA phantoms and accessories

2 | Introduction | myQA User's Guide - Vol.3 myQA Machines

1.4. Related Documents
This document is one volume of the myQA User’s Guide. The complete User’s Guide includes:
Vol. 1: myQA Platform and Devices
Vol. 2: myQA Cockpit
Vol. 3: myQA Machines
Vol. 4: myQA FastTrack
Vol. 5: myQA Patients
Vol. 6: myQA Accept
For general safety precautions, technical support, and contact information including complaint report
form, please see Vol. 1, myQA Platform and Devices.

myQA User's Guide - Vol. 3 myQA Machines | Introduction | 3

2. Getting Started with the Software
A typical workflow for generic QA tests, including creating a protocol from the predefined protocol
templates, executing the tasks, and generating a test report, is as following:
1. Set up the equipment (machines and measurement devices) in myQA Platform > Equipment
Setup (see Vol. 1 myQA Platform and Devices, Chapter 7).
2. Create a QA protocol by copying a predefined protocol template and adapting it to the own clinical
QA routine in myQA Machines > Test Setup (see Section 3.3).
3. Assign the protocol to a certain machine and adapt it accordingly (e.g. by changing the reference
values and tolerances, by performing baseline measurements for the Dosimetry Plugin tests, etc.)
(see Sections 3.3.4.3 and 4.5).
4. Execute the tests of the machine QA protocol in myQA Machines > Test Run.
5. Print the report in myQA Machines > Test Repository.
In the following sections, an overview over the workflow for each of these steps is provided.

2.1. Step 1 – Set up the Equipment

The machines and measurement devices are defined in myQA Platform > Equipment Setup (see Vol.
1 myQA Platform and Devices, Chapter 6 for instructions). See an example below:

The myQA Platform > Equipment Setup (example).

4 | Getting Started with the Software | myQA User's Guide - Vol.3 myQA Machines
2.2. Step 2 – Create a Protocol Template
Click the workspace selection button and then select myQA Machines (1).
Note that the machines are listed in the Machines & Templates panel (2).
Select the Edit icon (3) in the ribbon to enter the Edit mode.
Select Protocol Templates (2a) in the Machines & Templates panel and then Protocol Templates in
the Protocol Tree panel (4).
Under Protocol Templates (4a) in the Protocol Tree panel (4), select a predefined protocol template
(e.g., TG-142 General (4b)), and then click Copy (5) in the ribbon.

1
3 5
6

2a 4a

4b

2 4 7

Select Protocol Templates (4a) again and then click Paste (6) in the ribbon.
Note that the name of the new protocol template has a suffix, (n), for the nth copy of the same
protocol template (4c).

4c

(Optional) change the name of the protocol template to be specific to each machine and add some
comments to the protocol:
Select a protocol template in the Protocol Tree panel (4) and then edit the name and description in
the Definition panel (7).

Check the test parameters: select a test in the Protocol Tree panel (4) and edit it in the Definition
panel (7) if necessary, e.g. if the Result Type is Numeric, click Edit under Acceptance Criteria,
and then edit the parameters in the popup dialog (7a).

myQA User's Guide - Vol. 3 myQA Machines | Getting Started with the Software | 5
 7a
7

(The Machines & Templates panel and ribbon are hidden in this example)

2.3. Step 3 – Create a Machine Protocol

This step includes creating a protocol for a machine by assigning and adapting a protocol template and
setting it as an active protocol. Only an active protocol can be run in Test Run.
In the Machines & Templates panel (2), select a machine.
In the ribbon, click From Template (8), and then select a protocol template for this machine (8a).

8a

2 4

8b

Note that when the cursor is placed on a protocol template, its description is displayed (8b).

6 | Getting Started with the Software | myQA User's Guide - Vol.3 myQA Machines
 Select a machine protocol in the Protocol Tree panel (4), and edit its name in the Definition panel
(7) if desired.
Select a machine protocol in the Protocol Tree panel (4) and then click the Set Active icon (9) in
the ribbon so that this protocol will appear in Test Run.

10 9

2 4 7

If necessary, the acceptance criteria of tests can be still edited in the Definition panel (7).
Click the Save icon (10) in the ribbon.

2.4. Step 4 – Execute the Tests

Click the Test Run button (1) in the Main Workspace Navigation area.
In the Agenda panel (2), select the to-be-tested machine in the Machines group, and then a task in
the Active Tasks group.

1 3

Select a test in the Task View panel (3).

 For a Numerical test, enter the test value in the Actual box(es).

myQA User's Guide - Vol. 3 myQA Machines | Getting Started with the Software | 7
  For a Pass-Warning-Fail test, select an option.
 Optionally, if a note should be added/edited to a task/test, click the Edit button under Task/Test
in the Task/Test Note panel (4), and enter the text.
 Click Finish.
Repeat the steps in the Task View panel (3) until all tests are finished. Click Finish (5) in the ribbon.
Select the next task if applicable and go through the above steps until all tasks are done for this
machine.

2.5. Step 5 – Print a Report

Click the Test Repository button in the navigation area. All finished tests are listed.
Use the filters in the column header to sort the tests to be printed.
Select the tests to be printed.
 Select a test, and then while pressing down the Shift key, click another test: selects all test
between two selected tests.
 While pressing down the Control key, click a test: adds this test to the selected tests.
Click the Report icon in the ribbon.
In the Report for Selected Tests window, click one of the Export buttons to export the report with
html/rtf/pdf format or the Print button to print a hard copy of the report.

8 | Getting Started with the Software | myQA User's Guide - Vol.3 myQA Machines
3. Software Description
3.1. myQA Machines User Interface Overview
The myQA Machines window follows Microsoft Windows standards and consists of several sub-areas:
2a

1c
1a 2

1b

The myQA Machines > Test Setup (example)

1: Main workspace navigation

1a: Workspace selection button – displays the title and the icon of the currently selected workspace.
Click this button to open the dropdown list and then select the desired workspace.

1b: myQA Machines navigation panel – navigates the myQA Machines workspace via buttons. myQA
Machines consists of three navigation pages:

 Test Setup
 Test Run
 Test Repository

1c: The Workspace Navigation panel collapse button – click it to hide and show the Workspace
Navigation panel.

2: Ribbon – contains the commands of the currently selected navigation page in 1b.

2a: Ribbon collapse button – click it to hide and show the ribbon.

3: Content area – the main display area of application.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 9

3.2. General Description of a Protocol Template and
Device Protocol
The QA process in the myQA software is based on protocols. A protocol contains several tasks, each
task consisting of one or more tests.
■ The tests are the actual QA checks that have to be performed.
■ A task includes all tests that have to be performed e.g. with a certain frequency (daily, weekly,
monthly, etc.), after a machine repair, etc.
■ A protocol embodies the entire QA routine of a type of machine (linear accelerator, CT, MR,
etc.), of a specific QA standard (TG-142, DIN 6847-5, etc.), or of the own clinical QA structure.
One has to differentiate between protocol templates and machine protocols. A protocol template,
containing task and test templates, is independent from any machine. The tests within a protocol
template can only be performed after the protocol template has been assigned to an existing machine.
Through this assignment, the protocol template becomes a machine protocol, i.e. a machine protocol
belongs to a specified machine.
Note that changes applied to a machine protocol will not affect the original protocol template and vice
versa.

3.3. Test Setup

In this page, following items can be created and/or edited:
■ Protocol templates including the contained tasks and tests.
■ Machine protocols including the contained tasks and tests.
The Test Setup consists of four major parts, as depicted in the screenshot below.

2 3 4

The myQA Machines - Test Setup (example)

1: Test Setup ribbon - contains commands available in this page.
2: Machines & Templates panel - lists the Protocol Template folder and the available machines.
3: Protocol Tree panel – displays the protocols, tasks and tests in tree view.
4: Definition panel – displays the selected item in the Protocol Tree panel in detail. Some parameters
can be edited in this panel.

10 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Test Setup Ribbon and Context Menu
Test Setup ribbon

Table 3.1. Description of the Test Setup ribbon; (*) these functions are also available in context menus.

Shortcut
Group Icon name Description
key
Opens a list of clinics for selection. Only the clinics assigned
to the current user are in the list. Only the machines for the
Locations Clinics -
selected clinics are displayed in the Machines & Templates
panel.
Enters the Edit mode.
Edit - If the Edit icon is grayed out, then the page is in the Edit
mode. Otherwise, it is in the View mode.
Edit Saves the changes done in the Edit mode and switches the
Save -
page to the view mode (see Section 3.3.1.5).
Cancels the all changes done in the Edit mode and switches
Cancel -
the page to the view mode (see Section 3.3.1.5).
Paste* Ctrl + v Pastes the contents from the clipboard.
Clipboard Cut* Ctrl + x Copies the selected item into clipboard and deletes it
Copy* Ctrl + c Copies the selected item into clipboard.
In Edit mode: Creates an empty user-defined
New* Ctrl + n
Item protocol/task/test (see Section 3.3.1.2).
In Edit mode: Deletes the selected items (protocol/task/test)
Delete* Del
in the Protocol Tree panel (see Section 3.3.1.4).
Import - In Edit mode: Imports a protocol template from a XML file.
Protocol
Template In View mode: Exports the selected protocol template into a
Export* -
XML file.
In Edit mode, for a selected machine: Opens a drop-down
From
- list of available templates. The selected template is copied to
Template*
the selected machine.
Create as In Edit mode, for a selected machine: Creates a copy of the
-
Protocol Template* selected machine protocol as protocol template.
In Edit mode: Sets the selected machine protocol as the
Set active protocol.
-
Active* Note: Only tests within an active protocol can be performed
in the Test Run page.
Data Refresh - Refreshes the Test Setup data from database.
Sort by
View - Sorts the tests in the Protocol Tree by category.
Category

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 11

Context menus
The ribbon functions that are applicable to an item in the Protocol tree panel are also available in the
context menu. See the description of each context menu item and shortcut key in the table above.

3.3.1.1. View Mode and Edit Mode

In the Test Setup page, any editing can only be performed while the page is in Edit mode. To enter the
Edit mode, click the Edit icon in the ribbon. Otherwise, the page is in the View mode.

View mode
In View mode, users can view the Test Setup details and export protocol templates. No modifications
are allowed.

Edit mode
In Edit mode, protocols, tasks, and tests can be created or edited. While in Edit mode, the user cannot
switch to any other myQA Machines workspace, e.g. Test Run. Note that switching to another
application main workspace, e.g., myQA Platform, is still possible.
Only one user can edit the test setup simultaneously. If a user tries to switch to Edit mode while
another user is already in Edit mode, an information message pops up.
To exit Edit mode, click the Save/Cancel icon in the ribbon (see Section 3.3.1.5).

3.3.1.2. Create New Items

With the New icon in the Test Setup ribbon, a new item can be created according to the Protocol Tree
structure:
■ For a protocol template, clicking the New icon will create
 a new protocol template, if the Protocol Templates folder is selected,
 a task template, if a protocol template is selected (see Section 3.3.4.2 for scheduling a task),
 a test template, if a task template is selected (see Section 3.3.4.3 for defining a test template).

12 | Software Description | myQA User's Guide - Vol.3 myQA Machines

■ For a machine protocol, clicking the New icon will create
 a new protocol, if the protocol folder of the machine is selected,
 a new task, if the machine protocol is selected (see Section 3.3.4.1 for scheduling a task),
 a new test, if a task within the machine protocol is selected (see Section 3.3.4.1 for defining a
test).
After a new item is created, it will be automatically selected in the protocol tree for further editing.

3.3.1.3. Cut, Copy and Paste

Protocols, tasks and tests can be cut/copied and pasted. This can be performed within the Protocol
Templates folder, within the same machine as well as between different machines.
When performing cut/copy and paste on a test setup item, the substructure of the item will be
preserved, e.g. a task will be copied and pasted with all the tests it contains. Also, the defined hierarchy
protocol  task  test has to be respected, i.e. a task cannot be pasted into another task, it has to be
pasted into a protocol.
The extent to which a protocol will be copied from one machine to another, depends on the type of the
tests belonging to the protocol and on the degree to which the properties of the source and target
machine (i.e. energies, wedge angles, etc.) are matching.
■ Non-dosimetry tests
The setup of non-dosimetry tests is not directly linked to the machine properties. Therefore, these
tests will be fully copied (i.e., including description, expected values, tolerances) between two
machines, regardless of differences between the machine properties.
■ Dosimetry tests
The setup of dosimetry tests is directly linked to the machine properties. Evidently, if a test is directly
linked to a certain machine property, it cannot be copied to a machine that doesn’t have this
property. A detailed description of the workflow in this cases is given in Section 4.5.2.

Recovering the cut item after cancelling the paste action

Select an item (e.g., a Test Definition) in a Protocol of Machine 1 and click the Cut function in the ribbon
or context menu, and then click Paste in Protocol Machine 2. If Machine 1 and Machine 2 are different
types or models, a warning message pops up:

By clicking the Cancel button, the cut item will not be recovered in the Protocol of Machine 1. However,
the cut item is still in the clipboard and can be pasted back to the Protocol of Machine 1 using the Paste
function in the ribbon or context menu,
Be aware that the clipboard is overwritten when another cut or paste action is done or emptied when
the save/cancel is executed.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 13

3.3.1.4. Delete
In Edit mode, select one or more Test Setup items (protocols/tasks/tests), then click the Delete icon in
the ribbon or in the context menu; the selected items will be deleted.
Note that if the active machine protocol is deleted, even if there is another protocol assigned to this
machine, it will not be automatically set as active. This has to be done manually. A protocol must be set
as active in the Test Setup so that it can be run in the Test Run (see also Section 3.3.3.3).

3.3.1.5. Save or Cancel

By clicking Save or Cancel in the ribbon, all changes will be saved or discarded and the page will be
switched to View mode.
Note that changes in the test setup cannot be saved if there are unsolved error indications (see Section
3.3.5).

Machines & Templates Panel

The Machines & Templates panel contains the machines defined in myQA Platform > Equipment
Setup. Only machines belonging to the selected clinics under Locations > Clinics in the Test Setup
ribbon are displayed. If a machine is not displayed in the Machines & Templates panel, please check
in myQA Platform > User Administration > User Management > Edit User > Site Management,
whether the clinic to which the machine belongs has been assigned to the current user.
This panel contains also the Protocol Templates folder. By default, there are two pre-configured
protocol templates in this folder (see Section 3.3.3.2 for more details):
1. TG-142 General,
2. TG-142 + PlugIn.
The tasks and tests of a protocol template are independent from an actual machine.
Clicking the left vertical bar will display/minimize the Machines & Templates panel.
Note: In Edit mode, any changes done in the myQA Platform > Equipment Setup page will only be
updated in the Machines and Templates panel after a Save or Cancel action in the Test Setup
page. This is designed to prevent data loss due to changing machines.

Protocol Tree Panel

If an item (the Protocol Templates folder or a machine) in the Machines & Templates panel is
selected, the protocols of this item including their tasks and tests will be displayed in a tree view in the
hierarchy order of protocol  tasks  tests.
A protocol contains tasks which define e.g. the frequency for performing certain QA tests; a task
contains a set of tests that define the parameters, e.g., reference values, tolerances etc., according to
applicable QA standards, e.g., TG-142.

3.3.3.1. Protocol Template / Machine Protocol

A protocol template / machine protocol is identified by a name and optionally a description. To see a
protocol:
Select the Protocol Templates folder or a machine in the Machines & Templates panel (2).

14 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Select a protocol in the Protocol Tree panel. The tasks and test are displayed (3). The name and
description are displayed in the Template / Definition panel (4).

3 4

Protocol
Task
2

Test

The myQA Machines - Test Setup (example - displaying a protocol of a machine)

A protocol template/machine protocol can contain one or more tasks and a task can contain one or
more tests.

Create a new protocol template

A protocol template can be created by
■ using the New command in the ribbon (see Section 3.3.1.2)

■ copying an existing one:

 Select an existing protocol template, and then click Copy in the ribbon
 Select the Protocol Templates folder and click Paste in the ribbon
■ creating one from an existing machine protocol:
 Select an existing machine in Machines & Templates
 Select a protocol of the machine and click Create as Template in the ribbon

Create a new protocol for a machine

A new protocol for a machine can be created by

■ using the New command in the ribbon (see Section 3.3.1.2)
■ creating one from an existing protocol template:
 Select the machine in Machines & Templates
 Click From Template in the ribbon
 In the drop-down list, select the protocol template that is supposed to be assigned to the machine
■ Copying an existing machine protocol:
 Select an existing machine in Machines & Templates
 Select a protocol of the machine and click Copy in the ribbon
 Select the machine the protocol shall be assigned to, click Paste in the ribbon
Remember that machine protocols must be adapted to the machine they are assigned to.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 15

3.3.3.2. Predefined Protocol Templates
In the myQA software, two predefined protocol templates are provided:
■ TG-142 General
It implements the daily, weekly, monthly and yearly QA procedures for a linear accelerator, as
recommended by the AAPM Task Group 142 Report: Quality Assurance of Medical Accelerators
(2009). Users are required to perform the tests separately, and then enter test results into the protocol.
Note: A test requiring to enter directly the test results into the protocol is called generic test.
■ TG-142 + PlugIn
It contains the tests of TG-142 General and additional Plugins for Dosimetry QA, MLC QA, kV/MV
Imaging QA and IsoCheck tests.
In the predefined protocols, a short description and hints for each test are provided in the Description
box of the Test Template.

3.3.3.3. Active Protocol

Each machine can have more than one protocol assigned to it. However, in order to be executable in
Test Run, a protocol must be active. In Edit mode:
Select a protocol in the Protocol Tree panel
Click the Set Active icon in the ribbon
The active protocol is labeled with a yellow light bulb on the right side.
An active protocol can be changed to inactive by selecting it (in Edit mode) and then clicking the Set
Inactive icon in the ribbon or by setting another protocol as active.

16 | Software Description | myQA User's Guide - Vol.3 myQA Machines

Note: Once protocol was set to active, it is in the in-process state, i.e. it is scheduled. Changes in the
tasks/tests of the protocol will not be applied to the already scheduled tasks in Test Run.

Template / Definition panel

Items selected in the Protocol Tree panel can be defined in the Definition panel. Here, also the name,
description and some properties of the item can be edited.
As depicted in the table below, the titles of the items differ in the Definition panel.

Table 3.2. Possible titles in the Definition panel

Item Title
Protocol template Protocol template
Protocol template Task template Task template
Test template Test template
Protocol Protocol Definition
Protocol Task Task Definition
Test Test Definition

3.3.4.1. Protocol Definition

A protocol is defined by a name and a description, the latter being optional. As depicted in the
screenshot below, the default protocol templates TG-142 General and TG-142 PlugIn have a
predefined description, providing information about source (i), frequency (ii) and nature (iii) of the
implemented tests.

ii

iii

iv

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 17

The user also has the possibility to attach different objects to the protocol description (iv). Section
3.3.4.5 provides a detailed description of the objects that can be attached and the corresponding
workflow.

3.3.4.2. Task Definition

A task is defined by a name, a description and a recurrence pattern.
The task description is optional. The task templates in the default protocol templates TG-142 General
and TG-142 PlugIn have predefined descriptions according to AAPM TG-142 (see the example in the
screenshot below).

ii
iv

For daily and weekly QA

For monthly and annually QA

iii
Calendar

The recurrence pattern is crucial for the tests belonging to the task, since it determines the schedule
based on which the tests shall be executed in Test Run.
The different possibilities to set the recurrence pattern are depicted in the screenshot above:
■ Tests that are no specific recurrence pattern: select None (i).
■ Tests that have to be performed with a certain frequency can be summed up tasks with the
recurrence pattern according to this frequency. The set up of the recurrence is fully flexible. For
example, in the default protocols TG-142 General and TG-142 PlugIn following tasks are defined:
 Daily QA: every week in combination with every weekday
 Weekly QA: every week in combination with any day of the week
 Monthly QA: every month on the first/second/etc. (ii) weekday/Monday/etc. (iii) of the month
 Annually QA: every 12 months on the first/second/etc. (ii) weekday/Monday/etc. (iii) of the month.
When a task is scheduled, the first due date which fits to the recurrence pattern should be set as start
date. It can be directly entered into the Start Date text box or selected using the calendar. Otherwise,
the current date is set as the start date by default.
The user also has the possibility to attach different objects to the task definition (iv). Section 3.3.4.5
provides a detailed description of the objects that can be attached and the corresponding workflow.

18 | Software Description | myQA User's Guide - Vol.3 myQA Machines

3.3.4.3. Test Definition
3.3.4.3.1. General Properties of a Test
General properties of a test are defined when the test is created.
In the Edit mode, select a task or a task template, and then click New in the ribbon. The New Test
Definition dialog opens:

iii ii

In the New Test Definition window, following positions are available:

■ Name
■ Description
The description of the test is optional. By default, the description field contains recommendations on the
information that the test description should contain.
■ Category
This informational parameter provides an overall classification of the test. Predefined categories are (i):
 CBCT kV/MV,
 Dosimetry,
 Mechanical,
 MLC,
 Planar kV,
 Planar kV/MV,
 Planar MV (EPID),
 Patient Positioning/Respiratory Gating,
 Safety,
 Wedge,
 Other.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 19

■ Result Type
The predefined result types (ii) determine the general structure of the test and specify the machine
property that will be checked. The result types Numeric and Pass/Fail are generic and applicable to
different QA tests according to the needs of the user.
■ Implementation
The test implementation is directly connected to the result type. Depending on the machine property to
be checked, it defines the test parameters and set up and the algorithms for calculating the test result.
In the current version, there is one implementation for the corresponding result type.
■ Acceptance criteria
Acceptance criteria, as for example expected values, warning and error tolerances, etc., are available in
the New Test Template dialog only if the selected result type requires a direct entry. This applies, e.g.,
for tests delivering numerical results. For tests requiring algorithm-based analysis, e.g., tests belonging
to the MLC Plugin, the acceptance criteria can be set up within the Plugin.
■ Attachments
The user has the possibility to attach different objects to the test definition (iii). Section 3.3.4.5 provides
a detailed description of the objects that can be attached and the corresponding workflow.

3.3.4.3.2. Create a Test Template / Test

Create a test template
Click Edit in the ribbon to enter the Edit mode.
Select a task template under a protocol template in the Protocol Tree panel.

• Create a test template from a predefined template:

o Select a test template and then click Copy in the ribbon or the context menu.
o Select a task template and then click Paste in the ribbon or the context menu. The selected
test template will be copied under this task template.
o For test templates generated by copying a predefined template, only the existing acceptance
criteria can be edited by clicking the Edit button.

20 | Software Description | myQA User's Guide - Vol.3 myQA Machines

• Create a test template using the New command:
o Select a task template and then click New in the ribbon or the context menu.
o Enter the name and select the appropriate Category, Result Type/Implementation from the
corresponding dropdown lists. If a test has numerical results, the tolerance fields will appear
after selecting the Result Type. For Dosimetry Plugin test, in addition, the inline and crossline
field sizes are also required to be defined
o Enter/edit all required parameters. Tolerances for the Acceptance Criteria can be edited,
added, and deleted using the corresponding buttons

Add
Click the Add button to open the Add dialog:

Enter/select the proper parameters in the dialog and click Add.

Edit
Select a tolerance, and then click the Edit button to open the Edit dialog:

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 21

 Edit parameters in the dialog and click Save.

Delete
Select a tolerance, and then click Delete.

Create a test
In the Edit mode, select a task under a machine protocol in the Protocol Tree panel.
 Create a test from an existing test:
o Select a test and then click Copy in the ribbon or the context menu.
o Select a task template and then click Paste in the ribbon or the context menu. The selected
test will be copied under this task template.
o The acceptance criteria can be edited by clicking the Edit button in the Test Definition panel.
For a test, the Category and Result Type of a test are shown in the upper-right corner of the Test
Definition panel and cannot be edited. However, the acceptance criteria can be changed. For
Dosimetry Plugin tests, reference baselines are required to be defined if not yet available. See
Section 4.5.1 for defining the baselines for the Dosimetry Plugin tests.

22 | Software Description | myQA User's Guide - Vol.3 myQA Machines

  Create a test using the New command:
o Select a task under a machine protocol and then click New in the ribbon or the context menu.
The New Test Definition dialog opens.

o Enter/edit all required parameters. Tolerances for the Acceptance Criteria can be edited,
added, and deleted using the corresponding buttons. See details in the Create a test template
section above.
Note that tests created from the New command can be also edited, added, and deleted in the
Test Definition panel
By clicking OK, the test will be displayed in the Test Definition panel. Some parameters can be
edited in Definition panel see Section 3.3.4).

