4. Position the dosimetric insert. The side without a handle should be inserted. Align the two black lines. As in step 2, be sure that the insert is in its correct position. 5. CT the phantom again with the same scan protocol as the previous scan. 6. Fuse the two CT image sets in your treatment planning system. 7. Segment the phantom images contouring the target, the TLD, and the outline of the dosimetry insert. Please see Proton Treatment Planning Addendum for further instruction. 8. For treatment, ensure that the dosimetric insert is still in the proper position from the CT scan. 9. Perform your customary QA of the proton plan prior to irradiating the phantom. Include in the form values and all the information you consider relevant for analysis . 10. Irradiate the IROC Houston TLD block according to the instructions provided. 11. Treat the phantom with the developed plan as you would a protocol patient. 12. Remove the dosimetric insert and place it in the box. 13. Put the empty phantom in the box. 14. Include the dosimetry data discussed above. Complete the attached forms. Be sure to include the scale used on the images coming from your TPS. 15. Return the complete package to the IROC Houston. /var/filecabinet/temp/converter_assets/5b/a3/5ba371289b44f75c32bc7308474c73a8931e55e8.doc The phantom should be imaged, planned and irradiated as if it were an actual protocol patient, incorporating all of your customary quality assurance checks. 3
IROC Houston Head Phantom Institution Information Institution:______________________________________________________________________ Address:_______________________________________________________________________ _______________________________________________________________________________ Person performing irradiation:______________________________________________________ Physicist to receive report:_________________________________________________________ Oncologist to receive report:________________________________________________________ Person to call in case of questions:___________________________________________________ Phone Number:_________________________Fax Number:_______________________________ Email address: _________________________________________________________________ Treatment Unit: Manufacturer:____________________________Model:_______________________________ In-house specification: Serial #______________________ Proton Energy: Nom ________ (MeV) Range: ______ cm 1. For the phantom irradiation, technique used was (check one) IMPT (variable intensity spot scanning). Continue to next section Spot Scanning (energy stacking). Continue to #4 Uniform Scanning. Continue to #2 Passive Scattering. Continue to #2 2. Collimation technique: _ Multileaf Solid Aperture 3. Range modulation technique: Range modulator wheel Range shifters Both RMW and shifters Other, please describe ______________________________ 4. Compensator technique:
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