TrueBeam System

Installation Product Acceptance

TrueBeam/ TrueBeam STx

EDGE / VitalBeam

IPA-HT-C AUGUST 2022

 MANUFACTURER Varian Medical Systems, Inc.
3100 Hansen Way
Palo Alto, CA 94304
United States of America

EUROPEAN Varian Medical Systems Nederland B.V.

REPRESENTATIVES Kokermolen 2
3994 DH Houten
The Netherlands

PUBLICATION Information in this publication is subject to change without notice and does not
INFORMATION represent a commitment on the part of Varian. Varian is not liable for errors contained
in this publication or for incidental or consequential damages in connection with the
furnishing or use of this material.
This publication is the English-language original.

TRADEMARK Varian products referenced herein are either registered trademarks or trademarks of
INFORMATION Varian Medical Systems in the U.S. and/or other countries. The names of other
companies and products mentioned herein may be the trademarks of their respective
owners. Any rights not expressly granted herein are reserved.

CONTACT Support services are available without charge during the initial warranty period. If you
INFORMATION seek information not included in this publication, contact Varian support.
You may use MyVarian for all means of contacting Varian. Click Contact Us. No
registration is required but is recommended.
If you are unable to access MyVarian, use the following email address for support:
[email protected]

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TABLE OF CONTENTS
1 Instructions for Use ...................................................................................................................................... 7
1.1 IPA Use ................................................................................................................................................ 7
1.2 Lotus Notes Users ................................................................................................................................ 7
1.3 Non-Lotus Notes Users ........................................................................................................................ 7
1.4 Document Distribution .......................................................................................................................... 8
1.5 Conventions ......................................................................................................................................... 8
1.6 Acceptance Form Information ............................................................................................................... 9
2 Reference Information ............................................................................................................................... 12
2.1 Revision Information ........................................................................................................................... 12
2.2 References ......................................................................................................................................... 13
2.3 Abbreviations ...................................................................................................................................... 13
2.4 Required Equipment and Tools .......................................................................................................... 15
2.5 Safety ................................................................................................................................................. 16
2.6 IEC Type Test for X-Ray Transmission and Leakage ......................................................................... 18
2.7 Position Readout Scale Convention.................................................................................................... 19
3 Preliminary Machine Checks...................................................................................................................... 20
3.1 Software Licenses .............................................................................................................................. 20
4 Safety Interlock .......................................................................................................................................... 25
4.1 Door Interlock ..................................................................................................................................... 25
5 Preliminary Radiation Survey ..................................................................................................................... 26
5.1 Site Radiation Survey ......................................................................................................................... 26
6 Mechanical Set Up and Alignments ........................................................................................................... 28
6.1 Isocenter Tuner Completion................................................................................................................ 28
6.2 Front Pointer Distance Alignment Verification ..................................................................................... 28
6.3 Field Light Alignment Verification ........................................................................................................ 29
6.4 Crosshair Alignment ........................................................................................................................... 30
6.5 Gantry Rotation PRO .......................................................................................................................... 32
6.6 Collimator Rotation PRO .................................................................................................................... 33
6.7 Couch Rotation PRO .......................................................................................................................... 34
6.8 Couch Longitudinal PRO .................................................................................................................... 35
6.9 Couch Lateral PRO ............................................................................................................................ 35
6.10 Couch Vertical PRO............................................................................................................................ 36
6.11 Optical Distance Indicator (ODI) ......................................................................................................... 37
6.12 PerfectPitch Couch Pitch & Roll PRO Accuracy.................................................................................. 38
7 Accessory Mount and Electron Applicators ................................................................................................ 40
7.1 Communications and Switches Verification ........................................................................................ 40
8 MLC and Jaws Verification with Collimation Devices Check ...................................................................... 42
9 Radiation Isocenter and Beam Coincidence Verification ............................................................................ 46
9.1 Coincidence of Light Field and X-Ray Field ........................................................................................ 46

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 9.2 Isocenter Verification with IsoLock ...................................................................................................... 47
10 Integrated Conical Collimator Verification and Interlock System (ICVI) ...................................................... 49
10.1 Enabling ICVI ..................................................................................................................................... 49
10.2 Conical Collimator Recognition ........................................................................................................... 50
10.3 Conical Collimators Alignment Verification.......................................................................................... 51
10.4 Machine Radiation Isocenter Verification with ICVI ............................................................................. 53
11 Energy and Beam Profile Verifications (IC Profiler) .................................................................................... 56
11.1 Definitions........................................................................................................................................... 56
11.2 X-Ray and Electron Beam Conformance Option ................................................................................. 56
11.3 Sun Nuclear IC Profiler Preparation and Set Up ................................................................................. 58
11.4 Photon/FFF Symmetry and Flatness .................................................................................................. 60
11.5 Electron Field Flatness & Symmetry ................................................................................................... 64
11.6 Photon Energy Verification ................................................................................................................. 69
11.6.1 Copper Wedge Photon Energy Measurement with ICP ......................................................... 69
11.7 Electron Energy Verification................................................................................................................ 71
12 Energy and Beam Profile Verifications (Water Phantom) ........................................................................... 74
12.1 Definitions........................................................................................................................................... 75
12.2 X-Ray and Electron Beam Conformance Option ................................................................................. 75
12.3 Scanning Setup .................................................................................................................................. 77
12.4 Photon Depth of Ionization ................................................................................................................. 78
12.5 Photon Field Flatness and Symmetry ................................................................................................. 79
12.6 Photon Field Intensity and Symmetry ................................................................................................. 81
12.7 Electron Depth of Ionization ................................................................................................................ 84
12.8 Electron Field Flatness and Symmetry ............................................................................................... 86
13 Dynamic Therapy, RapidArc (VMAT) and HyperArc Verifications .............................................................. 89
13.1 Enhanced Dynamic Wedge Verification .............................................................................................. 89
13.2 Arc Dynamic Verification ..................................................................................................................... 90
13.3 Moving Window IMRT Test with Gantry 90 and 270 ........................................................................... 91
13.4 RapidArc (VMAT) Verification ............................................................................................................. 92
13.5 HyperArc Test Plan Verification .......................................................................................................... 93
14 LaserGuard and Collision Protection System ............................................................................................. 98
14.1 Protection Zone Area Verification ....................................................................................................... 98
14.2 Protection Zone Tilt Verification .......................................................................................................... 99
14.3 Motion Stop Function Verification ..................................................................................................... 100
14.4 Collision Override Function Verification ............................................................................................ 101
14.5 PU Arm Motion Interlock ................................................................................................................... 102
14.6 PU Arm Motion Collision Override .................................................................................................... 103
15 Positional Unit, Isocal and PRS Positioning Accuracy .............................................................................. 104
15.1 Vertical Motion Run-out .................................................................................................................... 104
15.2 Vertical Accuracy .............................................................................................................................. 105

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 15.3 Lateral and Longitudinal Accuracy (MVD and KVD) .......................................................................... 106
15.4 Travel Range (MVD and KVD) .......................................................................................................... 107
15.5 Dynamic Stability (Isocal) ................................................................................................................. 108
15.6 Couch Pitch and Roll Spatial Translational Positioning Accuracy ..................................................... 110
16 MV Imaging Acquisition ........................................................................................................................... 113
16.1 No Radiation Images ........................................................................................................................ 113
16.1.1 Dark Field Image ................................................................................................................. 113
16.1.2 Noise Image ........................................................................................................................ 114
16.2 Pixel Correction ................................................................................................................................ 114
16.3 Radiation Images.............................................................................................................................. 115
16.3.1 Contrast Resolution ............................................................................................................. 115
16.3.2 Small Object Detection ........................................................................................................ 117
16.4 Dosimetry Integration (Portal Dosimetry Option) ............................................................................... 118
17 X-Ray Generator Verification ................................................................................................................... 121
17.1 kVp, mA, and ms Accuracy ............................................................................................................... 121
17.2 Half Value Layer (HVL) with Digital Fluoroscopy (Canada and USA only) ........................................ 123
17.3 Air Kerma Test Verification ............................................................................................................... 124
18 kV Imaging Acquisition............................................................................................................................. 128
18.1 Radiation Images.............................................................................................................................. 128
18.1.1 High Contrast Resolution..................................................................................................... 128
18.1.2 Gray Scale Linearity ............................................................................................................ 129
18.1.3 Low Contrast Sensitivity ...................................................................................................... 130
19 KVS Collimator Verification ...................................................................................................................... 132
19.1 KVS Blades Travel Range ................................................................................................................ 132
19.2 KVS Filter Foil................................................................................................................................... 133
19.3 kV Filter Shape ................................................................................................................................. 134
20 CBCT Image Acquisition .......................................................................................................................... 135
20.1 Density Resolution (HU Calibration) ................................................................................................. 135
20.2 Spatial Linearity Measurements (Distance) ....................................................................................... 137
20.3 Image Uniformity Measurements ...................................................................................................... 138
20.4 High Contrast Resolution .................................................................................................................. 139
20.5 Low Contrast Resolution ................................................................................................................... 140
21 Respiratory Gated MV Beam and VCD .................................................................................................... 142
21.1 Verification of Respiratory Gated MV Beam without VCD ................................................................. 142
21.2 Verification of Respiratory Gated MV Beam with VCD ...................................................................... 145
22 Additional Purchasable Products ............................................................................................................. 150
22.1 EXIO and MMI Functionality Verification ........................................................................................... 150
22.1.1 EXIO Loopback Testing....................................................................................................... 150
22.1.2 MMI – EXGI Simulator Test ................................................................................................. 151
22.2 Varian Verification System (VVS) Installation ................................................................................... 153

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23 Miscellaneous Items ................................................................................................................................ 154
23.1 Laser Configuration Form ................................................................................................................. 154
23.2 FDA Form 2579 Submission (USA Only) .......................................................................................... 155
24 Customer Documentation Access ............................................................................................................ 156
24.1 Instruct Customer to Access Customer Technical Bulletins (CTBs) .................................................. 156
25 Customer Basic Operational Training ...................................................................................................... 157
Appendix A Template for air kerma test ....................................................................................................... 159
Appendix B Collimation devices check ........................................................................................................ 161
B.1 MLC Positional Accuracy and Repeatability ...................................................................................... 161
B.2 Jaws Positioning Accuracy and Parallelism ...................................................................................... 163
B.2.1 Parallelism ........................................................................................................................... 163
B.2.2 Jaws Positioning Accuracy................................................................................................... 163

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1 Instructions for Use
1.1 IPA Use
This IPA includes tests that are performed solely by the Varian Customer Support Representative (CSR) and
some tests that are performed with the customer. This acceptance procedure can be used for new installations
or for upgrades. Each test will contain detailed procedures to be performed and the required specification or
tolerance. To finalize the acceptance procedure all data boxes must be completed with test results. Tests to be
performed with the customer are easily identified in the IPA document by a predetermined Customer Demo
Required row at the bottom of the corresponding data table.
Test result information may be completed as follows:
• Actual measured values or parameters
• Checkmark or X to indicate tested parameters meet the criteria
• NA when specific test, or subset of the test, is non-applicable

NA will be used when the configuration or the options purchased do not apply to the specific
acceptance document being used. Each test shall provide the specific reasons that detail when a
NA entry is allowable.

1.2 Lotus Notes Users

This IPA is the source document for the Lots Notes IPAD (Installation Product Acceptance Document) and
CPAD (Customer Product Acceptance Document). All test results will be entered in Lotus Notes and this data
will be stored within the IPAD and CPAD. The IPA is then used as a reference document by the user for test
procedures only.
The IPAD tasks are performed by the Varian CSR during the installation. All tests must be completed, and the
results recorded in Lotus Notes before the IPAD can be submitted for approval by the Varian manager.
The CPAD is printed out and completed with the customer. The CPAD will contain both blank and filled-out
tables used as follows:
• Filled-out Data Tables: Tests the Varian CSR has performed and recorded during the installation. These
test tables are:
• Included to provide a record of all test results.
• Signed by the Varian CSR.
• Not repeated during customer acceptance testing.
• Blank Data Tables: Indicate tests that require customer demonstration. They are completed and signed by
both the Varian CSR and the customer.

1.3 Non-Lotus Notes Users

A printed copy of this IPA document will be used for all test procedures and data recording.
Print the latest revision of this IPA from the Data Center. Complete all applicable tests in this IPA and fill out
the corresponding data tables using a pen.
• Data tables without the Customer Demo Required row: Perform these tests during the installation and
fill out the data tables.

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• Data tables with the Customer Demo Required row: Perform these tests before customer acceptance
testing to verify that they pass but leave the data tables blank. Repeat these tests again during customer
acceptance testing and have the customer fill out the data tables.

1.4 Document Distribution

IPAD: When the installation is complete, the automated IPAD (Lotus Notes users) or paper IPAD document
(non-Lotus Notes users) must be completely filled out by the VMS CSR, leaving no blank spaces. When
completed and signed, this document will be retained by Varian for proof of product performance and
compliance to specification.
CPAD: When the installation is complete, the CPAD paper document must be completely filled out by the VMS
CSR and customer, leaving no blank spaces. When completed and signed by both the Varian CSR and the
customer, return only the signed cover page to Varian for permanent record. It is not necessary to return the
full CPAD document to Varian.

This document is intended for use by trained Varian personnel or authorized

CAUTION agents. Use by untrained personnel could result in possible injury or damage
to the equipment.

1.5 Conventions
These are the types of notes and precautionary notices along with their icons which are used in this document.

A warning describes actions or conditions that can result in serious injury or

WARNING death.

A caution describes hazardous actions or conditions that can result in minor

CAUTION or moderate injury.

A notice describes actions or conditions that can result in equipment damage,

NOTICE non-compliant operation and / or other significant issues that do not involve
injury.

A stop describes actions or conditions that must be verified or satisfied before continuing.

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 A note describes actions or conditions that help the user obtain optimum performance from the
equipment or software.

A tip describes actions or conditions that simplify, improve, or assist the end user with the
required steps.

Place
An icon box shows the user an image of the icon, button, app quick start, or other object to be
image
used and describes the objective or instructs how it should be used. This is a new table type.
here

1.6 Acceptance Form Information

Complete the following IPA Acceptance Form.

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 Print all information clearly

COMPLETION DATE OF ACCEPTANCE ________________________________________

(DD Mon YYYY)

TRUEBEAM (H19) ____ ____________________________

PCSN

STX (HST), EDGE (HED), VITALBEAM (HVB) OR N/A ____ ____________________________

PCSN

MLC (HHM,HML,HLM) OR N/A ____ ____________________________

PCSN

RAPIDARC (HRD) OR N/A ____ ____________________________

PCSN

COUCH (HCU) OR N/A ____ ____________________________

PCSN

PITCH & ROLL STAGE (HPR) OR N/A ____ ____________________________

PCSN

QFIX KVUE COUCH TOP (HVU) OR N/A ____ ____________________________

PCSN

QFIX KVUEONE COUCH TOP (HVV) OR N/A ____ ____________________________

PCSN

CIVCO UCT LE COUCH TOP (HCV) OR N/A ____ ____________________________

PCSN

XI KV (HXK) OR N/A ____ ____________________________

PCSN

MVD (HMA) OR N/A ____ ____________________________

PCSN

KVD (HKA) OR N/A ____ ____________________________

PCSN

KVS (HKA) OR N/A ____ ____________________________

PCSN

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 OPTICAL IMAGING (HOI) OR N/A ____ ____________________________
PCSN

ICVI (HEC) OR N/A ____ ____________________________

PCSN

VCD (HCD) OR N/A ____ ____________________________

PCSN

VVS (HVS) OR N/A ____ ____________________________

PCSN

INSTITUTION ________________________________________

ADDRESS ________________________________________

________________________________________

________________________________________

CUSTOMER REPRESENTATIVE ________________________________________

Printed name

________________________________________
Signature Date signed (DD Mon YYYY)

VARIAN CSR REPRESENTATIVE ________________________________________

Printed name

________________________________________
Signature Date signed (DD Mon YYYY)

The customer and Varian signatures above indicate that all

applicable and required tests within this document, have been
satisfactorily performed and met the required product
specification.

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2 Reference Information
2.1 Revision Information
REVISION INFORMATION
REV DATE DESCRIPTION OF CHANGE AUTHOR NAME
Moved Table of Content to appear before Chapter 1.
Section 1.6: Added PCSN registration for VCD.
Section 1.6: Removed the PCSN registration for Calypso
and OSMS.
Section 2.2: Added reference UG-HT-Isolock.
Section 2.3: Removed abbreviations (AM, OPM, VIS)
Section 2.4: Renamed Unfors Xi to currently available
RaySafe Xi and RaySafe X2.
Section 2.6: Updated the information on X-Ray
transmission and leakage IEC type tests.
Section 5.1: Updated the form and instruction table for
preliminary radiation survey.
Section 6.1: Edited instructions and data table to record a
completion of Isocenter tuner only.
Section 7: Reduce procedure to test the accessory mount
and electrons applicators only.
Section 9: Removed Beam Output vs Gantry Rotation
stability verification test as the test is already part of
C 15 Aug 2022 machine auto PMI feature and checklist task of Mike Tham
installation.
Section 9.2: Updated the Isolock instruction to use lastest
version 3.3.x.
Section 11: Removed the instruction to upload IC profiler
files to GCS-FTP site.
Section 13 (previous): Removed the Dosimetry
Verification test as it is already conducted in
manufacturing final test.
Section 13.1 to 13.4: Updated test plan verifications to
record only pass/fail criteria, removing analysis via Offline
QA application.
Section 15.6: Corrected the title by changing the word
“transitional” to “translational”.
Section 16: Removed the chassis to ground measurement
for DMI panel from IPA procedure.
Section 17.1: updated the procedure to do kV
measurement.
Section 22: Remove the verification tests for Calypso and
OSMS.

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 Removed the instruction of using Offline QA application
(previously Appendix A) as it is no longer application in
this document.
Appendix B1: Updated figures and table to show the exact
sequence of MLC checks during MPC-CDC.

Section 2.6: Updated the scale convention figure.

Section 11: Added abbreviation “ICP” to the title of all
Data Table to indicate scanning with IC profiler.
Section12: Added abbreviation “WP” to the tile of all Data
Table to indicate scanning with water phantom.
B 06 Dec 2021 Section 17.3: Update the requirement for High Resolution Mike Tham
maximum number of defective lines for DMI panel from 5
to 12 based on engineering feedback.
Section16.2: Updated data table to include the kV panel
4030CB PN#149974 that has different vertical
specification.
Template transfer to TMP-GE-IPA_HW-B

2.2 References
[1] RIG-HT-SLIM TrueBeam Rigging and Isocenter Manual
[2] CAL-HT-DS02x_SL TrueBeam/TrueBeam STX Version 2.x Configuration and Alignment
[3] CAL-HT-XI2x TrueBeam X-Ray Imaging Calibration Manual
[4] CAL-HT-PU02X TrueBeam 2.x Positional Unit Calibration Manual
[5] SIM-HT-2x TrueBeam Software Installation Manual (version 2.x)
[6] CTB-GE-791 TrueBeam Power Up Instructions
[7] UG-HT-Isolock TrueBeam Isolock User Guide
[8] UG-GE-Profiler Sun Nuclear IC Profiler User Guide
[9] CTB-GE-228 Dosimetry Monitoring System Calibration

2.3 Abbreviations
CCDS Capacitive Collision Detection System
CPAD Customer Product Acceptance Document (generated in Lotus Notes)
CSR Customer Service Representative (Varian employee)
DF/FF Dark Field and Flood Field
DICOM Digital Imaging and Communications in Medicine
DMI Digital Megavolt Imager
DR-X Dose Rate, X= MU / Min
EA Electron Applicator
EBC Enhance Beam Conformance
E-Max Refers to the highest electron installed on the machine
EXGI External Gating Interface

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EXIO External Input/Output Module
FBIA Fine Beam Isocenter Accuracy
FFDA Final Field Defining Aperture
GCS Global Customer Service
HDTSe- High Dose Total Skin Electrons
HI High-Intensity (High intensity energies without Flattening Filter)
ICVI Integrated Conical Collimator Verification and Interlock System
IPA Installation Product Acceptance
IPAD Installation Product Acceptance Document (generated in Lotus Notes)
IRM In-Room Monitor
IDU Image Detection Unit
kV Kilovolt
KVD kV Detector
KVS kV Source
LDR Low Dose Rate
MCN Motion Control Node
MLC Multi-Leaf Collimator
MMI Motion Management Interface
MVD Mega Voltage Detector
ODI Optical Distance Indicator
PCSN Product Code and Serial Number
PRO Position Read Out
PU Position Unit
ROI Region of Interest
SID Source to Image Distance
SMC Service Mode Console
SNC Sun Nuclear Corporation
SSD Source to Surface Distance
TC Tissue Compensator
VCD Visual Coaching Device
VMS Varian Medical Systems
VVS Varian Verification System
XI X-Ray Imaging System
WS Workstation

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2.4 Required Equipment and Tools
TOOLS AND EQUIPMENT
VARIAN PROVIDED
QUANTITY DESCRIPTION
1 each Precision level, 6-8 inches (150 – 200 mm) and white tape

Sun Nuclear IC Profiler (Varian Tools Depot Item # 421 - IC Profiler Kit for Installation
1 each
Acceptance)

1 each Tape Measure with cm/mm divisions

1 each Couch PRO Alignment Tool

1 each IsoLock test tooling and software

1 each 50 cm Precision Metal (rigid) Ruler

External kV measurement tools which may include

• RaySafeXi / RaySafeX2 / Unfors
1 each
• Fluke (or Nuclear Associates 07-523) line pair tool
• Aluminum step wedge 07-456
1 each Calibrated Front Pointer
1 each ISOCAL, Las Vegas and Gating Phantoms

1 each 0.5 mm diameter wire (lead, tungsten, tantalum) P/N TM61451000

1 each Leeds TOR [18FG]

1 each Catphan P/N: SS5034900x

SNC profiler software installed on CSR laptop

Latest serialized Profiler_Support_files.exe file downloaded from the GSC data center

TrueBeam Test Plans available on GSC data center

TrueBeam Dosimetry Spreadsheet Rev_xx.xls from the GSC data center
CUSTOMER PROVIDED
QUANTITY DESCRIPTION
As Required

1 each Electrometer and secondary ionization chamber (with appropriate buildup)

Ready Pack X-ray Film (Kodak X-Omat Type V, Carestream EDR2 or equivalent) or
1 each
Gafchromic film (if no processor available)

1 each Film processor (not needed for Gafchromic film)

1 each Graph paper with mm increments (measure for accuracy)

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2.5 Safety
The tasks listed in this procedure are to be performed by Varian-trained
personnel only. Untrained personnel should not attempt any procedures or
WARNING tests contained within this document. VARIAN is not liable for errors made by
others using these instructions. This document is subject to change without
notice

Misuse or improper servicing of the linac systems can expose the operator,
service technician, and/or the patient to one or more of the following hazards:
Mechanical collision

WARNING Electrical shock

Any of these hazards could cause serious injury or death. Persons who
service or maintain the system must read, understand, and be familiar with the
material in the applicable product Safety Guide available at
http://myvarian.com

Machine cover fasteners can wear and come loose over time, or the covers
can be installed incorrectly. Always inspect primary and redundant fasteners
for operation when any cover is removed.
WARNING
Never return the machine to clinical operation when the covers are
compromised and not securely fastened in a way that could create a hazard,
which could cause serious injury to patients.

Radiation exposure may cause serious injury or death. Never produce x-rays
from the linac when anyone is in the treatment room or with the required
treatment room door open. Always wear or carry your provided dosimetry
WARNING device when working in the radiation environment. For clip-on dosimetry
devices, make sure the device is attached to the trunk of your body. For
additional radiation safety information, refer to the product Safety Guide,
available at http://myvarian.com

When servicing the machine, the following risks exists that could cause minor
to moderate injury.
Pinch points. All pinch point labels should be observed to reduce the risk of
injury.
WARNING Exposed metal edges when the covers are removed. Use proper Personal
Protective Equipment (PPE) to reduce the risk of injury, e.g., hard hats, gloves,
safety goggles.
Heavy lifting: Use proper lifting technique, and when possible, use mechanical
fixtures or assistance when lifting heavy items to avoid injury

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 Potential Radiation Exposure from Clinac, TrueBeam, and VitalBeam Systems
High energy linear accelerators are capable of inducing radioactivity in matter.
The process where non-radioactive substances become radioactive due to
interactions with high-energy radiation is called activation. Metal parts that are
in, or near contact with linear accelerator radiation beams with energy greater
than 8 MV are susceptible to activation. These accelerator parts should be
considered radioactive unless/until they have been checked with appropriate
instrumentation and shown to be non-radioactive. While much of the created
radionuclides decay within a short time (days or weeks), longer-lived
radioactive materials, which can be detected even after a few years, are also
produced.
Only trained radiation workers are authorized to handle radioactive materials.
If you are performing maintenance tasks that may expose you to potentially
radioactive components, always wear your assigned dosimeter(s), and follow
any procedures communicated to you by the Varian Radiation Safety staff.
Observe As Low As Reasonably Achievable (ALARA) practices and minimizes
your exposure by working quickly and spending as little time as possible near
unshielded radioactive parts.
The following areas of the linac are expected to contain radioactive metals:
BMAG/Orbital Chamber components
All lead shielding components
Structural steel components in the Gantry head
Carrousel metal components and high energy flattening filters
CAUTION
Ion Chamber assembly
Target assembly and target drive metal components
Collimator area metal components
Additional information and guidance are provided in the following
documentation:
TrueBeam/VitalBeam Safety Guide: Induction of Radioactivity
Clinac Safety Guide: Induction of Radioactivity
CTB-GE-924: Radionuclides Created in High Energy Linear Accelerators by
Nuclear Activation Processes
PFU-195: Shipping Activated Accelerator Components
DDP-HT-HAXMAT: TrueBeam Hazardous Substances and Materials – Removal
and Disposal
DDP-HE-HAZMAT: High Energy Clinac Hazardous Substances and Materials –
Removal and Disposal
Instruction L6103: Handling and Shipping Radioactive Materials Associated
with Varian Linear Accelerators (applies to the Americas)
Instruction L12192: Radiation Safety – Information on Activated HE Linac
Components for HW Field Service (applies to EMEA and APAC)
The instructions L6013 (Americas) can be obtained using following link:
https://pse.oscs.varian.com/GI/Environmental/HSRadioLINAC/369

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 Do not attempt to return any potentially radioactive components unless
specifically requested, and then only after review of the instructions provided
in the previously mentioned documents.

All external fastening screws on the machine should be in place and tightened
WARNING to the proper torque to prevent possible serious injuries from falling objects

2.6 IEC Type Test for X-Ray Transmission and Leakage

Information
This data is available from Varian customers via the link provided below.
http://myvarian.com/
Upon logging in to the above website, select Documentation > Documentation Library > Product Group
(TrueBeam) > Document Type (Reference Materials) > Version (2.x). The above data can be found in the
available TrueBeam Type Tests document.

