Multi-Purpose Body Phantom

Legal & Copyright Notice Information in this manual is subject to change without notice. Permission is granted to Owners of the to reproduce the Worksheets included in this manual for their own use. No other part of this manual may be reproduced in any form without the written permission of Modus Medical Devices Inc. (Modus). Copyright 2003, 2006, 2010 Modus Medical Devices Inc. QUASAR and the QUASAR logo are trademarks of Modus Medical Devices Inc. Modus reserves the right to make any changes without further notice to any products herein. Modus makes no representation, warranty or guarantee regarding the suitability of its products for any particular purpose, nor does Modus assume any liability arising out of the application or use of any product, and specifically disclaims any and all liability, including without limitation consequential or incidental damages. Typical parameters can and do vary in different applications. All operating parameters, including Typicals must be validated for each customer application by customer s technical experts. Modus does not convey in this user s guide any license under its patent rights nor the rights of others. Copyright 2010 Modus Medical Devices Inc. 2 QBDP-MP UGR9

Table of Contents Legal & Copyright Notice... 2 Introduction... 5 QUASAR... 5 This Guide... 5 Important Note... 5 Phantom Components... 5 Safety, Care & Handling... 7 Warning... 7 Do not immerse... 7 Use only approved cleaners... 7 Handle with care... 7 General Maintenance... 8 Cleaning Instructions... 8 Storage Conditions... 8 Ideal Operating Conditions... 9 Appearance... 9 Recommended Procedure... 10 Nondosimetric Tests... 10 Dosimetric Tests... 10 Worksheets... 10 Nondosimetric Tests... 11 CT Scanning... 11 Image Acquisition and Transfer Tests... 11 Target Volume Evaluation... 12 20 Air Wedge, 5 mm Rod, 10 mm Rod... 12 125 cc Cube, 27 cc Cube... 13 60 Air Wedge with Delrin Spheres... 14 Copyright 2010 Modus Medical Devices Inc. 3 QBDP-MP UGR9

CT Number to Relative Electron Density Conversions... 16 Light Field Alignment Verification... 16 Dosimetric Tests... 17 CT Scanning... 19 Plan Generation... 20 Dose Measurement... 21 Dose Comparison... 22 Warranty and Support... 23 Modus Medical Devices Inc. Limited Warranty... 23 Customer Support... 23 Appendix A Worksheets... 24 Copyright 2010 Modus Medical Devices Inc. 4 QBDP-MP UGR9

Introduction QUASAR The Quality Assurance System for Advanced Radiotherapy (QUASAR ) supports the testing of a wide variety of dosimetric and nondosimetric functions of Radiation Therapy Planning Systems and CT Simulators using a set of innovative QA tools. The QUASAR phantoms should be used for regularly scheduled testing, as well as commissioning new systems and upgrades, and for testing repairs. The QUASAR system provides you with the confidence that your radiation treatment planning software and CT simulators are performing to their full potential. This Guide This document provides a recommended procedure for use of the QUASAR Multi-Purpose Body Phantom in the routine quality assurance of a threedimensional Radiation Therapy Planning System. The same general guidelines are applicable to CT-simulators. Important Note This provides information necessary for the proper use and maintenance of the QUASAR Multi-Purpose Body Phantom. It is not a guide to Radiation Therapy Planning Systems, or CT Simulators. Accurate Quality Assurance of these systems depends primarily on the skills and knowledge of the operators of these systems. Consequently, technical competence in the operation of this phantom must be supplemented by a thorough understanding of the systems being tested. Phantom Components The QUASAR Multi-Purpose Body Phantom consists of the following components: Body Oval Electron Density Ring (removable) Electron Density (ED) rods consisting of: Lung (inhale) Polyethylene Water Equivalent Trabecular Bone Dense Bone Copyright 2010 Modus Medical Devices Inc. 5 QBDP-MP UGR9