3.3.4.4. Spell Check

myQA provides a spell check function for the text in the description panel of protocols, tasks and tests.
The spell checking is available for the following languages:
■ English
■ French
■ Spanish
■ German
The language can be set in the Spell Checker Settings in myQA Platform:

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 23

As depicted in the screenshot below, misspelled words are marked by a red wavy underline. A right
click on the marked word opens the spell checker drop down menu. The user has the opportunity to
choose one of the offered alternatives (i). Missing alternative(s) means that the word is not in the
dictionary. The user can either add the word to the dictionary (ii) or ignore it in the spell check (iii). In
both cases, the word will be unmarked.

ii
iii

Note: The changes made to the dictionary by adding new words are user based.

3.3.4.5. File Attachments

In the definition panel, the user has the possibility to provide information about the protocol, task, and
test by editing the description field. However, in order capture the entire knowledge based picture of the
QA system, the user has the opportunity to attach different objects to the protocol, task, test, such as
standard operating procedures, instruction manuals of software and measurement devices, technical
notes, instructional movies, links to files or applications, etc. The attachments can be
■ any kind of files
■ shortcuts to files, folders, applications, etc.
■ URL links
Note: The attachments are saved in the myQA database. Thus, to save database space, it is
recommended to attach shortcuts to files rather than the files themselves.

Create a URL link shortcut

Method 1:
In a location (e.g., a folder) where the shortcut should be located, right click on any empty area,
select New, and then Shortcut:

24 | Software Description | myQA User's Guide - Vol.3 myQA Machines

Enter the URL and then click Next:

Enter the name of the URL, and then click Finish.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 25

Method 2:
In an internet browser, add your URL link into the list of bookmarks (“Favorites” in Internet Explorer
browser)
Open the Bookmarks (or Favorites), drag and drop one of the bookmarks to a desired location.
Note that the bookmark can be directly attached to myQA by dragging and dropping into the drop-file
area (i) in myQA in Edit mode (see Attach an object below).

Attach an object
In Edit mode, drag and drop an object (file, shortcut, or URL link) with mouse into the drop-file area
(i), or
click the Attach icon (ii) and browse the computer for the object.
The attached object will appear below the drop-file area (iii). The attachments are ordered by date of
addition with the most recent at the top.

ii
i

iii
iv v

Delete an attachment
Click the Delete icon (iv).

Open an attachment
In Edit mode, click the Open icon (v).

26 | Software Description | myQA User's Guide - Vol.3 myQA Machines

In View mode, the attachments are available over direct links. Note that attachments are opened in
read-only mode and thus modifications will not be saved in the database.

View mode

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 27

 Error Indication
If an entity has validation errors, the relevant items will be highlighted with a red exclamation icon. For
example, when assigning a protocol template containing Dosimetry Plugin tests to a machine, it cannot
be used until the baselines are measured in the Test Definition panel. As long as the reference values
have not been define, the related task, protocol, and machine are highlighted:

Note: Changes in the Test Setup cannot be saved as long as validation errors have not been resolved.

28 | Software Description | myQA User's Guide - Vol.3 myQA Machines

3.4. Test Run
If the Test Setup is in View mode, Test Run can be opened by clicking the Test Run button in
Navigation Panel area. The Test Setup consists of four main parts. See an example below, 1: Test
Run ribbon, 2: Agenda panel, 3: Task View panel, 4: Task/Test info panel.

3 4

Test Run Ribbon and Context Menu

Test Run ribbon

Table 3.3. Description of the Test Run ribbon

Group Icon name Description

Opens a list of clinics for selection. Only the clinics assigned to the
Locations Clinics current user are in the list. Only the tasks for the selected clinics
are displayed
Active Add
Click and then select to add a task
Tasks Unscheduled
Skip Skips the selected task
Task
Finish Finishes the task (see Section 3.4.6)
Skip Skips the selected test
Test
Reset Resets a selected executed test to the not-started test status
Override Status Overrides the test status
Do not group No grouping for the tests
Group by
View Groups the tests by their categories (Dosimetry, Safety, …)
Category
Group by Status Groups the tests by their status (Pass, Fail, Not started, …)
Data Refresh Refreshes the data display

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 29

Context menus

The ribbon functions can be also accessed via a context menu. Right-click a listed item to open a
context menu containing available functionality. Only applicable ones are enabled. For example, right-
click anywhere on an unfinished test, only Skip is enabled; whereas on a finished test, Reset and
Override Status are enabled.

Context menu for adding an unscheduled task from a machine protocol

Context menu for an active task

Context menu for an unfinished test

Context menu for a finished test

30 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Agenda Panel
The Agenda panel gives an overview of the active and upcoming QA tasks.
To hide/display the Agenda panel, click the area close to the left vertical edge.

Machines:
i: Name of the machine
ii: Name of the active protocol
iii: Number of the tasks in the protocol

i ii iii

Active Tasks:
i: Name of the task
ii: Task due date
iii: Number of executed tests/number of tests

i ii iii

The Agenda panel of the Test Setup window (example)

Machines:
The Machines group shows the machines as configured in the Equipment Setup including the active
protocol and the number of tasks in this active protocol.
By right-clicking a machine, if the machine has an active protocol, a context menu with Add
Unscheduled Task command will appear. A task in this protocol can be selected as unscheduled task
and listed in Active Tasks (see screenshot below left).

Machine context menu Active task context menu

Active Tasks:
The Active Tasks group displays the active tasks of the selected machine if they are not yet finished
within the current scheduling interval and the unscheduled Tasks.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 31

Right-click a task; the context menu opens (see screenshot above right).

Table 3.4. Description of active task context menu

Icon Icon name Description

Skip* Skips the task

Skip All Overdue Skips overdue task

Finish* Opens the Finish Task dialog. See Section 3.4.6

Reschedule Opens the Reschedule Task dialog. See detail below.

*Also available

Reschedule Task dialog:

Name of the task to be reschedule

Calendar

Selected new schedule

Click the calendar and select a new date for the task and then click OK.
The reschedule action will be automatically shown in the Note of the Finish Task dialog (See
Section 3.4.6).

By placing the cursor on a machine/task, a tooltip appears and displays information of this item.

32 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Task View Panel
The Task View panel shows the tests of the selected active task and allows performing the tests.

Task name
Due date Protocol Name

Hide/display the grouped tests if the tests are grouped

Test name
Category

Test execution date Operator

Task View panel with example: the tests are grouped by Category
The Task View panel has the following features:
■ The test category is shown under the test name.
■ The test status is shown with the following symbols:

: Not yet executed test

: Skipped test

: Executed test, result: passed

: Executed test, result: warning

: Executed test, result: failed

For the executed tests, the operator and execution date are also displayed.
■ Grouping the tests into different sub-lists:
 Click Group by Category in the View group of the Test Run ribbon, the test list will be divided
into several lists based on the category. The tests having the same category will be in the same
list.
 Click Group by Status in the View group of the Test Run ribbon, the test list will be divided into
several lists based on the test status: Not Started, Skipped, Pass, Warning, and Fail.
For above two groupings, the list can be hidden or displayed by clicking the row of the list name.
 Click Do not group in the View group of the Test Run ribbon, there is only one list according to
the order in the protocol. All tests are displayed.
■ By clicking a test, the detail test view is displayed. The operations described in the next section are
available.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 33

Execute a test

Clicking a not-started test to display its detail view.

For a Numeric test, type in the actual test value into the Actual box. The State box will automatically
update according to the Acceptance Criteria. Then click Finish.

If the measured result should take the average of several measurements, click the Calculator button,
enter all results, and then click Apply Result, the average will be entered into the Actual box.

For a Pass/Warning/Fail test, click the Pass, Warning, or Fail button according to the rest result.

Test/task executions will be saved every time when the test/task execution status changes.

Override a test status

Status of a test can be overridden using the Override Status command in the Test group of the ribbon.
Select a performed test; click Override to open the Override Test Result dialog.

Select the desired status from the Override with dropdown list, enter a note optionally, and then
click Override.

Skip a test
Select a test in the Task View panel, click Skip in the Test group of the ribbon.

34 | Software Description | myQA User's Guide - Vol.3 myQA Machines

Reset a test
Select an executed (skipped or finished) test in the Task View panel; click Reset in the Test group of
the ribbon.

Task/Test Info Panel

Task/Test Info panel
In the Task/Test Info panel, click the Task/Test button, a textual note can be typed in the Edit
Task/Test Note dialog, and then click the Save button. The Task/Test Note will appear in the task/test
detail view.
To hide/display the Task/Test Info panel, click the area close to the right vertical edge. To hide/display
the Task/Test detail view, click the Task/Test title (top) bar.

Click the Edit button of Attachments to display the attached files or enable the attachment editing:

Attach a file: dag a file to the Dag files here area or click , and then browse and open the file.

Delete an attached file: click its .

Open an attached file: click its .

Clicking the Edit button again will save the attached files to the database.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 35

 Skip a Task
If one or more tests have not been performed according to the planned schedule, the task to which they
belong will be highlighted (i) as overdue in the Active Tasks panel (see picture below).

ii

Overdue tasks can be removed from the Active Tasks list by right clicking on an overdue task and
choosing one of the three alternatives provided in the drop-down menu (ii):
■ Skip,
■ Skip All Overdue, or
■ Finish.
The procedure of finishing a task will be discussed in the next section.
To skip a single overdue task,
select the task in the Active Tasks panel, click Skip in the context menu or in the ribbon; the Skip
Task dialog opens (see screenshot below). Enter a comment in the Note box if desired, and then
click Skip. If the task contains unfinished tests, a warning is displayed in the dialog.

If a scheduled task has not been performed more than once, than only the oldest overdue task will be
displayed in the Active Tasks panel. Also, only the oldest overdue task will be affected by the Skip
function. Subsequently, the second oldest overdue task will be displayed in the Active Tasks panel.
To skip all overdue tasks,
select the task in the Active Tasks panel, choose Skip All Overdue in the context menu; the Skip
Task dialog opens (see screenshot below). Enter a comment in the Note box if desired, and then
click Skip. If the tasks contain unfinished tests, a warning is displayed in the dialog.

36 | Software Description | myQA User's Guide - Vol.3 myQA Machines

The skipped tests will be documented in the Test Repository.
Note: If the test setup is changed, overdue tasks cannot be deleted during the recreation of the tasks.
If an overdue task should be performed with the new values of the test setup, first, skip this
overdue task, and then create a new task and set it as an unscheduled task.
Skip an overdue task if it is not valid any more due to the changes of the test setup.

Finish a Task
Select a task in the Agenda panel, click Finish in the Task group of the ribbon; the Finish Task
dialog opens.
Enter a comment in the Note box if desired, and then click Finish.

Status according to tests:

By default, the task status is concluded based on the status of the tests:
 If at least one test has the status failed, the task status is Failed.
 If at least one test has the status warning, and no tests has the status fail, the task status is
warning.
 Only if all tests are passed, the task status is Passed.
 Tests with status skipped have no influence on the task status.
If there are unfinished tests, a warning message will appear in the Finish Task dialog and the
unfinished tests will be set to Skip.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 37

Override Status:
Status of a task can be overridden by selecting the Override status check box and then the desired
status in the dropdown list.

Due next:
It shows the next due date of the task execution.
Warning display:
If the task contains unfinished tests, by clicking Finish in the ribbon, the unfinished tests will be set to
Skipped; a warning describing the situation is displayed in the dialog:

IM PO RT ANT N O T IC E
WRONG STATUS OF MACHINE
Accidentally finish of a task before all tests are executed, or incomplete/wrong
tasks may lead to incorrect conclusion for the status of a machine.

C AUT IO N
INACTIVE FUNCTIONAL MACHINE
An incomplete or wrong task leads to inactive functional machine.

38 | Software Description | myQA User's Guide - Vol.3 myQA Machines

3.5. Run an Imported Excel Spreadsheet Test
myQA can perform a test of numerical result type with the to-be tested parameters in an Excel
spreadsheet. An Excel template for one kind of tests is required to map the values in an Excel
spreadsheet to the corresponding acceptance criteria in the protocol.
General procedure to run an imported Excel spreadsheet test:
In the Test Setup page, create a machine protocol for the test (Section 3.5.1)
Create an Excel template and map each parameter to the corresponding acceptance criteria in the
protocol (Section 3.5.2). This template will be used for the same type of tests
Create an actual parameter table for the test. It may be convenient to put the data tables of the
same kind of tests and the related template in one folder.
Run the test in the Test Run page (Section 3.4)

Create a Machine Protocol

Note: To use an Excel spreadsheet for testing, the Result Type must be “Numeric”.
See Sections 3.3.3 and 4.5 for the detail instruction of creating a protocol.
Create a protocol template in the Test Setup page so that it can be used for different machines
later.
 Click Edit in the ribbon.
 Select Protocol Template in Machines and Template and the Protocol Tree panels.
 Click New in the ribbon.
 Select “Numeric” for the Result Type.
 Enter acceptance criteria.
See an example below:

Create a machine protocol:

 Select a machine in the Machines & Templates panel. Click From Template and then select
the template created in the previous step.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 39

  Edit the protocol as needed.
Set the protocol active by clicking selecting it and then click Set Active.

Map the Excel Template to the Acceptance Criteria

The following screenshots show an Excel template on the left and an Excel spreadsheet on the right.
The Excel spreadsheet hereby contains the values of actual parameters for the protocol created in the
previous section.

Excel template Excel spreadsheet with to-be-tested parameters

In this example, cell A1 is reserved for the date. The orange and green cells contain measured raw
values, whereas the yellow cells contain calculated averages, which are the result of Excel formulas.
Each average value will be mapped to the corresponding acceptance criterion in the Test Run page for
QA test. The following section will outline the steps necessary to map cells to acceptance criteria in
myQA.

Mapping parameters
In the Test Run page, right-click anywhere in the row of the acceptance criteria, except for the
Actual text field and then select Copy in the context menu, or press the Shift key and left-click in
the Actual text field to generate and save an identifier to the clipboard. The identifier is later on used
to map cells to conditions in myQA.

40 | Software Description | myQA User's Guide - Vol.3 myQA Machines

To map a reference date, right-click the date picker button of the calendar control next to the
Reference Date textbox and then select Copy.

W AR NI NG
ENSURE CORRECT MAPPING
It is the user’s responsibility that the relevant cells in the Excel template are
correctly mapped to the corresponding acceptance criteria in the Test Run page.

There are two ways to map the identifier to a cell in the template:
 Select the cell (1) to be mapped, press Control + V and then Enter the Name Box (2) on the
upper left of Excel.

 In the Excel template, right-click the cell to be mapped (A1 in this example), and select Defined
Name…. In the Name box of the opened New Name dialog, press Control + V and then click
OK.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 41

 Repeat the above steps to map all parameters to its acceptance criterion.
A cell identifiers consists of three parts:
myQA_6FFFMVAverage_PhotonsEnergy (example)

Prefix Dimension of the parameter

Name of the acceptance criterion

The maximum length of cell name that is supported by Excel is 254 characters. If the acceptance
criterion name contains characters, which are not allowed by Excel, e.g., #, /, etc., they will be
converted into ASCII hexadecimal numbers during the generation of the identifier.
Note: Cell identifiers in a spreadsheet template must be unique.
Note: When entering the values in the Excel spreadsheet, ensure that they have the same units as the
unit settings in myQA Platform > Options > Platform > Site > Units.

Editing or deleting defined names in the Excel template

In the opened template, click Name Manager in the FORMULAS tab in the ribbon:

42 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Select name in the Name Manager dialog, use the Edit or Delete button for editing or deleting
defined names

Performing a Test
The Excel template and spreadsheet files must be closed to be used in Test Run page.

Click the Import button , and then select the spreadsheet to be tested in the open file browser.

If the template and spreadsheet files are in the same folder and only one template file is in this
folder, no second open file browser to query for the template will appear. The SW will automatically
use the only template present in the folder for the mapping during import.
If there are more than one template or no template in the folder, the browser will open for selecting a
template.
The Import Result dialog will open and report the import status.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 43

 If some parameters cannot be imported, e.g., due to wrong mapping, click the Detail button to see
which parameters could not be imported.

As other myQA tests, the test results are shown in the Status column. The imported parameters are
shown in the Actual column:

W AR NI NG
CHECK MAPPING WHEN USING THE TEMPLATE THE FIRST TIME
To ensure that the mapping in the template is correct. It is recommended to
check the values in the Actual column against those values in the original table
when using the template the first time.

44 | Software Description | myQA User's Guide - Vol.3 myQA Machines

3.6. Test Repository Page
The Test Repository displays a table of the executed tests including the test names, categories, tasks,
machines, protocols, finishing date, operator, and result on the left. If a test is selected, the detail
information about this test is shown in the info panel on the right.

Test Repository page

Ribbon and Context Menu

Test Repository Ribbon:

The Test Repository ribbon contains a set of predefined filters to easily sort and identify the tests that
are documented in this page. The table below contains the description of the icons in the Test
Repository ribbon:

Table 3.5. Description of the Test Repository ribbon

Group Icon name Description

Opens the list of available clinics for selection. Only the
clinics assigned to the current user are listed. In the
Locations Clinics
result table, only the tests for the selected clinics are
displayed.
Opens a list of available machine categories as defined
in the Equipment Setup in myQA Platform. Only tests
Equipment Category
performed on machines belonging to the selected
categories are displayed in the result table.
Opens a list of available machine types as defined in
the Equipment Setup in myQA Platform. Only tests
Type
performed on machines belonging to the selected types
Equipment are displayed in the result table.

Manufacturer Opens a list of available machine types as defined in

the Equipment Setup in myQA Platform. Only tests

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 45

 Group Icon name Description
performed on machines belonging to the selected types
are displayed in the result table.
Skipped Only skipped tests are displayed in the test table.
Passed Only passed tests are displayed in the test table.
Status Failed Only failed tests are displayed in the test table.
Only tests with the result type Warning are displayed in
Warning
the test table.
Only tests finished in the last seven days are displayed
Last 7 Days
in the test table.
Only tests finished in the last four weeks are displayed
Last 4 Weeks
in the test table.
Only tests finished in the last six months are displayed
Last 6 Months
Time Range in the test table.
Only tests finished in the last twelve months are
Last 12 Months
displayed in the test table.
Opens a menu where the user can choose a time
User defined range. Only tests finished in the set time rage are
displayed in the test table.
Opens the dropdown menu providing three printing
Reporting Report
styles. See Section 3.6.4.
Refresh Updates the data display in the Test Repository page.
Data Deletes the selected task in the Test Repository
Delete task
workspace.

Please note that the filters in the Test Repository ribbon can be combined and are stored on a per
user basis to the database.

Sorting the Listed Items

The values of parameters are organized in columns. By default, the data are arranged according to the
time that the tests were performed: the oldest one on the top and the latest on the bottom.
By clicking the name of a column in the head cell, the data of this column is sorted in alphabetic order.
The rest of the columns will be arranged accordingly.

Display Filter
By clicking the filter icon on the right of a column head cell, the Filter dialogue for this column will open.
The items of this column can be selected for display. The rest of the column will automatically update
accordingly.
There two kinds of filters:
■ Number filter: Finishing Date and Result columns. The numbers with exact format are used for
filtering. It is more convenient to use the range filters (IsLessThan / IsLessThanOrEqualTo /
IsGreaterThan / IsGreaterThanOrEqualTo). The filter contains “IsEqualTo” is only valid if the
compete number is correctly entered.

46 | Software Description | myQA User's Guide - Vol.3 myQA Machines

 Note that for the Result column the numeric equivalents of the result are,
Skipped = 30
Passed = 40
Warning = 50
Failed = 60
■ Item-name filters: the rest of the columns use the names of items for filtering. The filters are free-text
fields, i.e., part of the name can be also used for filtering.

Print a Report

3.6.4.1. Print Procedure

Go to the Test Repository page.
Select the tests to be printed.
 Select a test, and then while pressing down the Shift key, click another test: selects all test
between two selected tests.
 While pressing down the Control key, click a test: adds this test to the selected tests.
 Select all tests in the list by pressing Control key + A
Click the Report icon in the ribbon and select one of the printing styles in the dropdown list or by
right clicking on the table of executed tests to open the respective context menu.

Table 3.6. Report styles

Report Description
Report Summary A4 Provides a list of protocol/task/test names of
Report Summary Letter the selected tests in A4 /Letter paper format.
Provides a detailed description of the selected
Report Detailed
tests.

In the Report for Selected Tests window, click one of the Export buttons to export the report with
the desired format or the Print button to print a hard copy of the report.

myQA User's Guide - Vol. 3 myQA Machines | Software Description | 47

3.6.4.2. Report for Selected Tests window
Example of a summary report:

Table 3.X. Description of the commands in the Report for Selected Tests window

1 2 3 4 5 6 7 8 9 10 11 12 13 14
Command Icon Description
Navigate back in history 1 Navigates back in history
Navigate forward in history 2 Navigates forward in history
Stop 3 Stops a running action
Refresh 4 Refreshes the report view
First page 5 Goes to the first page
Previous page 6 Goes to the previous page
Current page 7 Shows the page number of the displayed page
Total page 8 Shows the total page number
Next page 9 Goes to the next page
Last page 10 Goes to the last page
Opens the Page Setup dialog for setting up paper, size,
Page Setup… 11
source, orientation, and Margins
Switch to print preview 12 Shows the print preview
Print report 13 Opens the Print dialog for printing
Opens the export format menu for selecting one format to
Export 14 export the report. The formats include PDF, Excel, Rich Text,
TIFF, Web Archive, and XPS Document.

48 | Software Description | myQA User's Guide - Vol.3 myQA Machines

4. Dosimetry QA Plugin
The Dosimetry QA Plugin provides fully integrated dosimetry QA process. The reference measurements
are integrated in the test-setup step and the QA measurements are integrated in the test-run step. The
supported measurement devices are the StarTrack detector, the MatriXX detector and the Dolphin
transmission detector. With the Dosimetry QA Plugin, several tests with the same configuration can be
performed in one measurement.
There are four Dosimetry QA test types in this Plugin:
■ Energy Constancy
■ Output Constancy
■ Profile Constancy
■ Wedge Constancy
For every test type, a setup containing reference measurements (baselines) and test acceptance
criteria (tolerance value, tolerance band, etc.) will be defined first in Test Setup. The QA tests can be
then performed in Test Run.

C AUT IO N
THE SAME SETUP FOR BOTH TEST SETUP AND TEST RUN
The measurement setup in test setup and test run must be the same. It is
recommended to describe the test procedure and indicate the following
parameters in the Description box of the Test Definition dialog (see Section
4.5):
■ Field Size
■ Energy
■ Gantry Angle
■ Detector type
■ Detector orientation
■ Detector build-up /depth.

IM PO RT ANT N O T IC E
ASSIGN TEST PARAMETERS
Only the person who is responsible for QA can define the parameters of the
tests. The parameters given in the user manual are only examples .

IM PO RT ANT N O T IC E
THE OUTPUT CALIBRATION SHOULD NOT BE OLDER THAN THREE
MONTHS
If the output calibration is older than 3 months, the SW will display a warning. It
is recommended to perform the Output Calibration again.

About FFF beam analysis

In the current SW version, the analysis method for the penumbra calculation for FFF beams (see
Section 5.2, Vol. 6) is sensitive to the correctness of device positioning. In addition, to ensure correction
results, the field size is limited to 20 cm × 20 cm.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 49

It is recommended to use the FFF analysis method for analyzing the profiles of FFF beams. A warning
sign appears next to the name of the analysis method if a non-FFF analysis method is chosen for a FFF
frame. Users should be cautious about results.

4.1. General Description of Dosimetry QA Tests

Profile Constancy
With the Profile Constance analysis, up to four profiles can be analyzed in an open field simultaneously:
■ Inline Profile (1)
■ Crossline Profile (2)

■ Diagonal Profiles (3) and (4)

However, with the Dolphin detector, only profiles for photon beams can be measured.

1 1
1

2 2
2

4 3 4 3
4 3
 
(a) (b) (c)

Profile coordination of StarTrack (a), MatriXX (b) and Dolphin (c).

Various parameters, e.g. field width, penumbra, symmetry, flatness, are computed according to
predefined active protocol with selected analysis method, e.g. DIN, IEC-60976, etc.
By specifying tolerances, you can verify your existing reference values when repeating the
measurement process. A status display (Passed/Warning/Failed/Skipped) shows immediately whether
the measurement has been performed successfully within the defined tolerances.
Note: The Dolphin profiles are rescaled from SDD to SAD before the analysis parameters are
calculated. The rescale is a simple geometry projection, without fit or artificial changes of the
detector response. The main inline, crossline as well as the diagonal profiles are automatically
saved in the myQA database as raw data.
Note: Due to the size limitation of the device, field size for the Dolphin profile analysis should not
exceed 35 cm × 35 cm.

