TABLE 8.
Example initial EBRT treatment plan/chart check items for medical physicists
| Sections | Recommended | Optional |
|---|---|---|
| Plan integrity check | ||
| Patient name/MRN/DOB | ||
| Isocenter/initial reference point matched with simulation doc | Dose calculation algorithm (per institutional policy) | |
| Isocenter/initial reference point matched with the patient skin marks | ||
| Isocenter shift documented | ||
| Rx dose in plan matched with Rx in RO‐EMR | ||
| Field parameters (MUs, dose, field size, collimator, gantry, and MLC positions) reasonable or following local policy | ||
| Calculation dose grid included all critical contours | ||
| Beams associated with appropriate isocenter | ||
| If multiple isocenters are used, clearly labeling of each isocenter | ||
| 3D field shapes appropriate for physician intent (3D plans only) | ||
| Plan quality and dose metrics reasonable (if applicable) | ||
| Beam name following institutional convention | ||
| Beam modification (bolus) noted and documented | ||
| Check Beam clearance (potential collision) | ||
| Correct CT dataset used | ||
| ROI density override appropriate | ||
| Deliverability of beams (minimum MU for EDW, and maximum MU allowed for high dose, or high dose box checked, errors and warning messages addressed) | ||
| Couch included/excluded correctly | ||
| Implanted electronic device dose documented (if applicable) | ||
| Prior treatment dose added and plan sum appropriate (if applicable) | ||
| Report conformal index (SRS/SBRT plan only) | ||
| Secondary dose calculation difference <5% | ||
| Preparation in RO‐EMR | ||
| Rx in RO‐EMR in accordance with Table 3 | Setup beams associated with the same treatment isocenter | |
| Rx approved by physician | Image fusion/registration completed and documented | |
| Plan approved by physician and physicist (or in plan document) | Patient‐specific QA reviewed | |
| All field parameters input (or associated) correctly and approved (if using third party system) | Special physics consult documented (if applicable) | |
| Site setup instruction (treatment positions, bolus, motion management, etc) are set correctly | Planned for a scheduled treatment machine | |
| Reference CT input with correct isocenter and include relevant targets and ROIs | Immobilization appropriate | |
| DRRs associated and approved (if use a third party system) | Dose tracking point (volume) matched Rx in RO‐EMR | |
| Tolerance table set correctly | Created QCL/task for therapy check | |
| CBCT/IGRT alignment instruction presence | ||
| Treatment schedule (eg, daily, BID) is in agreement with Rx | ||
| Dose tracking set correctly (if applicable) | ||
| Special instructions as needed (eg, surface guided imaging parameters, breath‐hold threshold) |
Abbreviations: DIBH, deep inspiration breath hold; DOB, date of birth; DRR, digitally reconstructed radiograph; EDW, enhanced dynamic wedge; IGRT, image‐guided radiotherapy; KVCBCT, Kilo‐voltage cone beam CT; MU, monitor unit; MVCBCT, Mega‐voltage cone beam CT; QCL, quality‐check‐list; RO‐EMR; Radiation specific electron medical record system; ROIs, regions‐of‐interest; Rx, prescription; SID, source‐imager distance; SSD, source‐skin distance; Tx, treatment.