Cylindrical Inserts 125 cc Cube, 27 cc Cube 60 0 Air Wedge with Spheres (40, 20 and 10 mm diameter) 20 0 Air Wedge, 5 mm Rod, 10 mm Rod Two solid acrylic inserts Two cedar inserts (lung equivalent) Rod Inserts Ion Chamber rod Six solid acrylic rods Bone rod Container for storage and handling or optional shipping case 2 solid acrylic inserts & 2 cedar inserts Light field alignment template Multi-Purpose body oval 3 cylindrical inserts 6 solid acrylic rods 1 bone equivalent rod (not shown) 5 electron density plugs and removable holder Ion Chamber holder and cylindrical insert Figure 1 QUASAR Multi-Purpose Body Phantom Copyright 2010 Modus Medical Devices Inc. 6 QBDP-MP UGR9

Safety, Care & Handling Read all warnings, precautions, and instructions carefully before use, and follow all operating and maintenance procedures described in this guide. Warning Do not immerse The QUASAR Multi-Purpose Body Phantom is not protected against the ingress of fluids, and certain fluids may interfere with its operation. The phantom should not be immersed in liquids of any kind. Use only approved cleaners Phantom parts are made of acrylic and other plastics, and are susceptible to attack by solvents and cleaning products. Approved cleaning procedures are described below in the section on General Maintenance. Handle with care Proper care must be used when lifting, carrying or positioning the QUASAR Multi-Purpose Body Phantom to prevent injury to the operator. This is also true of the storage and handling container. If the phantom is dropped or subjected to other mechanical shocks it may be damaged. If you suspect the phantom has been damaged (e.g. measurements are not as expected), contact Modus to arrange for service or repair. The QUASAR Multi-Purpose Body Phantom contains removable parts. These inserts should be easy to remove from the phantom. The inserts should not be forced either on removal or insertion. If the inserts become jammed in the phantom or impossible to remove please contact Modus to arrange for service or repair. Conversely, the components should be held in place with enough resistance to keep them from moving during use and handling. If they move too freely or do not hold their position once set, please contact Modus to arrange for service or repair. The phantom is provided with a container for storage and handling. This is not a shipping case. The phantom should be stored securely within the container in a safe location when not in use. Improper storage can lead to damage. An optional reusable case for shipping, storage and handling is available. Contact your distributor or Modus for more information. Copyright 2010 Modus Medical Devices Inc. 7 QBDP-MP UGR9

General Maintenance The QUASAR Multi-Purpose Body Phantom is manufactured to very close tolerances in order to ensure accuracy and good performance for many years. The materials used (predominantly acrylic) are susceptible to damage from impact, scratches, extreme temperature and chemical attack. In addition, the acrylic and other parts are susceptible to dimensional changes due to the absorption of water. Cleaning Instructions The phantom can be wiped clean with a mild soap or detergent solution. 1. Use a clean, soft cloth and apply only light pressure. 2. Dry the phantom by blotting with a damp cloth or chamois. If attempts to clean the phantom using this technique are unsuccessful, please contact Modus for approved alternatives. Do not use: Wax-based or chemical-based cleaners, Window cleaning sprays, Kitchen scouring compounds, or Solvents such as acetone, gasoline, benzene, alcohol, carbon tetrachloride, or lacquer thinner. These can scratch the surface and/or weaken the acrylic and other plastics causing small surface cracks called "crazing". Damage caused by inappropriate cleaning activities is not covered by the warranty. Scratches that arise during the normal use and handling of the phantom should not inhibit its performance. If you are concerned about the any issue regarding the appearance, care, or performance of the phantom please contact Modus. There are no field adjustable features of the QUASAR Multi-Purpose Body Phantom. Storage Conditions The QUASAR Multi-Purpose Body Phantom is designed and manufactured to operate at normal office or clinic temperature and humidity. Rapid changes in temperature and humidity may cause temporary or permanent changes in the dimensions of some parts. For this reason we recommend that the phantom be stored in the office or clinic where it is used. If conditions change, time is required to allow the phantom to become stable in the new conditions. Copyright 2010 Modus Medical Devices Inc. 8 QBDP-MP UGR9