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2.7 Position Readout Scale Convention

Figure 1: PRO Scale Conventions in Service Mode

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3 Preliminary Machine Checks
3.1 Software Licenses
Requirement
The following applicable licenses (per Sales Order) shall be installed on the TrueBeam workstation folder path
D:\VMSOS\License. The licensing structure shown in the tables is defined by Varian Product Management.

Some license features require configuration for clinical functionality. As an example, Varian
Product Management has defined RapidArc and VMAT as mutually inclusive features and may be
simultaneously enabled.
VVS license if exist may be installed only in IRM workstation.
MPC offline license is installed on customer preferred workstation.
Disregard Offline QA license (if exist) in sales order as it is currently not applicable.
Plan QA and QA Server licenses may exist in some license file but not included in the verification
table. Both these licenses are not implemented in any TrueBeam feature, hence can be disregard
if exist.

Test Method
1. Make a copy of license from TrueBeam folder D:\VMSOS\License\TrueBeamSNxxxx.lic and copy to Varian
issued service laptop.
2. Verify machine license configuration with WordPad or text viewer by comparing machine sales order to
TrueBeamSNxxxx.lic as defined in tables in this section by checking YES or NO.

If electronic copy of is available, use the word “lic” to search for all TrueBeam machine related
license in sales order.

3. Some optional packages come with a specific set of licenses. Compare the license file with the license
features in Table 2 and Table 3, and check YES or NO.
4. If there are any discrepancies, please contact VIS Project Management for resolution.
5. Record results.

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 TABLE 1: BASE MACHINE LICENSES
RE LICENSE FEATURE WHEN REQUIRED INSTALLED?
1 NDS Treatment Basic Photon Treatment Delivery Yes □ No □

2 NDS TBI Total Body Treatment Delivery Yes □ No □

3 NDS IMRT IMRT Treatment Delivery Yes □ No □

4 NDS MV Imaging Advanced 2D MV Radiographic and Cine image Yes □ No □

acquisition, review and match.

5 NDS SRS High Dose/Field limits for Hypo fractionated Yes □ No □

treatments

6 NDS Dosimetry Acquisition Portal Dosimetry acquisition Yes □ No □

7 NDS_2D3D_Match 2D / 3D Match with DDR generation Yes □ No □

8 NDS_On_Demand Online addition of kV and MV imaging protocols Yes □ No □

to treatment fields, with automated generation of
reference images

9 NDS_Image_Approval Online Physician Approval of Images at Yes □ No □

Treatment Console (compatible with ARIA only)

10 6 Dof ADI 6DOF capability for 3rd Party MMI device to Yes □ No □
Perfect Pitch couch via MMI/ADI connection
(refer to Sales Order for
VitalBeam)

11 MPC_Console Machine Performance Check Console Mode Yes □ No □

12 MPC_Offline Machine Performance Check Offline Mode Yes □ No □

13 MPC_MLC All EndSideRepro Enhanced MLC check. Provides ability to check Yes □ No □
all leaves including at the outer edges

14 MPC_Couch Full Rotation Enhanced Couch check. MPC geometry check Yes □ No □
through full range of couch rotation

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 TABLE 2: OPTIONAL PACKAGES LICENSES
RE LICENSE FEATURE WHEN REQUIRED INSTALLED?
1 NDS Electron Electron Treatment Delivery Yes □ No □

2 NDS RapidArc RapidArc Treatment Capability

Yes □ No □
(only VMAT license is required for V2.7.x or later)

3 NDS VMAT Load VMAT plan from planning system Yes □ No □

4 NDS Respiratory Gating Respiratory Gating Treatment Delivery Yes □ No □

5 NDS Dynamic MV Imaging Respiratory gated MV image acquisition and online

Yes □ No □
review

6 NDS Dynamic kV Imaging

Respiratory gated/synchronized kV image
or Yes □ No □
acquisition and online review.
NDS Resp Trig KV Imaging

7 NDS_Residual_Motion Display and review of only fluoroscopy frames

acquired within gating window during a gated Yes □ No □
treatment

8 NDS KV CBCT KV CBCT image acquisition, review and match Yes □ No □

9 NDS_Flouro_Overlay Displays structures projections of Fluoro images Yes □ No □

10 NDS_3DCBCT_Merged Acquisition of kV CBCT with a long field of view,

provided by merging of multiple indexed CBCT Yes □ No □
images

11 NDS_Time_Trig_kV_Imaging Time Triggered KV Imaging Yes □ No □

12 NDS_Gantry_Trig_kV_Imaging Gantry Angle Triggered KV Imaging Yes □ No □

13 NDS_MU_Trig_kV_Imaging MU Triggered KV Imaging Yes □ No □

15 Automated treatment delivery beam hold, based on

NDS_Auto_Beam_Off triggered image-based tracking of specified marker Yes □ No □
position

16 NDS_4DCBCT 4D kV CBCT image acquisition and online viewing Yes □ No □

17 VVS_AccessoryPatient VVS Patient & Accessory Verification Yes □ No □

18 VVS_ConicalCollimator VVS Conical Collimator Verification Yes □ No □

19 NDS Research Research/Development Mode enable Yes □ No □

20 NDS Tracking Tracking (for Development Mode only) Yes □ No □

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 TABLE 3: ADDITIONAL PURCHASABLE LICENSES
RE LICENSE FEATURE WHEN REQUIRED INSTALLED?
1 NDS_Gated_CBCT The ability to acquire CBCT images coordinated with
the breathing of the patient (using the respiratory
gating system). The acquisition of the CBCT images
is synchronized with the breathing of the patient so
the location of the moving anatomy is imaged only
while the patient is within respiratory gating Yes □ No □
thresholds. The operator sees the anatomy as it will
exist during the (gated) treatment irradiation, rather
than a blurred anatomic representation that shows
the range of anatomic motion over the complete
respiratory period.

2 NDS_4DCBCT_Match_Review Online 4D CBCT image data acquisition, image

Yes □ No □
review, and image match to 4D reference image

3 NDS_Short_Arc_CBCT The ability to acquire a CBCT image using a

140° gantry rotation (adjustable between 120° -
150°) rather than the standard 200° gantry rotation Yes □ No □
needed for a full-fan (small diameter) CBCT
acquisition

4 NDS_DeltaCouchShift The Delta couch shift feature manages offset shifts

(“delta couch shifts”) from the initial CT tattoo-based
set up position, as provided with the treatment plan.
This feature would include a workflow that requires
Yes □ No □
the delta couch shift to be implemented in the
treatment room when demanded by the plan and
verifies the completion of the delta couch shift before
allowing the initiation of treatment delivery.

5 NDS_Virtual_Cone Compact intensity modulated intracranial SRS

treatment delivery, featuring full automation of non-
coplanar delivery and MV imaging Yes □ No □
(HyperArc option)

6 iCBCT Stationary Iterative CBCT. Acquired CBCT projections will be

reconstructed using new scatter and back projection
algorithms that reduce artifacts due to scatter and Yes □ No □
reduce image noise, resulting in improved soft-tissue
visualization.

7 MPC ICVI Isocenter Provides fully automated machine radiation isocenter

verification with ICVI hardware Yes □ No □

8 MPC ICVI Isocenter Provides fully automated ICVI’s conical collimators

alignment verification with respect to machine Yes □ No □
collimator rotation axis

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Results

DATA TABLE: SECTION 3.1 – SOFTWARE LICENSES

PASS/FAIL CRITERIA √ = OK
TrueBeam license verification completed.

CUSTOMER DEMO REQUIRED

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4 Safety Interlock
4.1 Door Interlock
Requirement
The production of X-Rays will not be permitted while the treatment room door is open. An interlock equivalent
with a message will be displayed at the workstation.

Test Method
1. This test is performed in Service mode.
2. Open the treatment room door. Press Clear all.
3. Mode up an energy and try beam on.
4. Verify that the door interlock will prevent beam on.
5. Repeat test with any KV Imaging Mode (if installed) via XI tab > Acquisition > kV.
6. Record results in the data table.
Results

DATA TABLE: SECTION 4.1 – DOOR INTERLOCK

TEST √ = OK
Door interlock functions correctly

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5 Preliminary Radiation Survey
5.1 Site Radiation Survey
Possible death or serious injury could result from radiation exposure if the
TrueBeam is used to produce beam before a satisfactory radiation survey has
been completed by a competent radiation expert.
If dose rates in areas external to the treatment room exceed radiation levels
recommended by the governing agency, the machine is not to be operated
WARNING further until either the equipment or the facility is modified, or a temporary
deviation issued. A temporary deviation may consist of operating at a limited
dose rate, operating with restricted gantry angles, or a combination of both as
determined by the qualified radiation expert. This survey is a preliminary
check used to determine temporary safe installation environment and is not to
be used as the data-gathering survey that will be conducted by the customer
after installation.

Requirement
As soon as the linac is able to produce radiation, a qualified radiation safety expert, provided by the customer,
shall conduct a preliminary radiation survey to verify that it is safe to allow beam-on. This is an initial room
survey only, typically completed in less than 1 hour, which is solely intended to ensure Varian and customer
personnel safety during the installation process. A thorough survey will be performed by the customer after
product acceptance

Test Method
If the customer did not already receive the necessary survey form and instructions from the Project Manager,
then download the latest applicable radiation survey form and instruction listed in following table from the QMS
Portal: https://dms.varian.com/livelink/livelink.exe/open/QMSPortal

TABLE 4: RADIATION SURVEY FORM AND INSTRUCTIONS

REGION SURVEY FORM SURVEY INSTRUCTIONS
Document L9330A:
Customers Radiation Safety Check at First Beam on
Americas Document RMT06G03:
Delivery Americas – USEABLE
Initial Beam-on Radiation Surveys of
Customer LINAC Rooms
Document RMT0604F10:
EMEA &
Varian Radiation Survey Form (EMEA and APAC)
APAC

1. Perform the radiation survey with the customer radiation expert and fill out the radiation survey form. The
form must be filled out and signed before continuing with beam testing. Return this form to Varian along
with the product acceptance certificate at the end of the installation.
2. Record test results in the data table.

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Results

DATA TABLE: SECTION 5.1 – SITE RADIATION SURVEY

TEST CRITERIA √ = OK

Work environment is safe for beam work and the Radiation Survey form is filled out and signed
by the customer designated radiation expert.

CUSTOMER DEMO REQUIRED

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6 Mechanical Set Up and Alignments
Tasks in this section is for the purpose of recording mechanical set up and alignment data during
the machine installation by Varian representative. No customer interaction or demonstration is
required.

6.1 Isocenter Tuner Completion

Requirement
Isocenter Tuner for stand and VEO completed

Test Method
1. Perform Isocenter Tuner for stand and VEO according to procedure in RIG-HT manual .
2. Record completion acknowledgment in the data table.

Results

DATA TABLE: SECTION 6.1 – ISOCENTER TUNER COMPLETION

TEST CRITERIA REQUIREMENT √ = OK
Isocenter Tuner Stand and VEO adjustment Completed

6.2 Front Pointer Distance Alignment Verification

The Front Pointers provided with the TrueBeam system are only intended as isocenter distance
indicators, primarily for Physics use. Due to mechanical variances and tolerances within these
removable parts, they are not intended to represent the location of the isocentric sphere in any
other planes. The following test will verify the distance alignment of the ‘master’ Front Pointer
rod, which will be used for other verification tests later.

Requirement
• The Front Pointer shall accurately indicate the Target to Surface distance at 100 cm within ± 0.5 mm.

Test Method
1. Insert the Front Pointer tray with the Front Pointer rod that has index marks ranging from 95 to 101.
Accurately align the rod to the 100 cm index line.
2. Position the couch to 0° with the couch top at isocenter.
3. Without disturbing the Front Pointer, position gantry at 90°.
4. Attach a small strip of white tape (with a vertical line on it) to the front edge of the couch top.
5. Move the couch axes to accurately align the end of the Front Pointer tip to the taped line.
6. Rotate gantry to 270° and verify the tip of the Front Pointer is again aligned to the taped line.
7. Record results in the data table.

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Results

DATA TABLE: SECTION 6.2 – FRONT POINTER DISTANCE ALIGNMENT VERIFICATION

TEST REQUIREMENT √ = OK

Front Pointer is aligned to 100 cm TSD. 100 cm ± 0.05

6.3 Field Light Alignment Verification

Since the light field source does not rotate with the collimator, it is necessary to use two surfaces
that rotate with the collimator to verify light field run-out. The crosshair film and an inserted piece
of paper in the bottom of the 25X25 applicator are used as surfaces.
The crosshair assembly must be installed but crosshair alignment is not critical. This test only
requires visual observation of crosshair movement but not crosshair alignment.

Requirement
• The field light source run-out shall be ≤ 1.0 mm using an independent shadow source in the collimator for
both bulb 1 and bulb 2.
• The difference of projected field light position for bulb 2 shall be ≤ 0.5 mm from the projected position of
bulb 1.

Test Method

TABLE 5: FIELD LIGHT ALIGNMENT VERIFICATION SETUP

Gantry Angle 0°

Collimator Starting Angle 90°

Field Size 35 x 35 cm

25 x 25 cm applicator with standard mold frame inserted.

Accessory Require
Field Light Alignment Fixture (EDGE only)

1. Setup the test per Table 5.

Test Method: For TrueBeam /TrueBeam STx and VitalBeam with applicator installed
1. Tape a piece of paper to the 25x25 cm mold frame.
2. Rotate collimator to 90°.
3. Using a fine point pen, accurately bisect each of the projected crosshair lines with a single mark on the
paper.
4. In Service mode, under the CAROUSEL/ FIELD LIGHT tab, select Bulb 1 field light and turn on the field
light.
5. Rotate collimator from 90° to 270°. Make another single mark on the paper.
6. Measure and record crosshair run-out for both lines and verify worst-case field light run-out specification.

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7. Repeat the process but with Bulb 2 field light selected and use a different color pen to mark the projected
crosshair lines.
8. On the paper, measure the distance between the mark lines of Bulb 1 and Bulb 2 at position 90° and 270°
respectively. Record the worst–case distance difference.
9. Record results in the data table.
Test Method: For EDGE with field light alignment fixture installed
1. Rotate collimator to 90°.
2. In Service mode, under the CAROUSEL/ FIELD LIGHT tab, select Bulb 1 field light and turn on the field
light.
3. On the alignment fixture, loosen the spring loaded screw at the bottom of reference plate and align the
marked lines to the crosshair projection.
4. Rotate collimator from 90° to 270°.
5. Measure and record crosshair run-out for both lines and verify worst-case field light run-out specification.
6. Repeat the process but with Bulb 2 field light selected.
7. Measure the distance between the deviation points of Bulb 1 and Bulb 2 at position 90° and 270°
respectively. Record the worst–case distance difference.
8. Record results in the data table.

Results

DATA TABLE: SECTION 6.3 - FIELD LIGHT ALIGNMENT VERIFICATION

OPTICAL TEST REQUIREMENT(MM) ACTUAL

Field Light Run-Out Bulb 1 ≤ 1.0

Field Light Run-Out Bulb 2 ≤ 1.0

Difference between Field Light Bulb 1 and Bulb 2 ≤ 0.5

6.4 Crosshair Alignment

The MLC must be operational and aligned per procedure CAL-HT-DSxx manual before the
crosshair alignment.
Crosshair alignment accuracy is critical for proper mechanical alignments of the collimator, MLC
position offset, couch axes and for the imaging system. Therefore, observe the following
guidelines:
• The radial crosshair line (used for calibrating the MLC and collimator/couch rotation axes)
must be as parallel as possible to the MLC leaf banks.
The MLC is the primary field collimation device in present day clinical applications and jaws are
basically used for shielding. Therefore, the MLC should be the mechanical reference for all other
alignments. MLC and jaws parallelism verification shall be tested using the Collimation Device
Check feature in later section.

Requirements
• The crosshair intersection shall intersect mechanical isocenter within ≤ 1.0 mm radius at 100 cm TSD.
• The difference in crosshair run-out between Bulb 1 and Bulb 2 shall be ≤ 0.5 mm.

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Test Method

TABLE 6: CROSSHAIR ALIGNMENT TEST SETUP

Gantry Angle 0°

Collimator Starting Angle 90°

Field Size 35 x 35 cm

Couch top 100 cm TSD

Tool Graph paper on couch top aligned to crosshairs

1. Download the TrueBeam IPA zip file from the GSC Data Center > Products > TrueBeam > Software
section.
2. Extract the downloaded file to the following folder on the TrueBeam WS (create folders if necessary):
• D:\VMSOS\AppData\TDS\Input\Service\
• D:\VMSOS\AppData\TDS\Input\Daily QA\
• D:\VMSOS\AppData\TDS\Input\Treatment\
3. Log in to Service mode using the Service user right.
4. Select Plans tab and select the MLC static (120 or HD) DICOM plan or StatMLC80.mlc plan in the following
directory (see Figure 2):
• D:\VMSOS\AppData\TDS\Input\Service\TrueBeam IPA\STD 120MLC (or HDMLC or 80MLC)

Figure 2: Opening Plan in Service Mode

5. Press Continue in the DICOM RT Plan Load Warning windows.

6. Select the Repeatability field and verify that it is highlighted.
7. Select MLC tab and then click on the Go to Plan button at the bottom of the screen. The MLC will drive to
the field. See Figure 3.
8. Enter the treatment room and verify the gantry is leveled head-up and couch top is at 100 cm SSD.
9. Turn on the field light and accurately align the graph paper to the crosshair line that is parallel to the MLC
leaf tips.
10. On the graph paper, measure the distance between the crosshair line and MLC leaf tips at both ends of
projected field light. Verify the MLC leaf banks are as parallel as possible to the crosshair line
11. After verifying the parallelism of the crosshair line to the MLC leaf banks, retract the MLC by pressing the
Retract button at the bottom of the screen. See Figure 3.

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 Figure 3: MLC Tab in Service Mode

12. Setup the test according to Table 6.

13. Turn on the field light and verify that Bulb 1 is selected.
14. Rotate collimator from 90° to 270°, and verify crosshair run-out specification in the data table.
15. Select Bulb 2 and rotate collimator from 90° to 270°.
16. Verify the difference in crosshair run-out between Bulb 1 and Bulb 2 is ≤ 0.5 mm.
17. Record results in the data table.

Result

DATA TABLE: SECTION 6.4 – CROSSHAIR ALIGNMENT

TEST REQUIREMENT AT @ 100 CM SSD ACTUAL

Crosshair Run-Out ≤ 1.0 mm (radius)

Difference in Crosshair Run-Out Bulb 1 to Bulb 2 ≤ 0.5 mm

6.5 Gantry Rotation PRO

Specification
• The true angular position of the gantry shall coincide with the gantry PRO display to an accuracy of ± 0.3°.

Test Method

The recommended gantry leveling surface is the front section of the Interface Mount (near the
rangefinder hole). If using a magnetic level, the rear plate on the Interface Mount may be used if it
matches the front surface level.

1. Test is performed in Service mode using IEC scale.

2. Level the gantry at each position shown in the data table and verify PRO meets specification per the data
table.
3. Record results in the data table.

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Results

DATA TABLE: SECTION 6.5 – GANTRY ROTATION PRO

GANTRY ANGLE SPECIFICATION TOLERANCE (°) ACTUAL PRO (°)

180° ± 0.3

90° ± 0.3

0° ± 0.3

270° ± 0.3

180° E ± 0.3

6.6 Collimator Rotation PRO

This test will utilize the radial crosshair line as a collimator angle reference indicator. Per the
alignment requirements in Section 6.4, this line has been accurately aligned to be parallel with the
MLC leaf banks and the X-jaws. Therefore, this line accurately represents collimator angle and
will be used for the PRO checks in the following tests.

Specification
• The true angular position of the collimator shall coincide with the PRO to an accuracy of ± 0.5°.

Test Method
1. Test is performed in Service mode using IEC scale.
2. Rotate gantry to the head-up position and set the jaws to X = 5 cm and Y = 40 cm.
3. Rotate collimator to 90° to position the radial crosshair line into the transverse plane.
4. Using a piece of tape on the turntable, mark a reference dot on the tape at the intersection of the projected
crosshair.
5. Rotate gantry about 20° in the CW and CCW directions and observe the coincidence of the reference dot
with both ends of the projected crosshair line.
6. If not coincident, continue to make small collimator rotation corrections until the projected crosshair line
tracks the reference dot while rocking the gantry. This will be the collimator mechanical 90° position.
7. Level gantry at the head-up position and set jaws to 20 x 20 cm.
8. Align a piece of graph paper to the crosshairs on the couch top at 100 cm TSD. Due to slight non-
orthogonality between the crosshair lines, make sure the crosshair line that is parallel to the X-jaws is
accurately aligned to the graph paper. This may result in the other crosshair line having equal and opposite
deviations at each end of the crosshair line. This is acceptable since only the X-jaw crosshair line will be
used as the collimator angle indicator.
9. Verify collimator PRO meets specification for the 90° position per the data table.

In the following step, the crosshair line may shift slightly from the graph paper line due to minor
crosshair run-out, which was measured earlier in Section 6.4. If this is the case, just make sure
the crosshair line and graph paper line are parallel to each other to indicate 90° of rotation. Do not
realign the graph paper.

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10. Rotate collimator to the other two positions in the data table by rotating until the X-jaw crosshair line is
again aligned to the graph paper at each angle. Disregard the Y-jaw crosshair line due to its potential for
minor non-orthogonality. Verify PRO meets specification at each position per the data table.
11. Record results in the data table.
12. Do not disturb the test setup. This will be used for the next test.

Results

DATA TABLE: SECTION 6.6 - COLLIMATOR ROTATION PRO

COLLIMATOR ANGLE SPECIFICATION TOLERANCE (°) ACTUAL PRO (°)

90° ± 0.5

0° ± 0.5

270° ± 0.5

6.7 Couch Rotation PRO

Specification
• The couch rotation shall coincide with the PRO to an accuracy of ± 0.4°

Test Method
1. Test is performed in Service mode using IEC scale.
2. With the gantry, couch, collimator, and jaws still positioned from the previous test, rotate collimator back to
the 0° position on the graph paper. Make sure the crosshair line that is parallel to the X-jaws is accurately
aligned to the graph paper since this line will be used as the angle reference indicator for the couch rotation
axis. The collimator must be accurately positioned to 0° before continuing.
3. Mark the center of the crosshair intersection on the graph paper with a small dot.
4. Fully open the jaws.
5. Release couch Longitudinal brake and float the couch top forward and backward to verify the dot remains
on the X-jaw crosshair line at both edges of the field. If so, the couch is at mechanical center. If not, adjust
the couch rotation until the dot tracks the crosshair line.
6. Lock couch brake and realign the graph paper to the crosshairs. Make sure the X-jaw crosshair line is
accurately aligned since this will be the angle indicator for the following couch rotation checks.
7. Verify couch PRO meets specification for the 0° position per the data table.

The crosshair lines will shift away from the graph paper lines during couch rotation in the following
step. It is only important to make sure the X-jaw crosshair line is parallel to the graph paper lines.
This shift (or run-out) is expected because the Stand position has been mechanically adjusted so
the couch rotational axis will split the difference between gantry sag and skew at all gantry
angles. Essentially, the couch is rotating on an arc around the circumference of the isocentric
sphere. If the crosshair line did not shift during rotation, the Stand would be incorrectly positioned
and there would be a large couch isocentric deviation with the gantry head down.

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8. Rotate couch to 90° and 270° until the X-jaw crosshair line is again parallel with the graph paper line. Verify
the PRO meets specification at positions per the data table.

Results

DATA TABLE: SECTION 6.7 - COUCH ROTATION PRO

COUCH ANGLE SPECIFICATION TOLERANCE (°) ACTUAL PRO (°)

90° ± 0.4

0° ± 0.4

270° ± 0.4

6.8 Couch Longitudinal PRO

Specification
• The couch longitudinal position shall coincide with the PRO to an accuracy of ± 2 mm.

Test Method
1. This test is performed in Service mode with IEC scale selected.
2. Position couch rotation to 0° with the couch top at 100 cm SSD.
3. Install the Varian provided tape measure into the LOK-BAR PRO Alignment Tool. Align the 140 cm mark
on the tape measure with the sight window scribe marks. Fasten the LOK-BAR onto the couch top at the 0
index location with the end of the tape measure extended towards the gantry.
4. Support the end of the tape measure to keep it level and float the couch top until the crosshair and tape
measure are aligned to each of the target positions in the data table. Verify the PRO meets specification at
each position per the data table.
Results

DATA TABLE: SECTION 6.8 – COUCH LONGITUDINAL PRO

LONGITUDINAL POSITION (CM) SPECIFICATION TOLERANCE (CM) ACTUAL PRO (CM)

20 ± 0.2

150 ± 0.2

6.9 Couch Lateral PRO

Specification
• The couch lateral travel shall coincide with the digital display to an accuracy of ± 2 mm.

Test Method
1. This test is performed in Service mode with IEC scale selected.
2. Installed the LOK-BAR PRO Alignment Tool (without tape measure) onto the couch top at the 0 index
location.

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3. Center the couch top laterally by aligning the crosshair to the scribe mark on the LOK-BAR.
4. Verify digital PRO meets specification for the 0 cm position per the data table.
5. Tape a precision 50 cm ruler on the couch top with the center of the ruler aligned to the crosshair
intersection.
6. Release the couch lateral brake and float the couch top to the target positions in the data table. Verify the
PRO specifications at each position per the data table.

Results

DATA TABLE: SECTION 6.9 – COUCH LATERAL PRO

LATERAL POSITION (CM) SPECIFICATION
ACTUAL PRO (CM)
IEC 601 IEC 1217 TOLERANCE (CM)

980 -20 ± 0.2

0 0 ± 0.2

20 +20 ± 0.2

6.10 Couch Vertical PRO

If Couch Compensation was disabled during this test, please re-enable it now. Refer to SIM-HT to
enable Couch Compensation in System Administration.

Specification
• The couch vertical travel shall coincide with the PRO to within ± 2 mm.

Test Method
1. This test is performed in Service mode with IEC scale selected.
2. Level gantry at the head-up position.
3. Set the couch to longitudinal position 140 cm.
4. Using a calibrated front pointer, position the couch top (without service panel) to 100 cm TSD.
• Front pointer should contact center of couch top in-line with the position 0 index location.
5. Setup the Varian provided tape measure for reference measurements as follows:
a. Hang the lip of the tape measure over the bottom edge of the Interface Mount and extend it all the way
to the turntable. Do not make contact between the metal tape measure and any electrical circuits in the
collimator.
b. Move the tape measure or rotate the collimator as required until the tape measure just make contact
with the side edge of the couch top while making sure the tape is perpendicular to the floor (not tilted).
c. Secure the tip of the tape measure to the collimator with tape.
d. Place a piece of white tape on the side of the couch top and make a reference mark on the tape to
coincide with any mm mark on the tape measure. This point defines the reference value for 100 cm
TSD.

