IAEA Postal Dose Quality Audit for X ray and Co-60 γ beams Page 1 of 3

IAEA/WHO POSTAL DOSE QUALITY AUDIT for Co-60 γ beams Megavoltage X ray beams

DATA SHEET for Radiotherapy Centres

It is of a great importance for the RPLD evaluation that the information requested below be completed. Part I is mandatory. Complete Part II, if additional absorbed dose to water determination was made by ionization chamber measurements.

RPLD Batch No. RPLD SET No. Contact person: Family name* Given name* Position Department E-mail (individual)Telephone (individual)Name of Institution*

Address: Street* City* PO Box ZIP code Province / State Country*

E-mail (institutional)Telephone (institutional)Fax number (institutional)Form completed by:

Family name Given name Date* (dd/mm/yyyy)

RPLD Irradiation performed Family name Given name Position

Person 1* Person 2 Person 3

Previous participation in an external audit or intercomparison for this beam*: Yes* No Organiser Year Fields marked with (*) are mandatory

IAEA Laboratory Seibersdorf DOSIMETRY LABORATORY, DMRP SECTION, DIVISION OF HUMAN HEALTH

Friedensstrasse 1 A-2444 Seibersdorf, Austria

Fax: +43 1 2600781662, Tel: +43 1 2600-28207 or 28331, e-mail: Dosimetry@iaea.org

IAEA Postal Dose Quality Audit for X ray and Co-60 γ beams Page 2 of 3

PART I. For hospital staff (physicist, oncologist, technician) Specifications of the irradiation unit: Co-60 unit medical accelerator The treatment unit used for this audit is of the type:

Manufacturer and model* Other treatment unit (if not on the list) Serial number Production year* Installation year*

For a Co-60 unit the date of the last source For a medical accelerator the manufacturer stated X ray beam energy is MV.

The beam quality is characterized by one of the following: D20/D10 = (10 cm × 10 cm at SSD = 100 cm)

(10 cm × 10 cm at a const. source-to-detector distance of TPR20/10 = conditions: of

cm)

Irradiation of RPLD capsulesThe RPLD capsules were irradiated on the following date*: (dd/mm/yyyy) The RPLD capsules were irradiated at* cm depth in water using a field* cm × cm

at a distance* cm SSD fixed source skin distance SAD fixed source axis distance

For the different RPLD capsules, the irradiation time/monitor settings and the dose delivered (in grays) were: capsule ID* min MU D= Gy capsule ID* min MU D= Gy background capsule ID

Calculation of time/monitor settingProvide the data used for the calculation of time/monitor setting for the RPLD irradiation. Please give a detailed explanation of your procedure for the above time/monitor and dose calculation. Please provide all factors (beam output, any conversion or correction factors, etc.) you have used:

Beam output as stated for your clinical data: on the date (dd/mm/yyyy)

Please explain in detail the irradiation conditions for which this clinical beam output applies (e.g. depth in water, SAD or SSD, field size):

IAEA Postal Dose Quality Audit for X ray and Co-60 γ beams Page 3 of 3

PART II. Additional request for medical physicists Determination of the absorbed dose to water by ionisation chamber Measurements were performed by: Family name Given name Physicist assignment Date (dd/mm/yyyy)

The absorbed dose to water at the centre of the RPLD capsule was determined using a dosimeter system composed of :

an ionisation chamber

and an electrometer

The Co-60 calibration coefficient of the dosimetry system (ionization chamber together with electrometer) was:

The above stated calibration coefficient was determined by the following laboratory/manufacturer

on the following date (dd/mm/yyyy)and refers to a temperature of oC and a pressure of

The absorbed dose to water at the position of the centre of the RPLD capsule was measured under the following conditions:

phantom Water Plastic if plastic phantom, select the type of plastic field size cm × cm

distance cm SSD fixed source skin distance SAD fixed source axis distance

depth of of the ionisation chamber in phantom cm

For Co-60 beams and measurements in air: build-up cap material thickness g/cm2

Please give your reading results average uncorrected reading scale units measurement performed during min MU temperature oC pressure

The absorbed dose to water at the position of the centre of the RPLD capsule was determined by the following code of practice (dosimetry protocol) The shutter/monitor correction (timer error/MU effect) was (if any): s MU List all the factors and corrections you have chosen following your dosimetry protocol. If some of the items do not apply to your method employed, please give the detailed explanations below.