Ideal Operating Conditions Temperature: 15 degrees to 30 degrees Celsius Humidity: 30% to 80% relative humidity (non-condensing). Appearance The QUASAR Multi-Purpose Body Phantom may be damaged by extended exposure to direct sunlight, such exposure should be avoided. With age, exposure to sunlight and exposure to higher energy photons, the acrylic in the phantom may acquire a yellow tint. This is a normal and unavoidable characteristic of acrylic that does not affect the performance of the phantom. Copyright 2010 Modus Medical Devices Inc. 9 QBDP-MP UGR9

Recommended Procedure This document provides a recommended procedure for use of the QUASAR Multi-Purpose Body Phantom in the routine quality assurance of threedimensional Radiation Therapy Planning Systems and CT Simulators. The recommended procedure is a suggested basis for a nondosimetric and dosimetric quality assurance program, especially for 3D conformal radiation therapy and intensity modulated radiation therapy (IMRT). It is intended to test the function of the systems under typical conditions, but should not be expected to expose every potential problem associated with the systems being tested. Users should consider developing their own tests for particular aspects of their treatment planning software that may not be covered by the recommended procedure. The QUASAR Multi-Purpose Body Phantom is made of acrylic and the user must account for the difference in density between acrylic and tissue when using the phantom. The recommended procedure for a full set of tests with the QUASAR Multi- Purpose Body Phantom includes the following steps. Nondosimetric Tests CT scanning Image acquisition and transfer tests Evaluation of the test objects within the Cylindrical Inserts CT number to relative electron density conversions Light field alignment verification Dosimetric Tests CT scanning Plan generation Dose measurement Dose comparison Worksheets The QUASAR Multi-Purpose Body Phantom quality assurance worksheets in Appendix A are designed to assist you to record your data and summarize results. The worksheets may be copied as required. Copyright 2010 Modus Medical Devices Inc. 10 QBDP-MP UGR9

Nondosimetric Tests CT Scanning The first step in the use of the QUASAR Multi-Purpose Body Phantom is to acquire a CT data set. This requires precise positioning of the phantom on the CT scanner couch. 1. Place flat couch top inserts on the CT scanner couch. 2. Place the QUASAR Multi-Purpose Body Phantom on the couch, with the Electron Density Ring closest to the CT gantry. 3. Insert the Cylindrical Inserts into the Body Oval. 4. Insert the Electron Density Rods into the Electron Density Ring. For best results, the dense bone and trabecular bone Electron Density Rods should be placed opposite each other, and the water equivalent rod should be in the center. 5. Align the laser alignment marks on the Body Oval with either the CT suite room lasers or CT scanner lasers. 6. Acquire a pilot scan for the entire length of the phantom. 7. Acquire transverse CT images for the entire length of the Body Oval and Electron Density rods. For best results, it is recommended that slice thickness and spacing does not exceed 5mm. Tests should be repeated for the different CT imaging parameters that are used in practice. 8. Transfer the images to the Radiation Therapy Planning System or CT- Simulator workstation. Image Acquisition and Transfer Tests The following measurements and observations test a few aspects of the CT images to ensure that they have been correctly acquired by the CT scanner and correctly transferred to the treatment planning software. Failure of any of these tests may indicate errors in image acquisition and transfer. The non-dosimetric CT scan acquired previously should be used. 1. Measure the height and width of the QUASAR Multi-Purpose Body Phantom on a slice through the center of the Body Oval. This is a check of the geometric accuracy of the image. The height should measure 20 cm and the width should measure 30 cm. Copyright 2010 Modus Medical Devices Inc. 11 QBDP-MP UGR9