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6. Verify PRO meets specification for the 0 cm IEC position per the data table.
7. Vertically drive the couch to the other two target positions in the data table by adding or subtracting the
delta distance from the reference mark value on the tape measure. Verify PRO meets specification at both
positions per the data table.
8. Do not disturb the test setup as it will be used for the next test.

Results

DATA TABLE: SECTION 6.10 COUCH VERTICAL PRO

VERTICAL POSITION (CM) SPECIFICATION
ACTUAL PRO (CM)
IEC 601 IEC 1217 TOLERANCE (CM)

965 +35 ± 0.2

0 0 ± 0.2

50 -50 ± 0.2

6.11 Optical Distance Indicator (ODI)

Specification
• The ODI shall indicate the Target to Surface Distance (TSD) to an accuracy of ± 1 mm at 100 cm TSD and
to an accuracy of ± 5 mm for all other distances.

Test Method
1. This test is performed in Service mode with IEC scale selected.
2. Use the same setup as the previous couch Vertical PRO test.
3. Position a piece of white paper on the couch top at isocenter using the Front Pointer.
4. Turn on the Field Light and project the crosshairs and ODI rangefinder display on the paper.
5. Verify the ODI meets specification for the 100 cm position.
6. Sequentially drive the couch vertical position to 80.0 and 130.0 cm. Verify the ODI display meets
specification at both distances.
7. Record results in the data table.

Results

DATA TABLE: SECTION 6.11 – OPTICAL DISTANCE INDICATOR (ODI)

TSD (CM) SPECIFICATION TOLERANCE (CM) √ = OK
80 ≤ 0.5

100 ≤ 0.1

130 ≤ 0.5

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6.12 PerfectPitch Couch Pitch & Roll PRO Accuracy

This section only applies to TrueBeam systems equipped with the Varian PerfectPitch couch. Skip
to next section and enter NA in all data tables in this section if not applicable.

Specification
• The couch Pitch and Rolls axis shall coincide with the PRO to within ± 0.25°

Test Method
1. This test is performed in Service mode with Varian IEC 601 scale selected.
2. Level gantry at head up position.
3. Fully open the X/Y jaws and turns on the field light.
4. Move the couch to position: LNG 140 cm / VRT 0 cm / LAT 0 cm.
5. Place and center the dual axis digital level box to approximately ± 1 cm to the center of the Crosshair
projection on the couch top. If dual axis digital level box is not available, the test can be done with a single
axis digital level place along the Pitch or Roll axis.

Figure 4: Positioning Digital Level Box on Couch top

6. Using the Axis positioning function in Service mode, enter Program value of 0.0° for Pitch and click Go To
(see Figure 5). Execute the auto motion using hand pendant or side panel.

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 Figure 5: Entering Target Pitch Position in Service Mode

7. Verify the value shown on the digital level meets specification. Record results in the data table.
8. Repeat Step 6 and 7 to verify Pitch PRO accuracy at 3.0° and -3.0°.
9. Reposition Pitch to level.
10. Repeat steps 5 to 8 by entering and verifying the target positions for Roll axis. Record results in the data
table.

Results

DATA TABLE: SECTION 6.12 PERFECTPITCH COUCH PITCH & ROLL PRO ACCURACY
NA SHALL BE ENTERED IN ALL DATA BOXES IF THE VARIAN PERFECTPITCH COUCH IS NOT INSTALLED
ACTUAL
AXIS POSITION (°) SPECIFICATION TOLERANCE (°)
DIGITAL LEVEL (°)
Pitch 0.0 ± 0.25

Pitch 3.0 ± 0.25

Pitch -3.0 ± 0.25

Roll 0.0 ± 0.25

Roll 3.0 ± 0.25

Roll -3.0 ± 0.25

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7 Accessory Mount and Electron Applicators

Enter NA in data table in this section if electrons energy is not purchased.

7.1 Communications and Switches Verification

This test will sequentially add each of the collimator accessory subsystems to verify proper communications to
the collimator Controller. It will also test the interlock switches.

Requirement
• The accessory detection system shall provide a clear indication of an accessories related interlock if there
is an accessory hardware failure or an accessory mismatch. This includes faulty accessory latches,
switches, invalid codes, and communication problems.
• The IRM shall display the accessory installed.
• In the event of an applicator collision, all external axis motions shall be disabled. These axes include
gantry, couch, collimator, MV, and KV arms. All motions will cease to function until the collision condition
has been removed and the collision button on the collimator has been reset.

Test Method
1. Accessory Mount (A/M) tests:
a. Attached the (A/M) and verify that green LEDs on both sides are ON
b. Press the A/M latch bar, and verify the LEDs turn red and return to green when released.
c. Sequentially press both Accessories Mount releases (in the pillar mount) to release the A/M from each
side. Verify the LEDs on the Interface Mount turn red and return to green when the A/M is properly
latched.
d. Record result in the data table.
2. Electron Applicators (EA) tests:
a. In service mode, set up the lowest electron energy in a Fixed mode. Install the 10x10 applicator. Verify
the red/green LEDs on both sides of the Interface mount are green when latched and red when not
latched.
b. Remove the Final Field Defining Aperture (FFDA) insert. Under the Service Mode > Accessory tab,
verify that slot 3 Tray Install Switch LED is not green.
c. Verify the correct EA codes are displayed in the NAME box of the Accessories tab. Verify the selection
of an incorrect applicator resulted in an accessory related Routine Interlock.
d. Sequentially install each applicator into the A/M using only a selected electron energy. Press Prepare
each time after a new applicator is installed. Verify accessory related Routine Interlock clears, and the
jaws drive to a preset size per Table 7 depending on test energy used.
e. All electron applicators contain a collision detection touch guard. Apply pressure to one side of the
touch guard sensor. The red collision switch on the Interface Mount should illuminate, and the external
motor functions should cease to operate. Verify the presence of the routine interlock, 4020 and 1006.
Press the collision reset switch and verify that motor functions are restored. Repeat the test for all 4
sides of the touch guard.

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 f. With the last applicator still installed, press the A/M thumb switches to attempt to release the A/M.
Verify the A/M cannot be removed with an electron applicator installed.
g. Record results in the data table.

TABLE 7: ELECTRON APPLICATORS PRESET SIZES VS ENERGIES (CM)

APPLICATOR 6 MEV 9 MEV 12 MEV 15 MEV 16 MEV 18 MEV 20/22 MEV
JAW SIZE X - Y
6x6 20 x 20 20 x 20 11 x 11 11 x 11 11 x 11 11 x 11 11 x 11

10 x 10 22 x 22 20 x 20 15 x 15 15 x 15 15 x15 15 x 15 14 x 14

15 x 15 22 x 22 20 x 20 19 x 19 19 x 19 18 x18 18 x 18 17 x 17

20 x 20* 27 x 27 25 x 25 25 x 25 23 x 23 23 x 23 22 x 22 22 x 22

25 x 25* 32 x 32 30 x 30 30 x 30 28 x 28 28 x 28 27 x 27 27 x 27

10 x 6 16 x 13 16 x 13 16 x 11 16 x 10 16 x 10 16 x 10 16 x 10

Results

DATA TABLE: SECTION 7.1 – COMMUNICATIONS AND SWITCHES VERIFICATION

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF ELECTRONS ENERGY IS NOT PURCHASED
TEST REQUIREMENT √ = OK
Accessory Mount interlocks and switches Functioning

Electron Applicators interlocks and switches Functioning

Electron Applicator Codes read properly Functioning

Electron Applicator’s FFDA Reader Functioning

Electron Applicator Collision Touch Guard Functioning

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8 MLC and Jaws Verification with Collimation Devices Check
Collimation Devices Check (CDC) is a feature within the MPC to automate the verification of the collimation
devices (jaws and MLC) mechanical properties. CDC is a feature currently only available in MPC for user
logging in with HASP right.
The measurements are performed and calculated with reference to SSD of 100cm with gantry at 0. This is
possible, as the procedures below only uses relative measurements on the MV imager, and the imager is not
moved throughout the measurement procedure.
The center of collimator rotation is the origin of the reference coordinate system. During the test sequence, MV
images derived with MLC Comb pattern are acquired at 5 collimator rotation angles to determine the best-fit for
the rotation center point.
CDC calculates the positions of the collimation devices through the finding of the edges in acquisitions. The
position of the edge is calculated as the inflection point on acquisitions corrected for DF and FF.
Refer to Appendix B for more details and CDC sequence of events.

Specifications
• The MLC leaf end positioning accuracy (offset) of each leaf shall coincide targeted position within ± 1.0 mm
at 100 cm SSD.
• The MLC leaf end positioning reproducibility at same targeted position after intentional movement of leaf
and carriage shall match within ± 0.5 mm.
• The positioning accuracy (offset) for each of the lower (X) and upper (Y) jaws shall coincide targeted
position within accuracy of ± 1 mm for X and ± 2 mm for Y at 100 cm SSD
• The lower (X) and upper (Y) jaws shall be parallel within ± 0.4° with respect to reference line defined by
MLC leaf edge.

The MLC is the primary field collimation device in present day clinical applications and jaws are
basically used for shielding. Therefore, the MLC is used as the mechanical reference for all other
alignments including jaws parallelism

Test Method
1. From Major mode, log in to MPC with HASP user right.
2. Phantom or other tooling is not required for this test.
3. From the MPC menu, select Tools > Add Check > 6x – Collimation Devices Check.

Figure 6: Adding CDC in MPC Application

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4. Select to run the CDC and press Prepare. Move all axes to planned positions.
5. Beam on when ready. The plan shall automatically acquire all MV images at gantry 0°
6. Upon completion of beam delivery, click the button of CDC session just been performed on the right
monitor to display the result.
7. Verify “Beam Delivery” and “Processing” have green checks indicating a successful MPC.
8. Verify that all values under the “Value” column are within the “Thresholds” and have a green check mark.

Figure 7: Completion Result of CDC

9. The MLC leaf position accuracy (offset from target position) and reproducibility shall be measured at 3
different plan positions for both bank A and B respectively. Click on the arrow sign beside the MLC to show
more details of MLC results (Figure 8). Record the maximal offset and reproducibility values for A and B in
the data table.

Figure 8: Detailed MLC Results in CDC

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10. The jaw position accuracy (offset from target position) and parallelism shall be measured at 4 different plan
positions for X1 and X2 (Position 0 to 3), Y1 and Y2 (Position 4 to 7) respectively. Click on the arrow sign
beside the Jaws to show more details of jaw results (Figure 8). Record the maximal offset and parallelism
values for jaws in the data table.

Figure 9: Detailed Jaws Results in CDC

11. On the right monitor, click the drop-down arrow of “Options”. Select the option to generate the CDC Report.
The report shall be generated and stored in D:/VMsOS/AppData/ TDS/Output/MPC/Report folder of
Treatment WS (or retrieve also from I drive). Print out a copy of the CDC Report and insert to the printed
CPAD document to the customer.

Figure 10: Select Options to Print CDC Report

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Results

DATA TABLE: SECTION 8 - MLC AND JAWS VERIFICATION WITH COLLIMATION DEVICES CHECK
TEST CRITERIA SPECIFICATION TOLERANCE ACTUAL VALUE

MLC Maximal Leaves A Offset ± 1.0 mm

MLC Maximal Leaves B Offset ± 1.0 mm

MLC Maximal Leaves A Reproducibility ± 0.5 mm

MLC Maximal Leaves B Reproducibility ± 0.5 mm

Jaw X1 Maximal Offset ± 1.0 mm

Jaw X2 Maximal Offset ± 1.0 mm

Jaw Y1 Maximal Offset ± 2.0 mm

Jaw Y2 Maximal Offset ± 2.0 mm

Jaw X1 Maximal Parallelism Offset ± 0.4°

Jaw X2 Maximal Parallelism Offset ± 0.4°

Jaw Y1 Maximal Parallelism Offset ± 0.4°

Jaw Y2 Maximal Parallelism Offset ± 0.4°

CUSTOMER DEMO REQUIRED

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9 Radiation Isocenter and Beam Coincidence Verification
9.1 Coincidence of Light Field and X-Ray Field
The MLC is the primary field collimation device in present day clinical applications and jaws are
basically used for shielding. Therefore, Light field and X-ray field coincidence is verified using the
MLC only.
Light and X-ray source position will not vary between use of different collimation techniques (jaws
versus MLC leaves)

Specification
• Each of the light field and X-ray field edges shall coincide within ± 1.5 mm at 100 cm SSD. Field edges will
be defined by MLC leaves.

Test Method
1. Setup the TrueBeam per the following table.

TABLE 8: LIGHT FIELD VS. X-RAY FIELD TEST SETUP

Gantry Angle 0°

Collimator Angle 0°

Field Size (X and Y jaws) Preset in selected plan

Couch top 100 cm TSD

Tool X-Ray Film aligned to crosshairs on couch top

MLC PLAN LOCATION MLC MODEL MLC FIELD
D:\VMSOS\AppData\TDS\Input\Service\TrueBeam
Standard 120 MLC LF vs X 10x10cm
IPA\STD 120MLC\Static_120MLC\

D:\VMSOS\AppData\TDS\Input\Service\TrueBeam
Standard 80 MLC LF vs X 10x10cm
IPA\80 MLC\Static_80MLC\

D:\VMSOS\AppData\TDS\Input\Service\TrueBeam
HD MLC LF vs Xray 8x8
IPA\HDMLC\Static_HDMLC\

2. Log in to Service mode.

3. Using the same steps in Section 6.4 of opening and loading plan:
a. Select the applicable MLC field listed in the setup table field from MLC static DICOM or MLC type plan.
b. Drive MLC to the selected field.
c. Turn on the field light. Use a small pin or a ballpoint pen to mark the edges of the field on the film
package at the 50% density region.
d. Click on the Default Beam button. Select X-ray energy to be tested. Enter the appropriate MU for the
film in use.
e. Press Prepare on the control console to load the plan.
f. Press MV Ready and then MV Beam On.

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 g. Develop the film and compare the 50% isodensity lines of the X-ray field edges to the field light edges.
h. Record results in the data table.
i. Mark films with test parameters and have customer store films for future reference.
4. Repeat until all applicable energies are completed.
Results

DATA TABLE: SECTION 9.1 – COINCIDENCE OF LIGHT FIELD AND X-RAY FIELD
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED
SPECIFICATION
ENERGY ENERGY (MV) FIELD SIZE (CM) TOLERANCE √ = OK
PER EDGE (MM)
10x10
X-ray 1 ± 1.5
(8x8 for HD120)

10x10
X-ray 2 ± 1.5
(8x8 for HD120)

10x10
X-ray 3 ± 1.5
(8x8 for HD120)

10x10
X-ray 4 ± 1.5
(8x8 for HD120)

10x10
X-ray 5 ± 1.5
(8x8 for HD120)

10x10
6MV HI 6 ± 1.5
(8x8 for HD120)

10x10
10MV HI 10 ± 1.5
(8x8 for HD120)

Low X-ray 10x10

2.5 ± 1.5
Imaging (8x8 for HD120)

CUSTOMER DEMO REQUIRED

9.2 Isocenter Verification with IsoLock

Skip this section for TrueBeam systems that have ICVI included (PN: TVL001001175 in sales
order). Radiation Isocenter verification shall be performed with ICVI hardware in Section 10.4:
Machine Radiation Isocenter Verification with ICVI

Specification
• Central axis X-ray beam variation due to rotation of the gantry and collimator shall be confined to a sphere
of ≤ 0.5 mm radius.
• Central axis X-ray beam variation due to rotation of the couch, gantry, and collimator shall be confined to a
sphere of ≤ 0.75 mm radius.

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 Download and use the latest Isolock V3.3.x for this test.

Test Method
1. Log in to Service mode with HASP rights.
2. Refer to UG-HT-Isolock for setup and instructions.
3. Record results in the data table.

Results

DATA TABLE: SECTION 9.2 – ISOCENTER VERIFICATION WITH ISOLOCK

NA SHALL BE ENTERED IN ALL DATA BOXES IF RADIATION ISOCENTER VERIFICATION IS TO BE COMPLETED
WITH ICVI
ISOCENTER AXIS SPECIFICATION (MM RADIUS) ACTUAL
Gantry and Collimator ≤ 0.5

Couch, Gantry and Collimator ≤ 0.75

CUSTOMER DEMO REQUIRED

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10 Integrated Conical Collimator Verification and Interlock
System (ICVI)

Enter NA in all data tables in this section if ICVI is not purchased.

10.1 Enabling ICVI

Requirement
• The ICVI shall be enabled to use in a machine treatment administration system.

Test Method
1. From Major Mode on TrueBeam workstation, log in to System Administration.
2. Select Treatment tab and Clinical sub-tab (see Figure 11).
3. Change the Enforce electronics verification of conical collimator to Yes.
4. Record result in the data table.

Figure 11: Enabling ICVI in System Administration

Results

DATA TABLE: SECTION 10.1 – ENABLING ICVI

NA SHALL BE ENTERED IN ALL DATA BOXES IF ICVI IS NOT PURCHASED
TEST CRITERIA √ = OK
ICVI has been enabled in machine treatment administration system.

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10.2 Conical Collimator Recognition
Requirement
• Each available conical collimator shall have a unique identification code and shall be uniquely recognized
when install on ICVI mount.
• Visible label that corresponds to the aperture size is marked on each conical collimator.

Test Method
1. This test is done in Service mode.
2. On Service mode screen, select the Accessories tab (Figure 12).
3. Rotate the gantry to head down position.
4. Install the ICVI mount onto the interface mount of the machine.
5. Insert one of the conical collimator to the ICVI mount and lock in place.
6. Verify that the identification code of the conical collimator is correctly recognized by the system (Figure 12)
and matches the label on the conical collimator per Data Table Section 10.2.

Figure 12: Conical Collimator Recognition in Service Mode

7. Record result in the data table.

8. Repeat steps 4 to 6 for all available conical collimators.

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Results

DATA TABLE SECTION 10.2 – CONICAL COLLIMATOR RECOGNITION

NA SHALL BE ENTERED IN ALL DATA BOXES IF ICVI IS NOT PURCHASED
CONICAL COLLIMATOR APERTURE CONICAL COLLIMATOR LABEL ON CONICAL
√ = OK
SIZE (MM) IDENTIFICATION CODE COLLIMATOR
4 3268 4mm CC

7.5 3315 7.5mm CC

5 3269 5mm CC

10 3274 10mm CC

12.5 3316 12.5mm CC

15 3279 15mm CC

17.5 3317 17.5mm CC

10.3 Conical Collimators Alignment Verification

Specification
• Conical Collimator alignment deviation shall be ≤ 0.40 mm with respect to machine collimator rotation axis
with MPC-ICVI Axis Alignment Check

Test Method
1. From Major Mode, select and log in to MPC with service or physic user credential
2. From the menu, select Tools > Add Check > ICVI Axis Alignment Check, and select in order of all the
Conical Collimator (CC) from smallest (4mm) through the largest (17.5mm).

Figure 13: Adding ICVI Axis Alignment Check

3. On the MPC screen, select the ICVI Alignment Check for the 4mm CC from listed fields and then press
Prepare on Control Console.
4. Verify that any previously installed phantom or QA component that may obstruct the beam path at
isocenter is removed. On the MPC screen, click to acknowledge that phantom (or any QA component) has
been removed.

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 Figure 14: Click to Acknowledge Phantom is Removed (10mm CC shown as example)

5. Install the 4mm CC (or selected CC to be checked) to the ICVI Mount.

6. Attach the lock ring and confirm there is a green light on the Interface Mount.
7. Move all axes to planned positions via the pendant.
8. Confirm that the installed CC is detected and populated in the field on the Treatment WS.

Figure 15: Treatment WS with a 4mm CC Installed

9. Beam on when ready. The plan shall automatically acquire MV images at various collimator angles at
gantry 180°. The complete test takes approximately 90 seconds.
10. Upon completion, double click on the right most square for the ICVI Axis Alignment Check to show the
result of the latest CC check (example 4mm CC in Figure 16).
11. Record result in Data Table for CC that has passed.
12. Repeat the ICVI Axis Alignment Check for all remaining CC listed in data table.

Figure 16: IVCI Axis Alignment Check Result (Passed)

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Results

DATA TABLE: SECTION 10.3 - CONICAL COLLIMATORS ALIGNMENT VERIFICATION

NA SHALL BE ENTERED IN ALL DATA BOXES IF ICVI IS NOT PURCHASED.
TEST CONICAL COLLIMATOR SIZE SPEC √ = OK
4mm

5mm

7.5mm

ICVI Axis Alignment Check 10mm ≤ 0.40 mm

12.5mm

15mm

17.5mm

CUSTOMER DEMO REQUIRED

10.4 Machine Radiation Isocenter Verification with ICVI

Specification
• Central axis X-ray beam variation due to rotation of the gantry and collimator shall be confined to a sphere
of ≤ 0.5 mm radius.
• Central axis X-ray beam variation due to rotation of the couch, gantry, and collimator shall be confined to a
sphere of ≤ 0.75 mm radius.

Test Method
1. In treatment room, install the ICVI Mount with 10 mm CC and lock ring to the interface mount. Confirm the
interface mount has the green light lit.

This test can be run with the 10mm, 12.5mm, 15mm or 17.5mm conical collimator. The radiation
isocenter results using the MPC-ICVI Alignment Check is not subjective to the CC being used,
except for the reported Alignment to Collimator Rotation Axis which is specific to each CC.

2. Rotate the couch to 0°.

3. Attach and set up the ICVI QA Tool kit (micrometer stage and rod with tungsten sphere) to the couch.
Adjust the couch and/or micrometer stage to position the tungsten sphere approximately at isocenter using
lasers (or crosshairs). Sub-millimeter alignment of the sphere to isocenter is not critical for MPC Alignment
Check.

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 Figure 17: ICVI QA Tool Kit Setup and Positioned to Isocenter.

4. From Major Mode, select and log in to MPC with service or physic user credential
5. From the menu, select Tools > Add Check > ICVI Check, and select in order of all the Conical Collimator
(CC) from smallest (4mm) through the largest (17.5mm).

Figure 18: Add ICVI Check with 10mm CC

6. On the MPC screen, select the ICVI Check with 10mm CC from listed fields and then press Prepare on
Control Console.
7. Enter Treatment room. Verify couch still at 0°and ICVI QA tool kit already set up in previous steps.
Acknowledge the phantom (sphere) is mounted and aligned to the room lasers on IRM.

This step captures and sets the actual couch position as a reference position. Acknowledging this
dialog before setting the phantom to isocenter requires the deleting and re-adding the MPC ICVI
Check

Figure 19: Verify and Acknowledge Phantom Mounting

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8. Using the couch pendant, move all axes to planned position.
9. Exit Treatment room and beam on when ready.
• The plan will automatically acquire MV images at 5 gantry rotation angles namely, 180°, 90°, 0°, 270°
and 180E°.
• At each gantry rotation angle, 3 MV images will be acquire at various collimator rotation angles (270°,
0°and 90°)
• Once all the images with gantry and collimator rotation are acquired, the couch will start to rotate and
MV images acquire at couch positions 90°, 45°, 0°, 315° and 270°.
• The tungsten ball position adjustment is not necessary with the ICVI Check algorithm.
10. Once the ICVI Check plan is completed, double click on the rightmost square for the most recently
acquired ICVI Check results.

Figure 20: ICVI Check Results

11. Verify Gantry-Collimator and Gantry-Collimator-Couch Isocenter size meet specification.

12. Record results in the data table.
Results

DATA TABLE: SECTION 10.4 - MACHINE RADIATION ISOCENTER VERIFICATION WITH ICVI
NA SHALL BE ENTERED IN ALL DATA BOXES IF ICVI IS NOT PURCHASED
TEST RADIATION ISOCENTER AXIS SPECIFICATION (MM RADIUS) ACTUAL (MM)
Gantry-Collimator ≤ 0.50
ICVI Check
Gantry-Collimator-Couch ≤ 0.75

CUSTOMER DEMO REQUIRED

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11 Energy and Beam Profile Verifications (IC Profiler)
Skip the tests in this section entirely and enter NA in data tables if water phantom is used for
energy and beam profile verifications.

11.1 Definitions
Inplane (radial): Vertical plane in line with the accelerator gun and target.
Crossplane (transverse): Vertical plane that is at right angles to the inplane.
FWHM: Full Width Half Maximum is the central 80% region of the field size defined by the 50% intensity points.
Dmax: Abbreviation for depth of maximum ionization.
Flatness: Per Varian protocol, field flatness is calculated as follows:
Maximum variation from the mean dose intensity delivered within the FWHM region measured at 100 cm TSD
at a depth of 10 cm. The mean (normalized to 100%) is the median of the maximum and minimum intensity
points within the FWHM. The flatness value is measured as a ± value from the mean [(max-min)/2].
Symmetry: Per Varian protocol, field symmetry is calculated as follows:
Maximum difference between the dose intensity delivered to any two points which are equidistant and
symmetrical about the central axis and within the FWHM region measured at 100 cm TSD at a depth of 10 cm.

This point-to-point symmetry analysis protocol is more sensitive than other protocols that typically
average each half of the field profile and then compare the averages. As a result, Varian protocol
symmetry analysis results are typically higher than other protocols.

Figure 21: Flatness Definition

11.2 X-Ray and Electron Beam Conformance Option

Beam Conformance is a purchasable feature that consists of three possible options that are described in Table
9. Varian recommends the Enhanced Beam Conformance Specification option alone, versus the addition of
the Beam Conformance to Customer Reference Data options, as this will ensure tighter beam conformance
for all future installed systems.
The tighter Enhanced Beam Conformance (EBC) energy specifications are listed in the data tables Section
11.6 and Section 11.7.

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 TABLE 9: X-RAY AND ELECTRON BEAM CONFORMANCE OPTION
REFER TO THE X-RAY & ELECTRON BEAM CONFORMANCE SPECIFICATIONS RAD10174 SALES ORDER
BROCHURE FOR MORE INFORMATION ABOUT THESE OPTIONS. CATALOG #
Enhanced Beam Conformance Specification (standard for EDGE) xxx001027006
This is the most common and preferred option. This is not a matching service to customer
reference data, or to any particular machine data. Instead, it ensures conformance to
Varian’s new published Reference Beam Data. This new data provides tight tolerances for
X-ray and electron beam performance specifications.
This option involves demonstrating that the beam energy for X-rays and electron energies
meet the Enhanced Beam Conformance (EBC) Specifications, and then guarantees point
to point conformance of field intensity profiles to Varian published Representative Beam
Data. There is an EBC tolerance specification column in the Depth of Ionization tables
within this IPA document that is used for this option. After demonstrating these energy
specifications, the field intensity conformance specifications for the inplane and crossplane
profiles are essentially “guaranteed” and are confirmed by the customer during beam
commissioning. This allows a more rapid transition from acceptance testing to
commissioning.
Systems that are compatible with the Enhanced Beam Conformance Specification option
include TrueBeam platforms (TrueBeam, TrueBeam STx and Edge) and Clinac platforms
(Clinac iX, Trilogy, Novalis Tx, CX, DMX, DHX). Cross-platform matching is limited to
photon beam energy matching only. See RAD 10174 for more details.