50 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

 Principle of Energy Constancy Analysis
The energy constancy check uses the StarTrack or MatriXX detector together with a dedicated build-up
plate: one for photon beams (Co60, 4 MV to 18 MV) and the other for electron beams (6 MeV to 21
MeV).
In the electron plate, the eight sunken metal cylinders provide eight different depths (see photo,
Electron Energy Verification plate, below, labelled with “1” to “8”). In the photon plate a combination of
two depths only is repeated in each quadrant (see photo, Photon Energy Verification plate, below,
labelled with “1” and “2”), so that only two resulting depths are provided, with an averaging over the four
quadrants.
When the plate is properly placed on the top of the StarTrack/MatriXX, the cylindrical absorbers are
aligned to a set of dedicated chambers in the device. The design allows performing at once and with
only one acquisition both a set of 8 measurements corresponding to the 8 (for electron beams) or 2 (for
photon beams) given depths and a full set of field profiles on both main axis and main diagonals. The
characteristics of the metallic cylinders are such as not to perturb the measurement of the field profiles.
The rest of the material is RW3, a white polystyrene with 2% titanium oxide (TiO2), and nominal density
of 1.045 g/cm3. The thickness of the plate for electron beams is 10 mm and for photon beams 40 mm.

Electron Energy Verification plate Photon Energy Verification plate

An Electron Energy Verification plate is placed in position on the StarTrack

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 51

The values acquired by the 8 chambers are normalized to the value of the central chamber to be
independent from beam current fluctuations.
The measurement of the profiles is important for validating the beam quality reproducibility check, as
the 8 chambers are placed off-center and the 8 relative measured values are therefore prone to
changes in beam symmetry and flatness.
To validate the beam quality constancy check, the user must always compare the values of symmetry
and flatness of the day with the corresponding ones acquired at the reference measurement and verify
that whether the deviation is within the tolerances for the 8 (for electron beams) or 2 (for photon beams)
relative values.
With the photon plate, the dependence of the measured relative values on the changes of beam
symmetry is reduced by the averaging done on the 4 quadrants.
Note that the Dolphin cannot be used for energy verification in the current version.

Output Constancy Check

In the Output Constancy test, the dose output is measured with the StarTrack, MatriXX or Dolphin
detector. The average value of the 9 (StarTrack), 4 (MatriXX) or 9 (Dolphin) central chambers arranged
in the middle of the main axes are used for calculating the dose.

StarTrack MatriXX Dolphin

Wedge Constancy Check

The purpose of the Wedge Constancy check is to detect changes in the wedge angle and the wedge
position by determining the wedge factor.
The wedge factor is determined by comparing the dose on the central axis of an open field with the
dose on the central axis of a wedged field. The measurements should be performed for every available
wedge angle and direction.
The wedge constancy test can be performed with the StarTrack, MatriXX or Dolphin detector.

Note: The two measurements (open field, wedge) need to be performed with the same monitor units
(dose) to ensure a correct result.

52 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

4.2. Setting Up the Measurement Devices
The measurement device must be prepared to ensure a failure-free measurement process.

IM PO RT ANT N O T IC E
PREPARE THE DEVICE
Check whether the measurement device is properly connected and is ready to
use.
Make sure that the device is in the correct position.
Check the connection between the device and the PC (Ethernet or direct
connection).
Clean the surface of the device of any contamination.

IM PO RT ANT N O T IC E
DEVICE SETUP AND MEASUREMENT CONFIGURATION
Setup measurement devices and configuration in the SW should be done by
experienced users or under the supervision of an experienced user to ensure the
device and SW are properly prepared for measurements.

See Chapter 9, Vol.1 for specific hardware information such as installation and positioning, as well as
other possible applications and limits.

Installing the Measurement Devices

The setup of the StarTrack/MatriXX is the same for all type of measurements. They can be mounted in
two ways:
■ Table mount
■ Gantry Mount.
The setup of the Dolphin is the same for all type of measurements.
See Section 7.1, Vol. 1 (StarTrack/MatriXX) and the COMPASS user manual (Dolphin) for instruction
for mounting.

Orientation of the StarTrack/MatriXX in a linac

The StarTrack/MatriXX can be placed in different orientations under a linac. It will affect the detector
settings in the SW. The following drawings show the possible orientation of a table mounted detector
relative to the linac. Note that a clockwise rotation yields a positive value of angle. Normally, the device
is placed 0° under the linac for the dosimetry QA measurements.

Note: Use only the orientation 0° ( ) for the current SW version.

W AR NI NG
MEASUREMENT DEVICE ORIENTATON
The measurements for Output Calibration and QA tests should be the same.
Otherwise the Output Calibration may be incorrect and lead to wrong dose
delivery and wrong results in QA tests.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 53

 Using Energy Verification Plate
For Energy Verification measurement, a proper build-up plate is required. Two special desired build-up
plates for photon beams and electron beams are available.

StarTrack
Place the build-up plate on the StarTrack with the same orientation as the StarTrack and insert the two
pins in the two diagonal corners of the StarTrack in the corner holes of the plate.

Two pins on
the StarTrack

StarTrack detector

MatriXX
Place the build-up plate on the MatriXX with the same orientation as the MatriXX and align the three
edges to the corresponding lines on the MatriXX:

Three edges
to be aligned
to the edges
of the built-
up plate

MatriXX detector

54 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

 A Device Setup Example
In this example the StarTrack detector with Photon Energy Verification plate are set up for a linac.
Set the linac gantry angle at 0°. Place the StarTrack at 0° orientation to the linac on the patient’s
table. Connect the network cable and power cord. Turn on the power of the StarTrack.

A table-mounted StarTrack
Use the room lasers and the StarTrack alignment markers to position the StarTrack. Set the SDD =
100 cm.
Place the Photon Energy Verification plate on the active area of the StarTrack.

A Photon Energy Verification Plate on a table-mounted StarTrack

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 55

 Configure the Measurement Device in the Software
The definition and settings of the machine and detector in the software are defined in the myQA
Platform > Equipment Setup. Please see Chapter 6, Vol.1, myQA Platform and Devices User’s Guide,
if instruction is needed.

4.2.4.1. Default settings

C AUT IO N
DEFAULT CALIBRATIONS/CORRECTIONS
Be default, the following calibrations/corrections are used automatically for
measurements:
■ Latest factory calibration
■ Latest created or copied output calibration of the same beam quality
■ Ktp correction for the active valid output calibration (if available)
■ Latest user uniformity correction (if available)
Please ensure the latest calibrations/corrections match your measurement
settings.

4.2.4.2. Output Calibration

Procedure of creating the dose output calibration of a measurement device is described in Section
6.4.2.1, Vol. 1.

IM PO RT ANT N O T IC E
CALIBRATE THE ABSOLUTE DOSE OUTPUT REGULARLY
Absolute drift of a device may be unnoticeable. Absolute dose calibration should
be repeated regularly.

IM PO RT ANT N O T IC E
OUTPUT CALIBRATION SHOULD NOT BE OLDER THAN THREE MONTHS
If the output calibration is older than 3 months, the SW will display a warning in
the Test Setup and Test Run. It is recommend to perform the output calibration
again.

56 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

4.2.4.3. Selecting an active calibration/corrections
If a non-default calibration or user uniformity correction should be used, it can be selected in the myQA
Platform > Equipment setup workspace. See Section 6.4.2.3 in Vol. 1.

IM PO RT ANT N O T IC E
USING A NON-DEFAULT CALIBRATION
If the default calibration or user uniformity correction for the measurements is not
used, it is user’s responsibility to ensure that the selected calibration delivers
acceptable results.

4.3. General Steps for Dosimetry QA

Similar to a generic QA procedure, the general steps to run a fully integrated dosimetry QA are also
including:
1. Create a protocol template for dosimetry QA tests (see Section 4.4)
2. Create a protocol for a machine to be tested. (see Section 4.5)
3. Perform the QA tests
Step 1 is the same for creating protocols described in Section 3.3.3. However the details of steps 2 and
3 are different. They will be described in the following sections.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 57

4.4. Create a Protocol Template for Dosimetry QA
In the Test Setup, click Edit in the ribbon, select Protocol Templates in the Machines &
Templates panel.
Click New in the ribbon or context menu.
Enter the name of the protocol, e.g., Dosimetry QA, and description if desired.
With the Dosimetry QA protocol selected (if not, click to select it), click New in the ribbon, and enter
the task template name, e.g., Dosimetry QA Task. Select the task execution interval in Recurrence.
See Section 3.3.4.1 for the detailed instruction.
To create test templates, select the task where the tests should be located, click New in the ribbon,
select the appropriate Category and Result Type, and enter description, acceptance criteria, field
size and gantry angle.
Repeat the last step until all tests are created.

Example: Test Template for Wedge Constancy

W AR NI NG
MEASUREMENT DEVICE ORIENTATON
The field size given in the tests in the Dosimetry Plugin is at the isocenter.
Please note:
It is possible to add attachments to protocols, tasks and tests of Protocol Templates and Protocol
Definitions as described in Section 3.3.4.5.
In order to define a Test Template for Profile Constancy, two more parameters are required: profile
directions (1) and the analysis method (2). These two parameters affect the acceptance criteria entries
and cannot be edited in the Test Definition panel for a machine protocol.

58 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

 1

Example: Test Template for Profile Constancy

The available analysis methods for both electron and photon beams are:

Note that Warning and Error Tolerances are given only for the analysis method based on the
International Electrotechnical Commission Standard IEC-60976 (see screenshot below) in the software.
The tolerances for other protocols can be taken e.g. from the acceptance criteria of the machine
vendor, or clinical QA standards. The users need to enter these values manually.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 59

4.5. Create a Machine Protocol for Dosimetry QA
In the case described below, the protocol is created by copying one protocol template. It can be also
created from scratch; see Section 4.4.
Select a machine in the Machines & Templates panel.
Click From Template in the Test Setup ribbon and select the dosimetry QA protocol created in the
previous section.

The Test Setup (example – creating a protocol for a machine)

See Section 4.5.1 for creating the baselines for the Dosimetry Plugin tests.

Create Baselines for Dosimetry QA

If no reference measurement is available, at least two measurements are needed to set the baselines
for all test types, one measurement without and the other with wedge. The hardware includes a
StarTrack or MatriXX with an Energy Verification Plate on the top.
The baselines for dosimetry QA is generated in the Test Definition panel.

60 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

4.5.1.1. Output Constancy baseline measurement

The general properties of a

test are defined in the copied
protocol template. They can
be still edited here.
(If the test is created from
scratch it can be also defined
2 3 4
1 during the creation.)

11

10 9
6

Example: Test Definition for Output Constancy

1: Combo box for the available measurement devices. Select the one to be connected to the SW.

2: Connect / disconnect button / , connects / disconnects the selected measurement device.

3: Background Measurement button , click it to start the background measurement. Measurement

time is 20 s.
4: Temperature / Pressure Offsets button , click it to set/adjust temperature and pressure.
cGy box: for entering the default dose output value
Set to all button: sets the value in the cGy box to all enabled energies in the Measured column.
Enable column: the energy with checked box will be measured
Energy column: lists the available energies of the machine defined in the myQA Platform >
Equipment Setup. If the output calibration of this energy is older than 3 months, a warning sign (5) with
tooltip appears:

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 61

Output Calibration column: place the cursor on the info icon (6); the tooltip displays detailed
information of the output calibration.

For the same beam quality, output calibration with the active icon in myQA Platform > Equipment
setup > Calibrations box will be selected. The latest output calibration is set as active by default.
However, if a different calibration should be used, it can be selected with the Edit button in the
Calibrations box.
If no output calibration with the same beam quality is available, a warning sign (7) appears in the
Action column. The tooltip displays the possible causes:

Actions column: contains the action buttons, Start (8), Reset (9), and/or Paste (10) buttons.
Paste button: in myQA FastTrack workspace, measured values can be copied to a clipboard (see
Section 2.5.1.1, Vol.4, myQA FastTrack User’s Guide) and can be pasted as expected values here with
the Paste button,. When the Paste button is disabled, a tooltip shows the possible causes:

Measured column: The measured result can be directly entered, measured, or the average of several
measurements using the Calculator (11).

Baseline measurement

Pre-requirement: the device is ready for measurement.

Click the Connect button (2)
Click the Background Measurement button (3). The default
measurement time is 20 s. It can be stopped by clicking the
Stop button. However, the background measurement is
invalid if stopped pre-maturely.

62 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

 Click Temperature / Pressure Offsets button (4) set/adjust
temperature and pressure.
The Measured values (i) are the internal temperature and ii iii
pressure given by the measurement device. The user can keep
i
these values or adjust them according to an external
measurement device for temperature and pressure. The
external values are entered in the Actual fields (ii). The
difference between the internal and external values are
displayed in the Offset column (iii).

Check the Enabled box of the energy to be tested.

If the device is properly connected and a valid output calibration is available for the selected energy, the
Measurement button (8) will appear in the Actions column.
Click the Measurement button and turn on the beam (e.g., 100 MU, 600cGy/min). Click the Stop
button when the beam is off.
The results will be automatically filled into the Measured box. The button in the Action box is changed
to the Reset button (9).

If the measurement should be re-run, click the Reset button , the Measurement button (8) will
appear again, and the Measured box become empty. The new measurement can be run again.
If the measured result should take the average of several measurements,
Write down each measurement result,
Click the Calculator button (11), enter all results.
Enter all measured results.
If temperature and pressure calibration should be
applied, checkmark the KTp box, enter the
temperature and pressure values measured by a
reliable external devices in the Temperature and
Pressure boxes, respectively.
Note: Do not checkmark the KTp box if the entered
values have already been corrected during
their measurement!
Optionally if a user defined factor should be
applied to the average, enter it in the Factor
field.
Click the Apply Result button; it will be
automatically fill into the Measured box.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 63

4.5.1.2. Energy Constancy baseline measurement
The baseline measurement is the same as for Output Constancy describe above.

Example: Test Definition for Energy Constancy

64 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

4.5.1.3. Profile Constancy baseline measurement

13

8 12 10

Example: Test Definition for Profile Constancy

The expected values can be taken from a measurement by clicking the Measurement button (8) or
from an imported one by clicking the Import Measured Data button (12), or, paste with the Paste
button (10) if the measurement has been copied from FastTrack (see Section 2.5.1.1, Vol.4, myQA
FastTrack User’s Guide), or manually enter them.
After a measurement is done, the reference detector type will be shown.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 65

Beside the parameters/features for other Dosimetry QA Test Definition, the profile constancy has more
functionality:

Chart View button (13):

If there is measurement data available, click this button, the profiles can be viewed graphically (13a).
The intensities at the cursor position are displayed (13b).

13a 13b

Context menu of the expected and tolerance values

Right-click the select a value in the table, the context menu opens.

Cut: deletes the selected value

Copy: copies the selected value to the clipboard.
Paste: pastes the value in the clipboard to the cell where it was clicked.

Import Measured Data button (12):

Click this button, a table appears containing the data imported into myQA and in myQA Machines >
Test Repository which has the same measurement settings (machine, energy, field sizes and gantry
angle) and can be imported into the current test. For the gantry angle value, a tolerance of +/- 1° is
accepted.

66 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

Examples: measured data available to be imported as profile baselines

IM PO RT ANT N O T IC E
ASSIGN MEASURED DATA TO MACHINE
Be aware that the data imported in the myQA Platform workspace will be
assigned to the selected machine and can be used only for this machine in the
myQA Machines workspace.

Select a measurement (row), its properties are shown on the right panel.
Click Ok, the data is imported into Test Definition panel.

Beam Quality combo box (14):

Select the desired beam quality.

If there is a valid output calibration for the selected beam quality, the Measurement button is
available. If at least one expected value is inserted, the Beam Quality box will be inactivated. The
energy can be changed after all expected values are deleted (the Beam Quality combo box becomes
activated again).

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 67

4.5.1.4. Wedge Constancy baseline measurement
For a Wedge Constancy baseline, two measurements, with and without wedge, are required. They can
be measured or imported. The measurement for the open field is automatically shared for all wedge
angles, thus it must be performed only once. Measurements can only be imported if the measurement
settings (machine, energy, gantry angle, field sizes and wedge angle) match. They can be viewed
graphically by clicking the Chart View button in the last column.

In the Wedge Direction column, the inline profiles are automatically indicated as direction “In/Out” or
“Out/In” whereas the crossline profiles are automatically indicated as the wedge direction “Right to Left”
or “Left to Right”.

Click Save in the ribbon when all test templates are created. This template can be used for so many
machines as desired.
After the machine protocol is set up, select the protocol in the Protocol Tree View panel, and click Set
Active in the Test Setup ribbon. Finally click Save in the Test Setup ribbon to exit the Edit mode. The
protocol is now ready to be run in the Test Run page.

Note: When measuring wedge constancy with Dolphin in combination with an accelerator where the
direction of the wedge is changed by rotating the collimator, only one wedge direction must be
measured.

68 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

 Copy/Paste Machine Protocols
As already mentioned in Section 3.3.1.3, user can copy a protocol from a source machine and paste it
to a target machine. In this section, we will refer to the tests within the dosimetry Plugin, i.e., profile,
energy, output and wedge constancy tests. Dosimetry tests are directly linked to the machine
properties, such as the available energies and wedge angles. Therefore, the extent to which a protocol
is copied depends on the extent to which the properties of the source and the target machine match.
When copying dosimetry tests, there are three trivial combinations of source and target machines:
■ Source and target machine are completely identical (i.e., they have the same machine setup)
 All tests are copied, including description, reference values and tolerances

■ Source and target machine are of different type or model, yet the machine properties are
completely identical
 After pasting, the software warns the user that the source and target machines are of different
type or model

 After clicking OK, all tests are copied, including description, reference values and tolerances

■ Energies and wedge angles of source and target machine are completely different
 After pasting, the software warns the user that the source and target machines are of different
type or model

 After clicking OK, the software informs about the status of the copy/paste process

 In this case, the protocol and the tasks including description and schedule, yet no tests will be
copied

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 69

For copied tests, all information contained in these tests (test description, baselines, tolerances) has
been preserved through the copy/paste action. However, the user shall revise these values and adapt
them to the target machine if necessary.
In the following, we will describe the results of copying/pasting Dosimetry Plug-In tests between two
machines with partly identical properties, using the example of two linear accelerators Linac A and
Linac B (see table below).

Linac A Linac B
6 MV 6 MV
10 MV FFF 10 MV
Energies 15 MV
6 MeV 6 MeV
12 MeV 9 MeV
15° 15°
Wedge angles
45° 30°
Example of two Linacs with some identical (green) and some different properties (red).

4.5.2.1. Profile Constancy Tests

Profile constancy tests are set up for every single energy:

Therefore, the machine protocol of Linac A will contain five profile constancy tests:

For simplicity, we created a protocol for Linac A containing only one task with the beam profile
constancy tests.

70 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

After copying the protocol and pasting it to the Linac B, the software warns the user that the two
machines are not of the same type or model:

After clicking OK, the software informs about the status of the copy/paste process:

As depicted in the screenshot above, the profile constancy tests for the energies of Linac A that are not
available in Linac B have been removed from the clipboard before pasting and will therefore not be
copied.
After the copy/paste action, the protocol of Linac B contains only the profile constancy tests for the
identical energies with Linac A:

All information contained in these tests (test description, baselines, tolerances) have been preserved
through the copy/paste action. However, the user shall revise these values and adapt them to the target
machine if necessary.

4.5.2.2. Energy Constancy Tests

Energy constancy tests contain the checks for all available energies:

For simplicity, we created a protocol for the source machine Linac A containing only one task with the
energy constancy test for all available energies.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 71

After copying the protocol and pasting it to the Linac B, the software warns the user that the two
machines are not of the same type or model:

After clicking OK, the software informs about the status of the copy/paste process:

As depicted in the screenshot above, the energy constancy test has been removed from the clipboard
before pasting and will therefore not be copied, although Linac A and Linac B have two energies in
common. After the copy/paste action, only the empty protocol and task have been copied to the target
machine:

Generally, if one or more energies of the source and target machines are different, the energy
constancy test cannot be copied.

4.5.2.3. Output Constancy Tests

Output constancy tests contain the checks for all available energies:

For simplicity, we created a protocol for the source machine Linac A containing only one task with the
output constancy test for all available energies.

72 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

After copying the protocol and pasting it to the Linac B, the software warns the user that the two
machines are not of the same type or model:

After clicking OK, the software informs about the status of the copy/paste process:

As depicted in the screenshot above, the output constancy test has been removed from the clipboard
before pasting and will therefore not be copied, although Linac A and Linac B have two energies in
common. After the copy/paste action, only the empty protocol and task have been copied to the target
machine:

Generally, if one or more energies of the source and target machines are different, the output constancy
test cannot be copied.

4.5.2.4. Wedge Constancy Tests

Wedge constancy tests are set up for every single (flattened beam) energy:

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 73

Therefore, the machine protocol of Linac A will contain two wedge constancy tests. For simplicity, we
created a protocol for the source machine Linac A containing only one task with the wedge constancy
test for all available energies:

After copying the protocol and pasting it to the Linac B, the software warns the user that the two
machines are not of the same type or model:

After clicking OK, the software informs about the status of the copy/paste process:

As depicted in the screenshot above, both wedge constancy tests have been removed from the
clipboard before pasting and will therefore not be copied, although Linac A and Linac B have one
flattened beam energy in common. After the copy/paste action, only the empty protocol and task have
been copied to the target machine:

Generally, both the energy and the wedge angles of the source and target machine have to match in
order for the wedge factor test to be successfully copied.

74 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

4.6. Perform Dosimetry QA Tests
After the protocol is setup, performing the QA tests is straight forward.
Click the Test Run navigation button under myQA Machines.
Click Clinics in the ribbon to select the clinic where the machine is located
Select the machine and then an active task in the Agenda panel (left panel).

2 3 4
1

Select a test in the Task View panel (middle panel).

The buttons/icons have the same functions as in the Test Definition panel described in Section
3.3.4.
Prepare the measurement device by selecting the device (1), connect it to the SW (2), measure the
background (3) and set the temperature / pressure correction (4).
Note: The temperature and pressure values entered for a dosimetry test are automatically taken for the
other dosimetry tests of the same session.
Perform all the required measurements.
After a measurement is done, the status (Pass/Warning/Failed) is immediately updated in the State
column.
After all measurements are done, click the Finish button in the lower-right corner of the test block to
finalize the test.
After all tests are done, click the Finish icon in the ribbon to finalize the task.

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 75

 Share Measurements

By selecting this box, the measurement(s) will be populated to other tests that have the same
parameters including the same machine, energy, inline and crossline field sizes, gantry angle; for
Wedge Constancy tests: with/without wedge and wedge direction (i.e., left-to-right or right-to-left),
whichever is applicable. In this way, the number of measurements can be minimized.
Note: Pressing the Reset button in the Action column resets only the measurement in the current test.
It does not affect the measurements that has been already populated to other applicable tests.
Note: If Share Measurement is activated, please ensure that the correct number of MU are irradiated
in case the output constancy test is one of the tests to be shared.

Import of Profiles into the Compare Page

Upon finishing the profile constancy test (by clicking the Finish button), four profile import icons, for
importing profiles of inline, crossline, and two diagonals, respectively, will appear on the top of the table.
The measured and expected profiles of one direction can be selected for analysis and graphical display
in Compare.

By clicking one of the icons, e.g. Inline profiles, the inline profiles will be added to the Compare page.
The SW performs the following actions automatically:
The Compare page opens, displaying the measured (measured in Test Setup) and expected
profiles (measured in Test Run) of the selected direction. They are also listed in Data Import.
The expected profile is set as reference.
If a new direction is selected in myQA Machines, the previous profiles will be deleted from
Compare and Data Import.

76 | Dosimetry QA Plugin | myQA User's Guide - Vol.3 myQA Machines

myQA User's Guide - Vol. 3 myQA Machines | Dosimetry QA Plugin | 77
5. CBCT QA Plugins
5.1. Introduction
The CBCT (Cone Beam Computed Tomography) is commonly integrated into modern linear
accelerators. It is a necessary part of an overall QA program as recommended by AAPM TG-142.
CBCT QA is generally performed by capturing a CT scan through a specially designed phantom. These
phantoms have many segregated regions to test different aspects of image quality. Important aspects of
image quality include contrast, spatial resolution, uniformity, and noise.
The CBCT QA Plugin is designed to analyze the routine CT / CBCT image quality and give reproducible
results. Its calculations are intended to satisfy the routine QA specified in the following standards:
■ AAPM TG 142: Quality assurance of medical accelerators[1]
■ DIN 61223-2-6: Leistungsmerkmale zur Bildgebung von Röntgeneinrichtungen für die
Computertomographie[2]
■ Quality Control in Cone Beam Computed Tomography EFOMP-ESTRO-IAEA Protocol[3]

CBCT QA Plugin Test Types

The CBCT QA Plugin includes the following test types:

Table 5.1. The CBCT QA Plugin test types and test parameters

Test result type Test result parameter [unit]

Geometric Distortion Maximum deviation [mm]

Spatial resolution Spatial resolution [lp/mm]

contrast Contrast [%] and CNR

HU constancy Maximum HU deviation [HU]

Overall uniformity [%]

Uniformity
Minimum uniformity [%]

The CBCT QA Plugin provides Individual tests for each test type and a combined test for all test result
parameters.