2. Confirm that the CT slices containing the ED Rods are at the superior end of the data set. If not, the data set may have been flipped in the superiorinferior direction. 3. Confirm that the Cylindrical Inserts are in the correct order from left to right. If not, the data set may have been flipped in the left-right direction. Target Volume Evaluation 20 Air Wedge, 5 mm Rod, 10 mm Rod This cylinder contains two small diameter Delrin rods and a wedge-shaped opening. The small diameter rods can be used to determine the accuracy of the volume calculation for small, thin cylinders and 3-D views of patient anatomy. The wedge allows the assessment of automatic margin generation tools (such as for generating a Planning Target Volume from a Clinical Target Volume), volume determination, and 3-D views. The 20 Air Wedge has a volume of 40 cc with an overall length of 5 cm. The 5 mm diameter rod and 10 mm diameter rod are also 5 cm long. 1. Contour the air wedge and the two rods. 2. Determine the area of each structure on a CT slice near the center of the phantom. Compare the area determined by the software to the specified area. Item Specified area (cm 2 ) Wedge 8.0 5 mm rod 0.20 10 mm rod 0.78 3. Determine the volume of each structure. Compare the volume determined by the software to the specified volume. Item Specified volume (cm 3 ) Wedge 40.0 5 mm rod 0.98 10 mm rod 3.9 Copyright 2010 Modus Medical Devices Inc. 12 QBDP-MP UGR9

4. Use the auto-margin tools to create a 2 cm margin around the air wedge. Ensure that the margin is correctly displayed and is 2 cm at all points, particularly at the tip of the wedge. 5. Display the volumes in three dimensions. 6. Using the ruler function (or by inspection, if a ruler is unavailable), check that the display matches the phantom geometry. 125 cc Cube, 27 cc Cube This cylindrical insert contains a 27 cc acrylic cube (3x3x3 cm) within a 125 cc Delrin cube (5x5x5 cm). These volumes can be used to assess the accuracy of automatic margin generation tools, 3-D display, volume calculations algorithms, and dose-volume histograms. 1. Contour the acrylic and Delrin cubes. 2. Determine the area of each structure on a CT slice near the center of the phantom. 3. Compare the area determined by the software to the specified area. Item Specified area (cm 2 ) Notes Acrylic cube 9.0 Delrin cube 25.0 Includes the area of the acrylic cube Delrin cube 16.0 With acrylic cube area removed 4. Determine the volume of each structure. Compare the volume determined by the software to the specified volume. Item Specified volume (cm 3 ) Notes Acrylic cube 27.0 Delrin cube 125.0 Includes the area of the acrylic cube Delrin cube 98.0 With acrylic cube area removed Copyright 2010 Modus Medical Devices Inc. 13 QBDP-MP UGR9

5. Use the auto-margin tools to create a 1 cm margin around the acrylic cube. 6. Compare the margin superimposed upon the Delrin cube. Note the agreement in the corners of the Delrin cube. A 1cm margin should have rounded corners, while a margin that corresponds perfectly to the Delrin corners is actually 1.4cm at the tip. 7. Display the volumes in three dimensions. Using the ruler function (or by inspection, if a ruler is unavailable), verify that the display matches the phantom geometry. 8. Create a wedged radiation field that is large enough to be uniform over the Delrin cube with its isocenter in the center of the cube. 9. Calculate a dose distribution (no inhomogeneity corrections, if available). 10. Display isodose lines in 5% increments. From the positions of the isodose lines, estimate the volume of the Delrin cube that is within each isodose line. This can be determined by examining the dose distribution on the central slice. If the length of the top and side edge that are enclosed within the isodose line are measured, the volume can be approximated by V = 0.5 x 5cm x (enclosed length of top edge) x (enclosed length of side edge). This can be performed for each isodose line crossing the cube. 11. Calculate a dose volume histogram for the Delrin cube. A 5 x 5 x 5 mm grid (or finer) is recommended for both the dose and volume calculation grids. Record the volume receiving the same doses recorded in step 10. The percent volume at each dose level should agree within 5%. Note that the volume determined will depend on how the radiation treatment planning software determines volumes. If the software does not subtract the volume of the acrylic cube from the Delrin, the Delrin cube should be 125 cm 3. If the volume of the acrylic cube is subtracted, the volume of the Delrin cube should be 98 cm 3. 12. Repeat steps 8-11 for the acrylic cube. The volume of the acrylic cube should be 27 cm 3. 60 Air Wedge with Delrin Spheres This cylinder forms a half cylinder of air, cut on a 60-degree angle across its long axis. It can be used to determine the accuracy of the volume calculation and 3-D views. The high contrast interface along the scanning axis makes determination of this volume particularly susceptible to partial volume effects, and can be used to test the planning software in this regard. Three Delrin spheres of 10, 20 and 40 mm diameters are embedded within the half cylinder. Copyright 2010 Modus Medical Devices Inc. 14 QBDP-MP UGR9

