TABLE VI.

Example checklist for physics check of treatment plan suggested by FMEA failure modes of steps 81–173, Appendix C1 (Ref. 141).

Dose prescription and planning constraints used for planning/optimization are consistent with site-specific protocol (example checklist 1) or with plan directive

Correct selection of ROIs: Correct use of overlapping and non-overlapping structures in optimization; best choices of beam energies and modalities have been made

Doses from previous treatments were accounted for in the plan

Optimization goals were achieved or failure understood, discussed with the radiation oncologist and acknowledged □ Yes  □ No

Dose calculation algorithm and density correction (algorithm, on/off) are correctly chosen

Dose distribution is reasonable for the plan and anatomy

1. PTV coverage consistent with initial planning directive or site-specific protocol (example checklist 1) or deviations discussed with the physician(s) and formally accepted

□ Yes  □ No

2. The doses to OARs within tolerances (as specified by site-specific protocol) or deviations reviewed with physician(s) and formally accepted

□ Yes  □ No

Plan agrees qualitatively with experience in similar cases

Overall plan includes separate boost or concomitant boost doses per prescription.

Plan accounts for specified immobilization, localization, and positioning methods

Verify documentation of use of bolus, type, and location

Verify that beams are deliverable

1. Deliverable MLC patterns used in the final plan; leaf-sequencing parameters correct

2. Monitor units within deliverable ranges

The plan prescription and treatment plan information have been downloaded to the correct course in the delivery system database

4D plan remains within the reliability limits of the system