Supported CBCT phantoms

The CBCT QA Plugin supports the following phantoms:
■ CatPhan® 503, 504, 600 and 604
■ CIRS 610 AAPM
■ Gammex 464 and 467
■ GE QA phantom
■ Tomo Cheese
For all these phantoms, the modules, the ROIs, the materials and the corresponding HU are predefined.
However, the user can modify any of these parameters in the Test Setup page. The user can also
define new phantoms.

78 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

5.2. CBCT Test Algorithms
Prerequisites
 Align phantom on patient couch to isocenter
 FOV (field of view) covers complete phantom
 ROIs for different modules are defined. ROIs covering inserts or structures should not exceed the
structures. An exception are the ROIs for the geometric distortion test (see below).
 Image data and file format: The image data are converted to Hounsfield units (HU) via the DICOM
tags rescale intercept (0028|1052) and rescale slope (0028|1053). An exception is the uniformity
test in which the raw images are used.
 The CBCT Plugin supports the DICOM format (file based and DICOMDIR).

Preparatory Automatic Processing

Before the images can be used for calculations, 3 preparatory steps are automatically processed:
1. Finding the center of the images.
2. Detect the best slice for each phantom module.
3. Rotate the image if necessary so that it is best-fit to the defined ROIs.

5.2.1.1. Center Detection

The coordinates of the ROIs are defined relative to the center of the phantom (image). Therefore, one
of the preprocessing steps is to locate the coordinates of the phantom center.
The outer contour of the phantom is first detected using the OpenCV library (https://opencv.org/).
Subsequently, depending on the phantom type, the minimum enclosing circle, or bounding rectangle is
used to extract the coordinates of the phantom center.

5.2.1.2. Automatic Slice Detection

A CBCT phantom consists of several modules for different aspects of tests. A CBCT scan of a complete
phantom can contain about 100 slices. Two methods described below are used for searching the best-
suitable slice taken from a module for its designated analysis.

Slice Detection for phantoms with known fixed module positions

For phantoms of the CatPhan type, the known positions of the modules inside the phantoms is used for
slice detection. The module for the spatial resolution test serves as the reference.
The algorithm to find this slice uses the ROIs for the spatial resolution test. For each slice the accumulated
signal in these ROIs is extracted. The slice, which generates the maximum signal, contains the module
for the spatial resolution test. With the z-position of the slice, the expected positions of the two other
modules are calculated. The corresponding slices which come closest to these expected positions are
retrieved.

Slice Detection with unknown module positions

For phantoms where the positions of the individual modules are unknown or where they could be
modified by the user, an approach based on the Pearson Correlation Coefficient [7] is applied. Here, the
reference image for each module, which is foreseen for analysis, needs to be stored. The correlation
coefficient between the reference image and each slice of the DICOM stack is calculated. The slice with
the maximum value of the correlation coefficient is proposed to the user.
An example is given in the figures below, with the correlation coefficient as a function of the slice
number on the left. The middle and right part of the figure show the reference image and the found

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 79

slice, respectively. It can be seen that they come close, but do not match perfectly (slice 10 and 14).
These differences are also revealed in the wires for the slice thickness detection which are not centered
for slice 14.

Left: correlation coefficient, middle: reference image, right: found slice

5.2.1.3. Automatic Rotation

Automatic rotation is applied when an angular mismatch between the previously defined ROIs and the
actual image occurs. This may cause fail of the test calculation.
Depending on the module type, two strategies can be applied to find the optimum rotation angle. Noted
that the image stays always constant and the ROIs are rotated around the center of the phantom.

Strategy 1: Maximum sum signal

In this strategy, the ROIs are rotated around the center in steps of 0.2°, from -6° to +6° for each angle,
the content of all ROIs are summed up for each step. The rotation angle is optimized as the one that
results in the maximum sum signal. . This strategy is followed for the spatial resolution module.

Strategy 2: maximum difference

This strategy is applied to the HU Constancy module. Identify the ROIs with maximum and minimum
HU reference values. Rotate the ROIs around the center in steps of 0.2 degree from -6° to +6°. The
rotation angle is optimized as the one where the difference in the content of the two ROIs is highest.
The automatic rotation function is located in the Tools panel in the myQA – Imaging QA -TestSetup
CBCT windows.

Geometric Distortion
This test verifies distances obtained from an image to the known values[3]. For this purpose, distances
between two structures of the phantom (holes or inserts) are extracted from the image; see an example
below.

Example - phantom, CT slice containing the CTP404 module. ROIs are set on two pairs of structures
for distance extraction.

80 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

In the Geometric Distortion test, the distance is measured between the centers of two structures. The
centers are automatically derived via circular contour detection with the OpenCV library. Therefore,
unlike in other tests, the ROIs need to be larger than the structures to cover also surrounding bulk
material. Crosses indicate the centers of the detected circles.
Each measured distance (dmeasured) is then compared to its nominal value (dnominal ),defined by the
phantom geometry.
∆𝑑 = 𝑑𝑚𝑒𝑎𝑠𝑢𝑟𝑒𝑑 − 𝑑𝑛𝑜𝑚𝑖𝑛𝑎𝑙
The maximum deviation, dmax is the Geometric Distortion and stored in the myQA database.
Note: In some cases, the calculation of the centroid of a ROI for the geometrical distortion fails. This
problem most likely can be solved by adjusting the size (or shape) and position of the ROI.

Spatial Resolution
The Spatial Resolution test is to verify the capability of dissolving narrow lines via MTF (Modulation
Transfer Function). The phantom modules used for measurements of the spatial resolution contain line
bar groups. Within a group, the distances between two adjacent pairs are the same. The distance
among groups are different. Spatial frequency is defined as the line pairs per mm (unit: lp/mm) within a
group.
An ROI should include all bars in a group but the area should not exceed the outer edges of the bars.

Example module for the spatial resolution test

For each ROI, the value of Modulation is:

𝑀𝑜𝑑𝑢𝑙𝑎𝑡𝑖𝑜𝑛 = 𝑆𝑡𝑎𝑛𝑑𝑎𝑟𝑑 𝐷𝑒𝑣𝑖𝑎𝑡𝑖𝑜𝑛 𝑝𝑒𝑟 𝑅𝑂𝐼
All extracted Modulation values are normalized to the maximum value and plotted as a function of the
Spatial Frequency. The data points are then linearly interpolated. Spatial resolution corresponds to the
Spatial Frequency where the MTF drops below a given level, e.g. 50% in the example below.

Example: Modulation transfer function and indication of the 50 % level.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 81

 Contrast
The parameters of the Contrast test includes Low Contrast Visibility (LCV) and Contrast to Noise Ratio
(CNR). The test requires a module of the phantom containing at least two inserts with different materials
(thus different HU values). For example, the phantom provides several inserts for multiple
measurements simultaneously.

An image of the CTP404 module of the CatPhan 504 phantom used for LCV, CNR and HU constancy
tests.

Low Contrast Visibility (LCV)

The LCV test is to check how well two different materials (e.g., fat and water in human body) with close
HU values in a CBCT image can be distinguished.
To demonstrate the LCV test, ROI 5 and ROI 6 in the example cover polystyrene (PS) and Low-density
polyethylene (LDPE). The HU values of these materials are similar to fat and water inserts, respectively.
The LCV is defined as[4]:
𝑅𝑒𝑓𝑒𝑟𝑒𝑛𝑐𝑒 𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡/10
𝐿𝐶𝑉[%] = ,
𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡/𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝑁𝑜𝑖𝑠𝑒

with:
𝑅𝑒𝑓𝑒𝑟𝑒𝑛𝑐𝑒 𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡 = 𝐶𝑇𝑃𝑆 − 𝐶𝑇𝐿𝐷𝑃𝐸 , CTPS and CTLDPE: nominal HU values of the two materials,
𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡 = 𝑀𝑃𝑆 − 𝑀𝐿𝐷𝑃𝐸 , MPS and MLDPE: mean measured HU values in the two ROIs
𝑆𝐷𝑃𝑆 −𝑆𝐷𝐿𝐷𝑃𝐸
𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝑁𝑜𝑖𝑠𝑒 = , SDPS and SDLDPE: the standard deviations of the two ROIs
2

To obtain meaningful measured data, the ROIs should not cover any area outside the inserts; e.g., in
the example given in the figure above, the ROIs are inside the insert borders.
An example acceptance criteria from a LINAC vendor is LCV < 2% [4] [5].

The parameter LCV is called “Contrast” in the SW.

Contrast to Noise Ratio

Contrast to Noise Ratio (CNR) is defined as[3]:

𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝑐𝑜𝑛𝑡𝑟𝑎𝑠𝑡
𝐶𝑁𝑅 = , with,
𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝑛𝑜𝑖𝑠𝑒

𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡 = |𝑀1 − 𝑀2 |,

𝑆𝐷1 −𝑆𝐷2
𝑀𝑒𝑎𝑠𝑢𝑟𝑒𝑑 𝑛𝑜𝑖𝑠𝑒 = ,
2

where, M1 and M2 are the mean HU values in ROIs covering two different inserts; SD1 and SD2 are the
standard deviations in these ROIs.

82 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

 HU constancy
The test for the HU constancy uses inserts with different materials. In the example of the previous
section, ROI 1-8 can be used for this test. For each ROI, the mean content is extracted and compared
to nominal values for the corresponding material. The maximum deviation of the measured value is
displayed together with the corresponding ROI number.

Uniformity
The uniformity test is done with a homogeneous slice of a phantom (see an example below).

Example: Slice used for the uniformity test with five ROIs.

It is recommended to use a central ROI together with more than two peripheral ROIs. In a first analysis
step it is determined which of the ROIs is the central one. The mean values of all ROIs are stored. The
raw pixel values are used for the calculations of this test.
The following uniformity values in % are calculated:

Overall uniformity
𝑀𝑚𝑎𝑥 − 𝑀𝑚𝑖𝑛
Overall-uniformity = 100 ∗ (1 − )
𝑀𝑎𝑣𝑔

where, Mmax and Mmin are the maximum and minimum mean values of the ROIs and Mavg is the average
mean value of all ROIs.

Minimum-uniformity
Minimum-uniformity is the relative difference of the maximum mean value among the peripheral ROIs to
the central ROI:
𝑀𝑑𝑖𝑓𝑓_𝑚𝑎𝑥
Minimum-uniformity = 100 ∗ (1 − )
𝑀𝑐𝑒𝑛𝑡𝑒𝑟

where, Mdiff_max is the maximum mean value among the peripheral ROIs and Mcenter is the mean value of
the center ROI.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 83

5.3. Workflows for CBCT QA Plugin Tests

Setting up CBCT QA Baselines in Test Setup

The test settings and baselines are defined in the Test Setup workspace and cannot be modified in the
Test Run workspace.
In Test Setup, click Edit in the Test Setup ribbon to enter the Edit mode.
Select the desired machine in the Machines & Templates panel.
In the Protocol Tree panel, click New in the ribbon to create a task.
When the task is selected, click New in the ribbon to create tests:
 In the New Test Definition dialog (see next page), enter the required name of the test and
optionally a description.

New Test definition window

 Select CBCT kV/MV for Category (1) (for information display only)
 Select one of the CBCT Result Type (2), e.g., CBCT: Contrast for an individual test or CBCT:
Combined for all test result types.
 Define Energy (3): e.g., select the kV round button and enter the value of the kV
Note that when Undefined is selected, the exact value of the energy cannot be entered.
Note: Only tests with the same defined energy or those with Undefined selected can be shared.
Migrated tests from a previous version will have an undefined energy by default. A manual
adjustment in the Test Setup to match the actually used energy type and value is advised.
 Click OK (4). The test is listed in the Protocol Tree panel and displayed in the Test Definition
panel.
 Repeat the previous steps to create more tests as needed.

84 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

Define the test baseline.
 Select a test in the protocol tree.

Test Setup workspace

 In the Test Definition panel, click Open Module (5). The myQA - Imaging QA – TestSetup
CBCT window opens with default settings.
 Click the Import folder box in the Equipment setup section. Browse and select the folder
containing the image or image stack as reference images and then click Open Folder. Select the
desired series in the Select Series dialog.

Once the images are imported and the ROIs have been already defined (e.g., a SW supported
phantom), the SW automatically selects the correct slice and assigns it to a designated module
as a reference image. It is recommended to check whether the auto-slice selection is correct:
o Select a phantom module in the Modules box. In the Images section, check whether the
predefined ROIs are correctly placed. Do this for all modules.
o If the ROIs are only slightly miss-placed, use the functions provided in the Tools panel to
move the ROIs (Section 5.3.3.3).

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 85

 o If a different slice needs to be selected, scroll through the slices to search for the right image
for this module. Once found and the ROIs are also properly defined, click the Is reference
button.
If the ROIs need to be defined or re-defined, see Section 5.3.3 for detailed instructions.

myQA - Imaging QA – TestSetup CBCT window

 After reference images for all modules are set, click the Process button in the Baseline values
section. The Expected and tolerance (Warn and Fail) values will be filled. Edit the tolerances if
necessary. They can be edited by changing the values in the corresponding boxes.
 Click the OK button. The reference images and configuration files are listed in the Test
Definition section.

Example: reference images and configuration for a combined CBCT test

Repeat the above “Define the test baseline” step for CBCT QA test if desired.
Click Set Active in the ribbon if the protocol is not yet set as an active protocol.
Click Save in the ribbon.
Note: For this step, you can also create a test template first, and then copy the template into the
machine protocol, see Section 3.3 for instructions.

86 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

 Execute CBCT QA Tests in Test Run
Click the Test Run button in Navigation Panel.
In the Agenda panel, select the corresponding protocol and task.
In the Task View panel, select a test.
Optionally, for an individual test, if the Share Results checkbox is checked the results will be shared
by other CBCT tests in the test list. When this test is finished, other CBCT tests that use the same
image will also be finished automatically. The Share Results checkbox is irrelevant for a combined
test.

Test Run workspace (before tests are executed)

Click the Start button. The myQA – Imaging QA – TestRun CBCT window opens.
Hint: If no setup is saved, the Start button in Test Run is disabled.
Click the Import folder button. Browse and select the CBCT image folder. The SW loads all images
taken for each module.
As importing a reference image, once the images are imported, the SW automatically selects the
correct slice based on the ROIs and assigns it to a designated module as a test image (active
image). It is recommended to check whether the auto-slice selection is correct:
 Select a phantom module in the Modules box. In the Images section, check whether the image
is similar to the reference image and the ROIs are correctly placed. Do this for all modules.
 If the ROIs are only slightly miss-placed, use the functions provided in the Tools panel to move
the ROIs (Section 5.3.3.3).
 If a different slice needs to be selected, scroll through the slices to search for the right image for
this module. Once found and the ROIs are also properly defined, click the Is active image
button.

If necessary, the Image view can be displayed in full window by clicking the icon and the user
can zoom the image furthermore. See Section 5.3.3 for more information on the myQA – Imaging
QA – TestRun CBCT window.
Once the test images for all modules are properly selected, click Process in the Baseline values
section. See the description of test results in Section 5.3.3.5.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 87

 myQA – Imaging QA – TestRun CBCT window

Click OK; results for executed CBCT tests that share the same module are displayed if the Share
Results checkbox is checked.

Test Run workspace (after tests are executed)

Repeat the above step to execute the next test until all tests are finished.
Click Ok to close the myQA – Imagine QA – TestRun CBCT window.
Click Finish in the Test Run ribbon and then finish in the Finish Task dialog.
Afterwards, the test results will appear in myQA Cockpit and a report can be created in the Test
Repository page.

88 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

Test Repository page with executed test list

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 89

 myQA - Imaging - Test Setup/Test Run Windows
The structures and functionalities of the myQA – Imaging QA -TestSetup / TestRun [Plugin Name]
windows for setting up baseline values and in Test Setup / performing the test in Test Run are very
similar. They are described in this section together.
Moreover, these windows for the CBCT and EPID Plugins are also almost the same. In this section,
CBCT QA is used as example for description. The small part that is dedicated only to EPID will be
described in Section 6.5.3.

myQA – Imaging QA – Test Setup CBCT

myQA – Imaging QA – Test Run CBCT

90 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

5.3.3.1. Equipment setup section

Machine
This field displays the machine that was used to perform the QA. It is for information display only.
SID (mm)
This field displays the source to imager (SID) distance in mm. The SID is typically imported from the
evaluated image, but it can be edited if necessary. The SID is used to calculate distances at the
isocenter and used in ROI placement and scaling discrepancy.
In Test Run, if the imported file has a SID different from the one used to create the baselines, a
warning message pops up:

SAD (mm)
This field displays the Source to Axis Distance (SAD) that
was used to perform the QA. The SAD comes typically from
the myQA Platform > Equipment setup, but it can be
edited if necessary. The default SAD value is 1000 mm.
Phantom model
The phantom model is only selectable during the Test
setup. Select the phantom used for the CT scan. The
dropdown list shows the phantoms containing predefined
ROIs for tests.
Module
Select different modules of the selected phantom to display their respective images and results.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 91

During Test setup, once a phantom with ROIs defined is imported, the SW automatically assigns a
reference image to each module.
During Test run, once the files of a phantom are imported, the SW automatically assigns an image to
each module for tests.
If a different image needs to be selected for a module, scroll the mouse wheel or drag-and-move the
slider to search for the desired image (see sub-section, Slices, in Section 5.3.3.2).
Phantom Image(s)
For importing reference images (in Test setup) or test images (in Test run). A reference image is an
image of the phantom or module used to calculate baseline values.
Parameters
■ MTF for spatial resolution - enter the MTF percentage that intersects the MTF curve
■ Geom. Distortion distance (mm) - enter the geometric distortion distance (for CBCT Plugin)

Edit or delete a CBCT phantom model

Click the Edit button next to the Phantom module box, the Edit phantom dialog opens. In this
dialog, the names of phantoms and modules can be edited, deleted, and added.
Note: The Edit button is only enabled during test setup.

To edit the name of a phantom or module, select the item and then enter the new name.

Edit phantom dialog

To delete a phantom or module, select the item and click the corresponding Delete button.

92 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

Add a CBCT phantom model
To add a new phantom / module, click the corresponding Add button, and then enter the name in
the space created for the new item.

Edit phantom dialog

Click OK to confirm the change.

In the myQA - Imaging - Test Setup CBCT windows, Click Import file, browse and select the
folder containing the image or image stack as reference images. Select the desired series in the
Select Series dialog.
Select the newly created phantom in the Phantom model dropdown list.
 Select a module in the Modules box.
 In the Images section, scroll through the slices to search for the reference image for this module.
 In the Region of Interest panel, define ROIs (see Section 5.3.3.4 for instructions).
 Click Set as a reference after all ROIs are defined.
 Repeat the above steps to define the ROIs for the next module until the ROIs for all modules of
the new phantom are defined.
Click Process and then check whether the Expected values and the tolerances (Warn and Fail) are
ok. If the expected value is not ok, check the ROIs. Edit the tolerances if necessary.
Click OK to close the window.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 93

5.3.3.2. Images section
This section displays the loaded CT scans. For Test Setup, there is only one scan view that displays
the loaded scans for selecting the reference image. For Test Run, there are two scan views: the
reference image is automatically displayed (and cannot be edited; it can be removed from display by
clicking the Hide reference button), and the other scan view displays the loaded scans for selecting the
test image.

(Example for Test Setup) (Example for Test Run)

Region of Interest (ROI)

On an image, various ROIs are defined according to the test. A ROI is a small area of the image
designated to calculate some specific property of the image. ROIs typically represent different regions
in phantoms, such as areas with inserts of different materials used to verify HU levels or areas with
different levels of contrast.

Full display
To facilitate the inspection of the image or ROIs, the image can be displayed in full view by clicking the
full view button in the lower-left corner:

Zoom in/out
Place the mouse on an image and then scroll the mouse wheel up /down to zoom in / out this image.

94 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

Coordinates and intensity of a pixel
Place the cursor on the reference image during Test Setup or the test image during Test Run, the pixel
coordinates of the displayed image and DICOM voxel coordinates [(x, y); (x, y, z) and intensity in
Hounsfield Unit will be displayed below the image.
Slices
Viewing the CT scan is useful in determining which slice best represents each module. To change the
displayed slice, select the slider and then scroll the mouse wheel or drag-and-move the slider if the
slider is active.
The selected slice is used for the calculations on the selected module.
Set as reference / Is reference button
For Test Setup, once the reference image is displayed, click this button, it will be changed to the Is
reference button.
Set as Active / Is active image button
For Test Run, once the image for test is displayed, click this button, it will be changed to the Is active
image button.
Hide reference button
Click this button to remove the reference image from display.

Resize/move ROI
Place the cursor on the edge of an ROI, you can drag-and drop to change the size of the ROI. Place the
cursor inside an ROI, you can drag-and drop to move the ROI to any position in the image.

5.3.3.3. Tools Panel

Click the Tools tab to display the Tools panel. In the Tools panel, the ROIs can be rotated and the
brightness and contrast of an image display can be changed. However, the image data are not affected.

Rotates the selected ROI around the ROI center with the defined angle
Rotates the selected ROI around the phantom center with the defined angle

Rotates all ROIs around the phantom center with the defined angle
Rotates all ROIs around the phantom center with an optimized angle

Changes brightness of the image

Changes contrast of the image

Color Palette dropdown menu

Resets the image to the default size

Tools panel for Test Setup

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 95

 Rotates the selected ROI around the ROI center with the defined angle
Rotates the selected ROI around the phantom center with the defined angle

Rotates all ROIs around the phantom center with the defined angle
Rotates all ROIs around the phantom center with an optimized angle

Changes brightness of the reference image

Changes contrast of the reference image

Changes brightness of the actual image

Changes contrast of the actual image

Color Palette dropdown menu

Resets the image to the default size

Tools panel for Test Run

If ROIs in the SW are not aligned with the desired regions on your CT image, use the Move and/or
Rotate functionalities for the ROIs. The rotate function is especially useful for modules for the spatial
resolution test of the CatPhan® phantoms.

96 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

5.3.3.4. Region of interest Panel
Click the Region of interest tab to display the Region of interest panel. It displays the name of an
ROI and its reference HU values (for HU Constancy, Contrast, and Geometric Distortion tests) / spatial
frequency (for Spatial Resolution test). No parameter display for the Uniformity test.

Region of interest panel

ROI Coordinates
The ROI coordinates are (x, y) pairs that define a sequence of boundary points for positioning the
selected ROI on the image. ROI coordinates are measured from the center of the phantom. The SW
automatically detects the center of each module when results are calculated, even without a reference
image.
By clicking the Edit button to open the Edit regions of interest dialog. You can edit, delete the existing
ROIs, and add new ROIs.

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 97

Edit regions of interest dialog

Edit regions of interest dialog

Edit a ROI
Select the module and then the ROI to be edited in the Region of interest section. Edit the parameters
in the Coordinates and Test sections.
ROI coordinates:
 Circle: x, y coordinates of center and radius
 Rectangle: x, y coordinates of four corners
ROI coordinates are measured from the center of the phantom. The SW automatically detects the
center of each module when results are calculated, even without a reference image.
Note that for an existing ROI, it can resized and moved by drag-and-dropping with the mouse, and
rotated in the Tools panel.

Delete a ROI
In the Region of interest section, select the module and the ROI, then click Delete.

Add a ROI
In the Region of interest section, select the module and a ROI with the same test you want to add,
then click Add. A new ROI name is added at the end of the list.
In the Coordinates section, select the ROI shape between circle and rectangle, edit coordinates.
Enter the name of the material if applicable.
In the Test section, select the test name and enter the parameter if required.

Note: The SW does not check the ROI coordinates against the borders of the image. Ensure the
defined ROI does not exceed the image borders.

98 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

5.3.3.5. Baseline values section

Expected, Warn, and Fail Values table

Each analysis tool computes a set of results for an image, and each result may be associated with a
baseline value and two tolerances levels (warn and fail). Customize these levels for your QA program.

Expected values
Enter the expected values for the test result of interest in the units indicated in parentheses next to the
result (e.g., %, mm, or HU). The absolute differences between computed results and their baseline
value are calculated to compare with tolerances. See AAPM’s TG-142 for guidance in determining an
expected value for each result.
Disable an analysis: leave the expected value box of a parameter empty, this parameter will not be
analyzed.

Passed
The expected value does not exceed the warning tolerance.

Warning
Enter a positive value for the minimum deviation from the baseline that will generate a warning sign in
display. A warning’s value should be less than or equal to the value entered in the Fail column (equal if
you wish to use only pass or fail indications).