1. Contour the air cavity defined by the half cylinder. Figure 2 - The contoured half cylinder of air, and the three Delrin spheres. 2. Determine the volume of the half cylinder. 3. Compare the volume determined by the software to the specified volume of 116 cm 3. This volume does not include the air space between the narrow tip of the 60 wedge and the end of the phantom. 4. Display the volume in three dimensions. Using the ruler function (or by inspection, if a ruler is unavailable), check that the display matches the phantom geometry. 5. Contour each of the spheres. 6. Determine the volume of each of the spheres. 7. Compare the volume of each of the spheres to the specified volume of (from largest to smallest): 33.5 cc, 4.2 cc and 0.52 cc. Copyright 2010 Modus Medical Devices Inc. 15 QBDP-MP UGR9

8. Display each of the spheres in three dimensions. Using the ruler function (or by inspection, if a ruler is unavailable), check that the display matches the phantom geometry. CT Number to Relative Electron Density Conversions These ED Rods are intended to facilitate the measurement of the calibration of the CT scanner and confirm the conversion of CT numbers to relative electron densities by the radiation treatment planning software. 1. Choose a transverse CT slice near the center of the ED Rod cylinder. 2. For each of the five ED Rods, sample a 1.5 x 1.5 cm region of interest at the center of each ED Rod and determine the CT number and relative electron density (if region of interest analysis is unavailable, sample several pixels near the center and use the median value). The CT numbers should agree with previously recorded values 20 Hounsfield units. The relative electron density should agree 4%. Material Relative Electron Density Physical Density (g/cc) Lung inhale 0.253 0.28 Polyethylene 0.945 0.965 Water equivalent 1.007 1.03 Trabecular bone 1.09 1.12 Dense bone 1.362 1.42 Light Field Alignment Verification The templates on the top and sides of the QUASAR Multi-Purpose Body Phantom are intended for alignment verification of the light field. 1) Place the Body Oval on the treatment couch, and align it with the treatment room lasers. 2) Compare the light field to the 5 x 5 cm 2 and 10 x 10 cm 2 templates on the phantom. This test should be performed at gantry angles of 0, 90 and 270. The template is designed to account for the divergence of the light field. The isocenter must be placed at the center of the phantom. Copyright 2010 Modus Medical Devices Inc. 16 QBDP-MP UGR9

Dosimetric Tests The QUASAR Multi-Purpose Body Phantom supports several dosimetric tests that can be divided into two different scenarios: Commissioning tests Dosimetric QA for individual patients For both applications the user must have a planning CT scan of the phantom with suitable field of view, slice spacing and number of slices. The scan should be done using similar parameters as for clinical practice making sure the whole phantom is scanned with a large field of view. The CT scans have to be transferred to the treatment planning system. In the commissioning tests the user must create a treatment plan using the phantom as the patient with a specific test question in mind. It is the responsibility of the user to identify the appropriate test procedure. Examples can be given for two specific contexts: During commissioning of the treatment planning system, the phantom can be used to verify contour corrections and the treatment of inhomogeneities during the dose calculation. This has to be performed for each commissioned radiation beam separately. The QUASAR Multi-Purpose Body Phantom can be used to test new treatment techniques prior to clinical implementation. In this case the phantom is planned and treated like a patient and the measurements compared with the expected dose distribution. The QUASAR Multi-Purpose Body Phantom can be used to verify the plan dosimetry for individual patients. The process will depend on the treatment planning system and it is the responsibility of the qualified medical physicist to set-up appropriate procedures. Typical applications would be (but are not limited to): Electron radiation fields, in particular if they are small or irregularly shaped Intensity Modulated Radiation Therapy (IMRT) Copyright 2010 Modus Medical Devices Inc. 17 QBDP-MP UGR9