Beam Conformance to Customer Reference Data – X-Rays xxx001027008

Beam Conformance to Customer Reference Data – Electrons xxx001027009
These two separate options are less common, and each one must be separately
purchased and listed on the sales order, in addition to the Enhanced Beam Conformance
Specification option stated above.
These options are considered a beam matching service because they involve onsite
refinement of the X-ray and/or electron energy depth of ionization and field intensity
performance to conform to customer reference data. However, the reference data must
conform to the original Varian published specifications for the designated reference system.
If the customer reference data is outside of the Enhanced Beam Conformance
specifications (listed in the Depth of Ionization data tables in this IPA), it is strongly
recommended to only “detune” the new system to the upper or lower limits of the Enhanced
Beam Conformance specifications to get as close as possible without exceeding the
enhanced specifications. This will allow future machines to match better.
These options are more labor intensive as they require beam data comparison to site beam
reference data that must be collected on the same scanning system.
Systems that are compatible with Beam Conformance to Customer Reference Data include
TrueBeam platforms (TrueBeam, TrueBeam STx, Edge) and Clinac platforms (Clinac iX,
Trilogy, Novalis Tx, CX, DMX, DHX, EX). Cross-platform matching is limited to photon
beam energy matching only. See RAD 10174 for more details.

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11.3 Sun Nuclear IC Profiler Preparation and Set Up
The copper traces in the IC Profiler unit and its copper wedge accessory can
become activated when exposed to radiation beams with energy greater than 8
MV. Only trained radiation workers are authorized to handle radioactive
materials.
When working in the Treatment Room, always wear your assigned
dosimeter(s), and observe As Low As Reasonably Achievable (ALARA)
practices. Minimize your exposure by working quickly and spending as little
time as possible handling the copper wedge after it have been exposed to
radiation.
Using the IC Profiler, with the combination of a Copper wedge, or an Aluminum
Wedge, along with Solid water buildup, will be referred to as the measurement
‘Setup’ and ‘Setup’ components.
When working with this measurement setup, observe the following guidelines
to minimize device radioactivity and potential radiation exposure.
Do not leave the measurement Setup in the primary radiation beam when not
performing measurements. Moving the Setup to the back of the couch top or
to a counter top will greatly minimize potential radioactivity.
Minimize the amount of dose delivery to the measurement Setup when
performing photon beam energy measurements. Only run the required
CAUTION measurements and avoid running excessive dose (MU).
Never leave the Setup in the primary beam path, during beam on, when not
taking measurements.
When handling the copper wedge accessory after measurements, wait at least
5 minutes and then quickly remove the device and place it on a counter top
away from the immediate work area. The device should only be handled for
less than 1 minute. Keep the device at arm’s length while transporting it.
If a Survey Meter is available, then use it to measure the amount of
radioactivity before handling setup components after exposure to radiation
beams with energy greater than 8 MV.
When realigning the Setup, after it has been exposed to radiation, align the
device to the crosshairs as quickly as possible. Minimize the amount of time
spent near the collimator area.
When all measurements are finished, allow the copper wedge to ‘cool down’
for at least 1 hour before repacking it. The devices can be left on the couch or
a counter top away from the immediate work area. Minimize the amount of time
required to pack the devices.
After packing the device in the shipping case, move the case to an
unpopulated area and do not ship it for at least one day.

Before using the SNC application, the latest Profiler_Support_files.exe file must be downloaded
from the GCS data center (Product Specific Pages > Other Products > Scanning Equipment) and
installed on the service laptop.

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 This executable file contains the normalization files for each specific IC Profiler unit, which is
frequently updated to ensure that the latest energy calibration files are selectable within the SNC
application.
This download and file execution must be performed each time before using an IC Profiler
unit. Refer to the UG-GE-Profiler for download and installation instructions.

1. Set up the IC Profiler per the following figure. Refer to UG-GE-Profiler manual if necessary.

Figure 22: IC Profiler Set Up

2. After installing the latest profiler support files (mentioned in the Stop note above), launch the SNC software
application on the service laptop.
3. Navigate to the Setup > Analysis screen and select the Energy tab (Figure 23).
4. Select the appropriate Analysis files for the serial number of the IC Profiler unit (Figure 24) and click OK.

Figure 23: SNC Configure Analysis Screen Figure 24: IC Profiler SN Label

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5. Set up the machine and IC Profiler per the following table. These conditions will be used for all beam
measurements unless specified otherwise in later set up tables.

TABLE 10: SET UP CONDITIONS

Gantry Angle Leveled head-up

Collimator Angle Mid-position

Couch Position Mid-position

Servos All ON (including PFN and DOSE)

ICP Panel Orientation ICP on couchtop with electronics facing away from the gantry (Y+ to gantry)

ICP Panel Alignment ICP panel aligned to crosshairs

SSD 99 cm (to top of ICP panel)

NOTE: Due to the low output of 2.5X,

SNC Application Control uncheck Beam is Pulsed for 2.5X
Menu Settings only. Make sure it is checked for all
other energies.

The accuracy of determining the beam energy using ICP is affected by beam profile that is not
symmetrical. Hence it is essential to adjust and verify the beam is symmetrical within specification
before performing the beam energy verification using ICP. The proceeding tests in this document
is arranged to perform the symmetry before the energy verification. In the case where necessary
energy adjustment is made, the flatness and symmetry verifications of that energy must be
repeated.

11.4 Photon/FFF Symmetry and Flatness

Flattening filter free (FFF), also referred to as High Intensity (HI), and low X-ray imaging (2.5X) do
not have flatness specification since these beam profiles are not flat.

Flatness Requirement
• The maximum variation in integrated dose between the minimum and maximum points, within the FWHM
of the inplane and crossplane central axes shall not exceed the requirements listed in the data tables.

Tests data have demonstrated that profiler flatness analysis results are higher than equivalent
water phantom measurements. The requirements listed in the data tables ensure than flatness
will meet the standard flatness specifications per Varian protocol when measurements are taken
using a water phantom.

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Symmetry Requirement
• The maximum variation in integrated dose between any two corresponding points equidistant from the
beam centerline within the FWHM of the radial and transverse major axes shall not exceed 2.0% for photon
and FFF, and 3% for the low X-ray imaging energy (2.5X).

Test Method
1. Sequentially acquire profiles for all applicable energies using the setup conditions in Table 11, and analyze
each profile after it is completed.
• Make sure that the correct calibration file is set in the SNC display for each energy. This can be
selected before or after the profile is acquired but must be correct for the analysis results.
• Verify that the correct energy is displayed in the SNC display (Figure 26). If not, use the Setup > Set
Energy menu to set the correct energy. Energy can be changed before or after the profile is acquired
without affecting the profile.

For 2.5X, select the energy as "Other" from the menu option and then set as "X-Ray FFF" type
per Figure 25.

• For 2.5X, uncheck Beam is Pulsed in the Control menu. Make sure that it is checked for all other
energies.
• Verify that the profiles are normalized to 100% at the central axis.
• Record flatness and symmetry results (Figure 27) in the data table and verify that all values meet
specification.
• Save each recorded profile.

Figure 25: 2.5X Energy Type Selection

Figure 26: Verify Energy Selected

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 Figure 27: Profile Flatness and Symmetry Results

TABLE 11: TEST SETUP FOR PHOTON FIELD FLATNESS AND SYMMETRY MEASUREMENTS
SSD 99 cm (to top of ICP panel)

ICP Buildup See below

ICP Accessory None

ICP Profile View Select Primary Axis view

ENERGY (MV) DOSE RATE DOSE FIELD BUILDUP

ICP CAL FILE ICP GAIN
BJR 11/17 (MU/MIN) (MU) SIZE (CM²) (CM)
4 #### 4x.cal 4 250

6 #### 6x.cal
8 #### 8x.cal 12 x 12
10 #### 10x.cal 100 & 9
4 400
15/16 #### 15x.cal 30 x 30

18/20 #### 18x.cal

20/25 #### 20x.cal

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 6FFF #### 6x.cal 2 400 10 x 10
&
10FFF #### 10x.cal 2 400
30 x 30

2.5 #### 2.5x.cal 8 60 60 30 x 30 4

Save Profiles as [energy]x [Field size] Symm.prs (e.g., 6x 30x30 Symm.prs)

Low X-Ray Imaging profiles are verified using 30 X 30 cm field size only and has to be run in
continuous beam mode, which is automatically selected when the Beam is Pulsed control
selection is deselected.

Results

DATA TABLE: SECTION 11.4 - PHOTON/FFF SYMMETRY AND FLATNESS (INPLANE - ICP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
ACTUAL SYMMETRY ACTUAL
ENERGY (MV) FIELD SIZE (CM²) FLATNESS REQ.(%)
FLATNESS REQ. (%) SYMMETRY
X-ray 1 ±

X-ray 2 ±

X-ray 3 12 x 12 ± 3.7 ± ≤2

X-ray 4 ±

X-ray 5 ±

X-ray 1 ±

X-ray 2 ±
± 3.0
X-ray 3 30 x 30 ± ≤2
(± 3.7 for 20 MV)
X-ray 4 ±

X-ray 5 ±

6FFF
10 x 10
10FFF
≤2
6FFF

10FFF 30 x 30

2.5X ≤3

CUSTOMER DEMO REQUIRED

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 DATA TABLE: SECTION 11.4 - PHOTON/FFF SYMMETRY AND FLATNESS (CROSSPLANE - ICP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
FLATNESS REQ. ACTUAL SYMMETRY ACTUAL
ENERGY (MV) FIELD SIZE (CM²)
(%) FLATNESS REQ. (%) SYMMETRY
X-ray 1 ±

X-ray 2 ±

X-ray 3 12 x 12 ± 3.7 ± ≤2

X-ray 4 ±

X-ray 5 ±

X-ray 1 ±

X-ray 2 ±
± 3.0
X-ray 3 30 x 30 ± ≤2
(± 3.7 for 20 MV)
X-ray 4 ±

X-ray 5 ±

6FFF
10 x 10
10FFF
≤2
6FFF

10FFF 30 x 30

2.5X ≤3

CUSTOMER DEMO REQUIRED

11.5 Electron Field Flatness & Symmetry

Flatness Requirement
• The maximum variation in integrated dose between the minimum and maximum points within the central
80% of the inplane and crossplane central axes shall not exceed the specifications listed in the data table.

Tests data have demonstrated that Profiler flatness analysis results are higher than equivalent
water phantom measurements. The requirements listed in the data tables ensure than flatness
will meet the standard the flatness specifications per Varian protocol when measurements are
taken using a water phantom.

Symmetry Requirement
• The maximum variation in integrated dose between any two corresponding points equidistant from the
beam centerline within the FWHM of the inplane and crossplane central axes shall not exceed
requirements listed in the data table.

Test Method

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1. Sequentially acquire profiles for all applicable energies using the setup conditions in the following table and
analyze each profile after it is completed.
• Make sure that the SSD is changed for the HDTSE energies.
• Make sure that the correct calibration file and energy is set in the SNC display for each energy.
• Verify that the profiles are normalized to 100% at the central axis.
• Record results in the data table and verify that all values meet specification.
• Save each recorded profile.

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 TABLE 12: TEST SETUP FOR ELECTRON FIELD FLATNESS AND SYMMETRY MEASUREMENTS
SSD See below (distances are measured to top of ICP panel)

ICP BUILDUP See below

ICP ACCESSORY None

ICP PROFILE VIEW Select Primary Axis view

ENERGY ICP DOSE RATE DOSE FIELD SIZE SSD BUILDUP

ICP CAL FILE
(MEV) GAIN (MU/MIN) (MU) (CM²) (CM) (MM)

6 #### 6e.cal 0

9 #### 9e.cal 5

12 #### 12e.cal 15 x 15 10
Applicator
15 #### 15e.cal 18
4 500 100 & 100
16 #### 16e.cal 18
25 x 25
18 #### 18e.cal Applicator 20

20 #### 20e.cal 25
22 #### 22e.cal 25

6 HDTSe- #### 6e.cal 0

1 2500 100 36 x 36 74
9 HDTSe- #### 9e.cal 5

Save Profiles as [energy]e [Field size] Symm.prs (e.g., 6e 30x30 Symm.prs)

When installing applicators make sure that the FFDA insert is fully seated and level in the bottom
of the applicator. Any misalignment or tilt on the FFDA may result in misleading profiles

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Results

DATA TABLE: SECTION 11.5 - ELECTRON FIELD FLATNESS & SYMMETRY (INPLANE - ICP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
FIELD SIZE FLATNESS REQ. ACTUAL SYMMETRY ACTUAL
ENERGY (MEV)
(CM²) (%) FLATNESS (%) REQ. (%) SYMMETRY (%)

E1 ±

E2 ±

E3 ±

E4 ±
25 x 25 ± 5.4
≤2
Applicator (± 6.0 for 6e)
E5 ±

E6 ±

E7 ±

E8 ±

E1 ±

E2 ±

E3 ±

E4 ±
15 x 15 ± 5.4
Applicator (± 6.0 for 6e)
E5 ±
≤2
E6 ±

E7 ±

E8 ±

6 HDTSe-
36 x 36 No Spec
9 HDTSe-

CUSTOMER DEMO REQUIRED

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 DATA TABLE: SECTION 11.5 - ELECTRON FIELD FLATNESS & SYMMETRY (CROSSPLANE - ICP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
FIELD SIZE FLATNESS REQ. ACTUAL SYMMETRY ACTUAL
ENERGY (MEV)
(CM²) (%) FLATNESS (%) REQ. (%) SYMMETRY (%)

E1 ±

E2 ±

E3 ±

E4 ±
25 x 25 ± 5.4
≤2
Applicator (± 6.0 for 6e)
E5 ±

E6 ±

E7 ±

E8 ±

E1 ±

E2 ±

E3 ±

E4 ±
15 x 15 ± 5.4
Applicator (± 6.0 for 6e)
E5 ±
≤2
E6 ±

E7 ±

E8 ±

6 HDTSe-
36 x 36 No Spec
9 HDTSe-

CUSTOMER DEMO REQUIRED

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11.6 Photon Energy Verification
Photon energy will be measured with the Sun Nuclear IC Profiler (ICP) using a copper wedge accessory. The
copper wedge is an ICP accessory that allows the measurement of photon beam energy, including FFF
modes. The wedge is thin near the middle of the beam and gets progressively thicker at the edges. This
means that higher energy beams create a wider profile.
During the profile analysis, a mathematical relationship is established between the copper wedge profile and
water phantom data at 10 cm. This relationship is then used to produce the profile D10 value analysis.
It is important to make sure that the correct wedge Analysis file is used with
the corresponding serial numbered wedge.

NOTICE Verify the beam is symmetrical within specification before performing the
beam energy verification using ICP. In the case where necessary energy
adjustment is made, the flatness and symmetry verifications of that energy
must be repeated

If the Enhanced Beam Conformance option was purchased, the data table tolerance values
listed in the EBC column must be met for all depth specifications.
If the Beam Conformance to Customer Reference Data – X-Rays option was purchased, the
data table tolerance values listed in either the TOL1 or EBC columns must be met for all depth
specifications. Achieving either specification is acceptable since it may be necessary to slightly
tune beyond the EBC specifications to match an existing machine. Varian will not detune a
system beyond the TOL 1 values and recommends remaining within the EBC tolerances for
future machine installations.

11.6.1 Copper Wedge Photon Energy Measurement with ICP

Specification
The PDD10 values (displayed as D10 in the SNC application) acquired with the ICP and copper wedge
accessory shall meet the specifications shown in the data table.

Test Method
1. Sequentially acquire profiles for all applicable energies using the setup conditions in Table 13 and analyze
each profile after it is completed.
• Make sure that the correct calibration file is set in the SNC display for each energy. This can be
selected before or after the profile is acquired but must be correct for the analysis results.
• Verify that the correct energy is displayed in the SNC display (Figure 26). If not, use the Setup > Set
Energy menu to set the correct energy. Energy can be changed before or after the profile is acquired
without affecting the profile.
• For 2.5X, uncheck Beam is Pulsed in the Control menu. Make sure that it is checked for all other
energies.
• Record the Photon D10 value (Figure 28) in the data table and verify that all values meet specification.
• Save each recorded profile.

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 Figure 28: Photon D10 Result

TABLE 13: TEST SETUP FOR COPPER WEDGE PHOTON ENERGY MEASUREMENTS
SSD 99 cm (to top of ICP panel)

ICP BUILDUP None

ICP ACCESSORY Quad Copper Wedge (placed on top of ICP and aligned to crosshairs)

ICP PROFILE VIEW Select Diagonal Profile view

ENERGY (MV) ICP CALIBRATION DOSE RATE DOSE FIELD SIZE

ICP GAIN
BJR 11/17 FILE (MU/MIN) (MU) (CM²)

2.5 #### 2.5x.cal 8 60

4 #### 4x.cal 8 250

6 #### 6x.cal
8 #### 8x.cal

10 #### 10x.cal
100 30 x 30
15 #### 15x.cal
4 400
18 #### 18x.cal

20 #### 20x.cal

6HI #### 6x.cal

10HI #### 10x.cal

#### represents the ICP serial number. Each ICP unit requires its own specific calibration files, which are
actually normalization files that make all the detector outputs equal for a given charge.
The calibration file can be applied at any time, either before or after the profile is acquired.
Always select the appropriate calibration file from the folder icon next to the Calibration pull down arrow.

Save Profiles as [energy]x Cu Wedge.prs (e.g., 6x Cu Wedge.prs)

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Results

DATA TABLE: SECTION 11.6 - PHOTON ENERGY VERIFICATION (ICP)

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
PHOTON D10
ENERGY (MV)
TOLERANCE (%) ACTUAL (%)
BJR 11 / 17 SPEC (%)
TOL 1 EBC

2.5 52.0 ±2 N/A

4 63.0

6 67.2

8 71.0

10 74.1

15 / 16 77.4 ±1 ± 0.5

18 / 23 80.2

20 / 25 82.0

6FFF 64.3

10FFF 71.8

TOL 1 = Tolerance specification for system without Enhance Beam Conformance option
EBC = Optional Enhanced Beam Conformance tolerance specification. EBC specifications do not apply to
the 2.5 MV imaging energy.

CUSTOMER DEMO REQUIRED

11.7 Electron Energy Verification

If the Enhanced Beam Conformance Specification option was purchased, the data table
tolerance values listed in the EBC column must be met for all depth specifications.
If the Beam Conformance to Customer Reference Data – Electrons option was also
purchased, the data table tolerance values listed in either the TOL1 or EBC columns must be met
for all depth specifications. Achieving either specification is acceptable since it may be necessary
to slightly tune beyond the EBC specification to match an existing machine. Varian will not detune
a system beyond the TOL 1 values and recommends remaining within the EBC tolerances for
future machine installations.

Specification
• The R50% Wedge Defining Field values acquired with the ICP and aluminum quad wedge accessory shall
meet the specifications shown in the data table.
• R50 is defined as the probe depth that corresponds to 50% ionization (profile normalized to 100%).

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Test Method
1. Sequentially acquire profiles for all applicable energies using the setup conditions in the following table and
analyze each profile after it is completed.
• Make sure that the SSD is changed from the previous photon energy measurements.
• Make sure that the correct calibration file and energy is set in the SNC display (Figure 26) for each
energy.
• Record results in the data table and verify that all values meet specification.
• Save each recorded profile.

TABLE 14: TEST SETUP FOR ELECTRON ENERGY MEASUREMENTS

SSD 100 cm (to top of ICP panel)

ICP BUILDUP None

Aluminum Quad Wedge (placed on top of ICP panel and aligned per instructions
ICP ACCESSORY
on the wedge)

ICP PROFILE VIEW Select Diagonal Profile view

DOSE RATE FIELD SIZE

ENERGY (MEV) ICP CAL FILE ICP GAIN DOSE (MU)
(MU/MIN) (CM²)
6 #### 6e.cal

9 #### 9e.cal
12 #### 12e.cal

15 #### 15e.cal 25 x 25 cm
4 500 100
16 #### 16e.cal Applicator

18 #### 18e.cal

20 #### 20e.cal
22 #### 22e.cal

Save Profiles as [energy]e Al Wedge.prs (e.g., 6e Al Wedge.prs)

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Results

DATA TABLE: SECTION 11.7 - ELECTRON ENERGY VERIFICATION (ICP)

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
R50% WEDGE DEFINING FIELD

ENERGY (MEV) TOLERANCE (CM) ACTUAL (CM)

SPEC (CM)
TOL 1 EBC

6 2.32

9 3.52

12 4.91

15 6.19 ± 0.07 (6e & 9e)

± 0.1
16 6.52 ± 0.08 (12e - 22e)

18 7.41

20 8.10

22 8.59

TOL 1 = Tolerance specification for system without Enhance Beam Conformance option
EBC = Optional Enhanced Beam Conformance tolerance specification

CUSTOMER DEMO REQUIRED

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12 Energy and Beam Profile Verifications (Water Phantom)
Skip the tests in this section entirely and enter NA in data tables if IC Profiler is used for energy
and beam profile verifications.

Scan profile analysis results are provided in this section. Printed copies of these acceptance
scan profiles are not provided by Varian since the customer will repeat the same scan profiles
during beam commissioning.

Figure 29: Axes Definition and Typical Setup for Scanning with Buddelship

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12.1 Definitions
Inplane (radial): Vertical plane in line with the accelerator gun and target.
Crossplane (transverse): Vertical plane that is at right angles to the inplane.
FWHM: Full Width Half Maximum is the central 80% region of the field size defined by the 50% intensity points.
Dmax: Abbreviation for depth of maximum ionization.
Flatness: Per Varian protocol, field flatness is calculated as follows:
Maximum variation from the mean dose intensity delivered within the FWHM region measured at 100 cm TSD
at a depth of 10 cm. The mean (normalized to 100%) is the median of the maximum and minimum intensity
points within the FWHM. The flatness value is measured as a ± value from the mean [(max-min)/2].
Symmetry: Per Varian protocol, field symmetry is calculated as follows:
Maximum difference between the dose intensity delivered to any two points which are equidistant and
symmetrical about the central axis and within the FWHM region measured at 100 cm TSD at a depth of 10 cm.

This point-to-point symmetry analysis protocol is more sensitive than other protocols that typically
average each half of the field profile and then compare the averages. As a result, Varian protocol
symmetry analysis results are typically higher than other protocols.

Figure 30: Flatness Definition

12.2 X-Ray and Electron Beam Conformance Option

Beam Conformance is a purchasable feature that consists of three possible options that are described in Table
9. Varian recommends the Enhanced Beam Conformance Specification option alone, versus the addition of
the Beam Conformance to Customer Reference Data options, as this will ensure tighter beam conformance
for all future installed systems.
The tighter Enhanced Beam Conformance (EBC) energy specifications are listed in the data tables Section
12.4 and Section 12.7.

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 TABLE 15: X-RAY AND ELECTRON BEAM CONFORMANCE OPTION
REFER TO THE X-RAY & ELECTRON BEAM CONFORMANCE SPECIFICATIONS RAD10174 SALES ORDER
BROCHURE FOR MORE INFORMATION ABOUT THESE OPTIONS. CATALOG #
Enhanced Beam Conformance Specification (standard for EDGE) xxx001027006
This is the most common and preferred option. This is not a matching service to customer
reference data, or to any particular machine data. Instead, it ensures conformance to
Varian’s new published Reference Beam Data. This new data provides tight tolerances for
X-ray and electron beam performance specifications.
This option involves demonstrating that the beam energy for X-rays and electron energies
meet the Enhanced Beam Conformance (EBC) Specifications, and then guarantees point
to point conformance of field intensity profiles to Varian published Representative Beam
Data. There is an EBC tolerance specification column in the Depth of Ionization tables
within this IPA document that is used for this option. After demonstrating these energy
specifications, the field intensity conformance specifications for the inplane and crossplane
profiles are essentially “guaranteed” and are confirmed by the customer during beam
commissioning. This allows a more rapid transition from acceptance testing to
commissioning.
Systems that are compatible with the Enhanced Beam Conformance Specification option
include TrueBeam platforms (TrueBeam, TrueBeam STx and Edge) and Clinac platforms
(Clinac iX, Trilogy, Novalis Tx, CX, DMX, DHX). Cross-platform matching is limited to
photon beam energy matching only. See RAD 10174 for more details.

Beam Conformance to Customer Reference Data – X-Rays xxx001027008

Beam Conformance to Customer Reference Data – Electrons xxx001027009
These two separate options are less common, and each one must be separately
purchased and listed on the sales order, in addition to the Enhanced Beam Conformance
Specification option stated above.
These options are considered a beam matching service because they involve onsite
refinement of the X-ray and/or electron energy depth of ionization and field intensity
performance to conform to customer reference data. However, the reference data must
conform to the original Varian published specifications for the designated reference system.
If the customer reference data is outside of the Enhanced Beam Conformance
specifications (listed in the Depth of Ionization data tables in this IPA), it is strongly
recommended to only “detune” the new system to the upper or lower limits of the Enhanced
Beam Conformance specifications to get as close as possible without exceeding the
enhanced specifications. This will allow future machines to match better.
These options are more labor intensive as they require beam data comparison to site beam
reference data that must be collected on the same scanning system.
Systems that are compatible with Beam Conformance to Customer Reference Data include
TrueBeam platforms (TrueBeam, TrueBeam STx, Edge) and Clinac platforms (Clinac iX,
Trilogy, Novalis Tx, CX, DMX, DHX, EX). Cross-platform matching is limited to photon
beam energy matching only. See RAD 10174 for more details.

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12.3 Scanning Setup
To prevent unnecessary rework due to any possibility of a beam position error, verify Section 9.2:
Isocenter Verification with IsoLock or Section 10.4: Machine Radiation Isocenter
Verification with ICVI have been successfully performed before scanning.

TABLE 16: SCANNING TEST SETUP

Gantry Angle Leveled head-up

Collimator Angle 0°

Dose Rate 300 - 600 (higher dose rates provide smoother scans)
Dose Rate 200 for 4X
Dose Rate
Dose Rate 60 for Low X-ray Imaging
Dose Rate 400 for High Intensity Photons.