Failed
Enter a positive value as the minimum deviation from the expected value that will generate a failure sign
in display. The fail value should be greater than or equal to the warn value.

Process button
Click the Process button to recalculate results.
Once a parameter is modified, a message appears next to the Process button to warn the user to
repeat the process:

myQA User's Guide - Vol.3. myQA Machines | CBCT QA Plugins | 99

5.3.3.6. MTF chart section
The extracted Modulation values normalized to the maximum value are plotted as a function of the
Spatial Frequency. The MTF curve is generated by linear-interpolation of the data points. The red dot
indicates the intersection of the MTF with the MTF level. The spatial frequency at the position of the red
dot corresponds to the spatial resolution.

An Example of MTF chart. The coordinates will be displayed by pressing the mouse on the curve.

5.4. References
[1] F. Klein, "Task Group 142 report: Quality assurance of medical accelerators," Med. Phys., vol. 36,
p. 4197, 2009.
[2] DIN, "Leistungsmerkmale zur Bildgebung von Röntgeneinrichtungen für die Computertomographie,"
DIN EN 61223-2-6, 2008.
[3] H. de las Heras-Gala, "Quality Control in Cone Beam Computed Tomography EFOMP-ESTRO-
IAEA Protocol," http://dx.medra.org/10.19285/CBCTEFOMP.V1.0.2017.06, 2017.
[4] ELEKTA, "XVI 5.0 Customer Acceptance Tests," 2013.
[5] Lehmann, "Commissioning experience with cone-beam computed tomography for image-guided
radiation therapy," Journal of Applied Clinical Medical Physics, p. 21, 2007.
[6] Kaur, "Image Recognition using Coefficient of Correlation and Structural Similarity Index in
Uncontrolled Environment," International Journal of Computer Applications, vol. 59, no. 5, p. 32,
2012.

100 | CBCT QA Plugins | myQA User's Guide - Vol.3. myQA Machines

6. EPID Plugin
6.1. Introduction
The EPID installed at the LINAC can be used for patient positioning, pretreatment patient QA and Dose
monitoring. The tests of the EPID Plugin are based on the recommendations of AAPM TG 142[1] and
DIN 6847-6[2].
Imaging QA is generally performed by capturing an image through a specially designed phantom. The
EPID QA Plugin is designed to analyze MV and kV phantoms for flat panel imager QA.

Table 6.1. The EPID QA Plugin test types and test parameters

Test result type Test result parameter [unit]

Scaling scaling discrepancy [mm]

Spatial resolution spatial resolution [lp/mm]

contrast contrast [%] and CNR

Uniformity and Noise Minimum uniformity [%]

The SW provides Individual tests for each test type and a combined test for all test result parameters.
Supported file formats: DICOM RT Image and tiff image.

6.2. EPID Test Setup and ROIs

The nominal setup for EPID measurements is illustrated below. The phantom is placed at isocenter
(SAD) on the patient couch. The imaging device, EPID, has a fixed distance to the source (SID, Source
to Imager Distance). Values for SID and SAD are extracted from the image files via the DICOM tags
RTImage SID (3002|0026) and Radiation Machine SAD (3002|0022), respectively. If necessary, these
values can be changed by the user. The length scales of the image are projected to isocenter using the
projection factor:
proj_fac = SID/SAD
Therefore, SID entered for calculation must be the same as the one used in measurements.

Illustration of principle setup of an EPID measurement with a phantom placed on the table.

The figure below shows an image of a supported phantom, the QC-3 phantom from Standard Imaging.
The length scale in mm is projected to isocenter and the displayed size corresponds to the actual
dimensions of the phantom. The defined ROIs for the different tests are indicated and numbered on the

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 101

image. The user can define ROIs for the different tests. The pre-defined ROIs are provided for the
supported phantoms.

Image of the QC-3 phantom from Standard Imaging

6.3. Supported Phantoms and Automatic-Calculations

It is assumed that the phantom is aligned to the center of the image. The coordinates for the ROIs are
defined relative to the center of the phantom. The center of an image and the possible rotation deviation
are automatically adjusted1 once the phantom image is loaded to the SW. As the various phantoms
have their own unique shapes, an individual algorithm is applied to each supported phantom type. See
more information in the following sub-sections where the supported phantoms are described.
If the pre-defined ROIs are still not perfectly aligned after auto-adjusting, the center of the phantom can
be set manually. Furthermore, the ROIs can be resized, moved, rotated (Section 5.3.3.3) or edited
(Section 5.3.3.4).

Table 6.2. Supported EPID phantom types

Supplier Phantom

Standard Imaging QC-3

Standard Imaging QC-kV1

Sun Nuclear MV-QA

Sun Nuclear kV-QA

PTW EPID-QC

Leeds TOR 18FG

Varian Las Vegas

Mobius MC2 MV

IBA Primus A

IBA DIGI-13

1 For Primus A phantom, this feature is not yet implemented.

102 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

PTW EPID QC

In the image of a PTW EPID QC phantom below, the circles in the corners are automatically detected.
The center of the large circle connecting the four corner-circles is used as the center of the phantom.
For automatic rotation, the rotation angle is determined via the positions of the four circles in the
corners. This angle is taken into account for placing the ROIs

o .

Image of the PTW EPID QC phantom with detected circles at the phantom center and corners

Mobius MC2 MV

For the Mobius MC2 MV phantom, a rectangle and a circle in the middle is detected. The center of the
circle is the center of the phantom. The nominal orientation angle of the rectangle is - 45°. The deviation
from this angle corresponds to the rotation of the phantom.

Mobius MC2 MV phantom with detected rectangle and circle

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 103

Standard Imaging QC-3/kV1

The SI QC-3 and kv1 phantoms for MV and kV radiation, respectively, have a very similar structure.
Rectangular structures are detected for the determination of the phantom center and the rotation angle.

+ +

SI QC-3 (left) and SI QC-kV1 (right) phantoms with detected rectangles

Sun Nuclear MV-QA / kV-QA

The cross in the middle is detected for the MV-QA and kV-QA phantoms from Sun Nuclear.

+ +

SNC MV-QA (left) and kV-QA (right) phantoms with detected rectangles

Las Vegas / IBA DIGI-13

The Varian Las Vegas and IBA DIGI-13 phantoms reveal external rectangular structures, which serve
for the determination of the phantom centers.

+ +

Varian Las Vegas (left) and IBA DIGI-13 (right) phantoms with detected rectangular structures

104 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

Leeds TOR 18FG

The Leeds TOR 18FG phantom as an external circular shape and internal rectangular structures. The
detected outer circle determines the phantom center. The centers of the two small rectangles are used
for the calculation of the rotation angle. The shown orientation corresponds to a rotation angle of 0
degree.

Leeds TOR 18FG phantom with detected circular and rectangular structures.

IBA Primus A

The center of the IBA Primus A phantom is automatically determined via a detection of the central
cross, indicated by the red circle in figure.

Primus A phantom with detected circle

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 105

6.4. EPID Test Calculations

Scaling Discrepancy
This test verifies the distance extracted from the image to a known value[5]. For this purpose, distances
between two structures of the phantom are extracted from the image. In the example below, two circular
ROIs (9 and 10) are placed on two diagonal corners of the phantom.

Scaling discrepancy test - the distance between the two circular ROIs is determined

The distance of the centers of the two ROIs are measured. The measured distance (dmeasured) is then
compared to its nominal value (dnominal defined by the phantom geometry),
∆𝑑 = 𝑑𝑚𝑒𝑎𝑠𝑢𝑟𝑒𝑑 − 𝑑𝑛𝑜𝑚𝑖𝑛𝑎𝑙
∆𝑑 denotes the scaling discrepancy which is stored in the myQA database.

Spatial Resolution
The spatial resolution test is the same as for the CBCT case (see Section 5.2.3). The example below
shows an image of a SI QC-3 phantom where the structures covered by ROIs 1-5 serve for the spatial
resolution determination.

Line patterns (ROIs 1-5) for spatial resolution determination.

106 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

 Contrast and CNR
The contrast and CNR is extracted for two ROIs covering regions of the phantom with different
absorptions, e.g., ROI 6 and ROI 11 in the image above. The contrast is defined as[4]:
𝑀1 −𝑀2
𝐶𝑜𝑛𝑡𝑟𝑎𝑠𝑡 = × 100%,
𝑀1 +𝑀2

where M1 and M2 are the mean signal values in the two ROIs.
The CNR is defined as[5]:
𝑀1 − 𝑀2
𝐶𝑁𝑅 =
0.5(𝑆𝐷1 + 𝑆𝐷2 )
with SD1 and SD2, the standard deviations in the two ROIs.

Minimum uniformity
The ROIs for the uniformity test must be in homogeneous regions of the phantom. In the example of the
image above, the ROIs for this test are ROIs 7-10. Uniformity is calculated for each ROI, it is defined
as:
𝑆90 − 𝑆10
𝑈𝑛𝑖𝑓𝑜𝑟𝑚𝑖𝑡𝑦 = (1 − ) × 100%
𝑆90 + 𝑆10
S90 and S10 denote the 90% and 10% percentiles of the signals, respectively. Using 90% and 10%
percentiles instead of minimum and maximum values has the advantage of being less sensitive to
single defect or noisy pixels. The value stored in the database is the minimum uniformity value,
obtained from the individual ROIs.

6.5. Workflows for EPID QA Plugin Tests

Setting up Baselines in Test Setup

Pre-conditions

The phantom is aligned to the center of the image. The MV or kV image has been acquired.
Note: The baselines and settings defined in Test Setup will be used for every execution in Test Run.
However, they cannot be changed in Test Run.

Procedure
Click Edit in the Test Setup ribbon to enter the Edit mode.
Select the desired machine in the Machines & Templates panel.
In the Protocol Tree panel, click New in the ribbon to create a Task.
With the task is selected, click New in the ribbon to create tests:
 In the New Test Definition dialog (see next page), enter the required name of the test and
optionally a description.
 Select Category (1) (Planar MV (EPID), for information display only).
 Select Result Type (2) (e.g., EPID (MV) / Planar (kV): Combined or Contest).
Implementation will be aumatically selected according to Result Type.
 Define Energy (3): select the MV round button and enter the value of the MV.
When Undefined is selected, the exact value of energy cannot be entered.

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 107

Note: Only tests with the same defined energy or those with Undefined selected can be shared.
Migrated tests from a previous version will have an undefined energy by default. A manual
adjustment in the Test Setup to match the actually used energy type and value are advised

1
2
3

New Test Definition dialog

 Click OK (4). The test is listed in the Protocol Tree and the Test Definition panel is displayed.
Define the test baseline.

Test Setup workspace – Test definition panel

 In the Test Definition panel, click Open Module (5). The myQA – Imaging QA – TestSetup
window opens. Note that detailed information and handling in the myQA – Imaging QA –
TestSetup window are provided in Section 5.3.3 and Section 6.5.3.

108 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

 In the myQA – Imaging QA – TestSetup window,
Machine: Displays the machine selected in the beginning of this procedure.
SID and SAD: Values are extracted from the imported file.
Phantom model: a predefined phantom can be loaded from the dropdown table.
Phantom image(s) / Import file: Click and then browse and select the desired reference image.
Once the image is loaded, it is displayed in the Images view.

myQA - Imaging QA - Test Setup CBCT window – the Equipment setup and Images sections

 Inspect the predefined ROIs on the reference image. If necessary, modify them.

o If desired, the Images view can be displayed in full window by clicking the icon and the
user can zoom the image furthermore.
o The ROIs on the test image on the right can be resized and moved by dragging-and-dropping
o Use the tools on the Tools panel to change the brightness and contrast of the images if
necessary (for instruction see Section 5.3.3.3). Changes of the brightness and contrast have
no influence on the calculation of the test results.
o The image can be displayed in several options of color palettes by selecting one in the Color
Palette dropdown menu.
o The ROIs can be edited using the Edit button in the Regions of Interest panel (for instruction
see Section 5.3.3.4).

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 109

 Images view in full view

 After checking the ROIs, click the Process button in the Baseline values section. The Expected
and tolerance (Warn and Fail) values will be filled. Edit the tolerances if necessary. They can be
edited by changing the values in the corresponding boxes.
 Click OK, the reference image and configuration files are listed in the Test Definition panel.

The current configuration files will be deleted by clicking Reset configuration or Open Module.
Repeat the above steps until all baselines for other EPID QA tests are created.
Click Set Active in the ribbon if you want to perform the tests.
Click Save in the ribbon.
Note: In this procedure, you can also create a test template first, and then copy the template into the
machine protocol, see Section 3.3 for instructions.

110 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

 Executing EPID Tests in Test Run
Pre-conditions
The protocol is set to active in Test Setup.

Procedure
In the Test Run workspace, select the corresponding protocol and task in the Agenda panel
In the content area, select a test.
Note the test results of the four EPID tests can be shared with each other. Checkmark the Share
Results box. By starting one test, all of four EPID tests will be performed.

Test Run workspace – an EPID task is selected (before tests are executed)

For a combined test, the Share Results box does not appear since it is obsolete.

Click Start. The myQA – Imaging QA – TestRun EPID window opens.

In the Equipment setup section, parameters (machine, SAD, SID, phantom model, MTF and
scaling discrepancy distance), the reference image, expected values and tolerances are loaded from
the baseline setup and displayed; none of them can be modified.
Click the Import file box. Browse and select the test image file. It will be loaded and displayed.

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 111

 myQA – Imagine QA – TestRun EPID window

 Inspect the predefined ROIs on the test image. If necessary, modify them.

o If desired, the Image view can be displayed in full window by clicking the icon and the
user can zoom the image furthermore.
o The ROIs on the test image on the right can be resized and moved by drag-and-dropping
o Use the tools on the Tools panel to change the brightness and contrast of the images if
necessary (for instruction see Section 5.3.3.3); ROIs can be edited using the Edit button in
the Regions of Interest panel (for instruction see Section 5.3.3.4).

myQA – Imaging QA – TestRun EPID window

112 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

Click Process; the test parameters of the test image are determined and compared to the specified
tolerances. The result of the test (pass, fail, warning) will be set accordingly (see Section 5.3.3.5).

Test results (Example) - Baseline values and MTF chart sections. In this example, more EPID
tests are defined and Share results is enabled, all the tests were run automatically and the results
were displayed.

Click Ok to close the myQA – Imagine QA – TestRun EPID window.

Test Run workspace – an EPID task is selected (after tests are executed)

Click Finish in the ribbon and then finish in the Finish Task dialog. Afterwards, the test results will
appear in myQA Cockpit and a report can be created in the Test Repository page.

Test Repository page with executed test list

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 113

 myQA - Imaging - Test Setup/Test Run EPID Windows
The windows for the CBCT and EPID Plugins are very similar. In this section, only the small part that is
dedicated to the EPID Plugin is described. For the rest that is the same as for the CBCT Plugin, please
refer to Section 5.3.3.
Unlike the CBCT QA phantoms containing different modules in a phantom, the EPID QA phantom only
has one module. Therefore, there is no the Modules combo box in the Equipment setup section and
no slider for slice section in the Image section in the EPID Plugin.
Under Parameters, the parameter, Geom. Distortion distance, is replaced by Scaling discrepancy
distance
Scaling discrepancy distance (mm) box: Enter the nominal distance between the selected structures
(for EPID Plugin).

Edit, delete, an EPID phantom model

Click the Edit button next to the Phantom module box, the Edit phantom dialog opens. In this
dialog, the names of phantoms and modules can be edited, deleted, and added.
Note: The Edit button is only enabled during test setup.

To edit the name of a phantom, select the item and then enter the new name.

Edit phantom dialog

To delete a phantom, select the phantom and click the Delete button.
Click OK

114 | EPID Plugin | myQA User's Guide - Vol.3. myQA Machines

Add an EPID phantom model
To add a new phantom, click the Add button, and then enter the name in the space created for the
new phantom.

Edit phantom dialog

Click OK
In the myQA - Imaging - Test Setup EPID Window, select the newly created phantom in the
Phantom model dropdown list.
Click Import file, browse and select the image and click Open to load it in the Images view.
In the Region of Interest panel, define ROIs (see Section 5.3.3.4 for instructions).
Click OK
Click Process and then check whether the Expected values and the tolerances (Warn and Fail) are
ok. If the expected value is not ok, check the ROIs. Edit the tolerances if necessary.
Click OK to close the window.

6.6. References
[1] F. Klein, "Task Group 142 report: Quality assurance of medical accelerators," Med. Phys., vol. 36,
p. 4197, 2009.
[2] DIN, “Elektronische Bildempfänger (EPID) – Konstanzprüfung“, DIN 6847-6, 2012.
[3] DIN, "Leistungsmerkmale zur Bildgebung von Röntgeneinrichtungen für die
Computertomographie," DIN EN 61223-2-6, 2008.
[4] D. Dance, "Diagnostic Radiology Physics," IAEA, 2014.
[5] H. de las Heras-Gala, "Quality Control in Cone Beam Computed Tomography EFOMP-ESTRO-
IAEA Protocol," http://dx.medra.org/10.19285/CBCTEFOMP.V1.0.2017.06, 2017.

myQA User's Guide - Vol.3. myQA Machines | EPID Plugin | 115

7. MLC QA Plugin
7.1. Introduction
The MLC QA Plugin is intended to find MLC positioning errors by determining if any of the strips are off-
centered and check the ratio between the exposed and non-exposed areas.
For positioning tests, very fine spatial accuracy and high resolution images are mandatory, i.e. images
acquired with EPID, and the MLC images shall be irradiated with multiple thin strips produced by narrow
MLC openings (picket fence).
The resulting lines can be analyzed in the MLC Plugin.

MLC QA Plugin tests

MLC QA Plugin tests provides test result are listed in the table below:

Table 6.1. The MLC QA Plugin test types and test parameters

Test result type Test result parameter [unit]

failing peaks [%]

maximum difference [mm]

MLC: Picket Fence standard deviation [mm]

interstrip ratio [%]

line distance [mm]

failing peaks [%]

maximum difference [mm]

MLC: Moving Window/Segmental IMRT
standard deviation [mm]

interstrip ratio [%]

MLC: Leaf Position Accuracy interstrip ratio [%]

The test procedures of these three test types are similar. However, the Picket Fence requires analysis
for only one gantry angle position; whereas the other two test types require analysis for four gantry
angle positions: 0°, 90°, 180°, and 270°.
The VMAT QA Plugin provides individual tests for each test type and a combined test for all test result
types.

Supported MLC modules

The application supports the following MLC models:
■ Elekta Agility, Beam Modulator, and MLCi2
■ Novalis 52mMLC
■ Siemens 58,82,and 160
■ Varian HD-120, Millennium 52,Millennium 80, Millennium 120, Halcyon

116 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

For these MLC, the leafs for bank are defined in terms of numbers and widths. During the test setup,
these parameters can be modified or new MLC models can be created

7.2. MLC Plugin Calculations

MLC QA Image Handling

■ DICOM or tiff images are supported.
■ Once the MLC model is chosen, the MLC are placed symmetrical around the isocenter. If the
number of MLC leaves is an even number, the two central leaves are on top and below the
isocenter. If the number of leaves is an odd number, the central leaf is on top of the isocenter.
■ The MLC numbering goes from top to bottom, starting with 1.
■ The stripe numbering goes from left to right, starting with 1.
■ The size covered by the MLC can be bigger than the EPID itself. In this case, not all MLC will be
placed on top of the image, the external MLC are “cut” and only the ones covering the image are
displayed.
■ The EPID pixel lines below the same MLC are grouped together; the user will have an indication of
which MLC met / did not meet the defined criteria.

Calculations
Automatic image pre-processing

Upon importing an image, it is pre-processed with following steps:

■ Automatic linear transformation of the image based on the grayscale of the background and
irradiated areas.
■ Automatic crop of failing and/or “empty” lines of pixels. Empty lines mean that they are not irradiated
with a picket fence.
■ Automatic correction of failing pixels through a smoothing function.

Irradiated peaks

For each MLC and each stripe, the irradiated peak is identified.
A peak is defined by field size and center position as:

𝑓𝑖𝑒𝑙𝑑 𝑠𝑖𝑧𝑒 = |𝑟50 − 𝑙50 |

and
𝑟50 + 𝑙50
𝑐𝑒𝑛𝑡𝑒𝑟 =
2
where, l50 and r50 are the respective left and right 50% points through linear interpolation.
For all irradiated stripes, the centers of each stripe, along all lines of the stripe, are fit using a first
degree polynomial to determine the expected position of each peak. The offset of each MLC from the
fitted line is calculated. For each MLC the deviation from the fit is compared with the respective
tolerances to determine pass/fail criteria of each leaf.

Results
The results will be displayed on the loaded image and a green mark (red cross) will be positioned on
the corresponding leaf if the result passes (fails).

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 117

If one or more MLC fails, the information will be given to the user in the detailed results view.
The standard deviation of the deviation in the MLC positioning is calculated and compared to the
tolerances.
The number of failing peaks is calculated and compared to the tolerances.
The distance (at isocenter plane) between the stripes is calculated as the distance between the mean
centers of the two adjacent stripes and will be then compared to the tolerances.
If there are more stripes, the interstrip ratio is defined as the ratio between the value in between the
stripes and the mean value of the two adjacent stripes. The maximum value is used for comparison with
the given tolerance.
The slope of each fitting line is converted to degrees using its arctangent. This information is given in
the detailed results view.
The field width of each stripe is calculated as the mean over all MLC lines and is displayed in the
detailed result view.

7.3. MLC QA Workflows

Pre-conditions

■ The MLC QA image is measured.

■ Following DICOM tags are mandatory:
 Rows (0028,0010)
 Columns (0028,0011)
 Bits allocated (0028,0100)
 High Bit (0028,0102)
 Photometric interpretation (0028, 0004)
 Image Plane Pixel Spacing (3002,0011)
Note: The minimum distance between the stripes around the isocenter should be at least 10 mm;
otherwise the stripes cannot be correctly recognized by the SW.

Creating a Test Protocol for MLC QA

The MLC QA protocol can be created in the Test Setup by selecting Result Type as MLC: Picket
Fence / Leaf Position Accuracy / Moving Window / Segmental IMRT. The protocol includes the
measurement sittings and baselines.
Click Edit in the Test Setup ribbon to enter the Edit mode.
Select the desired machine in the Machines & Templates panel.
In the Protocol Tree panel, click New in the ribbon to create a Task.
With the task is selected, click New in the ribbon to create tests:
 In the New Test Definition window, enter the required information:
Name: name of the test
Description: optionally a description of the test
Category: Select MLC (for information display only)
Result Type: Depending on the test, select Result Type: MLC: Picket Fence / Leaf Position
Accuracy / Moving Window / Segmental IMRT for an indiviual test or MLC: Combined for all test
results.
 Click OK.

118 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

New Test Definition window

Define the test baselines. Baseline for a test is defined once in the Test Setup and will be used in
every execution of the test.
 In the Test Definition panel, click the Open Module button. The myQA – Imaging QA –
TestSetup MLC window opens (for detailed information / instruction about this window, see
Section 7.3.3).
 Click the Import file box, browse and select the reference image, then click Open.
The image is loaded into the Images section and the SID, SAD, and gantry angle from the
DICOM file are displayed in the Equipment setup section.

myQA – Imaging QA – TestSetup MLC window (before process)

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 119

  By default, the isocenter (indicated with a red cross) is placed in the center of the original EPID
image (before the automatic preprocessing steps are applied). The isocenter position can be
modified:
o To select the isocenter, place the mouse cursor on it and then press and hold the mouse.
o Drag-and-drop the isocenter to the desired position.

The Images section is displayed in full view and further enlarged. The coordinates and intensity
of the cursor position is also displayed.

 Once the isocenter position is correctly defined, start the calculation by clicking the Process
button in the Baseline values section. The expected values will be determined.
 Inspect the tolerances (in the Warn and Fail columns) provided in the SW. Edit them if
necessary.
Note: The predefined expected values and tolerances are example values coming from test images,
protocols or best practice and users should inspect these values.

myQA – Imaging QA – TestSetup MLC window – Baseline values and Deviation histogram
sections (after process)

 Click OK. The reference image and configuration files will be listed. The current reference image
and configuration files can be deleted by clicking Reset Configuration.

120 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 Repeat the above steps until the baselines for other MLC QA tests are created.
Click Set Active in the ribbon if the protocol is not yet set as an active protocol.
Click Save in the ribbon.
Note: In this step, you can also create a test template first, and then copy the template into the
machine protocol, see Section 3.3 for instructions.

Executing MLC QA Test

Click Test Run in the myQA Navigation panel.
Select the corresponding protocol and task in the Agenda panel.
In the Task View panel, select the machine, task, and test, then click Start, the myQA – Imagine
QA – TestRun MLC window opens.