For patient treatment verification, individual treatment plans can be applied to the phantom geometry. Recalculation of the resultant dose map is required to determine the dose expected at measurement points in the phantom. QA of a treatment planning system is a more complex problem that is beyond the scope of this document, however, making dosimetric measurements in the phantom should be considered an integral part of any thorough QA program. Users should refer to standards published by appropriate territorial agencies and to peer reviewed publications for guidance on this topic. a) b) c) Figure 3. Sample steps in the verification of the treatment planning system using the QUASAR Multi-Purpose Body Phantom. a) A patient prostate plan (intensity modulated arc treatment) to be verified. b) This plan is transferred to the solid acrylic phantom and the dose distribution is recalculated for the same beams on the phantom. In general this results in a dose distribution that is different from a). In this case one of the central ion chamber positions can be chosen to verify that the correct monitor units are delivered. In c) another sample plan is shown, via a different delivery technique (four-field box). The small circle in each of these figures indicates the isocenter. Copyright 2010 Modus Medical Devices Inc. 18 QBDP-MP UGR9

Please note that a variety of phantom configurations are possible. One setup using a solid acrylic phantom (i.e. all holes filled with solid acrylic inserts) provides a homogeneous test environment. Other setups which make use of the lung inserts and/or the bone rod may be used for a more rigorous check of the ability of the treatment planning system to handle inhomogeneities. Prior to scanning the phantom, select the setup required for the tests to be performed. The phantom has two positions for the bone rod. This allows the user to select an appropriate spine depth to assess a given treatment plan. Spine depth varies from patient to patient and as a function of location in the back. Average spine depth also varies with the age of the patient and other factors (Van Dyk, J. et al., Medulloblastoma: Treatment technique and radiation dosimetry, Int. J. Radiat. Oncol. Biol. Phys., 2, 993-1005, 1977). CT Scanning The first step in the dosimetric applications of the QUASAR Multi-Purpose Body Phantom is acquiring a CT data set, similar to the method described above for nondosimetric testing this requires precise positioning of the phantom on the CT scanner couch. 1. Place flat couch top inserts on the CT scanner couch. 2. Place the QUASAR Multi-Purpose Body Phantom on the couch. The Electron Density ring is not necessary for these tests and may be removed. 3. Insert the selected Cylindrical Inserts into the QUASAR Multi-Purpose Body Phantom. Several different configurations may be required for commissioning. 4. Align the laser alignment marks on the QUASAR Multi-Purpose Body Phantom with either the CT suite room lasers or CT scanner lasers. 5. Acquire a pilot scan for the entire length of the phantom. 6. Acquire transverse CT images for the entire length of the QUASAR Multi- Purpose Body Phantom. For best results, it is recommended that slice thickness and spacing does not exceed 5mm. Tests should be repeated for the different CT imaging parameters that are used in practice. 7. Transfer the images to the Radiation Therapy Planning System or CT- Simulator workstation. These preliminary steps can be eliminated on subsequent tests if a set of standard images is retained on the planning system or CT Simulator. Copyright 2010 Modus Medical Devices Inc. 19 QBDP-MP UGR9