Field Size Specified in following procedures

PFN Servo ON

Dose Rate Servo OFF (for smoother scans)

Water Tank Setup Refer to OEM Manual for scanning system setup.
Key setup requirements include:
Tank must be accurately leveled
Water surface must be at 100 cm TSD
Scanning reference probe must be clear of scanning path to prevent
scatter to the dose probe.
Probe Depth: specified in following procedures
Probe effective center: If using customer 3-D scanning systems, the probe
effective center must be accurately positioned to prevent errors in the
Depth of Ionization profiles. Varian specifications in this document are
based on the effective center values for an IBA IC13 probe (0.13 cc
volume) as shown in the diagram below.

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 Extra care should be used when setting up for depth of ionization scans. Small errors in tank
level, probe effective center depth, probe correction offsets, reference probe scatter, etc., will
cause significant errors in the scan curves. A software background subtraction must be
performed before starting any scans and all scans must be plotted in the direction of maximum
depth to the surface.
As a rule of thumb, it should not be necessary to adjust the BMAG shunt values during
installation. If energy measurements are not in spec., verify the scanning system setup and
particularly the probe depth setting. A very small error in probe depth setup can result in out-of-
spec results, especially in electron energies. If still in doubt after verifying setup, Dmax Diagonal
scans can be plotted and compared to the Factory Red Book values to verify if the beam energy
is correctly setup. These scans (referred to as Horns) are not as sensitive to small probe depth
errors and are much more sensitive to energy changes than a Depth of Ionization curve. Only
make small BMAG shunt adjustments if absolutely necessary.

12.4 Photon Depth of Ionization

If the Enhanced Beam Conformance option was purchased, the data table tolerance values
listed in the EBC column must be met for all depth specifications.
If the Beam Conformance to Customer Reference Data – X-Rays option was purchased, the
data table tolerance values listed in either the TOL1 or EBC columns must be met for all depth
specifications. Achieving either specification is acceptable since it may be necessary to slightly
tune beyond the EBC specifications to match an existing machine. Varian will not detune a
system beyond the TOL 1 values and recommends remaining within the EBC tolerances for
future machine installations.

Specification
• The depth of maximum beam intensity (Dmax) and the beam intensity at 10 cm depth (D10) along the
central beam axis shall meet the specifications shown in the data table for a 10 X 10 cm field size
measured in a water phantom at 100 cm TSD.

Test Method
1. Setup system per Section 12.3 .
2. Position jaws to 10 x 10 cm.
3. Set up the scanning system for Depth Dose scanning.
4. Perform the depth of ionization scans for all applicable energies listed in the data table. Analyze each scan
after it is completed and save all scans with the following information:
5. Energy, Scan Type, Field Size (e.g. 6X Depth of Ion 10x10)
6. Record results in the data table. Enter N/A in any boxes that do not apply.

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Results

DATA TABLE: SECTION 12.4 – PHOTON DEPTH OF IONIZATION (WP)

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
DEPTH DOSE AT 10CM (D10)
ENERGY DMAX SPEC ACTUAL DMAX ACTUAL
SPEC (%) TOLERANCE (%)
(BJR11/ BJR17) (CM) (CM) 10 CM %
D10 TOL 1 EBC

4 MV 1.2 ± 0.20 63.0 ±1 ± 0.7

6 MV 1.6 ± 0.15 67.2 ±1 ± 0.5

8 MV 2.0 ± 0.15 71.0 ±1 ± 0.5

10 MV 2.4 ± 0.15 74.1 ±1 ± 0.5

15 / 16 MV 2.9 ± 0.15 77.4 ±1 ± 0.5

18 / 23 MV 3.3 ± 0.15 80.2 ±1 ± 0.5

20 / 25 MV 3.5 ± 0.15 82.0 ±1 ± 0.5

6 MV HI 1.5 ± 0.15 64.3 ±1 ± 0.5

10 MV HI 2.34 ± 0.15 71.8 ±1 ± 0.5

Dmax = Depth of maximum ionization

D10 = 10 cm depth
TOL 1 = Tolerance specification for system without Enhance Beam Conformance option
EBC = Optional Enhanced Beam Conformance tolerance specification

CUSTOMER DEMO REQUIRED

12.5 Photon Field Flatness and Symmetry

Varian-provided IBA scanning systems utilize the Varian protocol for analyzing beam flatness and
symmetry. The symmetry analysis compares equidistant points on each side of beam centerline
and displays the asymmetry between the two worst points. As a result, a small bump in a scan or
a central offset error can result in high asymmetry values. Generally, if the Varian protocol
symmetry analysis measures 1.0%, a customer scanning system analysis (which may utilize a
symmetry averaging protocol) will typically be <0.5%. This can be demonstrated by switching
between the Varian and IEC analysis protocols in the IBA scanning software

Flatness Specification
• The maximum variation in integrated dose between the minimum and maximum points within FWHM of the
inplane and crossplane major axes at 100 cm TSD and at a depth of 10 cm, shall not exceed the
specifications listed in the data tables.

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Symmetry Specification
• The maximum variation in integrated dose between any two corresponding points equidistant from the
beam centerline within the FWHM of the inplane and crossplane major axes at 100 cm TSD and a depth of
10 cm, shall not exceed 2.0%.

Test Method
1. Setup system per Section 12.3 with the probe depth at 10 cm.
2. Set up the scanning system for inplane (or crossplane) scanning.
3. Perform the central axis scans for all applicable energies listed in the following data tables. This will include
both scanning planes, different field sizes and different energies. Analyze each scan after it is completed
and save all scans with the following information:
4. Energy, Scanning Plane, Field Size (e.g. 6X Inplane 40x40)
5. Record results in the data table. Enter N/A in any boxes that do not apply.
Results

DATA TABLE: SECTION 12.5 – PHOTON FIELD FLATNESS AND SYMMETRY (INPLANE - WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
ACTUAL SYMMETRY ACTUAL
ENERGY (MV) FIELD SIZE (CM) FLATNESS SPEC (%)
FLATNESS SPEC (%) SYMMETRY
X-ray 1 10x10 ±3 ± ≤2

X-ray 2 10x10 ±3 ± ≤2

X-ray 3 10x10 ±3 ± ≤2

X-ray 4 10x10 ±3 ± ≤2

X-ray 5 10x10 ±3 ± ≤2

X-ray 1 40x40 ± 2.5 ± ≤2

X-ray 2 40x40 ± 2.5 ± ≤2

X-ray 3 40x40 ± 2.5 ± ≤2

X-ray 4 40x40 ± 2.5 ± ≤2

± 2.5
X-ray 5 40x40 ± ≤2
(± 3 for 20 MV)

CUSTOMER DEMO REQUIRED

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 DATA TABLE: SECTION 12.5 – PHOTON FIELD FLATNESS AND SYMMETRY (CROSSPLANE -WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
ACTUAL
ACTUAL SYMMETRY
ENERGY (MV) FIELD SIZE (CM) FLATNESS SPEC (%) SYMMETR
FLATNESS SPEC (%)
Y
X-ray 1 10x10 ±3 ± ≤2

X-ray 2 10x10 ±3 ± ≤2

X-ray 3 10x10 ±3 ± ≤2

X-ray 4 10x10 ±3 ± ≤2

X-ray 5 10x10 ±3 ± ≤2

X-ray 1 40x40 ± 2.5 ± ≤2

X-ray 2 40x40 ± 2.5 ± ≤2

X-ray 3 40x40 ± 2.5 ± ≤2

X-ray 4 40x40 ± 2.5 ± ≤2

± 2.5
X-ray 5 40x40 ± ≤2
(± 3 for 20 MV)

CUSTOMER DEMO REQUIRED

12.6 Photon Field Intensity and Symmetry

Hi Intensity mode (also referred to as FFF) and low x-ray imaging introduces a new field intensity
specification that replaces the traditional flatness specification. Since these beam profiles are not
flat, field intensity is measured at specific equidistant points from the central axis. The
measurement results are then compared to the specifications to verify correct profile shape.

Intensity Specification
• The radial and transverse profile field intensity, relative to central axis, normalized to 100% and measured
at 100cm TSD at a depth of 10 cm, shall not exceed the specifications listed in the data table.

Symmetry Specification
• The maximum variation in integrated dose between any two corresponding points equidistant from the
beam centerline within the FWHM of the radial and transverse major axes at 100 cm TSD and at a depth of
10 cm (5 cm for low x-ray imaging), shall not exceed 2.0%for HI and 3.0% for Low X-Ray Imaging

Low X-Ray Imaging profiles scans are verified using 40 X 40 cm filed size only at depth of 5 cm

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Test Method
1. Setup system per Table 11 with the probe depth at 10 cm (5 cm for low x-ray imaging).
2. Set up for Inplane (Crossplane) scanning.
3. Perform the central axis scans for all applicable energies listed in the following data tables. This will include
both scanning planes, different field sizes and different energies. Analyze each scan after it is completed
and save all scans with the following information:
4. Energy, Scanning Plane, Field Size (e.g. 6HI Inplane 40x40)
5. Verify the profiles are normalized to 100% at the central axis.
6. Using a manual cursor analysis function, determine the profile field Intensity value at the required
equidistant points listed in the data table on both sides of the central axis.
7. Determine the equidistant point that has the maximum deviation from the central spec value listed in the
data table and enter only this value in the “Actual Intensity” box in the data table.

Nominal field intensity distributions are measured as shown in the following figures. Field
intensity is relative to the central axis dose normalized to 100%.
The scanning system software cursor function must be used to manually analyze the field
intensity at each of the required measurement points.

Figure 31: 10x10 cm Field Intensity Specification

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 Figure 32: 40x40 cm Field Intensity Specification

Results

DATA TABLE: SECTION 12.6 – PHOTON FIELD INTENSITY AND SYMMETRY (RADIAL - WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.

10 X 10 CM INTENSITY SPEC ACTUAL ACTUAL ACTUAL

FIELD (FROM CENTRAL AXIS) SYMMETRY
ENERGY INTENSITY INTENSITY SYMMETRY
SIZE (CM) SPEC
± 2 CM ± 4 CM @ 2 CM @ 4 CM %

6 MV HI 10 x 10 97.5% ± 2 90.5% ± 2 2%

10 MV HI 10 x 10 95.5% ± 2 85.0% ± 2 2%
40 X 40 CM INTENSITY SPEC
ACTUAL ACTUAL
(FROM CENTRAL AXIS)
INTENSITY INTENSITY
± 6 CM ± 18 CM @ 6 CM @ 18 CM

6 MV HI 40 x 40 90.0% ± 2 59.5% ± 2 2%

10 MV HI 40 x 40 80.0% ± 2 45.0% ± 2 2%

Low X-Ray
40 x 40 96.5% ± 2 74.0% ± 2 3%
Imaging

CUSTOMER DEMO REQUIRED

DATA TABLE: SECTION 12.6 – PHOTON FIELD INTENSITY AND SYMMETRY (TRANSVERSE – WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.

10 X 10 CM INTENSITY SPEC ACTUAL ACTUAL ACTUAL

FIELD (FROM CENTRAL AXIS) SYMMETRY
ENERGY INTENSITY INTENSITY SYMMETRY
SIZE (CM) SPEC
± 2 CM ± 4 CM @ 2 CM @ 4 CM %

6 MV HI 10 x 10 97.5% ± 2 90.5% ± 2 2%

10 MV HI 10 x 10 95.5% ± 2 85.0% ± 2 2%
40 X 40 CM INTENSITY SPEC
ACTUAL ACTUAL
(FROM CENTRAL AXIS)
INTENSITY INTENSITY
± 6 CM ± 18 CM @ 6 CM @ 18 CM

6 MV HI 40 x 40 90.0% ± 2 59.5% ± 2 2%

10 MV HI 40 x 40 80.0% ± 2 45.0% ± 2 2%

Lo X-Ray
40 x 40 96.5% ± 2 74.0% ± 2 3%
Imaging

CUSTOMER DEMO REQUIRED

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12.7 Electron Depth of Ionization
If the Enhanced Beam Conformance Specification option was purchased, the data table
tolerance values listed in the EBC column must be met for all depth specifications.
If the Beam Conformance to Customer Reference Data – Electrons option was also
purchased, the data table tolerance values listed in either the TOL1 or EBC columns must be met
for all depth specifications. Achieving either specification is acceptable since it may be necessary
to slightly tune beyond the EBC specification to match an existing machine. Varian will not detune
a system beyond the TOL 1 values and recommends remaining within the EBC tolerances for
future machine installations.

Specification
• The depth of ionization at 90%, 80% and 50% of the maximum beam intensity shall be per the values listed
in data table for all electron energies. All tests are specified using a water phantom at 100 cm TSD and a
15 X 15 cm field size.

Test Method
1. Setup system per Section 12.3.
2. Install the 15 x 15 cm electron applicator and make sure the FFDA insert is fully seated.
3. Set up the scanning system for Depth Dose scanning.
4. Perform the depth of ionization scans for all applicable energies listed in the data table. Analyze each scan
after it is completed and save all scans with the following information:
5. Energy, Scan Type, Field Size (e.g. 6e Depth of Ion 15x15)
6. Record results in the data table. Enter N/A in any boxes that do not apply.

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Results

DATA TABLE: SECTION 12.7 – ELECTRON DEPTH OF IONIZATION (WP)

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
SPECIFICATIONS
ENERGY
90% DEPTH (CM) 80% DEPTH (CM) 50% DEPTH (CM)
MEV
D TOL 1 EBC D TOL 1 EBC D TOL 1 EBC
6e- 1.71 ± 0.1 ± 0.07 1.90 ± 0.07 ± 0.05 2.32 ± 0.1 ± 0.07

9e- 2.68 ± 0.1 ± 0.07 2.95 ± 0.07 ± 0.05 3.52 ± 0.1 ± 0.07

12e- 3.77 ± 0.1 ± 0.08 4.15 ± 0.07 ± 0.06 4.91 ± 0.1 ± 0.08

15e- 4.67 ± 0.1 ± 0.08 5.20 ± 0.07 ± 0.06 6.19 ± 0.1 ± 0.08

16e- 4.87 ± 0.1 ± 0.08 5.45 ± 0.07 ± 0.06 6.52 ± 0.1 ± 0.08

18e- 5.29 ± 0.1 ± 0.08 6.09 ± 0.07 ± 0.06 7.41 ± 0.1 ± 0.08

20e- 5.58 ± 0.1 ± 0.08 6.57 ± 0.07 ± 0.06 8.10 ± 0.1 ± 0.08

22e- 5.66 ± 0.1 ± 0.08 6.83 ± 0.07 ± 0.06 8.59 ± 0.1 ± 0.08

D = Depth specification
TOL 1 = Tolerance specification for system without Enhance Beam Conformance option
EBC = Optional Enhanced Beam Conformance tolerance specification
ACTUAL MEASURED DEPTHS
ENERGY
90% DEPTH (CM) 80% DEPTH (CM) 50% DEPTH (CM)
E1

E2

E3

E4

E5

E6

E7

E8

CUSTOMER DEMO REQUIRED

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12.8 Electron Field Flatness and Symmetry
Flatness Specification
• The maximum variation in integrated dose between the minimum and maximum points within the FWHM of
the inplane and crossplane major axes at 100 cm TSD and at a depth of 85%/2, shall not exceed the
specifications listed in the data table.

Symmetry Specification
• The maximum variation in integrated dose between any two corresponding points equidistant from the
beam centerline within the FWHM of the inplane and crossplane major axes at 100 cm TSD and at a depth
of 85%/2, shall not exceed 2.0%.

Test Method

TABLE 17: ELECTRON ENERGY SCANNING DEPTHS (DEPTH AT 85% DOSE /2)
ENERGY (MEV) DEPTH (CM)
4 0.6

6 1.0

9 1.4

12 2.0

15 2.6

16 2.7

18 3.0

20 3.3

22 3.4

1. Setup system per Section 12.3 using the probe depths listed for each energy in the table above.
2. Set up the scanning system for Inplane (or Crossplane) scanning. Inplane scans should always be
performed before crossplane scans in case any steering adjustments are required.

When installing applicators in the next step, make sure the FFDA insert is fully seated and level in
the bottom of the applicator. Any misalignment or tilt on the FFDA may result in misleading scan
profiles.

3. Perform the central axis scans for all applicable energies listed in the following two data tables. This will
include both scanning planes, different applicator sizes (none for HDTSe) and energies. Analyze each
scan after it is completed and save all scans with the following information:
4. Energy, Scan Plane, Field Size (e.g. 6e Inplane 25x25)
5. Record results in the data table. Enter N/A in any boxes that do not apply.

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Results

DATA TABLE: SECTION 12.8 – ELECTRON FIELD FLATNESS AND SYMMETRY (INPLANE - WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
ACTUAL SYMMETRY ACTUAL
ENERGY (MEV) FIELD SIZE (CM) FLATNESS SPEC (%)
FLATNESS (%) SPEC (%) SYMMETRY (%)
± 4.5 ≤2
E1 25 x 25 ±
(± 5.0 for 6e)

E2 25 x 25 ± 4.5 ± ≤2

E3 25 x 25 ± 4.5 ± ≤2

E4 25 x 25 ± 4.5 ± ≤2

E5 25 x 25 ± 4.5 ± ≤2

E6 25 x 25 ± 4.5 ± ≤2

E7 25 x 25 ± 4.5 ± ≤2

E8 25 x 25 ± 4.5 ± ≤2

± 4.5 ≤2
E1 10 x 10 ±
(± 5.0 for 6e)

E2 10 x 10 ± 4.5 ± ≤2

E3 10 x 10 ± 4.5 ± ≤2

E4 10 x 10 ± 4.5 ± ≤2

E5 10 x 10 ± 4.5 ± ≤2

E6 10 x 10 ± 4.5 ± ≤2

E7 10 x 10 ± 4.5 ± ≤2

E8 10 x 10 ± 4.5 ± ≤2

6 HDTSe- 36 No Spec N/A ≤2

9 HDTSe- 36 No Spec N/A ≤2

CUSTOMER DEMO REQUIRED

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 DATA TABLE: SECTION 12.8 – ELECTRON FIELD FLATNESS AND SYMMETRY (CROSSPLANE - WP)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
ACTUAL SYMMETRY ACTUAL
ENERGY (MEV) FIELD SIZE (CM) FLATNESS SPEC (%)
FLATNESS (%) SPEC (%) SYMMETRY (%)
± 4.5 ≤2
E1 25 x 25 ±
(± 5.0 for 6e)

E2 25 x 25 ± 4.5 ± ≤2

E3 25 x 25 ± 4.5 ± ≤2

E4 25 x 25 ± 4.5 ± ≤2

E5 25 x 25 ± 4.5 ± ≤2

E6 25 x 25 ± 4.5 ± ≤2

E7 25 x 25 ± 4.5 ± ≤2

E8 25 x 25 ± 4.5 ± ≤2

± 4.5 ≤2
E1 10 x 10 ±
(± 5.0 for 6e)

E2 10 x 10 ± 4.5 ± ≤2

E3 10 x 10 ± 4.5 ± ≤2

E4 10 x 10 ± 4.5 ± ≤2

E5 10 x 10 ± 4.5 ± ≤2

E6 10 x 10 ± 4.5 ± ≤2

E7 10 x 10 ± 4.5 ± ≤2

E8 10 x 10 ± 4.5 ± ≤2

6 HDTSe- 36 No Spec N/A ≤2

9 HDTSe- 36 No Spec N/A ≤2

CUSTOMER DEMO REQUIRED

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13 Dynamic Therapy, RapidArc (VMAT) and HyperArc
Verifications
1. If not already done so, download the following files:
• TrueBeam IPA file from the GCS Data Center > Products > TrueBeam > Software section.
2. Extract the downloaded TrueBeam IPA file to the following folders on the TrueBeam WS:
• D:\VMSOS\AppData\TDS\Input\Service\
• D:\VMSOS\AppData\TDS\Input\Daily QA
• D:\VMSOS\AppData\TDS\Input\Treatment
3. For system with HyperArc option in sales order, download the following file:
• HyperArc_Test_Plan_IPA-HT-STBIC599.zip (size 138MB) from the GCS Data Center > Products >
TrueBeam > Software section
4. Extract the downloaded HyperArc file to the following folders on the TrueBeam WS:
• D:\VMSOS\AppData\TDS\Input\Treatment

13.1 Enhanced Dynamic Wedge Verification

Not applicable to systems with no standard photon energy in the configuration (for example,
system with only FFF energy and electrons).

Requirement
Enhanced Dynamic Wedge (EDW) field can be executed and delivered in Machine QA mode successfully
without any interlock or fault. This is a pass/fail criteria test.

Test Method
1. From the Major mode screen, log in to Machine QA mode with Service or any authorized credential.
2. Select Open Plan and select the EDW plan in the following directory that corresponds to the appropriate
energy:
• D:\VMSOS\AppData\TDS\Input\Daily QA\TrueBeam IPA\TB_EDW\
3. Open the first EDW test plan listed with the parameters shown in the data table for available x-ray 1 energy
(example 6MV)
4. Select Machine Override.
5. In the External Beam Override dialog box, log in using the Service or any authorized credential .
6. Select the following buttons: Select All > Next > Convert > Done.
7. Move all axes to planned position.
8. Press Prepare on the control console. Press MV Ready until the MV Beam ON button lights and then
press MV Beam On.
9. Verify no Fault Interlocks activated during beam delivery.
10. Repeat the same steps to run the second EDW plan listed in the data table.
11. Record results in the data table.

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Results

DATA TABLE: SECTION 13.1 - ENHANCED DYNAMIC WEDGE VERIFICATION

NA SHALL BE ENTERED IN DATA BOX FOR SYSTEM WITHOUT STANDARD PHOTON ENERGY

TEST CRITERIA √ = OK

EDW test field Y1-IN 10° executed and delivered successfully without any interlock or fault

EDW test field Y2-OUT 10° executed and delivered successfully without any interlock or fault

13.2 Arc Dynamic Verification

To prevent damage to the equipment, verify the gantry can rotate a full 360°
NOTICE without risk of collision before performing the following test.

Requirement
Arc Dynamic plan can be executed and delivered in Machine QA mode successfully without any interlock or
fault. This is a pass/fail criteria test.

Test Method
1. From the Major Mode screen, log in to Machine QA using the Service or any authorized credential.
2. Select Open Plan and select the MLC Arc plan in the following directory that corresponds to the
appropriate energy (for example, 6x or any FFF if machine do not have standard photon):
• D:\VMSOS\AppData\TDS\Input\Daily QA\TrueBeam IPA\STD 120MLC (or HDMLC or 80MLC)
3. Select Machine Override.
4. In the External Beam Override dialog box log in using the Service or any authorized credential.
5. Select the following buttons: Select All > Next > Convert > Done.
6. Select the ARC 1 field.
7. Press Prepare on the control console
8. Move axes to planned positions.
9. Press MV Ready and then MV Beam On.
10. Allows the treatment to complete.
11. Repeat Step 6 to Step 10 for the ARC 2 field.
12. Verify no Fault Interlocks activated during beam delivery.
13. Record results in the data table.

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Results

DATA TABLE: SECTION 13.2 - ARC DYNAMIC VERIFICATION

TEST CRITERIA √ = OK

Arc 1 field executed and delivered successfully without any interlock or fault

Arc 2 field executed and delivered successfully without any interlock or fault

13.3 Moving Window IMRT Test with Gantry 90 and 270

To prevent damage to the equipment, verify the gantry can rotate a full 360°
NOTICE without risk of collision before performing the following test.

This test is not an energy dependent test. The energy for this test is not important. The plan for
any photon energy available on the machine may be used.

Requirement
Dynamic IMRT treatment field with MLC Sliding Window can be executed and delivered in Machine QA mode
successfully without any interlock or fault. This is a pass/fail criteria test

Test Method
1. From the Major Mode screen, log in to Machine QA using the Service or any authorized credential.
2. Select Open Plan and browse to the MLC Sliding Window plan in the following directory:
• D:\VMSOS\AppData\TDS\Input\Daily QA\ TrueBeam IPA\STD 120MLC (or HDMLC or 80MLC)
3. Select the MLC Sliding Window DICOM plan.
4. Select Machine Override.
5. In the External Beam Override dialog box log in using the Service or any authorized credential.
6. Select the following buttons: Select All > Next > Convert > Done.
7. Select the Gantry 270 field.
8. Press Prepare on the control console.
9. Move axes to planned position.
10. Press MV Ready and then MV Beam On.
11. Allow the treatment to complete.
12. Repeat steps 6 through 9 for the Gantry 90 field.
13. Confirm the plans execute without any faults asserted.
14. Record results in the data table.

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Results

DATA TABLE: SECTION 13.3 - MOVING WINDOW IMRT TEST WITH GANTRY 90 AND 270
√ = OK
TEST CRITERIA
GANTRY 90° GANTRY 270°
Dynamic IMRT treatment field with MLC Sliding Window executed and delivered
successfully without any interlock or fault

13.4 RapidArc (VMAT) Verification

Not applicable for VitalBeam with MLC80.

To prevent damage to the equipment, verify the gantry can rotate a full 360°
NOTICE without risk of collision before performing the following test.

Requirement
RapidArc (VMAT) treatment plan can be executed and delivered in Machine QA mode successfully without any
interlock or fault. This is a pass/fail criteria test

Test Method
1. From the Major Mode screen, log in to Machine QA using the Service or any authorized credential.
2. Select Open Plan and select the RapidArc plan in the following directory that corresponds to the lowest
available X-ray energy and type of MLC:
• D:\VMSOS\AppData\TDS\Input\Daily QA\TrueBeam IPA\RA_VMAT_M120 (or RA_VMAT_HD)
3. Select Machine Override.
4. In the External Beam Override dialog box log in using the Service or any authorized credential.
5. Select the following buttons: Select All > Next > Convert > Done.
6. Press Prepare on the control console.
7. Move axes to planned positions.
8. Press MV Ready and then MV Beam On.
9. Allows the treatment to complete.
10. Repeat the test with highest available X-ray energy.
11. Confirm the plans execute without any interlocks being asserted.
12. Record results in the data table.

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Results

DATA TABLE: SECTION 13.4 - RAPIDARC (VMAT) VERIFICATION

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR SYSTEM WITH 80 LEAF MLC

TEST CRITERIA √ = OK

Lowest X-ray RapidArc (VMAT) plan executed and delivered successfully without any interlock
or fault

Highest X-ray RapidArc (VMAT) plan executed and delivered successfully without any interlock
or fault

CUSTOMER DEMO REQUIRED

13.5 HyperArc Test Plan Verification

Skip this section and enter NA in the data table if this option is not included.

Requirement
• HyperArc plan can be executed and delivered in Treatment mode successfully without any interlock or
fault. This is a pass/fail criteria test.

