Table I.
Questions for defining the clinical use of an EPID.
| Questions | Options |
|---|---|
| 1. What is he purpose/goal of installing EPIDs in the clinic? | (a) Simple film replacement/routine QA |
| (b) Accurate and efficient patient setup and re‐positioning | |
| (c) Assessment of random and systematic errors in treatment delivery | |
| (d) Assessment of the efficacy of immobilization techniques | |
| (e) Inter (between) and intra (within) fraction motion studies | |
| 2. For which patients will EPID be used to verify treatment? | (a) All patients? |
| (b) Special cases that are difficult to setup? | |
| (c) Specific disease sites? | |
| 3. How will the EPID be used? | (a) Exclusively to eliminate film |
| (b) Combined with a predefined port film protocol | |
| 4. What will be the frequency of imaging? | (a) Weekly |
| (b) Daily | |
| (c) Dependent on site or patient | |
| (d) Dependent on the statistics of setup error or decision rules | |
| 5. Which image acquisition modes are required? | (a) Single exposure |
| (b) Double exposure | |
| (c) Movie loops | |
| 6. What is the choice of reference image? | (a) Digitally Reconstructed Radiograph |
| (b) Conventional Simulation film | |
| (c) First approved EPID image | |
| 7. How will image evaluation be accomplished? | (a) Electronically, side by side on computer workstation |
| (b) Hard copy on conventional view box | |
| 7(a). How many review stations will be needed and at what locations? | (a) At each treatment machine |
| (b) Also in viewing rooms | |
| (c) Also in Physicians offices | |
| 8. When will you intervene/adjust setup? | (a) Threshold for corrective action |
| (b) On‐line‐intrafraction correction | |
| (c) Off‐line‐Interfraction correction | |
| 9. What image analysis protocol will be used? (This may include image enhancement) | (a) Visual inspection only |
| (b) Manual tools | |
| (c) Semi‐automated | |
| (d) Automated | |
| 9(a). Which analysis tools are available and validated on the system? | (a) Visual inspection only |
| (b) Manual tools | |
| (c) Semi‐automated | |
| (d) Automated | |
| 10. How will physician approval be achieved? | (a) Signed hard copy off‐line |
| (b) Electronic signature on‐line | |
| (c) Electronic signature off‐line | |
| 10(a). How will physician comments be communicated to others? | (a) Hard copy |
| (b) Electronic annotation within EPID/information system | |
| (c) Electronic email outside of EPID/information system | |
| 11. What are the resources needed for storage, archival and retrieval? | (a) Standalone hard disk |
| (b) Distributed database | |
| (c) PACS | |
| 11(a). Is the system DICOM‐RT compliant? | (a) Specific conformance details assessed |
| 11(b). What network and communication infrastructure is required? | (a) No network |
| (b) Network with specific bandwidth and security | |
| (c) Permanent links to Diagnostic Radiology/others required? | |
| 12. Implementation of a QA program | (a) Establish baseline mechanical limits and imaging quality |
| (b) Establish weekly/monthly protocols | |
| 12(a). What are the vendor established QA routines? | (a) How do these compare to our own routines? |
| 13. How will training and education for ALL users be scheduled? | (a) Establish training schedule |
| (b) Define personnel responsibilities | |
| (c) Periodic in‐service to ensure uniformity of clinical practice |