Test Run workspace – an MLC QA task is selected (before tests are executed)

Note that for the Leaf Position Accuracy test, it requires analysis for four gantry angle positions: 0°,
90°, 180°, and 270°. Click the corresponding Start button to execute the test for each gantry angle.

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 121

 In the Equipment setup section, the parameters, reference image, and the baseline that was set in
the Test Setup are displayed. Click the Import file box. Browse and select the test image file, then
click Open.

myQA – Imagine QA – TestRun MLC window (before process)

Since the default isocenter position is the center of the image, check whether it is correct. As in Test
Setup, the isocenter position can be changed by drag and drop with the mouse. See detail
instruction in Section 7.3.3.2.

myQA – Imaging QA – TestRun MLC window - the Images section is displayed in full view and the
test image is further enlarged. The coordinates and intensity of the cursor position is displayed.

122 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

Once the isocenter position is correctly defined, start the calculation by pressing the Process button
in the Baseline values section. The Actual values are calculated and compared to the specified
Expected values. The test results (pass, fail, warning) are displayed with designated tolerance icons
(see Section 7.3.3.4). If interested, click Show detailed results to see more result information
(Section 7.3.3.4).

myQA – Imaging QA – TestRun MLC window (after process).

Click OK to close the myQA – Imagine QA – TestRun MLC window.

Repeat the above procedure to perform the test for other gantry angles. Click Finish.
If the Share results button is selected, once the Leaf Position Accuracy test for all four angles are
executed, the results are also shared by the other two tests. Click Finish for the Moving Window /
Segmental IMRT test.
Click Finish in the Test Run ribbon and then Finish in the Finish Task dialog.
Afterwards, the test results will appear in myQA Cockpit and a report can be created in the Test
Repository page.

Test Repository page with executed test list

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 123

Sharing results

Since the three MLC QA test types use the same images, the analysis results for one test can be
propagated to the other MLC QA tests in the test list by selecting the Share results box. This box is
available as long as there are more than one of the similar tests in one task.
Please note that results are only shared among the same type of tests either have a matching baseline
configuration or no baseline configuration.

Since the images of Leaf Position Accuracy and Picket Fence tests are gantry angle dependent, the
results can be shared only for the tests with the same gantry angle. For the image of the Picket Fence
test, the gantry angle from Test Setup is taken.

124 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 Imaging QA –TestSetup / TestRun MLC Window
The structures and functionalities of the myQA – Imaging QA -TestSetup / TestRun MLC windows for
setting up MLC QA baseline values and in Test Setup / executing the test in Test Run are very similar.
They are described in this section together.

myQA – Imaging QA – TestSetup MLC window.

myQA – Imaging QA – TestRun MLC window. The sections highlighted with red box are not available
in the myQA – Imaging QA – TestSetup MLC window

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 125

7.3.3.1. Equipment setup Section
Machine
This field displays the machine that was used to perform the QA. It is for information display only.
SID (mm)
This field displays the source to imager (EPID) distance in mm. By default, it is 1000 mm. The SID will
be updated with the value in the image DICOM file during importing. It can be edited.
SAD (mm)
This field displays the Source to Axis Distance that was used to perform the QA. By default, the SAD
from the myQA Platform - Equipment Setup is used. The SAD will be updated with the value in the
image DICOM file during importing. It can be edited.
Gantry Angle
Specify the gantry angle used for the exposure.
Collimator angle (°)
The collimator angle at which the image has been acquired.

In Test Run, if the SID / SAD / gantry angle / collimator angle value of the imported test image is
different from the value in Test Setup, a warning appears and the test setup value is shown when
hovering over the warning symbol. See an example below:

Click No and start importing again; click Yes, the image will be loaded and a warning sign is appear.
The analysis can be still executed.

MLC model
Specifying the MLC model allows the SW to overlay leaf numbers on the image, and determine which
leaves had errors. By default, the isocenter point is assumed at the center of the EPID image. User can
modify the isocenter position (see Section 7.3.3.2).
MLC Image
For importing the reference image (in Test Setup) or test image (in Test Run). A reference image is an
image of a MLC module used to calculate baseline values.
Offset tolerance (mm)
This is the offset of the measured peak position against the expected peak position. This tolerance
decides if the measured peak is passed or failed.

Edit, delete, or add a MLC model

Click the Edit button next to the MLC module box, the Edit MLC module dialog opens.
Note: The Edit button is only enabled during test setup.

126 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 Edit MLC model dialog

To edit a module, select the MLC module in the MLC section; in the Leaves section, edit the number
of the leaves and widths. Leaves can be added or deleted with the Add or Delete button. Use the
Up and Down buttons to re-arrange the order of the leaves if necessary.
To delete a module, select the MLC module and click the Delete button in the MLC section.
To add a new module, click the Add button in the MLC section, and then enter the module name in
the new space on the list (the MLC module name must be unique). In the Leaves section, click the
Add button, and then edit the number of the leaves and width. Repeat this until all leaves with
different widths are entered.
Click OK / Cancel to confirm /cancel the change.

7.3.3.2. Images Section

This section displays the loaded MLC images. For Test Setup, only one image selected as the
reference image is displayed. For Test Run, the reference image is automatically displayed on the left
(It cannot be edited, but can be removed from display by clicking the Hide reference button); the
loaded test image (Actual) is displayed on the right.

(Example for Test Setup) (Example for Test Run)

Image section in the myQA – Imaging QA – TestSetup / TestRun MLC window
The blue lines on top of an image are visual representation of the MLCs. The red cross represents the
isocenter.

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 127

Image full view
To facilitate the inspection of the image or ROIs, the image can be displayed in full view by clicking the
full view button in the lower-left corner.
Zoom in/out
Play the mouse on an image and then scroll the mouse wheel up /down to zoom in / out this image.

Coordinates and intensity of a pixel

Place the cursor inside the image area, the pixel coordinates and intensity will be displayed.

Isocenter
Coordinates (in pixel and mm) and
intensity of a pixel at the cursor position

Image section in full view. The Actual image is further enlarged.

Change the isocenter position

By default, the isocenter is placed in the center of the original EPID image. To change the isocenter
position, place the mouse cursor on it, press and hold the mouse and then drag-and-drop the isocenter
to the desired position.

Select the isocenter and then move it to a new position

Hide reference button

Click this button to remove the reference image from display (only available in Test Run).

128 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

7.3.3.3. Tools Panel
Click the Tools tab to display the Tools panel. In the Tools panel, the brightness and contrast of the
image can be changed. However, the image data are not affected.

Changes brightness of the test image

Changes contrast of the test image

Color Palette dropdown menu

Resets the image to the default size and position

Tools panel (Test run)

The Tools panels for Test setup and Test run is very similar. Except for brightness & Contrast (which
is available for both reference and test images, the rest are for the active image of the workspace.)

7.3.3.4. Baseline values Section

An example of the Baseline values section in Test Run

Line distance (mm): Maximum distance between the stripes

Failing peaks [%]: Percentage of failing peaks over the whole image
Maximum difference (mm): Max difference allowed between expected peak position and measured

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 129

Standard deviation (mm): Standard deviation of the distribution of the middle of each pixel row
difference vs the fit of the irradiated area
Interstrip ratio (%): Ratio between the value in the exposed area vs non exposed area

Table of results (expected and actual values and tolerances)

The expected values of MLC QA result parameters are calculated by the MLC plugin for MLC reference
image, while the actual values are calculated for the test MLC image. The tolerances (in the Warn and
Fail columns) are derived from test images, protocols or best practice. Customize these levels for your
QA program.
Disable an analysis: leave the Expected box of a parameter empty, this parameter will not be analyzed.

Passed
The expected value does not exceed the warning tolerance.

Warning
Enter a positive value for the minimum deviation from expected value that will generate a warning sign
in display. A warning’s value should be less than or equal to the value entered in the Fail column.

Failed
Enter a positive value as the minimum deviation from the expected value that will generate a failure sign
in display. The fail value should be greater than or equal to the warn value.

Process button
Click the Process button to calculate results.
During the Test setup, after processing is done, the user can modify any of the warning and fail
tolerances as desired.

Show detailed results button

Click this button to see the Detailed Results report

Example of the Detailed Results report

Besides the results displayed in the Baseline values section, the values of the following parameters
per strip are also displayed in the Detailed Results report:

130 | MLC QA Plugin | myQA User's Guide - Vol.3. myQA Machines

Failing leaves: Percentage of failing peaks per leaf (only for leaves with failing peaks)
Distance between lines: Distance between the stripes (A line is resulted from fitting the center of a
stripe)
Slope of lines: Slope of the fitted lines
Distance to isocenter: Distance between the center of each stripe and the isocenter
Mean field width: Mean width of a stripe
Maximal deviation from fit: Maximal deviation of the stripe position from fitted line
The detailed results are not saved to the myQA database. It can be copied to a text file.

7.3.3.5. Charts Section

In the Charts section, the strips are represent by different colors and numbered from left to right in the
image.
Deviation histogram: Histogram of the deviation in mm from the fit (expected position) for each MLC
pair.
Field size peaks: Field size for each MLC pair of each stripe
Center peaks: Center position of each MLC pair for each stripe
Deviation from fit: Deviation from the fit for each MLC pair for each stripe

Charts of a MLC model (example)

The stripes are identified by a number (numbering goes from left to right) and by a color. One or more
stripes can be hidden by deselecting them in the legend.

myQA User's Guide - Vol.3. myQA Machines | MLC QA Plugin | 131

8. VMAT QA Plugin
Volumetric Modulated Arc Therapy (VMAT) is a treatment modality where the irradiation field is rotated
around the patient. During the irradiation, the Gantry speed, Leaf speed (MLC) and dose rate are
continuously varied to adapt to the shape of the tumor and minimize the effect on the surrounding
healthy tissues.
The VMAT QA analysis is based the article by Ling et. al.[1]. An imaging device (EPID or film) rotates
with the gantry. Different parts of the imaging device are irradiated with the same total number of MUs
but under varying irradiation conditions:
■ Variation of the gantry speed and the dose rate (corresponds to Test 2 in [1])
■ Variation of the leaf speed and the dose rate (corresponds to Test 3 in [1])
Two images are acquired, a first one with a static open field and a second with the VMAT plan providing
a variation of dose rates. Both fields have the same dimensions. The analysis will be then executed by:
 normalize VMAT field to open field to account for flatness and symmetry of the beam,
 define ROIs (the ROIs are placed in the middle of the irradiation zones) and calculate mean and
standard deviation in each ROI,
 optional: normalize the results to the overall mean.

8.1. Data acquisition and analysis

The figure below (left) shows the principle of data acquisition with an EPID rotating together with the
gantry around the isocenter. The length scales of the images are given in mm and are projected to
isocenter.
Two images are acquired, a first one with a static open field and a second with the VMAT plan providing
a variation of dose rates (Figure below, middle and right). Both fields must have the same dimensions.

Left: principle of data acquisition, middle: open field, right: VMAT field.

Analysis steps:
 Read in open and VMAT field images.
 Extract information from file headers (if available):
o Pixel spacing
o SID and SAD
 Normalize VMAT field to open field to account for flatness and symmetry of the beam
 Detect center of field
Via image processing tools (same as for the EPID Plugin, see Section 6.3). This method is based
on the detection of a rectangle in the open field images. See examples shown in the figure below,
positive and negative contrast is treated automatically and the fields can also exceed the image in
one direction.

132 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

  Place ROIs and calculate mean and standard deviation in each ROI.
 Optional: normalize the results to the overall mean.

Examples of open fields and detected centers

Profiles of the open and VMAT fields are shown in the left figure below. Furthermore, vertical dashed
lines mark the found field center position (red) and ROI positions (green). The right figure below shows
the VMAT field after normalization to the open field. In this example, six different dose rates (from 125
to 440 MU/min) were irradiated. The ROIs are placed in the middle of the irradiation zones.

Left: horizontal profiles of open and VMAT fields. Right: Normalized VMAT field with ROIs and applied
MU/min.

8.2. Workflow for VMAT QA Tests

Setting up Baselines in Test Setup

Pre-conditions

The phantom is aligned to the center of the image. The EPID open field and MLC field images are
measured. The images can be in DICOM (RTImage), .tiff, or .opg file format.
Note: The baselines and settings defined in Test Setup will be used for every execution in Test Run.
However, they cannot be changed in Test Run.

Step 1. Create a test for VMAT QA

In Test Setup,
Click Edit in the Test Setup ribbon to enter the Edit mode.
Select the desired machine in the Machines & Templates panel, and then in the Protocol Tree
panel select a task in which the test is located.
Click New in the ribbon
 In the New Test Definition dialog, enter the required name of the test and optionally a
description.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 133

 New Test Definition dialog

 Enter the name of the test and optionally a description

 Select Category: MLC (for information display only)
 Select Result Type: MLC: VMAT/ Dynamic MLC. Implementation is automatically selected the
same.
 Click OK. The test is listed in the Protocol Tree and the Test Definition panel is displayed.

Test Setup workspace – Test definition panel

Define the test baseline.

134 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 In the Test Definition panel, click Open Module. The myQA – Imaging QA – TestSetup VMAT
window opens.

myQA – Imaging QA – TestSetup window

Note that detailed information and handling in the myQA – Imaging QA – TestSetup VMAT
window are provided in Section 8.2.3.
 In the Equipment setup section (1):
Machine: Displays the machine selected in the beginning of this procedure.
SID and SAD: Defult is 1000 mm. SID will be updated upon importing images.
ROI model: Click the dropdown box and select a desired ROI set in the predefined ROI set list.
Open field: Click the corresponding Import file button and load the desired open field image.
VMAT field: Click the corresponding Import file button and load the desired VMAT field image.
Select the Normalize ROI results to 1.0 check box if desired.
 To view the imported images, select the corresponding tab on the top of the Image view (2). The
display of an image can be adjusted with the tools in the Tools panel.
In the Profile chart section (5), the inline / crossline profiles of the open and VMAT fields are
displayed.
 The ratio of the two images is automatically calculated and displayed in the Ratio tab together
with the ROIs. The center of the image is automatically identified. However, it can be re-located
by drag and drop. The predefined ROIs will be automatically shifted. The ROI values can be
viewed and edited in the Region of Interest panel.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 135

  Once the isocenter and ROIs are properly defined, click the Process button in the Baseline
values section (4). The expected values are calculated and displayed along with the predefined
the warning and fail tolerances.

The ROIs mean values and standard deviations are shown by clicking the Show detailed
results button.

 Inspect the tolerances. Modify them if necessary.

Note: The predefined expected values and tolerances are example values coming from test images,
protocols or best practice and users should inspect these values.
 Click OK to close the window. The reference images and the used configurations are saved and
listed in the Test definition panel.

136 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 By clickig the Reset configuration button, the test setup prcedure shall be started from the
beginning.
 The configuration files are listed:
Click Set Active in the ribbon if the protocol is not yet set as an active protocol.
Click Save in the ribbon.
Note: In this step, you can also create a test template first, and then copy the template into the machine
protocol, see Section 3.3 for instructions.

Executing VMAT Tests in Test Run

Please note that a previously defined test baseline will be used during execution,
if such a baseline was previously defined in Test Setup.

Pre-conditions
The protocol is set to active in Test Setup.

Procedure
In the Test Run workspace, select the corresponding protocol and task in the Agenda panel
In the content area, select the test and then click Start.

Test Run workspace – a VMAT task is selected (before tests are executed)

The myQA – Imaging QA – TestRun VMAT window opens. The equipment setup parameters,
normalization, expected values and tolerances set up in the Test setup workspace are displayed.
They cannot be modified in the Test run workspace. SID and SAD can be adapted to the actual
setup.
Click Open field - Import and load the open field image file.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 137

 Click VMAT field - Import and load the MLC field image file.
Check that the isocenter and ROIs are properly positioned. Click Process in the Baseline section.
The Actual values are calculated and compared to the specified tolerances. The result of the test
(pass, fail, warning) will be set accordingly

Each ROI mean value and standard deviation are shown by clicking the Show detailed results
button.

Click Ok to close the myQA – Imagine QA – TestRun EPID window.

Test Run workspace – an EPID task is selected (after tests are executed)

Click Finish in the ribbon and then finish in the Finish Task dialog. Afterwards, the test results will
appear in myQA Cockpit and a report can be created in the Test Repository page.

138 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

Test Repository page with executed test list

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 139

 myQA - Imaging - TestSetup/TestRun VMAT Windows
The structures and functionalities of the myQA – Imaging QA -TestSetup / TestRun VMAT windows
for setting up baseline values and in Test Setup / performing the test in Test Run are very similar.
They are described in this section together.

myQA – Imaging QA – TestSetup VMAT

myQA – Imaging QA – Test Run VMAT

140 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

8.2.3.1. Equipment Setup Section

Machine
This field displays the machine that was used to perform the QA. It is for information display only.
SID (mm)
This field displays the source to imager (SID) distance in mm. The SID is typically imported from the
evaluated image, but it can be edited if necessary. Upon importing, a message pops up and inform that
the SID is different from the current definition. Click Yes to update the value to the one in the imported
file. The user can also edit these values if necessary.

The SID is used to calculate distances at the isocenter and used in ROI placement and scaling
discrepancy.
SAD (mm)
This field displays the Source to Axis Distance (SAD) that was used to perform the QA. The SAD
comes typically from the myQA Platform > Equipment setup, but it can be edited if necessary. The
default SAD value is 1000 mm.
ROI model
The ROI model is only selectable during the Test setup. Select a predefined ROI model for the test in
the dropdown list.

To edit and delete an existing ROI set or add a new ROI set, click the Edit button (see Section 8.2.3.4).

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 141

Open field – import file
This button opens a file browse window to load an image of the open field. After an image is selected, it
will be displayed by selecting the Open field tab in the Image view.
VMAT field – import file
This button opens a file browse window to load an image of the VMAT field. After an image is selected,
it will be displayed by selecting the VMAT field tab in the Image view.
Normalization to 1.0
Checking this box normalizes the ROI mean values from the MLC field image to an average value of
1.0. Normalize to 1.0 is recommended in the article by Ling, et al [1]. This allows the deviations between
the selected ROIs to be more easily observed.

8.2.3.2. Image View

This section displays the loaded images and their ratio. For Test Setup, there is only one ratio image
for selecting the reference image. For Test Run, there are two ratio images: the reference ratio image
is automatically displayed (and cannot be edited; it can be removed from display by clicking the Hide
reference button), and the ratio image from the loaded test images.

Examples for Image view in Test Setup (left) and Test Run (right)

142 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

Zoom
Place the mouse on an image and then scroll the mouse wheel up /down to zoom in / out this image. By
clicking the Zoom & Pan – Reset, the image will be reset to the default view.
Pan
Place the mouse on an image and press down the right mouse and drag the image to a desired
position. By clicking the Zoom & Pan – Reset, the image will be reset to the default view.

Isocenter
The isocenter is assumed at the center of the image that is automatically located by default and
displayed with a “+” on the active ratio image. It can be relocated per drag and drop by the user and
reset to default by clicking Isocenter – Reset in the Tools panel (section 8.2.3.3).

Region of Interest (ROI)

On an image, various ROIs can be defined according to the test. A ROI is a small area of the image
designated to calculate some specific property of the image. For VMAT QA, ROIs typically represent
different irradiated section images.

Resize/move ROI: Place the cursor on the edge of a ROI, you can drag-and drop to change the size of
the ROI. Place the cursor inside a ROI, you can drag-and drop to move the ROI to any position in the
image.

Full display
To facilitate the inspection of the image or ROIs, the image can be displayed in full view by clicking the
full view button in the lower-left corner:

Coordinates and intensity of a pixel

Place the cursor on the reference image during Test Setup or the test image during Test Run, the pixel
coordinates of the displayed image and DICOM voxel coordinates [(x, y); (x, y, z) and the value will be
displayed below the image.
Hide reference button
Click this button to remove the reference image from display.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 143

8.2.3.3. Tools Panel
Click the Tools tab to display the Tools panel. In the Tools panel, the ROIs can be rotated and the
brightness and contrast of an image display can be changed. However, the image data are not affected.

Tools panel for Test Setup

Tools panel for Test Run

8.2.3.4. Region of interest Panel

Click the Region of interest tab to display the Region of
interest panel. It displays the name of an ROI, typically the
moving speed the leafs or the dose-rate.

Region of interest panel

By clicking the Edit button to open the Edit regions of

interest dialog. You can edit, delete the existing ROIs, and
add new ROIs.

144 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

Edit or delete a ROI model
Click the Edit button next to the ROI module box, the Edit ROI modules dialog opens. In this
dialog, the names of an existing ROI module can be edited, deleted.
Note: The Edit button is only enabled during test setup.

To edit the name of a ROI module, select the item and then enter the new name.
To delete a module, select the item and click the corresponding Delete button.

Add a ROI model

To add a new ROI module, click the Add button, and then enter the name in the space created for
the new item.

Click OK to confirm the change.

In the myQA - Imaging - Test Setup VMAT window, load the open field and VMAT field images
with the corresponding Import file button, and check the Normalization to 1.0 box.
Select the Region of Interest tab and then click the Edit button.
In the Edit region of Interest dialog, according to the number of illuminated areas in the Ratio
image, add the same number of ROIs with the illuminated area in the middle. The VMAT file
horizontal profile displayed in the Profiles chart can also help to in identify the areas. Give a name
and approximated coordinates (center top and center bottom) to each ROI. Click OK.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 145

 Edit regions of interest dialog

Note: The SW does not check the ROI coordinates against the borders of the image. Ensure the
defined ROI does not exceed the image borders.

ROI Coordinates
ROI coordinates are (x, y) pairs at four corner points of the area, measured from the center of the
phantom. The SW automatically detects the center of each irradiation field when results are calculated,
even without a reference image. The center can be moved (see the step below)
In the Image view section of the myQA - Imaging - Test Setup VMAT window, adjust position and
area of the ROIs by drag and drop:
 Zoom the image to the area of interest, select a color palette and adjust the brightness and
contrast to have the best view of the image.
 Check the isocenter position with the help of the profiles in the Profiles chart display. Ensure the
isocenter is at the center of the profiles.
 Adjust the size and position of each ROI so that it is in the center of the irradiated area.
 Click Ok when it is done.

myQA - Imaging - Test Setup VMAT window

146 | VMAT QA Plugin | myQA User's Guide - Vol.3. myQA Machines

 Click Process in the Baseline values section, and then check whether the Expected values and
the tolerances (Warn and Fail) are ok. If the expected value is not ok, check the ROIs. Edit the
tolerances if necessary.
Click OK to close the window.

8.2.3.5. Baseline values section

For the Expected, Warn, and Fail Values table, comparison result symbols, Process button, and
disabling analysis of a parameter, see Section 5.3.3.5.

Show detailed results button

Click this button, the ROIs mean values and standard deviations of the active images are displayed.
The text can be selected and copied to a clipboard.

8.2.3.6. Profiles chart section

The horizontal and vertical profiles of the cursor position on the loaded images are plotted. The
isocenter should be located in the middle of the profiles. The profiles are plotted with raw data
regardless whether the Normalization to 1.0 box is selected or not.

The chart can be displayed in full window by clicking the button in the upper right corner.

An Example of a profile chart of the loaded images for VMAT QA analysis

8.3. References
[1] C. C. Ling, "COMMISSIONING AND QUALITY ASSURANCE OF RAPIDARC RADIOTHERAPY,"
Int. J. Radiation Oncology Biol. Phys., pp. 575-581, 2008.

myQA User's Guide - Vol.3. myQA Machines | VMAT QA Plugin | 147

9. IsoTrack Plugin
9.1. General Description
The IsoTrack Plugin employs Winston-Lutz test method to analyze the variation of isocenter position
present in the rotation of the gantry, collimator, and patient couch. Typically, a Winston-Lutz phantom is
a small metallic ball (radiation opaque) that represents the planned target, which is surrounded by
transparent plastic material. During measurements, the ball is aligned at the isocenter. Consequently,
Winston-Lutz images show a radiopaque object at the isocenter surrounded by a radiation field, usually
collimated by the treatment device used in the SRS/SBRT treatment (cone or MLC).
The IsoTrack Plugin analyses these images and the center of the object is compared to the center of
the radiation field, and the difference is the radiation field variance at that gantry, collimator, and couch
angle. The AAPM Task Group Report 142 (2009) recommends that up to ± 1 mm deviation between the
radiation and mechanical isocenter is acceptable for SRS/SBRT treatments2.

Image acquisition
In general, any phantom designed for the Winston-Lutz test can be used, e.g., QUASAR™ IsoCenter
Cube from Modus Medical Devices Inc., Winston Lutz Phantom from Standard Imaging Inc. An example
using the IBA cylindrical phantom is described in Section 9.4.1.
See the table below for the Winston-Lutz images acquisition techniques and for which types of the
measurements they are suitable.