Test Method
1. This test is performed in Treatment mode with a DICOM RT test patient.
2. If machine is installed with PerfectPitch couch top, verify the Pitch and Roll are leveled showing 0.0° on
PRO screen.
3. Launch and log in to Treatment application.
4. Using file mode, open test plan HyperArc_Test_Plan_IPA-HT-STBIC599 that was downloaded and
extracted in folder; D:/VMSOS\AppData\TDS\Input\Treatment\
5. Scroll down and select the relevant RP_HA plan (either 6FFF or 10FFF, STD MLC120 or HDMLC);
• Example: RP_HA_6XFFF_SMLC.dcm. This field is specific to 6XFFF with a STD MLC120. For High
Definition MLC choose RP_HA_6XFFF_HDMLC.dcm

Only 1 selected plan shall be tested for HyperArc feature verification.

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 Figure 33: Opening HyperArc Dicom RT File

6. Click Open
7. Perform machine override for all fields. If there are icons stating some couch axis positions not defined or
invalid, just continue to next step as these shall be captured later.

To prevent damage to the equipment, verify the gantry can rotate a full 360°
NOTICE and couch can rotate full 180° without risk of collision before performing the
following test.

Figure 34:HyperArc Test Plan After Machine Override

8. Select the kV CBCT field. On the PVA Imaging screen (Right Monitor):
• Select CBCT Mode > Pelvis
• For Reconstruction, select ICBCT (optional) if installed, otherwise select Standard.
• Click OK at bottom on screen to continue

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 Figure 35: Set KV CBCT Parameters for kV CBCT Field

9. A Plan Automation window instructing the user to perform a dry run appear will appear. Verify that the
gantry able to rotate fully and arms extended without collision. Click OK.
10. Go into the treatment room. Using the hand pendant, hold down the motion enable bar and press each of
the highlighted orange button. Selected axes shall move to positions. In V2.7.x and later, simultaneous
gantry and couch motions are not possible.

Figure 36: Using Hand Pendant to Initiate Auto Motion of Axes

11. Exit the treatment room and close the door.

12. At the control console, press Prepare.
13. Press KV Beam On when ready to run the CBCT scan.
14. Once the CBCT is reconstructed, the newly acquired image will be displayed on the PVA Imaging screen
along with DRR. Do not attempt to do any matching as it is not necessary.
15. Click Apply
16. If an Apply Shift Parameters window indicating that current couch position is outside of plan tolerance
appear, enter the user credential and click Apply to continue.

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 Figure 37: Apply Shifts Parameters Warning

17. Select the first Treatment Port imaging field.

Figure 38: Selecting Treatment Port Field

18. On the Control Console, select each flashing orange motion selection button (one at a time) and hold down
the motion enables until the selected axes reach the plan positions. Acquired any unplanned couch axes if
necessary, after verifying clearance for full gantry rotation.
19. Press Prepare. A High Dose Treatment window will open requiring sign-off. Enter the username and
password credential to continue.
20. MV Beam On when ready.
21. All six grouped, automated fields (2 Treatment Ports and 4 Treatment Fields) will run automatically. The
gantry and couch will rotate without user interaction during this process.
22. Confirm the plan execute without any interlock or fault being asserted during the beam delivery.
23. Record results in the data table.

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Results

DATA TABLE: SECTION 13.5 - HYPERARC TEST PLAN VERIFICATION

NA SHALL BE ENTERED IN DATA BOX IF HYPERARC OPTION IS NOT PURCHASED

TEST CRITERIA √ = OK

HyperArc test plan executed and delivered successfully without any interlock or fault

CUSTOMER DEMO REQUIRED

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14 LaserGuard and Collision Protection System
LaserGuard provides an infrared protection zone below the collimator to prevent gantry collisions with patients
and objects.

14.1 Protection Zone Area Verification

Requirement
With collimator and gantry at 0°, the protection zone area is centered and parallel to the Interface Mount and
meets the following requirements:
• 177.8mm handle protrusion of the T-shaped gauge (100012420-01) shall clear the protection zone.
• 36.9mm Gauge Plug (100011752-02) shall clear the protection zone.
• 2mm Gauge Shim (100011752-06) used with the 36.9mm Gauge Plug shall penetrate the protection
zone on either side of the zone.

Test Method
1. Position gantry and collimator to 0°.
2. Verify LaserGuard Control is enabled in System Administration.
3. Install T-shaped gauge on Interface Mount (shown in Figure 39), and verify red LED is not illuminated on
gantry LSG indicator and on the in room monitor LSG icon.

Figure 39: Protection Zone with T-Shaped Gauge Installed (Gantry 0°)

4. Attach 36.9 mm Gauge Plug (medium-height Plug) over Accessory Mount alignment pin (shown in Figure
40). Verify LSG do not trigger and the red indicator LED does not illuminate.
5. Place Gauge Plug over opposite alignment pin and verify red indicator LED does not illuminate.
6. Reattach medium-height Gauge Plug at each location with 2 mm shim in place. Verify LSG triggers and the
red LED illuminates.
7. Record test results in the data table

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 Figure 40: Gauge Plug Installed

Results

DATA TABLE: SECTION 14.1 – PROTECTION ZONE AREA VERIFICATION

TEST CRITERIA √ = OK

177.8 mm handle protrusion of the T-shaped Gauge clears the protection zone.

36.9 mm Gauge Plug clears the protection zone.

36.9 mm Gauge Plug with 2 mm shim penetrates the protection zone on both sides.

CUSTOMER DEMO REQUIRED

14.2 Protection Zone Tilt Verification

Requirement
With collimator at 90° and gantry at 0°, the protection zone tilt alignment is 3° relative to the Interface Mount
(shown in Figure 41) and meets the following requirements:
• 26 mm Gauge Plug (100011752-01) attached to rear Interface Mount pin (Stand side) shall clear the
warning zone.
• 47.8 mm Gauge Plug (100011752-03) attached to front Interface Mount pin (couch side) shall clear the
warning zone.
• 2 mm shim added to either Gauge Plug shall penetrate the warning zone.

Test Method
1. Rotate collimator to 90°.
2. Attach 26 mm (shortest) and 47.8 mm (longest) Gauge Plugs as shown in Figure 41 (long plug in front and
short plug in back). Verify yellow LED (on the Laser Unit body) does not illuminate.
3. One at a time, add the 2 mm shim to each Gauge Plug and verify yellow LED illuminates. Shim must only
be added to one plug at a time.
4. Record test results in the data table.

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 Figure 41: Tilt Alignment Test

Results

DATA TABLE: SECTION 14.2 – PROTECTION ZONE TILT VERIFICATION

TEST CRITERIA √ = OK

26 mm Gauge Plug attached to rear Interface Mount pin clears the warning zone.

47.8 mm Gauge Plug attached to front Interface Mount pin clears the warning zone.

Each Gauge Plug with 2 mm shim penetrates the warning zone (yellow LED).

CUSTOMER DEMO REQUIRED

14.3 Motion Stop Function Verification

Requirement
• With treatment room door closed, gantry motion should stop when an intrusion into the protection zone
occurs. The red LSG indicator LED should illuminate.

Test Method
1. In service mode enable LaserGuard control with the door open.
2. Place provided foam collision block on couch top in a position that will cause the collimator to hit the block
before it hits any portion of the couch (Figure 42).
3. Using a pendant, carefully rotate gantry towards the block to penetrate the collision zone. Verify the
following:
• Gantry motion stops.
• Red indicator LED is illuminated on the gantry display and IRM.

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 Figure 42: Collision Block Test

Results

DATA TABLE: SECTION 14.3 – MOTION STOP FUNCTION VERIFICATION

TEST CRITERIA √ = OK

With treatment room door closed, gantry motion stops when an intrusion into the protection
zone occurs. The red LED illuminates on the gantry and console LSG indicators.

CUSTOMER DEMO REQUIRED

14.4 Collision Override Function Verification

Requirement
• The side panel clearance override button shall be capable of overriding the LSG collision condition to back
away from an existing collision.

Test Method
1. With the LSG collision activated from the previous setup, at the couch side panel press and hold one of the
Motion Enable buttons and the Clearance Override button until you can verify using the Pendant that the
machine will allow the axes to clear the obstruction.

Results

DATA TABLE: SECTION 14.4 – COLLISION OVERRIDE FUNCTION VERIFICATION

TEST CRITERIA √ = OK

Collision Override Verification.

CUSTOMER DEMO REQUIRED

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14.5 PU Arm Motion Interlock

Enter NA in the data table for all KVD and KVS tests if the kV option is not included.

Requirement
• A collision detection system is built into the PU motion system. If any collision (including KVS collimator
CCDS) is detected, an audible alert shall be activated and a collision indication shall be displayed with all
major motions stopped. A manual reset at collimator touch guard or couch is required to restore major
motions once the collision is cleared.

Test Method
1. This test is performed in Service mode.
2. MVD imager cover – While rotating the gantry, firmly press the MVD imager cover and verify that a
collision is detected. All external motions should be disabled and an audible sound should be heard. Reset
the collision. Record results in the data table.
3. MVD arm paddles - While rotating the gantry, sequentially press all MVD arm paddles and verify that a
collision is detected. All external motions should be disabled and an audible sound should be heard. Reset
the collision. Record results in the data table.
4. KVD imager cover – While rotating the gantry, firmly press the KVD imager cover and verify that a
collision is detected. All external motions should be disabled and an audible sound should be heard. Reset
the collision. Record results in the data table.
5. KVD arm paddles - While rotating the gantry, sequentially press all KVD arm paddles and verify that a
collision is detected. All external motions should be disabled and an audible sound should be heard. Reset
the collision. Record status in the data table.
6. KVS cover CCDS – While rotating the gantry, gently place palm of hand on KVS collimator base (e.g.
center front cover) to activate CCDS. Verify that a collision is detected. All external motions should be
disabled and an audible sound should be heard. Reset the collision. Record status in the data table.
7. KVS arm paddles - While rotating the gantry, sequentially press all KVS arm paddles and verify that a
collision is detected. All external motions should be disabled and an audible sound should be heard. Reset
the collision. Record status in the data table.

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Results

DATA TABLE: SECTION 14.5 – PU ARM MOTION INTERLOCK

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF THE KV OPTION IS NOT INCLUDED
COLLISION TEST REQUIREMENT √ = OK
MVD Imager Cover

MVD Arm Paddles

All external motions stopped
KVD Imager Cover
Collision is activated
KVD Arm Paddles
Audible indication okay
KVS Cover CCDS

KVS Arm Paddles

CUSTOMER DEMO REQUIRED

14.6 PU Arm Motion Collision Override

All KVD and KVS tests in this section are not applicable to system without the kV imaging option.

Requirement
• In the event of a collision where at least one arm collision is present and there is a need to move the arm
away from the collision, an override can be performed.

Test Method
1. This test is performed in Service mode.
2. Create a collision by pressing and holding a collision paddle on an arm. KVS CCDS will require organic
object (e.g., palm of human hand) to be within 1 cm of KVS collimator cover to activate a collision.
3. Press and hold a collision reset button while moving the motion away from the collision.
4. Verify PU arms move at a slow speed.
5. Record status in the data table.

Results

DATA TABLE: SECTION 14.6 – PU ARM MOTION COLLISION OVERRIDE

COLLISION OVERRIDE CHECK REQUIREMENT √ = OK
At least one collision paddle and a collision
PU arm motion enabled at slow speed
reset button are continuously depressed.

CUSTOMER DEMO REQUIRED

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15 Positional Unit, Isocal and PRS Positioning Accuracy

Enter NA in the data table for all KVD and KVS tests if the kV option is not included

15.1 Vertical Motion Run-out

Specification
• The longitudinal and lateral position of the PU arms at -80.0/0/0.0 cm shall be within ±2 mm referenced to
the longitudinal and lateral position at 0.0/0.0/0.0 cm. This verifies system calibration for longitudinal and
lateral run-out. The KVD portion of this test requires in-room ceiling lasers to be accurately aligned.

Test Method
1. This test is performed in Service mode.
2. Rotate gantry to head-up position. Remove both kV and MV detector covers.
3. Position MVD arm at 0.0/0.0/0.0 cm. Using a piece of white tape, draw a small reference mark (+) on the
imager that is aligned to projected crosshair intersection for MVD.
4. Then move the arm to -80.0/0.0/0.0 cm by using the Axis Position Screen. Measure the amount of lateral
and longitudinal run-out with metric ruler.
5. Record results.
6. Retract MVD arm.
7. Rotate the gantry 90º IEC.
8. Repeat test for KVD arm using reference mark (+) on imager panel that is accurately aligned to ceiling
lasers.
9. Record results and retract the KVD arm.
10. Install detector (MVD and KVD) covers after tests have been completed.

Results

DATA TABLE: SECTION 15.1 – VERTICAL MOTION RUN-OUT

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF THE KV OPTION IS NOT INCLUDED.
MVD VERTICAL MOVEMENT FROM 0 CM TO -80 CM SPECIFICATION (MM) ACTUAL RUN-OUT
Lateral Run-out ≤ 2.0

Longitudinal Run-out ≤ 2.0

KVD VERTICAL MOVEMENT FROM 0 CM TO -80 CM SPECIFICATION (MM) ACTUAL RUN-OUT
Lateral Run-out ≤ 2.0

Longitudinal Run-out ≤ 2.0

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15.2 Vertical Accuracy
Specification
• The vertical accuracy shall be within ±2 mm of the displayed position.

The imaging layer is 12 mm below panel surface for MVD.

Depending on type of KVD panel installed, the imaging layer is 18 mm below panel surface (with
grid) for Paxscan V3 (PN# 10811) and 10mm for Paxscan V4 (PN# 1449977)
The X-Ray tube is 143 mm beyond the KV collimator surface.

Test Method
1. This test is performed in Service mode.
2. Rotate the gantry to head-up position. Remove the kV and MV detector cover and the KVS cover.
3. Position the MVD at 0.0/0.0/0.0 cm by using the Axis Position Screen in Service mode. Use the calibrated
mechanical front pointer to measure true position.
4. Verify result in the data table.
5. Position the MVD at -50.0/0.0/0.0 cm using the Axis Position screen. Position calibrated mechanical front
pointer to 100.0 cm. Use metric tape or ruler to measure true distance from the tip of mechanical front
pointer to MVD panel surface.
6. Verify result, remove front pointer and retract MVD arm.
7. Position the KVD at 0.0/0.0/0.0 cm using the Axis Position screen. Use crosshair projection and verify
vertical alignment with black line drawn on the side of the kV detector housing. The black line indicates the
top of the image detection layer. Use metric ruler to measure true position between crosshair projection
and black line.
8. Verify result in the data table.
9. Position the KVD at -50.0/0.0/0.0 cm using the Axis Position screen. Move couch top (vertical) towards
isocenter and couch longitudinal near +80.0 cm.
10. Use a metric ruler placed on couch top and measure true distance from machine crosshair projection to top
of KVD panel (including Grid).
11. Verify result in the data table and retract KVD arm.
12. Position the KVS at 100/0.0 cm (VRT / LNG) using the Axis Position screen.
13. Use a metric ruler placed on couch top and measure true distance from machine crosshair projection to
KVS collimator filter deck surface.
14. Verify result in the data table.

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Results

DATA TABLE: SECTION 15.2 – VERTICAL ACCURACY

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF THE KV OPTION IS NOT INCLUDED
DISPLAYED MVD POSITION SPECIFICATION √ = OK
0 / 0 / 0 cm 98.8 cm ± 0.2 cm

-50.0 / 0 / 0 cm 48.8 cm ± 0.2 cm

DISPLAYED KVD POSITION (PAXSCAN V3 PN# 10811) SPECIFICATION √ = OK
0 / 0 / 0 cm 0.0 cm ± 0.2 cm

-50.0 / 0 / 0 cm 48.2 cm ± 0.2 cm

DISPLAYED KVD POSITION (PAXSCAN V4 PN# 1449974) SPECIFICATION √ = OK
0 / 0 / 0 cm 0.0 cm ± 0.2 cm

-50.0 / 0 / 0 cm 49.0 cm ± 0.2 cm

DISPLAYED KVS POSITION (VRT / LNG SPECIFICATION √ = OK
100 / 0.0 cm 85.7 cm ± 0.2 cm

15.3 Lateral and Longitudinal Accuracy (MVD and KVD)

Specification
• The lateral and longitudinal axes positioning of the imager panel shall coincide with the displayed PRO to
within ± 1 mm tested at 50 below Isocenter.

Test Method
1. This test is performed in Service mode.
2. Remove the kV and MV detector cover.
3. With gantry at 0° IEC, position the MVD arm at -50.0/0.0/0.0 cm using the Axis Position screen.
4. Using white tape, mark the side wall laser line (for longitudinal) and sagittal laser line (for lateral) projected
on the panel.
5. Using Axis Position screen, move the MVD arm to -50.0 / +10.0 / +10.0 cm.
6. Using a ruler, measure the distance of travel between the tape reference marks and the laser lines.
7. Repeat the process for MVD arm position -50.0 / -10.0 / -10.0 cm.
8. Verify status in the data table.
9. Rotate gantry to 90° IEC.
10. Repeat the position accuracy test for KVD using the overhead laser lines as reference.

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Results

DATA TABLE: SECTION 15.3 - LATERAL AND LONGITUDINAL ACCURACY (MVD AND KVD)
NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF THE KV OPTION IS NOT INCLUDED.
DISPLAYED MVD POSITION SPECIFICATION TOLERANCE √ = OK
LAT 10.0 cm 10.0 cm ± 0.1 cm

LNG 10.0 cm 10.0 cm ± 0.1 cm

LAT -10.0 cm -10.0 cm ± 0.1 cm

LNG -10.0 cm -10.0 cm ± 0.1 cm

DISPLAYED KVD POSITION SPECIFICATION TOLERANCE √ = OK
LAT 10.0 cm 10.0 cm ± 0.1 cm

LNG 10.0 cm 10.0 cm ± 0.1 cm

LAT -10.0 cm -10.0 cm ± 0.1 cm

LNG -10.0 cm -10.0 cm ± 0.1 cm

15.4 Travel Range (MVD and KVD)

Specification
The following travel ranges shall be possible at MVD and KVD -50.0/0.0/0.0 cm. This allows PU Arms to make
full use of its travel range without reaching its mechanical limits.
• MVD Longitudinal: Travel range shall be -13.5 cm to +30.5 cm from isocenter for DMI panel.
• MVD Lateral: Travel range shall be -16.0 cm to +15.5 cm from isocenter.
• KVD Longitudinal: Travel range shall be -22.0 cm to +24.0 cm from isocenter.
• KVD Lateral: Travel range shall be -18.5 to +15.5 cm from isocenter.

Test Method

Travel range test is to verify travel distance achievable within the software limits. This test is
based on the PRO values on the screen only and no actual measurement is required

1. This test is performed in Service mode.

2. Position the MVD arm at -50.0/0.0/0.0 cm.
3. Slowly move the arm with the hand pendant longitudinally and laterally to both limits.
4. Record the PRO values display on the in-room monitor at travel limits for each axis.
5. Repeat for KVD arm.

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Results

DATA TABLE: SECTION 15.4 - TRAVEL RANGE (MVD AND KVD)

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES IF THE KV OPTION IS NOT INCLUDED.
MVD TRAVEL RANGE AT VRT -50 CM SPECIFICATION (CM) ACTUAL PRO (CM)
Min ≤ -13.5
Longitudinal (DMI panel)
Max ≥ +30.5

Min ≤ -16.0
Lateral
Max ≥ +15.5
KVD TRAVEL RANGE AT VRT -50 CM SPECIFICATION (CM) ACTUAL PRO (CM)
Min ≤ -22.0
Longitudinal
Max ≥ +24.0

Min ≤ -18.50
Lateral
Max ≥ +15.5

15.5 Dynamic Stability (Isocal)

The same procedure applies to system without the KV option. IsoCal can be run with MV imaging
only

Specification
• The dynamic motion shall be within 0.5 mm for MV and kV detectors at -50.0/0.0/0.0 cm. This is PASS /
FAIL test.

Test Method
1. This test is performed in Service mode within PVA Calibration tab.
2. Setup the IsoCal phantom and plate.
3. On the PVA Calibration screen, select Details tab.
4. In the Select Modality drop down menu, select Geometry.
5. Select Isocenter Verification and then click Calibration to run IsoCal verification.

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 Figure 43: Selecting Isocenter Calibration Verification

6. Record IsoCal verification status (PASS / FAIL) in the data table. See Figure 44.
• Green Bar represents a passed test.
• Red Bar represents a failed test.

Figure 44: IsoCal Results (Passed Shown for System with KV option)

Results

DATA TABLE: SECTION 15.5 – DYNAMIC STABILITY (ISOCAL)

ISOCAL TEST SPECIFICATION √ = OK
ISOCAL Verification Passed

CUSTOMER DEMO REQUIRED

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15.6 Couch Pitch and Roll Spatial Translational Positioning Accuracy

This section only applies to TrueBeam systems equipped with the Varian PerfectPitch couch. Skip
enter NA in all data tables in this section if not applicable.

Specification
• The positioning accuracy of relative angular pitch and roll move of ≤ 3.0º at isocenter shall be ≤ 0.7 mm.

Test Method
1. This test is performed in Service mode.
2. Verify that couch ISO box is checked for this test. (See Figure 45)

Figure 45: Couch ISO Checked in Service Mode

3. Move couch to position LNG 100 cm / VRT -2.5 cm / LAT 0 cm / ROT 0°, Pitch and Roll 0.0º.
4. Place the Isocenter Cube (PN: TM55150000) on the couch top and align to Isocenter using lasers or
crosshairs. Move the couch vertically if necessary. It is advisable to tape and secure the cube to prevent it
from sliding when couch top is tilted in later steps.

Figure 46: Isocenter Cube on Couch Top

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5. Select XI tab > Acquisition > kV. Acquire High Quality Single images using 50 kVp / 20 mA / 20 ms / Small
Focal Spot with gantry at 0º and 90º.

A = Zoom Function tool B = Grid C = Ball Detection tool

Figure 47: Function Tools on PVA Screen

6. On the PVA screen, turn on the Grid for both acquired images.
7. Using the Zoom function tool, magnify the images to see the ball and grid intersection.
8. Select the Ball Detection tool and then click on balls in the two acquired images. The Ball detection tool will
automatically detect the center of selected ball image and provides the offset values from the Grid lines.
See Figure 48.
• Offset from Grid = (Horizontal X coordinate, Vertical Y coordinate) cm

Figure 48: Ball Detection Tool in PVA Screen

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9. Using the offset values from previous step, enter the new target positions on the service screen (see Figure
49) and use remote motion to shift the couch to align the cube precisely to center of Grid.

Figure 49: Entering Target Couch Linear Shift Positions

10. Repeat the steps 5 to 9 until ball is aligned within ≤ 0.1mm from center of Grid.
11. Apply isocentric Pitch and Roll motions by entering +3.0º for Pitch and Roll axis in Service mode and press
“Go to” to execute the motion. This will not only move Pitch and Roll axis but also the compensated LNG /
LAT / VRT translations.

Figure 50: Entering Target Pitch and Roll Positions

12. Repeat steps 5 to 8. Verify ball remains within 0.7mm (0.07 cm) from Grid using Ball Detection tool. Record
result in the data table.

Results

DATA TABLE: SECTION 15.6 - COUCH PITCH AND ROLL SPATIAL TRANSLATIONAL POSITIONING
ACCURACY
NA SHALL BE ENTERED IN ALL DATA BOXES IF THE VARIAN PERFECTPITCH COUCH IS NOT INSTALLED

PITCH & ROLL DELTA MOVE SPECIFICATION TOLERANCE ACTUAL (MM)

3.0° ≤ 0.7 mm

CUSTOMER DEMO REQUIRED

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16 MV Imaging Acquisition
16.1 No Radiation Images
16.1.1 Dark Field Image
Specification
• For DMI: The mean pixel value shall be in the range of 400 to 800 pixels for a Full Resolution (1280 x
1280) Dark Field image.

Test Method
1. This test is performed in Service mode.
2. In XI tab > Acquisition > MV tab, select Image Mode > Highres-DF.
3. Press Acquire.

Figure 51: MV Highres-DF Image

4. Enable ROI and expand it to Full Image Size (1280 x1280 for DMI) and read the Mean value in the
Statistics.
5. Record results in the data table.

Results

DATA TABLE: SECTION 16.1.1 – DARK FIELD IMAGE

DARK FIELD IMAGE, FULL RES SPECIFICATION ACTUAL MEAN
Pixel Statistics, Mean Value (DMI) +400 ≤ Mean ≤ +800

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16.1.2 Noise Image
Specification
• The result of two DF images (acquired shortly after each other) subtracted shall be a homogeneous grey
image whereby the Standard Deviation (SDev) pixel value shall be < 10.

Test Method
1. This test is performed in Service mode.
2. In XI tab > Task > MV tab, select Test Imaging Chain, and press Start.
3. Images will be acquired automatically; scroll down to the Noise Image.
4. In the XI Service Viewer, enable ROI and set it to 512 x 512 size. Position the ROI such that it does not
contain any defect lines (Figure 52). Read the Deviation value in the Statistics. Read the Deviation value in
the Statistics section.

Figure 52: Setting ROI to 512 x 512 size

5. Record results in the data table.

Results

DATA TABLE: SECTION 16.1.2 - NOISE IMAGE

NOISE IMAGE SPECIFICATION ACTUAL SDEV
Standard Deviation < 10

16.2 Pixel Correction

Specification
• High Resolution maximum number of defective lines for DMI panel is ≤ 12
• High Resolution maximum number corrected pixels (total defects) is ≤ 20,000.
• Low Resolution maximum number corrected pixels (total defects) is ≤ 11,000.

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Test Method
1. In Service mode, select PVA Calibration tab.
2. On the PVA Calibration screen (right monitor), click on Details.
3. In the Select Modality drop down menu, select MV.
4. Right-click on the cell in the column Pixel Correction and a row High Quality and select Calibrate
Selected Steps.
5. Record the detected corrected pixels and number of detected defective line (whole vertical line).
6. Record results.
7. Right-click on the cell in the column Pixel Correction and a row Low Dose and select Calibrate Selected
Steps.
8. Record results.

Results

DATA TABLE: SECTION 16.2 - PIXEL CORRECTION

TOTAL CORRECTED PIXELS SPECIFICATION ACTUAL CORRECTED PIXELS COUNT
Highres = High Quality ≤ 20000

Lowres (512 x 384) = Low Dose ≤ 11000

Defective Lines (Highres) ≤ 12

16.3 Radiation Images

16.3.1 Contrast Resolution
Specification
Contrast detail resolution defines the imager’s ability to display objects with low contrast for a given energy and
dose. It is determined by taking images of the MV Las Vegas phantom with a high and low energy mode. The
different hole depths correspond to different object contrasts depending on the beam energy.

TABLE 18: CONTRAST DETAIL RESOLUTION SPECIFICATIONS

IMAGING MODE PHOTON ENERGY MINIMUM VISIBLE HOLES IN PV PHANTOM
Low X-Ray Imaging 2.5 MV A, B, C, D, E, F

Low X 4 - 8 MV A, B, C, D, E

10X or greater 10 - 25 MV A, B, C, D

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 Figure 53: Contrast Detail Specification Figure 54: Typical Phantom Image (Low-X)

Test Method
1. This test is performed in Service mode.
2. Place the couch top to isocenter (use aligned in-room lasers if possible) and place phantom tool on couch
top. Use machine crosshairs to center the phantom.

Make sure DMI panel is powered ON for at least 2 hours before final calibration is performed for
acceptance. Warm-up time is required for pixel leakage stabilization in the detector.

3. In XI tab > Acquisition > MV select Highres Single Imaging Mode for Low X. Move the arm to -
50.0/0.0/0.0 Recommended collimator value is a 13 x 13 cm² field with the phantom aligned at isocenter.

TrueBeam supports multiple photon configurations. For example, if machine is delivered with 4
MV, 6 MV, and 8 MV; LOW X should be considered the lowest X-Ray energy (e.g.: 4 MV).

4. Acquire the Highres image.

5. Analyze the image for the contrast specification and record all visible holes per energy according to
Contrast Specification.
6. Repeat test for Low X-ray Imaging and High X if applicable.
7. Record results in the data table.

TrueBeam supports multiple photon configurations. For example, if machine is delivered with
6MV, 10 MV, 15 MV and 18 MV; HIGH X should be considered the highest X-Ray energy (e.g. 18
MV).

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Results

DATA TABLE: SECTION 16.3.1 – CONTRAST RESOLUTION

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
PHOTON ENERGY SPECIFICATION √ = OK
Low X-Ray Imaging Holes Visible (A, B, C, D, E, F)

MV (Low-X) Holes Visible (A, B, C, D, E)

MV (High-X) Holes Visible (A, B, C, D)

CUSTOMER DEMO REQUIRED

16.3.2 Small Object Detection

Specification
• 0.5 mm diameter wire (lead, tungsten, or paperclip) placed diagonally at isocenter can be detected.

Test Method
1. This test is performed in Service mode.
2. In XI tab > Acquisition > MV and select Highres Single Imaging Mode for Low X.
3. Acquire an image with a 0.5 mm diameter wire (P/N TM61451000) placed diagonally at isocenter.

All machines come with a 0.5 mm diameter tungsten wire P/N TM61451000

4. Record results in the data table.

5. Repeat for Low X-Ray Imaging if applicable.

Results

DATA TABLE: SECTION 16.3.2 - SMALL OBJECT DETECTION

NA SHALL BE ENTERED IN APPLICABLE DATA BOXES FOR ANY ENERGIES THAT ARE NOT PURCHASED.
PHOTON ENERGY SPECIFICATION √ = OK
Low X-Ray Imaging
Wire Is Visible
MV (Low-X)

CUSTOMER DEMO REQUIRED

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16.4 Dosimetry Integration (Portal Dosimetry Option)

Enter NA in data table if the Portal Dosimetry option is not included

Specification
• Integration check will define the linearity of pixel counts relative to the dose. The image detector is placed
at 0/0/0 cm. The accumulated pixel value shall not deviate more than 2% relatively to the programmed
dose. This test will require a license to acquire integrated images.
Test Method

TABLE 19: SETUP FOR DOSIMETRY INTEGRATION TEST

Gantry Angle 0°

Collimator Angle 0°

Field Size (X, Y jaws) 10 x 10 cm

MVD Position 0/0/0

Energy Low-X

MU setting 50, 100 and 200

1. In Service mode, select XI tab > Acquisition > MV and highlight Dosimetry Continuous Mode.
2. Position the MVD to isocenter 0/0/0.
3. Open the jaws to a field size of 10 cm x 10 cm.
4. Select Low-X and set Dose to 50 MU.

Do not mouse click on Acquire button on XI tab as this will give incorrect results by causing the
panel to read out frames before MV Beam On.

5. Press Prepare, MV Ready and MV Beam On when ready to acquire the Integrated Image.

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 Figure 55: Mean Value of ROI within Open Field (200 MU test shown)

6. On PVA screen, Use the Window Level tool to optimize the 10 x 10 cm² image.
7. Use the ROI drop down menu and select 128 x 128 ROI. Place the ROI approximately in the center of the
10 x 10 cm² image. Use mouse to drag the edges of ROI until it is just within the 10 x 10 cm² image. (See
Figure 55).
8. Obtain pixel Mean value.
9. Record result in the data table.
10. Do not close or move the ROI on the active image window.
11. Repeat for 100 MU and 200 MU respectively.
12. Perform calculation in the data table.

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Results

DATA TABLE: SECTION 16.4 - DOSIMETRY INTEGRATION (PORTAL DOSIMETRY OPTION)

NA SHALL BE ENTERED DATA BOX IF PORTAL DOSIMETRY OPTION IS NOT INCLUDED
INTEGRATED VALUE IN %
DELIVERED MUS MEAN VALUE EXPECTED (TO BE CALCULATED ==>)
(100 / MEAN FOR 100 MU) * MEAN OF DOSE
50 50% (± 2%)

100 100% Reference (100%)

200 200% (± 2%)

CUSTOMER DEMO REQUIRED

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17 X-Ray Generator Verification

Enter NA in all data tables in this section if the kV option is not included.

17.1 kVp, mA, and ms Accuracy

Specification
• EMD generator for TrueBeam

TABLE 20: EMD GENERATOR ACCURACY SPECIFICATIONS

X-RAY FACTOR SPECIFICATION
kVp ± (5% + 2 kVp)

mA ± (5% + 0.5 mA)

Exposure Time ± (5%+0.2ms)

Test Method

TABLE 21: GENERATOR MEASUREMENTS SETUP

PARAMETER SETUP VALUE
Gantry 90°

KVS 100 / 0 cm
KVD -50 / 0 / 0 cm

Couch Top 10 cm above isocenter

kV Collimator /Blades Fully OPEN

Bowtie None

1. This test is performed in Service mode.

2. Set the system per Table 21 and following figures.
3. RaySafe Xi setup:

Refer to UG-GE-RaySafeX2 manual if the equipment received is a RaySafeX2. Follow the section
titled “TrueBeam Ethernet Connection” to perform the setup.

a. Make sure the base unit is charged.

b. Make sure the base unit and the service laptop do not have AC/DC adapters connected.

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 c. R/F detector must be oriented with the sensor facing the tube (white side facing up), and the detector
must be perpendicular to the tube axis (Figure 56).
d. Only the Xi Platinum Plus model can measure and display both kVp and mA at the same time.
e. Connect the mAs meter to the red and black mAs jacks on the front panel of the EMD generator as
shown in Figure 57.
f. Base Unit Setup:
• Press the left button to turn ON the unit.
• After the startup routine is completed, Sensor Menu should be displayed with R/F low flashing. Press
the right Select button once to make R/F high start flashing, and then press and hold the Select button
to select R/F high. The unit should now display mAs, mA and kVp.

Figure 56: System and Raysafe/Unfors Setup

1. W150 Serial Service cable (to service laptop)
2. Serial Crossover cable
3. Mini-USB cable (to R/F detector)
4. mA/mAs cable (to generator HT tank)
5. R/F Detector

Figure 57: mA/mAs Cable Connection at EMD Generator

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4. In XI tab > Acquisition > kV, beam on for each listed technique in Data Table Section 17.1.
5. Record the kVp, mA, and ms values in the data table.
6. Verify the recorded values are within the specifications.

Results

DATA TABLE: SECTION 17.1 – KVP, MA, AND MS ACCURACY (EMD GENERATOR)
NA SHALL BE ENTERED IN ALL DATA BOXES IF THE KV OPTION IS NOT INCLUDED.
SMALL FOCAL SPOT (SINGLE HIGH QUALITY KV)
TECHNIQUE SPECIFICATION ACTUALS
KVP MA MS KVP MA MS KVP MA MS
60 25 100 55 - 65 23.25 - 26.75 94.8 - 105.2

90 50 100 83.5 - 96.5 47.0 - 53.0 94.8 - 105.2

120 80 20 112 - 128 75.5 - 84.5 18.8 - 21.2

LARGE FOCAL SPOT (SINGLE HIGH QUALITY KV)
TECHNIQUE SPECIFICATION ACTUALS
KVP MA MS KVP MA MS KVP MA MS
60 25 100 55 - 65 23.25 - 26.75 94.8 - 105.2

90 200 20 83.5 - 96.5 189.5 - 210.5 18.8 - 21.2

90 200 150 83.5 - 96.5 189.5 - 210.5 142.3 - 157.7

120 100 20 112 - 128 94.5 - 104.5 18.8 - 21.2

120 200 100 112 - 128 189.5 - 210.5 94.8 - 105.2

17.2 Half Value Layer (HVL) with Digital Fluoroscopy (Canada and
USA only)
Specification
The Half Value Layer (HVL) is a function of tube potential and the total filtration for diagnostic X-Ray units are
published in CFR, volume 21, 1020.30, paragraph ‘M’, Table 1.
• For 100 kVp, the HVL is equivalent to a minimum of 2.7 mm of Aluminum.
• For 70 kVp, the HVL is equivalent to a minimum of 1.5 mm of Aluminum.

Test Method
1. HVL measurements are made with the kV setup used previously. The HVL reading in the example above is
the amount of aluminum required to cut the dose in half.
2. The unfiltered dose is read with UNFORS by acquiring a 70kV test image.
3. The filtered dose value is 50% of the unfiltered dose reading.

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4. Record the unfiltered dose value displayed on the UNFORS Xi program. The filtered dose value will be half
of unfiltered dose value.
5. Record the amount of aluminum displayed on the UNFORS Xi program required to reduce the dose by
half.
6. Repeat above steps for a 100kV test image..

Results

DATA TABLE: SECTION 17.2 – HALF VALUE LAYER (HVL) WITH DIGITAL FLUOROSCOPY (CANADA
AND USA ONLY)
NA SHALL BE ENTERED IN ALL DATA BOXES FOR ALL COUNTRIES EXCEPT USA AND CANADA.
NA SHALL BE ENTERED IN ALL DATA BOXES IF THE KV OPTION IS NOT INCLUDED

UNFILTERED MGY FILTERED MGY SPECIFICATION MM OF ALUMINUM

70 kVp > 1.5 mm

100 kVp > 2.7 mm

17.3 Air Kerma Test Verification

Specification
• The kV Air Kerma (in Gy absorbed dose) value must be within 35% tolerance between displayed clinically
(e.g., PVA) and measured UNFORS values.

TABLE 22: AIR KERMA SPECIFICATIONS

kV Tube GS-1542

kV Generator EMD or VMS 200

Tolerance (skin dose [uGy]) PVA Displayed AK vs UNFORS Measured AK ± 35%

Test Method

Refer to Appendix A create a KV imaging template for Air Kerma test.

1. This test is performed in Treatment mode with a DICOM RT test patient.

2. Verify the following machine setup.

TABLE 23: AIR KERMA SETUP

Gantry 90°

Couch Vertical -15 cm (IEC 61217), see Note below

KVS 100/0 cm

KVD -50/0/0 cm

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 KVS Blades Automatic

Bowtie None

kV Filter Titanium

KV Mode Dynamic Gain

UNFORs Mounting Bracket and Probe On couch top

The UNFORS mounting fixture is 30 cm in length, so if couch vertical is set 15.0 cm below
isocenter, the UNFORS probe will be positioned 15.0 cm above isocenter for the Air Kerma
measurement. Xi UNFORS measurement chamber should be oriented perpendicular to the X-Ray
tube (see UNFORS manual). UNFORS unit scaling is set to Gy for this test but the UNFORS Xi
View application will display results in µGy. The conversion must be done manually prior to
recording results. (e.g.: 100 µGy = 0.1 mGy)

3. Position the UNFORS test fixture on top of the couch. Use the lasers or crosshairs projection to align the
probe at approximately position 15/0/0 cm (see Figure 58). This position will simulate absorbed dose at
patient skin level.

Figure 58: Air Kerma Setup with Probe at Position 15/0/0 cm

4. Launch Treatment application and select Tools > File Mode.

5. Browse to D:\VMSOS\AppData\TDS\Input\Treatment\TrueBeam IPA\SVS CAP HET_Catphan\ folder and
select DICOM RT plan _RP.SVS CAP HET_Catphan.dcm.
6. Perform any machine overrides.

Click “OK” and close the pop- up window that indicates error in importing CT slices for reference
images. Reference images are not required for this test

7. Select field MV LT-MV LT and click Add > Add Imaging at bottom of screen.

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 Figure 59: Click Tab to Add Imaging Setup

8. On the Modify Imaging window (right side monitor), select as shown in following figure. Press OK to
continue.

Figure 60: Selecting Imaging Session Option

9. Under the KV Acquisition Parameters on the PVA screen, select Air Kerma Test for Anatomy and test 1
for Size (following figure). Verify the kV and mAs per technique in data table. Press OK when done.

Figure 61: PVA Screen to Set Up KV Acquisition Parameters (test 1 shown)

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10. On control console, press Prepare and then KV Beam On to acquire the Dynamic Gain image.
11. After image is acquired, record the Total KV Dose [mGy] value (Air Kerma) shown in PVA screen and
UNFORS measured value. Calculate deviation percentage per the formula:

PVA displays Air Kerma as the cumulative value between acquired kV images. It is recommended
to record absolute difference in displayed values between consecutively acquired images.
Alternatively, exit Treatment mode and then relaunch and reload the test patient between
consecutive images to reset the displayed dose

Displayed AK – Measured AK
Deviation (%) = X 100
Dispalyed AK
12. Press Preview on control console. Change the Size in the KV Acquisition Parameters until all techniques
listed in the data table are completed.

Results

DATA TABLE: SECTION 17.3 - AIR KERMA TEST VERIFICATION

NA SHALL BE ENTERED IN ALL DATA BOXES IF THE KV OPTION IS NOT INCLUDED.

RF MODE DISPLAYED KV DOSE MEASURED DOSE

DEVIATION
KVP MAS [MILLI-GRAY] [MILLI -GRAY]
UNFORS [%]
(DISPLAYED AK) (MEASURED AK)
60 10.0

RF High 90 10.0

120 6.3

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18 kV Imaging Acquisition

Enter NA in all data tables in this section if the kV option is not included

18.1 Radiation Images

18.1.1 High Contrast Resolution
Specification
• The imaging system shall resolve 1.25 (lp/mm) using Huttner or 1.30 (lp/mm) using Fluke (Nuclear
Associates) line pairs per millimeter in low resolution mode.

TABLE 24: KV IMAGING HIGH CONTRAST RESOLUTION

TOOL SPECIFICATION
Huttner 1.25 lp/mm

Fluke (Nuclear Associates) X-ray Test Pattern 1.30 lp/mm

Test Method
1. This test is performed in Service mode.
2. Position the gantry at 90° IEC.
3. Move KVS to 100/0 cm.
4. Move KVD to -50/0/0 cm.
5. Make sure that beam path is clear of any objects or filtration (e.g. Foil and Filter are out of beam) and the
kV blades should be fully open.
6. Place the high contrast resolution test tool Fluke (Nuclear Associates model # 07-523), or Huttner type 18
at a diagonal angle on the center of the kV panel cover.
7. In XI tab > Acquisition > kV, acquire a DynamicGainFluoro image with 50 kVp / 50 mA / 10 ms / Large
Focal Spot / ABC OFF technique.
8. Select zoom function from toolbar and draw an area around the test tool to magnify the test tool. Adjust the
window and level scroll bars for the sharpest display. It may be easier to distinguish the line pairs with the
room lights off.
9. Record results in the data table.

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Results

DATA TABLE: SECTION 18.1.1 – HIGH CONTRAST RESOLUTION

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
IMAGE MODE SPECIFICATION VISIBLE LINE PAIRS / MILLIMETER
Huttner: 1.25 lp/mm
DynamicGainFluoro
Nuclear Associates: 1.30 lp/mm

CUSTOMER DEMO REQUIRED

18.1.2 Gray Scale Linearity

Specification
• The imaging system shall display 11 uniform shades of gray (from black to white) using the Fluke (Nuclear
Associates 07-456).

Test Method
1. This test is performed in Service mode.
2. Position the gantry at 90° IEC.
3. Move KVS to 100/0 cm and KVD to -50/0/0 cm.
4. Make sure that beam path is clear of any objects or filtration (e.g. Foil and Filter are out of beam). Use PU
Services to collimate kV blades to a smaller field around the test tool as this will result in a better image.
5. Place a step wedge penetrometer test tool on the center of the kV panel cover.
6. In XI tab > Acquisition > kV, acquire a DynamicGainFluoro image with 75 kVp / 50 mA / 10 ms / Large
Focal Spot / ABC OFF technique.
7. Maintain kVp while fine-tuning the mA and ms technique to maximize the number of gray levels visible on
image. Use of window/level may be required.
8. Record results in the data table.

Results

DATA TABLE: SECTION 18.1.2 - GRAY SCALE LINEARITY

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
SPECIFICATION √ = OK
Visible Number of Gray Shades 11

CUSTOMER DEMO REQUIRED

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18.1.3 Low Contrast Sensitivity
Specification
• Using the Leeds test object type TOR [18 FG]. The imaging system shall resolve a minimum of 2.33%
sensitivity in fluoro mode.

Test Method
1. This test is performed in Service mode.
2. Position the gantry at 90° IEC.
3. Move KVS to 100/0 cm and KVD to -50/0/0 cm.
4. Tape a 1 mm copper filter on the source face (collimator faceplate). Verify that the collimation does not
exceed the edges of the copper filtration.
5. Make sure that the beam path is clear of any objects or filtration.
6. Use arrow indicator on the test tool and place the tool on the center of the kV panel cover.
7. Reset CCDS in Service mode, Positioning Unit > KVS Collimator > CCDS > Reset CCDS. Clear any active
collision on collimator Touch Guard before leaving treatment room.
8. In XI tab > Acquisition > kV, acquire a DynamicGainFluoro image with 75 kVp / 25 mA / 10 ms / Large
Focal Spot / ABC off technique.
9. Adjust the window/level until a small white circle is visible within the white square and the small black circle
is visible within the black square.

Turn off the console area lights and view the image. The image is best viewed at a distance
approximately four times the diameter of the displayed field

10. For the Leeds TOR[18FG] tool there are 18 low-density disks embedded in the phantom in a 9 disks arc at
the top of the image and a 9 disks arc at the bottom. Starting with the darkest disk (disk 1 at roughly 10
o’clock) count to the lowest density disc that can be resolved. Refer to Contrast Sensitivity Table to note
the disk number in the provided box.
11. Record results in the data table.
12. Remove the 1mm copper filter after the test is completed.
13. Reset CCDS in Service mode, Positioning Unit > KVS Collimator > CCDS > Reset CCDS. Clear any
active collision on collimator touch guard.

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 TABLE 25: CONTRAST SENSITIVITY TABLE WITH LEEDS TEST OBJECT TOR [18FG]
DISK NUMBER CONTRAST SENSITIVITY %
1 14.9

2 13.2

3 11.4

4 9.7

5 7.8

6 6.7

7 5.99

8 4.7

9 3.99

10 3.47

11 3.01

12 2.33

13 2.01

14 1.61

15 1.45

16 1.22

17 1.03

18 0.81

Result

DATA TABLE: SECTION 18.1.3 – LOW CONTRAST SENSITIVITY

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
SPECIFICATION ACTUAL
Number of Visible Leeds Disks ≥ 12

CUSTOMER DEMO REQUIRED

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19 KVS Collimator Verification

Enter NA in all data tables in this section if the kV option is not included.

19.1 KVS Blades Travel Range

Specification
• The collimator blades X1, X2, Y1, and Y2 shall have minimum travel range of -3 cm to +25 cm at isocenter.
Verify these positions by driving kV blades as displayed by PVA Calibration.

Test Method
1. This test is performed in Service mode within PVA Calibration tab.
2. Level the gantry at head up position.
3. In PVA Calibration, select Details tab and then select Modality > KV
4. Select Test Image on the High Quality mode.
5. Change the Tracking mode to manual.
6. Change the blades position: Y1 = -25 cm; Y2 = -3 cm; X1 = -25 cm; X2 = -3 cm.
7. Press OK to move blades; no beam on is necessary.
8. Verify blades move to positions.
9. Record status in the data table.
10. Repeat test with blades at: Y1 = 3 cm; Y2 = 25 cm; X1 = 3 cm; X2 = 25 cm.

Results

DATA TABLE: SECTION 19.1 – KVS BLADES TRAVEL RANGE

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.

SPECIFICATION TOLERANCE (IEC 61217 SCALE)

√ = OK
MIN MAX

X1 ≥ 3.0 cm ≤ -25.0 cm

X2 ≤ - 3.0 cm ≥ 25.0 cm

Y1 ≥ 3.0 cm ≤ - 25.0 cm

Y2 ≤ - 3.0 cm ≥ 25.0 cm

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19.2 KVS Filter Foil
Specification
• There are two foil positions (Titanium and Open) port for KVS collimator. Verify these positions are
mechanically centered as displayed by PVA.

Test Method
1. This test is performed in Service mode within PVA Calibration tab.
2. In PVA Calibration, select Details tab and then select Modality > KV.
3. Select Test Image on the High Quality mode.
4. Change the Tracking mode to manual.
5. From kV Filters drop down menu, select Titanium.
6. Press OK; no beam on is necessary.
7. Verify that the position readout for the kV filter now displays Titanium.
8. Visually inspect the kV Filter position on the KVS collimator. The Titanium filter should be centered on the
X-Ray tube exit window. The white line on the collimator face plate indicates the center of the X-Ray tube
exit window.
9. Record results in the data table.
10. From kV Filters drop down menu, select None.
11. Press OK; no beam on is necessary.
12. Visually inspect the kV Filter position on the KVS collimator. No filter should be centered on the X-Ray tube
exit window.
13. Record status in the data table.

Results

DATA TABLE: SECTION 19.2 – KVS FILTER FOIL

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
FILTER FOIL POSITION SPECIFICATION √ = OK

Titanium Foil Inside Beam Path

None Foil Outside Beam Path

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19.3 kV Filter Shape
Specification
• There are two Filter Shape positions (HALF and FULL) BOWTIE for KVS collimator. Verify these positions
are mechanically centered as displayed by the PVA application.

Test Method
1. This test is performed in Service mode within PVA Calibration tab.
2. In PVA Calibration, select Details tab and then select Modality > KV
3. Select Test Image on the High Quality mode.
4. Change the Tracking mode to manual.
5. From Bowtie drop down menu, select Full Fan.
6. Press OK; no beam on is necessary.
7. Verify the position readout for the Bowtie now displays Full Fan.
8. Visually inspect the Bowtie position on the KVS collimator. The filter should be centered on the X-Ray tube
exit window. The white line on the collimator face plate indicates the center of the X-Ray tube exit window.
The hole in the assembly should be aligned to the white line.
9. Record results in the data table.
10. From Bowtie drop down menu, select Half Fan.
11. Press OK; no beam on is necessary.
12. Visually inspect the Bowtie position on the KVS collimator. The filter should be centered on the X-Ray tube
exit window. The white line on the collimator face plate indicates the center of the X-Ray tube exit window.
The hole in the assembly should be aligned to the white line.
13. Record results in the data table.
14. From Bowtie drop down menu, select None.
15. Press OK; no beam on is necessary.
16. Visually inspect the Bowtie position on the KVS collimator. No filter should be centered on the X-Ray tube
exit window.
17. Record status in the data table.

Results

DATA TABLE: SECTION 19.3 – KV FILTER SHAPE

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
BOWTIE FILTER SPECIFICATION √ = OK
POSITION
Full Fan Centered

Half Fan Centered

None X-Ray Beam Path Unobstructed

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20 CBCT Image Acquisition

Enter NA in all data tables in this section if the kV option is not included.

20.1 Density Resolution (HU Calibration)

Specification
• This procedure verifies the accuracy of the HU calibration (± 50 HU) using the PVA Calibration tool to
calculate the HU values of the Catphan phantom. See Catphan manual for module and density target
orientation.

Test Method
1. This test is performed in Service mode within PVA Calibration tab.
2. Place the Catphan Phantom onto the couch and align it to the wall lasers.
3. In PVA Calibration, select Details tab and then select Modality > CBCT.
4. Acquire a Test Scan on the Head mode.
5. Select and expand the Transversal view. Use Window level tool to adjust the image.
6. Referring to Figure 62, select Histogram tab (labeled A) on the tool bar and then move the mouse curser
to click on Air substance (labeled B) on the image. Right mouse clicked within the Histogram window and
then select “Show Statistics” (labeled C).

Figure 62: Selecting Statistics for Substance

7. Using mouse, right-click on the ROI and select 7 x 7 mm. Use mouse to drag and placed ROI within the
homogenous substance of the Catphan Phantom specify in the data table (see Figure 64)

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 Figure 63: Placing ROI within Substance for Mean Value

8. Determine the HU mean value.

9. Record results. Enter NA if not applicable.
10. Repeat the above steps for the CBCT mode Pelvis using same ROI size.

Figure 64: Catphan Phantom

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Results

DATA TABLE: SECTION 20.1 – DENSITY RESOLUTION (HU CALIBRATION)

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
CBCT MODE HEAD MATERIAL SPECIFICATION ACTUAL
Air - 1000 ± 50

Acrylic 120 ± 50

LDPE - 100 ± 50
CBCT MODE PELVIS MATERIAL SPECIFICATION ACTUAL
Air - 1000 ± 50

Acrylic 120 ± 50

LDPE - 100 ± 50

CUSTOMER DEMO REQUIRED

20.2 Spatial Linearity Measurements (Distance)

Specification
• This procedure verifies the distance measurement using the distance measuring tool to measure the
distance between four holes (three Air and one Teflon) spaced 50 mm apart on the Catphan phantom.

Test Method
1. Using the same Head scan from previous section, verify the distance by measuring the distances between
the verification holes located on Catphan phantom using the Measure tool on the tool bar.
2. Record results.
3. Repeat the above steps for CBCT mode Pelvis.

Results

DATA TABLE: SECTION 20.2 – SPATIAL LINEARITY MEASUREMENTS (DISTANCE)

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
CBCT MODE SPECIFICATION ACTUAL
Head 50 mm ± 0.5 mm

Pelvis 50 mm ± 0.5 mm

CUSTOMER DEMO REQUIRED

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20.3 Image Uniformity Measurements
Specification
• This procedure determines the Image Uniformity of the scanned image. This must conform to a value
measured at the Image Uniformity Module of the Catphan phantom. See Data Table: Section 20.3 Image
Uniformity Measurements for specifications.