Images Measurement type

acquisition Gantry Collimator Patient couch
EPID   
Film   

The images can have any size and can be inverted. For 3D results, it is required that the measurements
are repeated at cardinal angles, 0°, 90°, 180°, and 270º. If multiple images are processed, they must all
be the same size and the same characteristics, e.g., SDD and DPI.

Note: The field size depends on the phantom used for the test. It should be big enough to contain the
WL ball. However, it should not be so big that it also covers the irrelevant parts of the phantom,
e.g., legs of the phantom, or any other object, e.g., the couch, that generates a pattern interfering
the contour analysis.

W AR NI NG
3D ANALYSIS
Four images with the following angle information should be provided to calculate
the 3D error correctly:
▪ Gantry angle are 0°, 90°, 180°, and 270°, respectively
▪ Same collimator angle for all 4 images
▪ Same couch angle for all 4 images.

2Klein EE, Hanley J, Bayouth J, et al. Task Group 142 report: quality assurance of medical
accelerators. Med. Phys. 2009: 36(9): 4197-4212

148 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

Image format
Note: IsoTrack Plugin only supports pixel formats, grayscale 8-BBP, 16-BBP, and 32 BBP.

Images Image format

acquisition DICOM TIFF
EPID  
Film  

9.2. Winston-Lutz Test Workspace

The Winston-Lutz test can be accessed by running a test created with result type: Mechanical:
Isocenter Check; see Section 9.3 and 8.4 for creating and executing a Winston-Lutz test, respectively.

Winston-Lutz test

1: Inner/outer contour threshold for analysis

2: Table of the image parameters (see Section 8.2.1)

3: Display of the selected image and the analysis results (if available) (see Section 8.2.3)

4: Results

5: General information:

SAD: it is taken from value defined in myQA Platform > Equipment Setup.
SDD: it is read from the DICOM data. For the TIFF images, the SDD value needs to be
entered upon loading the images. The SDD is editable.
DPI: Dots per Inch of the images.

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 149

 Table of the Image Parameters
Column name Description

Checkmark the box if the image should be analyzed. Checkmark the

(First column)
column tile box for select all images.

DICOM: ID (content of the nametag in the DICOM header);

Image
TIFF: filename

DPI Dots Per Inch

Source Detector Distance - the distance between the radiation source
SDD[mm]
and the film or imager (editable)
SAD[mm] Source Axis Distance - the distance from the source to the isocenter

Gantry[º] Gantry angle (editable)

Col[º] Collimator angle (editable)

Couch[º] Couch angle (editable)

DV[mm] 2D deviation (see Section 9.5 for definition)

State Passed/warning/failed status according to the specified tolerance.

(Last column) Click any in this column to delete the selected image

Loading Images
Load image
Click Load Images to open the dropdown list:

DICOM: Loads DICOM images. See Section 11.1.2 for more instruction.
Tiff: Loads TIFF images. Select Tiff, in the Open browser, select the TIFF images, click Open, and
enter the SDD value in the popup dialog and click OK.
For loading multiple images, the order of the images follows the order of the filename for the TIFF
images, and of the ID (content of the nametag in the DICOM header) for DICOM images (same as in
the DICOM browser).

IM PO RT ANT N O T IC E
GANTRY ANGLE INFORMATION
The SW only imports gantry angles from DICOM data if those are present in the
DICOM header. For TIFF images, the gantry angle needs to be defined
manually.

Perform analysis
Check that the checkboxes of the images to be tested are selected.

Click the Start button, .

150 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

 Selecting Image for Display
By selecting the image (it is highlighted) in the parameter table, the image including the inner and outer
contours and their centers (if available) will be displayed on the right side.

The displayed coordinates are the EPID’s coordinates for images from EPID and the image’s
coordinates of images for TIFF images.
D↑ or D→: projection of the 2D deviation vector on vertical or horizontal axis
Dv: length of the 2D deviation vector

: Un-zooms the zoomed/panned image to the default (full image) display

: When selected (on), it will zoom to the mouse-defined rectangle (place the cursor on the upper
corner, press and drag to the lower diagonal corner, and then release the mouse).
When un-selected (off), it is a pan tool: place the mouse anywhere on the image, press and drag
the image to the desired position.

Perform Analysis

9.2.4.1. Setting Up Inner/Outer Contour Threshold

Inner contour threshold: minimum intensity of the inner pattern threshold. This value determines the
edge of the center object.
Outer contour threshold: minimum intensity of the inner pattern threshold. This value determines the
edge of the radiation field.
Both thresholds are the percentages (0-100) of gray scale corresponding to the absolute value of 0-255.
After images are selected, the SW automatically searches for the contour pattern and the inner and
outer contours as defaults. They can be changed by setting different numbers in the Inner / Outer
contour box. By press the Refresh button , they are reset to the defaults.
Upon loading images, the SW automatically calculates the outer and inner contours using the first
image in the Image Parameter Table.

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 151

 IM PO RT ANT N O T IC E
RESET THRESHOLDS AFTER DELETING THE FIRST IMAGE
If the first image is deleted, the threshold are not automatically recalculated with
the new first image. The default calculated threshold is only recalculate when
importing images.
0.1Some manipulation may be required to determine a set of threshold values that works
simultaneously for all images. If the contour and consequently the center of an object cannot be
determined, the most likely cause is that a threshold does not work for the image. This issue can be
corrected by changing the threshold until the contour can be defined, or by analyzing one image at a
time for noisy images.

9.2.4.2. Perform Analysis

Check that the checkboxes of the images to be tested are selected.

Click the Start button, (1) in on the top of the table to perform the test with the default contours
defined in (2).

Click Finish (3), the results will be displayed.

152 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

2D deviation calculation

Selecting/de-selecting an image by clicking the selection box will trigger calculation for this image
(displaying/removing the results for this image).

By clicking the Start button , all selected images are calculated. All 2D results will be displayed in
the table of the image parameters.

3D deviation calculation

IM PO RT ANT N O T IC E
REQUIREMENTS FOR 3D CALCULATION
The 3D results are provided only if the following conditions are fulfilled:
• Only four images with gantry angle information, 0°, 90°, 180°, and 270°,
respectively, are selected for calculation.
• Collimator angle and couch angle are the same for all four images.
• All the images have the same DPI to calculate the 3D analysis
Note: If gantry angles are changed, the calculation does not re-start automatically. Calculation will start
after clicking the Start button.

9.3. Create a Winston-Lutz Test Protocol

In Test Setup, click Edit in the ribbon.
In the Machines & Templates panel, select the desired machine and then in the Protocol Tree
panel, select or create a task in which the test should be located (see Section 3.3.4 for detailed
instruction on creating a new protocol and task).
Click New in the ribbon. In the New Test Definition dialog, enter/select the following information,
and then click OK.
Name: name of the test
Description: (optional) enter any description
Category: Mechanical (for information display only)
Result Type: Mechanical: Isocenter Check
Implementation: Winston Lutz (automatically loaded after selecting a Result Type)
Warning tolerance: value of warning tolerance
Error tolerance: value of error tolerance

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 153

 Click Set Active in the ribbon if the protocol should be run next.
Click Save in the ribbon.

Note that you can also create a test template first, and then copy the template into the machine
protocol. See Section 3.3 for instructions.

154 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

9.4. Example – Winston-Lutz Test on EPID Images

Phantom for Winston-Lutz Test

In this example, the images are taken with an IBA cylindrical phantom equipped with a 6 mm steel ball
insert. The material for the phantom is PMMA. Outer diameter: 13 cm, inner diameter: 2 cm, length: 13
cm. Engraving on surface indicates the center of the steel ball.
Due to the structure of the IBA cylindrical phantom, it is only suitable to be used with small field sizes,
e.g., 2 cm × 2 cm or 3 cm × 3 cm.

IBA Cylindrical Phantom IBA Cylindrical Phantom during measurements

Obtaining Winston-Lutz Images with EPID

The IBA cylindrical phantom is placed on the couch and aligned at the isocenter with the laser
alignment system of the treatment room. In this example, 4 EPID images with 6MV, 2 MU, and gantry
angle at 0°, 90°, 180°, 270°, are captured with EPID with single-exposure mode. The images were save
as DICOM format.

Execute Winston-Lutz Image Analysis

Create a protocol containing a Winston-Lutz test and set it as active protocol in Test Setup (see
Section 9.3).
In Test Run, select the machine under Machines, and the activated Winston-Lutz test under Active
Tasks.

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 155

 Click Load images. (See Chapter 10 for detailed information of DICOM image import)

In the Import images dialog:

 Select File based.
 Click the Folder browse button, and then select the DICOM folder click Ok.
 Select the images to be import and then click Ok.
In Test Run, select the images to be analysed by clicking the check boxes in the first column.

156 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

Check the gantry angle in the Gantry column if 3D analysis is required.

Click .
See results listed in the Dv (deviation) and State (Passed/Warning/Failed/Undefined) columns,
Results boxes.
Click Finish, the results will be displayed.

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 157

9.5. Winston-Lutz Calculation Algorithm
Currently, the SW supports only grayscale images with rectangular and circular shapes types of
contours.

Determining Outer/Inner Contours and Their Centers

Outer contour and its center
This is the contour of the radiation field.
The SW automatically searches for the contour pattern - rectangular or circular shape.
The center of the contour is the diagonal intersection of a rectangle or the center of circle.
The SW displays a red outline on the image, indicating the detected radiation field edge and a red “+” is
drawn indicating the center the outer contour.
Inner Contour and its center
This is the contour of the Winston-Lutz ball. The coordinate of center of the inner contour is 𝑐𝑖𝑐 (𝑥𝑖𝑐 , 𝑦𝑖𝑐 )
The SW automatically searches for the circular contour of the Winston-Lutz ball.
The center of the contour is the center of circle.
The SW displays a green outline on the image, indicating the detected radiation field edge, and a green
“×” is drawn indicating the center the outer contour.
Calculate the center of the contour.

2D Deviation Calculation
Assuming the coordinate of the outer contour center is 𝑂𝐶(𝑂𝐶ℎ𝑜𝑟𝑖𝑧𝑜𝑛𝑡𝑎𝑙 , 𝑂𝐶𝑣𝑒𝑟𝑡𝑖𝑐𝑎𝑙 ) and the coordinate of
the inner contour center is 𝐼𝐶(𝐼𝐶ℎ𝑜𝑟𝑖𝑧𝑜𝑛𝑡𝑎𝑙 , 𝐼𝐶𝑣𝑒𝑟𝑡𝑖𝑐𝑎𝑙 ). We have
 Deviation along the horizontal direction:
𝐷ℎ_𝑝𝑥𝑙 = 𝑂𝐶ℎ𝑜𝑟𝑖𝑧𝑜𝑛𝑡𝑎𝑙 − 𝐼𝐶ℎ𝑜𝑟𝑖𝑧𝑜𝑛𝑡𝑎𝑙 ,
 Deviation along the vertical direction:
𝐷𝑣_𝑝𝑥𝑙 = 𝑂𝐶𝑣𝑒𝑟𝑡𝑖𝑐𝑎𝑙 − 𝐼𝐶𝑣𝑒𝑟𝑡𝑖𝑐𝑎𝑙 ,
 2D Euclidian distance between the centers of outer and inner contours:

𝐷𝑝𝑥𝑙 = √𝐷2ℎ_𝑝𝑥𝑙 − 𝐷2𝑣_𝑝𝑥𝑙 ,

where, the coordinates, deviations and the distance are expressed in pixels.
Since 1 inch = 25.4 mm, the following formula transfers pixels to mm:
𝐴𝑝𝑥𝑙
𝐴𝑚𝑚 = × 25.4 ,
𝐷𝑃𝐼

where, DPI is dots per inch.

158 | IsoTrack Plugin | myQA User's Guide - Vol.3. myQA Machines

 3D Deviation Calculation
The 3D deviation calculation is based on the paper, “A quality assurance method with submillimeter
accuracy for stereotactic linear accelerators” by J. Grimm et al3 .

Image directions

AP (anterior to posterior) = 0°
PA (posterior to anterior) = 180°
RT (patient’s right) = 90°
LT (patient’s left) = 270°

Definitions of Parameters
Bx (for each direction): distance in x between inner contour center and outer contour center
By (for each direction): distance in y between inner contour center and external contour center
D3d: 3D Euclidian distance between the centers of outer and inner contours.

3D deviation formula

𝐷3𝐷 = √𝐵𝑥2 + 𝐵𝑦2 + 𝐵𝑧2

where, the ball coordinate (𝐵𝑥 , 𝐵𝑦 , 𝐵𝑧 ) is:

𝐵𝑥𝑅𝑇 + 𝐵𝑥𝐿𝑇
𝐵𝑥 = −𝐵𝑥𝑃𝐴 +
2
𝐵𝑦𝑅𝑇 + 𝐵𝑦𝐿𝑇
𝐵𝑦 =
2
𝐵𝑥𝑅𝑇 − 𝐵𝑥𝐿𝑇
𝐵𝑧 =
2

3 Grimm J, Grimm SL, Das IJ, et al. J Appl Clin Med Phys. 2011; 12(1):182-198

myQA User's Guide - Vol.3. myQA Machines | IsoTrack Plugin | 159

10. Sphinx Plug-In
10.1. Product Description
To ensure the expected clinical outcomes and patient safety using PBS in a proton therapy system, QA
measurements are required on a daily basis. The Sphinx Plugin is designed to analyze proton beam
images acquired with a Sphinx measurement device.
The Sphinx Plugin includes the following test types:
■ Energy consistency verification through PDD wedges, a SOBP block, or modular blocks,
■ Beam optics check: single spot position, sizes and symmetry,
■ Coincidence of proton beam vs X-ray,
■ Output consistency: ion chamber support (PPC-05 from IBA Dosimetry GmbH) available for dose
measurement,
■ Field homogeneity,
■ Patient positioning system (coordinates) consistency.
There are two measurement systems available:
■ Sphinx V1 ( two devices: Lynx detector and Sphinx phantom).
■ Sphinx Compact (one device including XRD Flat Panel detector and a compact phantom)
For detail description of the devices, please see Section 7.3 in Vol. 1, myQA Platform and Devices
User’s Guide.

10.2. Setting up for Measurements

Setting up the PTS Communication

For the IBA PT users with Proton Therapy System (PTS) version R11, the Sphinx Plugin provides an
automation of measurement and analysis. To be able to use this function, the communication between
the Sphinx Plugin and the PTS requires to be established:
Open the file, IBADos.CSP.Run.Shell.exe.config, in C:\Program Files (x86)\IBA Dosimetry\myQA
with a text editor, e.g., Notepad, and move down to the line, “<add key="MQA_DOPA_Hostname"
value="" />”
Insert the IP address and the port of the room in which the DOPA server is running e.g.,
“10.192.254.8:8081” or “tcrw1.ptcg.org:8081”. See an example below:

160 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

 In this example, the IP addresses of two PTS server in two treatment rooms are inserted. If there are
more than one IP address, they will be appear in the dropdown list of the Auto button in the Test
Run workspace. The user should select the room for performing QA.

Click File > Save

Setting up the Device in a Proton Treatment Unit

10.2.2.1. Sphinx V1
Normally, the Sphinx phantom is oriented on the patient couch as shown in the photo below. However,
the Lynx, which is attached to the Sphinx, can be oriented in 4 positions. The Sphinx phantom is
aligned through the X-ray imaging system, the in-room lasers can be checked on the markers engraved
on the phantom frame. See Section 7.3.3 in Vol.1, myQA Platform and Devices User’s Guide for the
detail procedure for setting up the Sphinx V1 system.

Example: the orientation of the Sphinx V1 with the gantry angle at 0˚

The orientation of the Lynx needs to be entered into the SW for the test (see Section 10.3.1.2). The
illustration below shows different orientation of the Lynx detector.

Illustration of the Lynx orientation using the shape of the Lynx. The BEV goes vertically to the paper.
For example, in BEV, the Lynx is rotated clockwise 90˚ is +90˚.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 161

10.2.2.2. Sphinx Compact
The Sphinx Compact can be used with Gantry at 0°, 90° and 270° (see an illustration below). The
Sphinx Compact can be used with Gantry at 0°, 90° and 270°.

Gantry at 90° Gantry at 0° Gantry at 270

Illustration of the Sphinx Compact orientation at gantry angles of 90°, 0°, and 270°

The phantom is aligned with the in-room lasers to central fiducial and the markers engraved on the
phantom frame. The photo below show a setup that the Sphinx Compact is orientated for the gantry
angle at 90°. The PLD and template included in myQA are made for the gantry at 90°.

Example: the orientation of the Sphinx Compact with gantry angle at 90˚
See Section 7.3.4 in Vol.1, myQA Platform and Devices User’s Guide for the detail procedure for setting
up the Sphinx Compact system.

Baseline Measurements
Initial measurements can be performed to generate baseline and tolerance values. These value is then
entered into a Sphinx Plugin protocol (see Section 10.3.1.2) for future analysis.
The baseline includes an X-ray image, a DICOM CT image of the Sphinx phantom, output
measurement (with e.g. DOSE 1 and PPC05 chamber), and a complete beam image. These
measurements should be done before using the Sphinx Plugin on a recurrent basis for Machine QA.
They will be used every day later on as a reference for comparison. Therefore, the baseline should be
taken with the same measurement setup as for subsequent daily QA checks.

162 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

10.3. Workflow for Sphinx QA Tests
General workflow:
1. Define the detector in the SW (Section 6.4.3, Vol.1, myQA Platform and Devices User’s Guide)
2. Create a Sphinx QA protocol template (Section 10.3.1)
3. Create a machine QA protocol with the protocol template created in the previous step (Section
10.3.2)
4. Perform test and analysis (Section 10.3.3)

Creating a Sphinx Protocol Template

10.3.1.1. PBS Layer Definition Files

In a Sphinx protocol, the PBS Layer Definition (PLD) file which defines the daily QA irradiation pattern is
used for defining the test. A PLD file can be created by simply saving a plain text file with file extension
“.pld”. In the PLD file, energies are defined by layers, starting from the distal energy to the proximal
energy. Each layer represents an energy. In a layer, spots are defined by a position [X, Y] and dose (MU).
See an example of IBA PLD file for the Sphinx V1

The structure of a PLD file can be summarized as:

1st line - PLD Header: it is a summary information for the PBS field, defining total dose, dose per
meterset weight, and number of layers;
2nd line, Layer Header: it defines the energy of the Layer and the sum of meterset weight;
3rd line, spot data: each spot is defined by a position and a dose.
When a PLD file is uploaded into myQA Sphinx Plugin, the only information captured by the software
are layer’s energy and spots coordinates.
The PLD image shows that a certain pattern is used for a specific test. When defining a test that
requires to define an area to be analyzed (the object of interest, OOI), the OOI should cover the pattern
that is designated for the test.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 163

PLD image for Sphinx V1

An example of a PLD image for Sphinx V1 system. All layers are selected to display

PLD image for the Sphinx Compact

An example of a PLD image for Sphinx Compact system. All layers are selected to display. The PLD
has been created to use the Sphinx Compact with the gantry at 90°.

An example of a PLD (Sphinx Plugin-PLD Template.pld) shown in the figure above can be found in
C:\ProgramData\IBA Dosimetry\MachineQA\SphinxSamples

164 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

10.3.1.2. Creating a Sphinx Protocol Template
Once a protocol template is created, it can be used for creating similar machine protocols.
In myQA Machines > Test Setup, select your clinic by clicking Clinics in the ribbon.
Click Edit in the ribbon.
In the Machine & Template panel, select Protocol Templates.
Click New in the ribbon and enter the name of the protocol template and optionally a description.
While the newly created protocol template is selected, click New; and enter the name of the task
template and optionally a description in the Task definition. Then define a task schedule in
Recurrence.
While the newly created task template is selected, click New; and enter the name of the test
template and optionally a description. And then define a test as follows:
 Select Other for Category
 Select Sphinx for Result Type
 Select Sphinx or Select Sphinx Compact for Implementation depending on the system used
Note: Please ensure that the selection in the Implementation box matches the type of the
measurement device (Sphinx V1 or Sphinx Compact) that will be actually used.
 Click OK

Click the Import *.pld button and browse for, select, and open the PLD file. See Section 10.3.1.3 for
more information.
In the Geometry group, edit the values according to the actual setup if necessary.
Defining the tests – it can be done by directly entering the baseline and user-defined tolerance
values. See Section 10.2.3 for the baseline measurements.
There are six test categories. Based on the procedure, they can be separated in two groups for
description.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 165

 Group 1: for the Output and Couch Translation categories, only the expected values and tolerance
values need to be entered:
1. Create a new test
2. Enter the name of the test
3. Enter the expected values and tolerances.
See an example of the procedure for defining an Output test below.

Defining an Output test

 Under Analysis, click the Output tab (1) and then select Create New in the dropdown menu
 Enter a name (2)
 Enter the expected value and tolerance (3).

The procedure for defining a test of the Couch Translation category is similar as above. Here the
expected values and tolerances are taken from the analysis of the X-ray image.
Group 2: procedure for the other group of categories, Energy, Homogeneity, Spot, and
Coincidence, the definition:
1. Create a new test
2. Enter a name
3. Define the OOI (Object Of Interest)
4. Enter the expected values and tolerances.
See an example of the procedure for defining an Energy test below.

Defining an Energy test

166 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

  Select an energy (1) by clicking the corresponding button, e.g. 106 in Layers (MeV)
 Under Analysis, click the Energy tab (2) and then select Create New to define the area that is to
be analyzed, i.e. OOI.
By default, an OOI of 10 mm x 10 mm is automatically created in the center of the PLD map (3).
It can be changed by entering the coordinates (4) or by dragging an edge of the OOI with the
mouse after selecting the drag-and-drop button (5). Normally, the OOI should cover the PLD
pattern (6).
 Edit the name of the OOI (7)
 Select a value in the dropdown list in
o the Wedge Thickness box (8a) that is the thickness of the wedge used for the selected
energy test if Sphinx Compact is used). For the Sphinx V1, it is always 20 mm / 65 mm.
o the Additional Thickness box (8b) that is suitable for the selected energy (if Sphinx V1 is
used).
 Enter the expected values and tolerances in the table (9)
 Enter the measurement settings (see the next section for the description), start a measurement
by clicking the Measurement button, and then check whether in image fits to the defined OOI; if
not, the Rotation or Shift may need to be adjusted.

(Sphinx V1)

(Sphinx Compact)

 Repeat the above steps to define a test for another energy until all the desired energy tests are
defined. The procedure is similar as above for defining the Energy, Homogeneity, Spot, or
Coincidence test.
 Click the OK button to finish editing the test
After all tests are defined for the protocol template, click Save in the ribbon

An example of a Sphinx protocol template (Sphinx Plugin-Protocol Template.xml) based on the

previously shown PLD can be found here: C:\ProgramData\IBA Dosimetry\MachineQA\SphinxSamples.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 167

10.3.1.3. Information of the Test Definition Window
PLD File group

Import *.pld: click to import a PLD file

Import *.dcm: click to import an image *.dcm file
Dicom Opacity: drag the cursor to adjust the image signal intensity
Layers (MeV): click All to display all energies; click a numbered button to display only a specific layer
of the corresponding energy in the PLD window.

: Resets the image to the default display, which is the full size of the image, i.e. all pattern defined
in the PLD are shown.

: Zooms or resets the zoom by placing the mouse on the new center, and then rotating the mouse
wheel up or down.

: By selecting it, the cursor becomes double-arrows when it is placed on an edge of an OOI. Hold
down the left mouse and drag the edge to the desired position. When placed inside an OOI, the
cursor becomes four-arrows. Hold down the left mouse and drag the OOI to a desired position.
Cursor: coordinate of the intersection of the two-cursor lines.
Place the mouse on a cursor line, hold down the left mouse and drag the line to the desired position.

Measurement devices group

168 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

Upper box: for selecting a detector for measurement
Lower box: calibration file uploaded when creating the device in the Equipment Setup window in the
myQA Platform workspace.

Settings group

1: for entering frame duration time (sec), the default value is 2 seconds
2a (only for Sphinx V1): for entering iris aperture (%); default: 100%
2b (only for Sphinx Compact): for entering the gain. The smaller the value the greater the signal
3: starts background measurement
4: connects/disconnects the detector for measurements

W AR NI NG
SPHINX COMPACT SETTINGS
The default values for the gain and frame duration are:
- Frame duration = 2 sec
- Gain = 4 pF

Geometry group

Rotation: for entering the orientation of the phantom. The orientation entered will be indicated with a
green corner of the outer edge of the full image. See the screenshot under PLD File group on the
previous page.
Phantom orientation indication: a corner of the outer edge of the full image becomes green, starting
from upper-left corner: 0˚, 90˚, 180˚, -90˚. See Section 10.2.2.1 (Sphinx V1) and Section 10.2.2.2
(Sphinx Compact) for the definition of phantom orientations.
By default, the following values are set in the Geometry group:

Rotation (°) Shift-x (mm) Shift-y (mm)

Sphinx V1 0 0.0 20.0*

Sphinx Compact 90 0.0 0.0

*In the Sphinx V1 system, 20 mm shift in Y-axis is due to the housing of the device, which is also the
shift when the device is oriented at 0˚ and aligned with the room lasers.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 169

Shift: for entering the shift of the device in measurements, left box: X-coordinate; right box: Y-
coordinate. See the shift coordinate below:

Illustration of the shift coordinate. The BEV goes vertically to the paper.