Test Method
1. Using the same Head scan from previous section, select the correct image slice that displays the Image
Uniformity module by using the Page Up / Page Down keys. See Catphan manual for module orientation.
2. Use the toolbar and select the Histogram tab, and then show Statistics. With the mouse curser placed at
the corner circle of ROI, right-click and select the defaults 20 x 20 mm size.
3. Measure the Mean value of each homogenous substance of the Catphan Phantom by placing the ROI on
each of the outlined regions as in Figure 65.
4. Record the values in the data table.

Figure 65: ROI Placement for Uniformity Measurements

5. Verify the difference between mean HU Value Center ROI #5 (reference value) and mean HU values for
each of the peripheral ROIs (#1 Left; #2 Top ; #3 Right & #4 Bottom)
6. Repeat the above steps for CBCT mode Pelvis.

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Results

DATA TABLE: SECTION 20.3 – IMAGE UNIFORMITY MEASUREMENTS

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
STANDARD-DOSE HU VALUE CENTER CALCULATION
HU VALUE SPECIFICATION
HEAD SCAN (#5) HU DIFFERENCE

A B C=A-B

Left (#1)

Top (#2)
± 30 HU
Right (#3)

Bottom (#4)
STANDARD-DOSE HU VALUE HU VALUE CENTER CALCULATION
PELVIS SCAN (#5) HU DIFFERENCE SPECIFICATION
A B C=A-B

Left (#1)

Top (#2)
± 30 HU
Right (#3)

Bottom (#4)

CUSTOMER DEMO REQUIRED

20.4 High Contrast Resolution

Specification
• This procedure verifies the Spatial Resolution of the scanned image using the High Resolution Module in
the Catphan Phantom. Default CBCT slice thickness shall be 2 mm.

Test Method
1. Using the same Head scan from previous section, select the correct image slice that displays the High
Resolution module by using the Page Up/ Page Down keys. See Catphan manual for module orientation.
Switch off the control room lights, if required.
2. Using the Window/Level and zoom function, verify the line pair / cm.
3. Record results.
4. Repeat the above steps for CBCT mode Pelvis.

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 TABLE 26: CONTRAST SENSITIVITY TABLE WITH LEEDS TEST OBJECT TOR [18FG]
LINE PAIR/CM GAP SIZE LINE PAIR/CM GAP SIZE
1 0.500 cm 12 0.042 cm

2 0.250 cm 13 0.038 cm

3 0.167 cm 14 0.036 cm

4 0.125 cm 15 0.033 cm

5 0.100 cm 16 0.031 cm

6 0.083 cm 17 0.029 cm

7 0.071 cm 18 0.028 cm

8 0.063 cm 19 0.026 cm

9 0.056 cm 20 0.025 cm

10 0.050 cm 21 0.024 cm

11 0.045 cm

Results

DATA TABLE: SECTION 20.4 – HIGH CONTRAST RESOLUTION

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
CBCT MODE SPECIFICATION ACTUAL
Head Scan [2.0 mm default slice] ≥ 6 line pair/cm

Pelvis Scan [2.0 mm default slice] ≥ 4 line pair/cm

CUSTOMER DEMO REQUIRED

20.5 Low Contrast Resolution

This test section applicable to Pelvis scan only

Specification
• This procedure verifies Low Contrast Resolution of scanned image using the Low Contrast Sensitivity
Module in the Catphan Phantom. See data table for specifications.

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Test Method
1. Using the same Pelvis scan from previous section, select the correct image slice that displays the Low
Contrast Sensitivity module by using the Page Up / Page Down keys. See Catphan manual for module
orientation. Switch off the control room lights as required.
2. Using the Window/Level and zoom functions, verify the Low Contrast Targets.
3. Record results.

TABLE 27: SUPRA-SLICE 1% TARGET DIAMETERS

2.0 mm

3.0 mm

4.0 mm

5.0 mm

6.0 mm

7.0 mm

8.0 mm

9.0 mm

15.0 mm

Results

DATA TABLE: SECTION 20.5 – LOW CONTRAST RESOLUTION

NA SHALL BE ENTERED IN DATA BOX IF THE KV OPTION IS NOT INCLUDED.
CBCT MODE PELVIS SPECIFICATION ACTUAL
Supra - Slice 1% Target Size: 15 mm

CUSTOMER DEMO REQUIRED

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21 Respiratory Gated MV Beam and VCD
Skip this section entirely and enter NA in the data tables if Respiratory Gating system is not
purchased.
This verification procedure is applicable to system utilizing NDI or Single type of gating camera.
Single gating camera is optional only for system with software v2.7.x and later.

21.1 Verification of Respiratory Gated MV Beam without VCD

This section applies to systems WITHOUT the Visual Coaching Device (VCD) option. Skip to
next sub-section and enter NA in the data table if VCD is installed in the system

Requirement
• System shall track gating Marker Block B501928, hold-off MV Beam according to simulated breathing
cycle, and save a copy of the treatment record.

Test Method
1. This test is performed in Treatment mode with a DICOM RT test patient.
2. If machine is installed with PerfectPitch couch top, verify the Pitch and Roll are leveled showing 0.0° on
PRO screen.
3. Setup the gating phantom (Powered ON) on the couch top (near isocenter).
4. Launch Treatment application.
5. Using file mode, open test patient TrueBeam_SVS_GATING_rev_x in folder:
• D:/VMSOS\AppData\TDS\Input\Treatment\TrueBeam IPA\

Figure 66: Opening Gating DICOM RT File

6. Click Apply in the pop-up Motion Management Devices window to accept preferences for current session
only. (see Figure 67)

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 Figure 67: Motion Management Device Screen

7. Perform any Machine Overrides.

8. On the right monitor, select Amplitude Gating shown in following figure. Click Next.

Figure 68: Amplitude Gating Selected

9. Set the Gating Setup as shown in following figure and click Next.

Figure 69: Gating Setup Screen

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10. The Gating system will start to detect and learn the breathing pattern. Once the learning pattern is
achieved, the breathing curve will be shown as in following figure.

Figure 70: Acquire Breathing Pattern

11. Select START as shown in Figure 70 to acquire Reference Curve. After approximately 10 seconds, click
Stop to stop acquisition.
12. The acquired reference curve shall be shown as in following figure. Drag the blue and orange gating
threshold lines on the reference curve to set a desire gated period. Select OK to continue.

Figure 71: Changing Threshold on Reference Curve

13. Depending upon position, acquire new couch position as shown in following figure and then click Apply to
continue. Do not reposition Gating phantom outside camera detection zone by moving the couch. Click OK
to the expected PVA error message that indicates changes to the couch positions in the selected field.

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 Figure 72: Acquiring Couch Positions

14. Go into treatment room and verify audio coaching can be heard from the in-room speakers.
15. Exit treatment room. Beam on when ready.
16. Verify beam hold is functioning according to beam set thresholds.
17. When the field is completed, sign off and save the patient with a unique filename before closing.
18. Using Windows explorer, browse to D:\VMSOS\AppData\TDS\Output\Treatment\Record folder. Verify a
copy of the treatment history of the Gating patient is saved onto a local directory.

Results

DATA TABLE: SECTION 21.1 – VERIFICATION OF RESPIRATORY GATED MV BEAM WITHOUT VCD
NA SHALL BE ENTERED IN ALL DATA BOXES IF RESPIRATORY GATING SYSTEM OPTION IS NOT INCLUDED.
NA SHALL BE ENTERED IN ALL DATA BOXES IF VIDEO COACHING DEVICE (VCD) OPTION IS INCLUDED
PASS/FAIL CRITERIA √ = OK
Audio coaching can be heard in the treatment room.

Gated beam treatment field successfully completed.

Saved copy of treatment record onto a local directory.

CUSTOMER DEMO REQUIRED

21.2 Verification of Respiratory Gated MV Beam with VCD

This section applies to systems WITH the Visual Coaching Device (VCD) option. Enter NA in
data table for systems without VCD as it is covered in the previous sub-section.

Requirement
• System shall track gating Marker Block B501928, hold-off MV Beam according to simulated breathing
cycle, and save a copy of the treatment record.
• The VCD couch mount can be attached to the couch top and the VCD shows the course of the tracked
breathing pattern.

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Test Method
1. This test is performed in Treatment Mode with a DICOM RT test patient.
2. If machine is installed with Perfect Pitch couch top, verify the Pitch and Roll are leveled showing 0.0° on
PRO screen.
3. Setup the gating phantom (Powered ON) on the couch top (near isocenter).
4. Attach the couch mount with the VCD to the couch top.
5. Turn the VCD on and wait until it is started up.
6. Launch Treatment application.
7. Using file mode, open test patient TrueBeam_SVS_GATING_rev_x in folder:
• D:/VMSOS\AppData\TDS\Input\Treatment\TrueBeam IPA\

Figure 73: Opening Gating DICOMRT File

8. Click Apply in the pop-up Motion Management Devices window to accept preferences for current session
only.

Figure 74: Motion Management Device Screen

9. Perform Machine Overrides.

10. On the right monitor, select Amplitude Gating. Click Next.

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 Figure 75: Amplitude Gating Selected

11. Select the check box for Visual Coaching Instruction

12. Select Slider from the Visual Prompt Style drop down box menu.
13. Set the rest of the gating setup screen as shown in following figure and click Next.

Figure 76: Gating Setup Screen

14. The gating system will start to detect and learn the breathing pattern. Once the learning pattern is
achieved, the breathing curve will be shown as in Figure 77.
15. Press the Coaching icon at the bottom right of screen (Figure 77 ) to enable visual coaching.
16. Verify the sliding bar is visible in the Coaching area as shown on the bottom left (Figure 77).
17. Verify the sliding bar is moving up when the breathing trace is moving up and the sliding bar is moving
down when the breathing trace is moving down.

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 Figure 77: Verify Breathing Curve and Visual Coaching in PVA

18. Inside the Treatment room, verify on the VCD that the sliding bar is visible and the bar is moving up when
the marker block moves up and the bar is moving down when the marker block is moving down.
19. Click START as shown in Figure 77 to acquire reference curve. After approximately 10 seconds, click
Stop to stop acquisition.
20. The acquired reference curve shall be shown as in following figure. Drag the blue and orange gating
threshold lines on the reference curve to set a desire gated period. Select OK to continue.

Figure 78: Changing Threshold on Reference Curve

21. Depending upon position, acquire new couch position and then click Apply to continue. Do not reposition
Gating phantom outside camera detection zone by moving the couch. Click OK to the expected PVA error
message that indicates changes to the couch positions in the selected field.

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 Figure 79: Acquiring Couch Positions

22. Go into treatment room and verify audio coaching can be heard from the in-room speakers.
23. Exit treatment room. Beam on when ready.
24. Verify beam hold is functioning according to beam set thresholds.
25. When the field is completed, sign off and save the patient with a unique filename before closing.
26. Using Windows explorer, browse to D:\VMSOS\AppData\TDS\Output\Treatment\Record folder. Verify a
copy of the treatment history of the Gating patient is saved onto a local directory.
27. Record results in data table.

Results

DATA TABLE: SECTION 21.2 - VERIFICATION OF RESPIRATORY GATED MV BEAM WITH VCD
NA SHALL BE ENTERED IN ALL DATA BOXES IF RESPIRATORY GATING SYSTEM OPTION IS NOT INCLUDED.
NA SHALL BE ENTERED IN ALL DATA BOXES IF VIDEO COACHING DEVICE (VCD) OPTION IS NOT INCLUDED.
PASS/FAIL CRITERIA √ = OK
VCD couch mount can be attached to the TrueBeam couch top.

VCD shows the course of the tracked marker block

Audio coaching can be heard in the treatment room.

Gated beam treatment field successfully completed.

Saved copy of treatment record onto a local directory.

CUSTOMER DEMO REQUIRED

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22 Additional Purchasable Products
22.1 EXIO and MMI Functionality Verification
This section is to verify that EXIO hardware and interfaces are working properly during installation. This section
shall be performed even if MMI option is not purchased but EXIO hardware installed. If EXIO hardware is not
available for the system, then enter NA in the data tables for this section.

22.1.1 EXIO Loopback Testing

Requirement
• Confirm the operation of the EXIO Subcomponent’s RS422 and Digital I/O channels without having any
signals leave the PCB.

Test Method

No testing hardware is required to perform this test

1. Log in to Service mode as Hasp user

2. Select tab: External Interface > EXIO > Loopback Diagnostics > Internal
3. Test the Digital Channels:
a. Select Channel 1.
b. Click one of the buttons in the DO (digital output) column Bn
c. The corresponding LED in the DI (digital input) column will toggle state.
d. All eight digital channels shall be tested in this manner
4. Repeat step 3 for remaining channel 2 to 6.
5. Test the serial channel:
a. In the Serial Data Communications pull down menu, click one of the data selections.
b. Click Send to transfer the data and verify serial data is displayed in the text box
6. Record tests status in the data table.
7. Before exiting the EXIO > Loopback diagnostics screen, select loopback mode: None

Results

DATA TABLE: SECTION 22.1.1 – EXIO LOOPBACK TESTING

NA SHALL BE ENTERED IN ALL DATA BOXES IF EXIO HARDWARE IS NOT INCLUDED.
TEST CRITERIA √ = OK
All Internal EXIO tests passed.

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22.1.2 MMI – EXGI Simulator Test

This testing can only be performed by Varian CSR by referencing to instructions in SIM-HT

This procedure tests the EXIO sub-controller connections 1 - 4 using loopback cable PN 100058451-01.
There are six connections at the rear of the EXIO sub-controller. Connections 1 through 4 connect to external
gating devices. Connections 5 and 6 are utilized by Varian personnel for testing purpose only and shall not be
tested here.
Requirement
• Must be able to Assert and Release CDOS from the EXGI Simulator.
• Must be able to Gate Beam (Assert and Release) from the EXGI Simulator.

Test Method
1. Adding MMI devices:
a. Add four devices (0-3) in System Administration. For instructions on how to add these devices refer to
SIM-HT-20, section: Adding a MMI Device to TrueBeam 2.0.
b. See Figure 80 for an example of the added devices in System Administration. These devices will be for
EXGI simulator testing in this section

Figure 80: Example of Configuring MMI Devices for Testing

2. Setup the EXGI simulator and loopback cable per the SIM-HT-20, section: EXGI Simulator Testing.
3. See either Table 28 or Table 29 (single console cabinet) for the loopback cable and simulator
configurations specific to this test.
TABLE 28: LOOPBACK CABLE / SIMULATOR CONFIGURATION
GATING DEVICE EXIO_IN SIMULATOR CHANNELS EXIO_OUT EXGI SIMULATOR CHANNEL
EXIO channel 1 PP-J23 Channel 1

EXIO channel 2 PP-J26 Channel 2

EXIO channel 5 PP-J32
EXIO channel 3 PP-J29 Channel 3
EXIO channel 4 PP-J31 Channel 4

EXIO channel 1 PP-J2 EXIO channel 6 PP-J33 Channel 1

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 TABLE 29: LOOPBACK CABLE / SIMULATOR CONFIGURATION (SINGLE CONSOLE CABINET)
GATING DEVICE EXIO_IN SIMULATOR CHANNELS EXIO_OUT EXGI SIMULATOR CHANNEL
EXIO channel 1 PP-J161 Channel 1

EXIO channel 2 PP-J162 Channel 2

EXIO channel 5 PP-J165
EXIO channel 3 PP-J163 Channel 3

EXIO channel 4 PP-J164 Channel 4

EXIO channel 1 PP-J161 EXIO channel 6 PP-J166 Channel 1

4. With the EXGI Simulator, Click Assert and Release CDOS for each Gating Device channel. Figure 81 is
an example of a successful assertion of CDOS test

Figure 81: Successful CDOS Exertion Test

5. With the EXGI Simulator, click Assert and Release Gate Beam for each Gating Device channel. See
Figure 82 for an example of a successful Gate Beam assertion test.
6. Record tests status in the data table.

Figure 82: Successful of Gate Beam Assertion Test

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Results

DATA TABLE: SECTION 22.1.2 – MMI – EXGI SIMULATOR TEST

NA SHALL BE ENTERED IN ALL DATA BOXES IF EXIO HARDWARE IS NOT INCLUDED.
TEST CRITERIA √ = OK
CDOS test successful for all tested channels.

Gate Beam test successful for all tested channels

22.2 Varian Verification System (VVS) Installation

Enter NA in the data table if the VVS option is not purchased

Requirement
• VVS installation and IPA completed when included in sales order.

Test Method
1. Verify that VVS is installed and IPA-AC-HTVVS completed.
2. Enter NA if not purchased or is not installed at this time.

Results

DATA TABLE: SECTION 22.2 - VARIAN VERIFICATION SYSTEM (VVS) INSTALLATION

NA SHALL BE ENTERED IN ALL DATA BOXES IF VVS OPTION IS NOT INCLUDED.
TEST CRITERIA √ = OK
VVS installation and IPA-AC-HTVVS completed.

CUSTOMER DEMO REQUIRED

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23 Miscellaneous Items
23.1 Laser Configuration Form
Requirement
• Federal law requires Varian Medical Systems to fill out and maintain record for system lasers.

DATA TABLE: SECTION 23.1 – LASER CONFIGURATION FORM

Site Name

Address

City

State/Zip Country

PCSN Installation Date

Ceiling Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Sagittal Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Right Lateral Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Left Lateral Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Backpointer Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Backpointer Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

Barcode Scanner Laser Serial Number

Laser PN – DN

Laser Manufacturer: LAP Gammex Diacor Other

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23.2 FDA Form 2579 Submission (USA Only)
Requirement
• FDA Form 2579 is completed fully and submitted for USA only.

Test Method
1. Complete and submit FDA Form 2579 for USA sites.
2. Enter NA if not applicable.

Results

DATA TABLE: SECTION 23.2 – FDA FORM 2579 SUBMISSION (USA ONLY)
NA SHALL BE ENTERED IN ALL DATA BOXES FOR ALL COUNTRIES EXCEPT USA
FDA FORM SUBMISSION SPECIFICATION √ = OK

Pass/Fail Criteria FDA Form 2579 Submitted

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24 Customer Documentation Access
24.1 Instruct Customer to Access Customer Technical Bulletins
(CTBs)

This section is for instruction only. No actual website demonstration is required. Customers can
access the website at their leisure.

The customer shall be informed of how to locate and download CTBs for this Varian product.
3. Explain to the customer how to access the MyVarian website (http://my.varian.com) and how to create a
personal login account by clicking on the link Create new account.
4. Explain that after logging in to the MyVarian website, click on the link Product Information in the Product
Support section. Select the desired product and click on the link CTBs to display all the related customer
technical bulletins for this product.
5. Explain to the customer that it is their responsibility to remain up-to-date with the latest available CTBs for
their purchased products.

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25 Customer Basic Operational Training
This section contains basic TrueBeam operational information to allow the customer to start beam
commissioning work prior to Applications training. It is customer’s option to skip this section if
already familiar with the machine operation. No signature is required.
Complete training conducted by Varian Applications Specialist at a scheduled date coordinated
between the customer and Applications department

TABLE 30: CUSTOMER BASIC OPERATIONAL TRAINING

MODULATOR
Identify the START button (either set at main electrical panel or the modulator)

Explain the presence of HV in the modulator and the Crowbar noise when opening the door.

Explain the doors must be closed to clear the MOD interlock.

STAND
SF6 gas system nominal pressure (32 psig). Demonstrate how to refill.

Explain the water level check and how to refill water (distilled only).
COUCH
Explain proper pendant storage position (Routine Interlock and holder light indicator).

Demonstrate room control and axes motion (including the arms) using pendant or side panel
COLLIMATOR AND ACCESSORIES
Explain crosshair cannot be cleaned with water or cloth.

Explain Interface Mount LEDs and latches.

Demonstrate Accessory Mount install and removal and tray latch.

Demonstrate Electron applicators and collision protection (touch guard).

Explain that Electron applicators cannot be stored with weight on the touch guards.
CONSOLE
Explain the control console operations.

Explain the major mode options and standard login (customer credential).
SAFETY CIRCUIT, POWER DOWN AND POWER UP
Identify the location of all the machine EMO switches (control console, modulator, Stand, and couch) and the
customer EMO switches.

Identify the location of Emergency Disconnect Switch (normally located on the main breaker panel). Explain
the difference of Emergency Disconnect Switch and normal EMO switches.

Put system to Standby state and turn off all console computers. Demonstrate machine power off by pressing
the Emergency Disconnect Switch.

Demonstrate resetting of Emergency Disconnect Switch and system power up sequence.

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 Demonstrate all axes initialization using the “Axes Initialization” option in Major Mode.

Login to Treatment mode and load a test patient. Demonstrate emergency off by pressing one of the EMO
switches. Reset EMO switch and restart machine. Explain that Axes Initialization is required if EMO switch
is pressed in any mode other than Treatment. No demonstration is required.

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APPENDIX A TEMPLATE FOR AIR KERMA TEST
1. Login to Service Mode as Advanced user.
2. In Service mode, select the PVA Calibration tab.
3. On the right side PVA Calibration screen, click on the Administration tab and then select to show the KV
Templates. Referring to following figure:
• Create a new template by clicking New Anatomy (A). Use mouse to click and highlight on the new
anatomy. Rename the new anatomy to Air Kerma Test (C).
• Select the Air Kerma Test and create 3 new sizes by clicking New Size (B) each time. Rename the new
size to test 1, test 2 and test 3 (C)
• Highlighting on each size, edit the template settings per following figures for test 1, test 2 and test 3
respectively. The difference between each test sizes are the kV and mAs settings only.

Figure 83: Creating New Air Kerma Template (test 1 shown)

Figure 84: Test 2 Settings

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 Figure 85: Test 3 Settings

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APPENDIX B COLLIMATION DEVICES CHECK
CDC calculates the positions of the collimation devices utilizing the algorithm of locating the edges in MV
acquisitions. The position of the edge is calculated as the inflection point on acquisitions corrected for DF and
FF.
The CDC automatic sequence of checks using MV image acquisitions is in following order:
a. MLC positioning accuracy and repeatability checks.
b. X and Y jaws positioning accuracy and parallelism checks.
c. Determining the center of collimator rotation with MLC Comb pattern acquired at 5 collimator rotation
angles. The center of collimator rotation is the origin of the reference coordinate system.

B.1 MLC Positional Accuracy and Repeatability

The CDC uses three different MLC pattern fields. The largest possible range shall be covered by the patterns.
Movement of carriages shall be included. Patterns are driven by more than 10 cm over the centerline for each
side. In total, three nominal positions are measured. For each nominal position, two separate iteration of
accuracy measurements are performed. In between iterations, leaves are moved away and then approaching
nominal position again. The absolute position difference between 2 iterations of a nominal position check is
reported as the reproducibility.
1. The 3 MLC nominal positions are shown in following images.

2. The following table shows the nominal leaf centerline for each position in IEC1217 scale convention. Bank
A and bank B leaf positions are 2cm respectively from the centerline. For examples:
• Leaf #1 and Pos 1 where the centerline position is -0.7cm, leaf A1 shall be at position 1.3cm and B1 at
position -2.7cm respectively.
• Leaf #1 and Pos 18 where the centerline position is 0.3cm, leaf A1 shall be at position 2.3cm and B1 at
position -1.7cm respectively.

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 LEAF # POS 1 (CM) POS 2 (CM) POS 3 (CM) LEAF # POS 1 (CM) POS 2 (CM) POS 3 (CM)
1 -0.7 14.8 -13.2 31 -0.3 15.2 -15.2

2 -0.7 14.8 -13.4 32 -0.3 15.2 -15.4

3 -0.7 15.0 -13.4 33 -0.3 15.0 -15.4

4 -0.5 15.0 -13.4 34 -0.5 15.0 -15.4

5 -0.5 15.0 -13.6 35 -0.5 15.0 -15.6

6 -0.5 15.2 -13.6 36 -0.5 14.8 -15.6

7 -0.3 15.2 -13.6 37 -0.7 14.8 -15.6

8 -0.3 15.2 -13.8 38 -0.7 14.8 -15.8

9 -0.3 15.4 -13.8 39 -0.7 14.6 -15.8

10 -0.1 15.4 -13.8 40 -0.5 14.6 -15.8

11 -0.1 15.4 -14.0 41 -0.5 14.6 -16.0

12 -0.1 15.6 -14.0 42 -0.5 14.4 -16.0

13 0.1 15.6 -14.0 43 -0.3 14.4 -16.0

14 0.1 15.6 -14.2 44 -0.3 14.4 -15.8

15 0.1 15.8 -14.2 45 -0.3 14.2 -15.8

16 0.3 15.8 -14.2 46 -0.1 14.2 -15.8

17 0.3 15.8 -14.4 47 -0.1 14.2 -15.6

18 0.3 16.0 -14.4 48 -0.1 14.0 -15.6

19 0.5 16.0 -14.4 49 0.1 14.0 -15.6

20 0.5 16.0 -14.6 50 0.1 14.0 -15.4

21 0.5 15.8 -14.6 51 0.1 13.8 -15.4

22 0.3 15.8 -14.6 52 0.3 13.8 -15.4

23 0.3 15.8 -14.8 53 0.3 13.8 -15.2

24 0.3 15.6 -14.8 54 0.3 13.6 -15.2

25 0.1 15.6 -14.8 55 0.5 13.6 -15.2

26 0.1 15.6 -15.0 56 0.5 13.6 -15.0

27 0.1 15.4 -15.0 57 0.5 13.4 -15.0

28 -0.1 15.4 -15.0 58 0.7 13.4 -15.0

29 -0.1 15.4 -15.2 59 0.7 13.4 -14.8

30 -0.1 15.2 -15.2 60 0.7 13.2 -14.8

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B.2 Jaws Positioning Accuracy and Parallelism
B.2.1 Parallelism
The MLC leaf edges are used to define the collimation angle and as the reference for the jaw alignment.
Referring to following figure, the MLC leaf edges are determined from extended leaves (grey dotted lines). The
average leaf edge (red) serves as the reference for the jaw parallelism. For the X jaws, any discrepancy of this
angle β from 90° shall be reported. For the Y jaws, any discrepancy between the reference and the jaw edge α
is reported. The alignment of the jaws shall be determined for each acquisition where any jaw is detected

B.2.2 Jaws Positioning Accuracy

Jaw positioning will be given as the distance from the collimator center of rotation to the jaw edge along the
reference coordinate system.
The acquisition pattern shall be tested for maximum accuracy. The X-jaws are tested first with a set of images
which maximizes edge length, then the Y-jaws with a different set of images. The following images and tables
follow the IEC1217 scale convention.

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X2

X1
P0 P1 P2 P3

Y2 / Y1

P8
P5 P6 P7

IEC1217 P0 P1 P2 P3 IEC1217 P4 P5 P6 P7
X1 1 0 -10 -18 Y1 1 0 -10 -18

X2 18 10 0 -1 Y2 18 10 0 -1

164 of 164 IPA-HT-C

Format TMP-GE-IPA_HW-B