Analysis group

The Analysis group contains six tabs (1) for the supported test categories provided in the Sphinx
Plugin. To create a test,
Click the category tab for the desired test type (1), and select Create new; the test parameter
template (2) will open.
Edit the parameters.
This test will be listed in the dropdown menu of this tab.

To see or edit an existing test,

Click the category tab for the desired test type (1), and then select the test in the dropdown list
Edit the parameters in the opened test parameter template (2).

Note: When entering values for the OOI coordinates, do not enter values beyond the image size
(< -149.5 mm or > 149.5 mm). Otherwise an Error Analysis message will appear. Then click OK
and re-enter a proper value.

170 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

Wedge Thickness: The wedge thickness for Sphinx V1 is 20.0 mm / 65.0 mm. For Sphinx Compact,
three wedges are provided. Click the dropdown list and select the wedge that shall be used for the
energy tests.
Addition Thickness (only used for Sphinx V1): the dropdown list contains the thickness values of the
RW3 blocks provided with the Sphinx V1 phantom. Select the value that is suitable for the energy.

Sphinx V1 Sphinx Compact

Wedge Thickness Addition Thickness Wedge Thickness Addition Thickness

20.0 mm / 65.0 mm 40.0 mm 34.0 mm / 58.0 mm (n/a)

100.0 mm 85.0 mm / 109.0 mm
150.0 mm 151.0 mm / 175.0 mm
200.0 mm
250.0 mm

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 171

 Creating a Machine Protocol
A device protocol can be created by adopting a Sphinx Plugin protocol template created in Section
10.3.1.
In the Machine & Template panel (1), select the machine to be tested.
Click From Template (2) in the ribbon, then select the protocol template created in Section 10.3.1.

Check through the parameters (3) that were defined in the copied template for all tests in the
Analysis group. If necessary, edit them so that they fit to the machine that is to be tested.

To activate the protocol for test run, select the protocol (4) and then click Set Active (5) in the
ribbon.
Click Save (6) in the ribbon.

172 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

 Test Run
In Test Run the tasks, which are due to be run are listed in the Active Tasks list. To run an
unscheduled task, click Add Unscheduled in the ribbon and then select the task. It will then appear in
the Active Tasks list.

10.3.3.1. Description of the Sphinx Plugin Test Run Interface

2a 2b 3a 3b

1: Agenda panel: select a task for a machine to be run, 2: perform measurements/load images for
analysis, 3: define analysis settings and view results, 4: Task/Test Info panel (Section 3.4.4)

Measurement devices group and Settings group: see Section 10.3.1.3.

To acquire an optimal image, the user needs to perform background subtraction. The background
image needs to be acquired at least once per measurement session, but not for each image as myQA
rescale the background image using the integration time.
As in the FIMEL application, background measurement takes both the switching noise and the intrinsic
noise into account. If the default value is 20 s, the background acquisition will take more than 40 s 4.
The values of frame duration (2a) and iris aperture (Sphinx V1) / gain (Sphinx Compact) (2b) will be
taken over the Settings of analyzed measurement group (3a and 3b) once the measurement starts.
For a loaded image, these values need to be entered.

Note: 3a and 3b settings will be saved and used everyday. It is recommended that the Iris opening
(3b) is at least 30 % to avoid image distortion.

Measure and Analysis group:

4The parameter, ‘BackgroundSamplingTime’, in the myQA configuration file is for the measurement of
the intrinsic noise, and is 20 s by default. In order to match better the use case, one can change the
parameter, “MQA_SphinxPlugin_BackgroundSamplingTime”, in the configuration file (open
IBADos.CSP.Run.Shell.exe.config, in C:\Program Files (x86)\IBA Dosimetry\myQA)
To make the changes effective, save the file and restart myQA.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 173

 These three buttons will be used for three different workflows provided
in Test Run:
2c: starts a measurement manually and then analysis automatically
(workflow 1, see Section 10.3.3.2.1).
2d: starts analysis of a loaded (imported or measured) image (workflow
2, See Section 10.3.3.2.2). It is enabled once an image is loaded.
2e: starts the automation of measurement and analysis (workflow 3, Section 10.3.3.2.3)

: opens the DICOM import dialog for importing DICOM image

: saves a Sphinx Plugin measured image in DICOM format

10.3.3.2. Measurement Workflows

There are three workflows to execute a daily PBS QA:

1. Perform measurement and analysis ( ); see Section 10.3.3.2.1.

2. Load an image ( ) and perform the analysis on it ( ); or perform analysis again

on the measured image. See Section 10.3.3.2.2.

3. Perform automatic measurement and (synced with the PT delivery machine) and analyze it ( ); see
Section 10.3.3.2.3.
Note: Before a test run, please check the pixel defect filtering parameters edited in the myQA Platform
- Options - myQA PT - Sphinx Plugin workspace. The default parameter values can be viewed
and Edit (see Section 5.4.1.4, Vol. 1, myQA Platform User’s Guide, where the defect filtering
algorithm is also described).

About image default settings

Images acquired with a Sphinx V1 have the following default settings:

■ Uniformity calibration applied. The uniformity calibration file loaded in the Equipment Setup
workspace is select by default. The filename with the Camera ID is displayed in the Test Run
workspace
■ Geometrical correction applied
■ Median filter applied ( size: 5 pixel)
■ Correction slope Y

Images acquired with a Sphinx Compact have the following default settings:
■ Uniformity calibration applied. The uniformity calibration file loaded in the Equipment Setup
workspace is select by default. The filename is displayed in the Test Run workspace.
■ Depth calibration applied. The depth calibration file loaded in the Equipment Setup workspace is
selected by default.
■ Defect pixel correction applied. The defect correction parameters from the Sphinx Settings in the
myQA Platform - Options workspace.
The status (“true” or “false”) of the following parameters can be changed in the configuration files:
 Geometrical correction
 Median filter

174 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

Note: When a session is restarted from sleep mode, the Lynx connection may be lost although the
displays shows as if it still connected and even a measurement can be started. However, after a
few minutes, an error message pops up and informs the user to reconnect the detector. The User
should click the Disconnect button and then the Connect button in the Measurement ribbon.

W AR NI NG
SATURATED IMAGES

If the image is saturated, a warning sign will appear in the Measure &
Analysis group. By placing the cursor on the warning sign, the following warning
message appears:
“The image appears to contain <n> saturated frames”, where <n> is the actual
number of frames where saturation was detected.
If it is an imported image, it is not qualified to be used for analysis. If it is a
measured image, the measurement should be repeated with a different gain
value of the Sphinx Compact or with a modified map by decreasing MU / spot
where the image is saturated.

10.3.3.2.1. Workflow 1 - Perform Measurements Manually and Analysis

5. In Agenda, select a machine to be tested under Machines (1a), and a task to be run in the Active
Tasks list (1b).

1a

2a 2c 2d
2b
2e 3c

1b

Note: if desired, the parameters for a test can be edited by selecting the tab of this test (3c). The
parameters in the Actual column will be filled during the measurement or the user can enter
them manually.
6. Select the detector (2a), click button (2b) to connect the Sphinx Plugin to the device, and enter the
measurement time (2c) and gain (for Sphinx Compact) or iris aperture (for Sphinx V1) (2d), click (2e)
to measure the background.

7. Click , and measurement starts. After measurement finishes, analysis for test categories,
Energy, Homogeneity, Spot, and Coincidence are automatically executed.
8. Perform analysis for the test categories, Output and Couch Translation (see Section 10.3.3.3 for
the description of the tests).
9. (Optional) click the Save Image button. The image will be saved in DICOM format.
10. To finish the tests, click Finish in the lower-right corner. The summary of the test results are
displayed.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 175

11. To finish the task, click Finish in the ribbon. If the overall status should be changed, checkmark the
Override status box, and then select a new status in the combo box.

For more information of the Finish Task dialog, see Section 3.4.6

12. Click the Finish button to finish the task or to finish the task and create a task report, click the
Finish & Report button. For more information about a report, see Section 2.5 and 10.4.

An example of a Lynx map (Sphinx Plugin - Measurement Example.dcm) and a test protocol (Sphinx
Plugin-Protocol Template.xml) are provided in C:\ProgramData\IBA
Dosimetry\MachineQA\SphinxSamples. User can use this example to practice the workflow 2.

176 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

10.3.3.2.2. Workflow 2 - Load an Image and Perform Analysis
If an image already exists, go to Step 3 directly.
1. In Agenda, select a machine to be tested under Machines (1a), and a task to be run in the Active
Tasks list (1b).

Note: if desired, the parameters for a test can be edited by selecting the tab of this test (3c). The
parameters in the Actual column will be filled during the measurement or the user can enter them
manually.

2. Click . In the Load Image Manually window, select an image and click OK. For
detail instruction of DICOM import, see Section 11.1.
If the DICOM image is older than one hour, a warning message is displayed. To continue the import,
click OK; the image is displayed.

W AR NI NG
QUALTY OF IMPORTED IMAGES
The software does not check the imported images. Please ensure that they are
suitable for the comparison.

3. Click . Analysis for test categories, Energy, Homogeneity, Spot, and Coincidence will be
executed.
4. Perform analysis for the test categories, Output and Couch Translation (see Section 10.3.3.3).

5. (Optional) click . The image will be saved in DICOM format.

6. To finish the tests, click Finish in the lower-right corner. The summary of the test results are
displayed.
7. To finish the task, click Finish in the ribbon. If the overall status should be changed, checkmark the
Override status box, and then select a new status in the combo box.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 177

 For more information of the Finish Task dialog, see Section 3.4.6

8. Click the Finish button to finish the task or to finish the task and create a task report, click the
Finish & Report button. For more information about a report, see Section 2.5 and 10.4.

178 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

10.3.3.2.3. Workflow 3 - Perform Automatic Measurements and Analysis

This workflow is only for IBA PT Users with PTS R11 (and above).
1. In Agenda, select a machine to be tested under Machines (1a), and a task to be run in the Active
Tasks list (1b).

Note: if desired, the parameters for a test can be edited by selecting the tab of this test (3c). The
parameters in the Actual column will be filled during the measurement or the user can enter
them manually.
2. Select the detector (2a), click button (2b) to connect the Sphinx Plugin to the device, and enter the
iris aperture (for Sphinx V1) or gain (for Sphinx Compact) (2d), click (2e) to measure the
background.
Note: It is not required to enter the measurement time (2c). It will be retrieved automatically from the
TCS (Therapy Control System).

3. Click , and the process info dialog opens. See sub-section, Measurement and Analysis
(Automation, IBA PT Users only), below for more information.
After measurement finishes, analysis for test categories, Energy, Homogeneity, Spot,
Coincidence, and Couch Translation are executed.
4. Perform analysis for the test category, Output (see Section 10.3.3.3).
5. (Optional) the image can be saved in DICOM format using the Save Image button.
To finish the tests, click Finish in the lower-right corner. The summary of the test results are
displayed.
6. To finish the task, click Finish in the ribbon. If the overall status should be changed, checkmark the
Override status box, and then select a new status in the combo box.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 179

 For more information of the Finish Task dialog, see Section 3.4.6

7. Click the Finish button to finish the task or to finish the task and create a task report, click the
Finish & Report button. For more information about a report, see Section 2.5 and 10.4.

Measurement and Analysis (Automation, IBA PT Users only)

Starting from PTS R11, myQA Sphinx Plugin and IBA PTS can communicate in order to synchronize
beam and lynx acquisition.

By clicking the button, the process info dialog appears:

1: Wait for beam to be ready

The myQA is waiting for the PTS machine to be ready to start a new irradiation (beam status: idle).
2: Wait for couch translation vector
The beam status ‘ready’ is retrieved by the system: the proton therapy machine is ready to start the
preparation of a new irradiation. The myQA is waiting to retrieve the Couch Translation vector
calculated by the dedicated software
3: Wait for beam to be prepared
myQA had retrieved the Couch Translation Vector received by the dedicated software.
Note: if the couch position is changed after the beam status is switched from 'in preparation' to 'ready',
the new couch position is not retrieved and updated.

180 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

 myQA is waiting for the preparation/request of the beam to be completed
4: Wait for beam to be started
The preparation of the beam is completed. myQA retrieves this status.
User action required: click Start in the TCS (Therapy Control System): in the busy indicator, the
message ‘Waiting for beam to be started’ is in progress. The irradiation is on hold because of the
beam lock set by myQA.
5: Preparing for measurement
The user already pressed the Start button to start the irradiation in the TCS.
Preparing for measurement is in progress. The communication with the detector is Sphinx V1/
Sphinx Compact is started: myQA sends the command for Iris opening (for Sphinx V1) or gain (for
Sphinx Compact) and expected exposure time. The irradiation time is retrieved by the TCS.
Additional 30 seconds are account for eventual beam pausing.
The irradiation is still on hold because of the lock set by myQA.
6: Releasing beam lock
The communication with the detector successfully started.
The beam lock is released.
The irradiation starts and the detector is integrating signal.
7: Performing measurement
The irradiation is complete.
The measured frame is displayed in myQA.
The effective exposure time is reported in the Test Run
The tests are automatically filled.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 181

10.3.3.3. Analysis – Description and Instruction
Categories of Energy, Homogeneity, Spot, and Coincidence
Once a button in the Measure & Analyze group is clicked, the resulting status for the Energy,
Homogeneity, Spot, and Coincidence categories will be displayed in the tabs in the Results panel.

Cursor: displays the coordinate and intensity of the intersection of the two cursor lines.
Click a category tab and then select a test, its test results can be viewed in the Result panel. For the
test categories that show a graph in the Results panel (i.e. Energy, Coincidence and Homogeneity),
the intensity of the cursor position on the curve is displayed in the lower left of the graph.

In the homogeneity graph, the flattened region which is considered for flatness calculation is highlighted
in a different color.

182 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

Output category
Click the Output tab and then select the test, and then enter the output values measured with
PPC05.

Couch Translation category

Click the Couch Translation tab and then select the test, and then enter the actual values from the
X-ray image analysis

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 183

10.4. Review and Report the Performed Tests
The performed test results can be viewed in the Test Repository (1) page.
Click to select a test in the list (2), its test information will be displayed in the right panel (3).

By selecting one or more tests, and then clicking Report (3) in the ribbon, a test report is created. It
can be exported as *.html, *.rtf, *.pdf or it can be printed by clicking the corresponding buttons on the
upper-right area (4).

184 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

10.5. Sphinx Plugin Calculation Algorithms
The Sphinx Plugin supports DICOM images with pre-defined irradiated patterns. The analysis is
performed over the OOI defined by the user.

Energy Calculation Algorithm

The depth-dose curve can be reconstructed from the geometrical characteristics of the four central RW3
wedges (two with modular blocks and two with fixed blocks).
In the Test Definition, it is important that the user defines an OOI which includes the slight signal
generated by the radiation delivered over the RW3 wedge (1). The rising part of this signal is used in the
algorithm to identify the physical edge of the RW3 block.

If the user defines an OOI which does not include the signal over the RW3 wedge (2, see the screenshot
below) the algorithm cannot properly run the analysis and an error message is displayed (3).
Once the correct OOI is defined, the first derivative of the raw signal is calculated in order to identify the
physical edge of the corresponding RW3 block. This method has been deployed for the first time in
myQA 2016-002.
The final depth-dose curve is calculated by assigning a value of depth to each pixel of the image. To
account for different phantom materials in the Sphinx Compact, all depth values obtained in a Sphinx
Compact test are converted to water-equivalent depth via the default depth conversion (*.dc) file set in
the myQA Platform - Equipment Setup workspace.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 185

Energy parameters (Distal Depth, Proximal Depth, Width and Distal Dose Fall-Off) are defined as:
■ Distal Depth: d(D80%,distal),
■ Proximal Depth: d(D80%,proximal),
■ Width: d(D80%,distal) - d(D80%,proximal),
■ DFO: d(D20%,distal) - d(D80%,distal),
where d(D80%,distal) is, for instance, the depth corresponding to the 80% of the dose (normalized to the
maximum of the curve) in the distal part of the Bragg peak.
The values of depths are extrapolated from data interpolated with a cubic spline fit.

186 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

 Spot Parameters Calculation Algorithm
The user shall define an OOI which includes the complete spot to get an accurate evaluation.
The software automatically searches for the maximum in the OOI defined by the user.
X-profile and Y-profile are extracted from the 2D image
A Gaussian fit is applied to both X-profile and Y-profile to extract the desired parameters. The fit is
performed in order to minimize the sum of square residuals S between raw data and fitting function
through an unconstrained nonlinear optimization:
𝑛

𝑆 = ∑ 𝑟𝑖 2
𝑖=1

where
2
(𝑋𝑖 − 𝜇)
𝑟𝑖 = {𝑌𝑖 − 𝑘 ∙ exp (−0.5 ∙ ( ) )}
𝜎

where k, µ and σ are free parameters and X, Y the raw data from the image.
The searched parameters are defined as:
Spot Position = µ
Spot Sigma = σ
Spot Skewness is defined as the third moment of the Gaussian distribution. To reduce influence of
noise on the evaluation of the skewness, a threshold of 5% (relative to spot maximum) is set and
only points above this threshold are considered
Spot intensity is defined as the percentage ratio between the maximum of the spot and the
maximum over the entire image

Coincidence Calculation Algorithm

The user shall define an OOI which includes the complete spot impinging on the central fiducial to get an
accurate evaluation.
The software automatically searches for the maximum in the OOI defined by the user.
The software automatically searches for the 50% isodose and determine the corresponding
centroid [Xbeam, Ybeam].
The software automatically searches for the fiducial position [X fiducial, Yfiducial] through a moving
threshold and a binarization of the image:

Coincidence test - raw image Coincidence test – binary image with spot and
fiducial contours

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 187

The searched parameters are defined as:
Distance X = Xfiducial - Xbeam
Distance Y = Yfiducial - Ybeam

Homogeneity Calculation Algorithm

The user shall define an OOI which completely includes the irradiated field to be analyzed (1).

The software automatically searches for the maximum in the OOI defined by the user.
The software automatically searches for the 20% isodose, the 50% isodose and the 80% isodose
The software automatically calculates the field size (defined as the size at 50% isodose) in both X
and Y dimensions
The software automatically calculates the penumbra (defined as the distance between the 80%
and 20% isodose levels
The software automatically identifies the major axis (M_axis) and the minor axis (m_axis) of the
irradiated field
The Uniform Field Region is defined along the major axis, as Field Size – 2·Penumbra (of each side)

This method has been deployed for the first time in myQA 2016-002.

188 | Sphinx Plug-In | myQA User's Guide - Vol.3. myQA Machines

The Flatness parameter is calculated according to [1]:
𝐹𝑙𝑎𝑡𝑛𝑒𝑠𝑠 = (𝑆𝑚𝑎𝑥 − 𝑆𝑚𝑖𝑛 )⁄(𝑆𝑚𝑎𝑥 + 𝑆𝑚𝑖𝑛 ) ∙ 100
where Smax and Smin are the maximum and the minimum of the signal in the calculated Uniform Field
Region, respectively.

[1] G. J. Kutcher et al. “Comprehensive QA for radiation oncology: Report of AAPM Radiation
Therapy Committee Task Group 40,” Medical Physics, vol. 21, no. 4, pp. 581–618, Apr. 1994.

myQA User's Guide - Vol.3. myQA Machines | Sphinx Plug-In | 189

11. Appendix
11.1. DICOM Image Import
The DOCOM import window opens after clicking Load Images in the IsoTrack Plugin or Load Image
Manually in the Sphinx Plugin, the Import images dialog opens:

Browsing for DICOM Images

There are four browsing modes for import (1):

File based
With this mode, the DICOM data are imported off-line, e.g. from a local or network storage.
Click the File based tab.
Type in the location of the folder in the Folder text box, or click the Folder browser button, then
select the desired folder and click OK.
Notes:
By checking the Look in subdirectories box, the studies in the subdirectories are also searched.
By clicking Add additional files …, a standard Open browser will open. More image files can be
added into the list in box on the right side of the window. However, if Update is now clicked, the list
will be reloaded from the folder currently selected in the Folder text box. The items added with Add
additional files … are removed.

Query/ Retrieve
With this mode, the DICOM data are retrieved from a DICOM Server.
Click the Query/Retrieve tab.
Enter the parameters to find the correct patient. You can search for a single attribute or for a
combination of several attributes by:
 Patient Name

190 | Appendix | myQA User's Guide - Vol.3. myQA Machines

  Patient ID
 Patient Sex (F: female; M: male; O: other; *: all)
 Birth Date start, define the starting date for the birthdate range
 Birth Date end, define the ending date for the birthdate range
All parameter can be entered only in part using any part of the text string.
 Click the Query button. The studies matching the search criteria are listed.

Listening
In the Listening mode, the DICOM browser listens to the network to receive data. A status bar on the
bottom of the window shows whether application is ready to receive data.
To use the Listening method, the Select a study to import window must be opened and the
Listening tab is selected.
Click the Listening button. Whenever data is received from a DICOM Server, the available items
are updated accordingly.

DICOMDIR
With the DICOMDIR mode, the DICOMDIR files can be imported.
Click the DICOMDIR tab.
Select the root DICOM directory using the Path button to browse for the directory.
Click Ok. The available studies are displayed.

Loading DICOM Images

On the right side of the window, the selected studies are listed. Select the desired one and check the
boxes of the images to be imported under RTIMAGE. Click Ok.

Example: import DICOM images with File based mode.

myQA User's Guide - Vol.3. myQA Machines | Appendix | 191

11.2. Applying kTp Correction Workflow in myQA
Machines

When performing measurements with dosimetry Plugins, the user has the possibility to apply the
temperature and pressure correction (kTp) within the Machines workspace. The workflow is
independent whether the measurements are performed in Test Setup for baseline definition or in Test
Run.
In the following, the workflow is described using an example in Test Run.

Single measurement with a connected device

If the measurements are performed directly in the software, the temperature/pressure correction is
applied after the measurement device has been connected and the background measurement has
been performed.
Click the Temperature / Pressure Offsets button (1) to open
the dialog.
The Measured values (i) are the internal temperature and
pressure given by the measurement device. The user can keep
these values or adjust them according to an external
measurement device for temperature and pressure. The
external values are entered in the Actual fields (ii). The
difference between the internal and external values are
displayed in the Offset column (iii).

To start the measurement, click the Measurement button (2). The results are automatically
temperature / pressure corrected.
Note: The temperature and pressure values entered for a dosimetry test are automatically applied to the
other dosimetry tests of the same session.

192 | Appendix | myQA User's Guide - Vol.3. myQA Machines

Average of several measurements
The user can perform more than one measurement and use the average value as test result.
Click the Calculator button (3) to open the dialog.
Enter the results of the single measurements in the Measurement field (4)

If the single measurements were performed without kTp correction, checkmark the KTp box and
enter the temperature and pressure values (5)
Click Apply Result.

Note: Do not checkmark the KTp box if the entered values have already been corrected during their
measurement! Otherwise, the correction will be applied twice.

myQA User's Guide - Vol.3. myQA Machines | Appendix | 193

12. Glossary
AAPM TG-142 American Association of Physicists in Medicine Task Group 142 report
BEV Beam’s Eye View
BQI Beam Quality Index
CBCT Cone Beam Computed Tomography
CNR Contrast to Noise Ratio
CT Computed Tomography
DICOM Digital Imaging and Communications in Medicine
DIN Deutsches Institut für Normung
DMLC Dynamic multi-leaf collimator
DPI Dots per inch
EMC Electromagnetic Compatibility
EPID Electronic Portal Imaging Device
FFF Flattening filter free
HU Hounsfield Unit
HW Hardware
IEC International Electrotechnical Commission
kV/MV EPID Kilovoltage/ megavoltage Electronic portal imaging device
linac Linear accelerator
MLC Multi-leaf collimator
MTF Modulation Transfer Function
MU Monitor Unit
MV Megavoltage
OOI Object of Interest
PBS Pencil Beam Scanning
PDD Percentage Depth Dose
ROI Region of interest
QA Quality Assurance
SAD Source to Axis Distance
SDD Source to Detector Distance
SID Source to Imager Distance
SOBP Spread-Out Bragg Peak
SRS Stereotactic radiosurgery
SW Software
TIFF Tagged Image File Format
TPS Treatment Planning System
VMAT Volumetric modulated arc therapy

194 | Glossary | myQA User's Guide - Vol.3. myQA Machines