Plan Generation 1. Import a treatment plan and apply it to the scan or Apply beams manually to the scan 2. Calculate the dose distribution 3. Select positions for ion chamber measurements. Possible chamber positions are indicated in figures 4 and 5. These positions may be visualized on CT images. If the solid acrylic inserts are in place the hole location may be visualized by finding the small circular air gap that surrounds the inserts. Image window and level controls may assist with this. With the exception of four of the small diameter holes the Body Oval is symmetric in the x, y, and z directions. This symmetry can be used when selecting ion chamber locations for measurements. Please refer to figure 5 for a drawing which shows all the possible ion chamber locations. Volume averaging of measurements will occur during measurement. For best results the dose measurement locations should be selected so the ion chamber lies within a homogeneous dose region (region of low dose gradient). It is important that homogeneity in the Z direction is taken into consideration. The Z location of the ion chamber within the Body Oval is adjustable. When fully inserted the ion chamber rod holds the ion chamber at the center of the phantom in the Z direction. There are centimeter and millimeter markings on the Ion Chamber Rod that indicate the distance the Ion Chamber has been drawn off center. The Rod can be introduced from either end of the phantom. Figure 4. Possible positions for ion chambers. All of the smaller holes are possible positions for the ion chamber. The larger insert outlined in a) has two potential ion chamber insert positions, and this insert is capable of rotating 360 and being placed in the center, or on either side of the phantom. b) Copyright 2010 Modus Medical Devices Inc. 20 QBDP-MP UGR9

demonstrates an increased number of potential ion chamber positions when the entire phantom is rotated or flipped. Figure 5. Hole locations for the Ion Chamber holder. The dashed rings indicate that the cylindrical insert may be rotated 360 within the openings. Dose Measurement 1. Place the phantom on the treatment couch and align it with the treatment room lasers. If the light field alignment has been verified then the light field may also be used to align the phantom. The Electron Density ring is not necessary for these tests and may be removed to improve access to the various ion chamber locations. 2. Perform Ion chamber measurements at the selected positions. The QUASAR Multi-Purpose Body Phantom is compatible with a variety of commercially available Ion Chambers. Selection of the appropriate chamber and techniques for acquiring accurate measurements in a phantom are Copyright 2010 Modus Medical Devices Inc. 21 QBDP-MP UGR9

beyond the scope of this document. Users should refer to guidance documents published by appropriate territorial agencies and to peer reviewed publications for guidance on this topic. Dose Comparison Compare the measured dose with the dose calculated by the radiation treatment planning system at the selected positions. Calculated and measured dose should be recorded on the worksheets. The accuracy of the measurements and the amount they differ from the calculated values of the planning system are important topics that are beyond the scope of this document. Users should refer to standards published by appropriate territorial agencies and to peer reviewed publications for guidance on this topic. Copyright 2010 Modus Medical Devices Inc. 22 QBDP-MP UGR9

Warranty and Support Modus Medical Devices Inc. Limited Warranty Modus Medical Devices Inc. warrants to the original purchaser that the products sold will be free from defects in material and workmanship for a period of one year from the date of delivery. If the product is found to be defective during the warranty period, the part(s) and labour required to repair the product will be provided free of charge. This warranty is subject to the following exceptions and limitations: The customer shall be responsible for proper maintenance and handling of the product. No warranty is extended to any equipment that has been altered or modified in any way. No warranty is extended to any equipment that has been misused, or damaged. This warranty is in lieu of all other warranties, express or implied, including warranties of merchantability or fitness for a particular purpose and is the sole and exclusive remedy for any claim of damages arising from defects in the Modus product. Modus shall have no liability for consequential damages or personal injury or for the loss, damage or expense, directly or indirectly arising from the use of this product. No distributor, dealer or other party is authorized to make any warranty on behalf of Modus, or to assume for Modus any other liability with respect to its products. Customer Support If you require service or support for this product please contact Modus Medical Devices Inc. at: Modus Medical Devices Inc. 1570 North Routledge Park London, Ontario N6H 5L6 CANADA Phone +1 519-438-2409 Toll-free (in North America) 866-862-9682 www.modusmed.com info@modusmed.com Copyright 2010 Modus Medical Devices Inc. 23 QBDP-MP UGR9

QUASAR Multi-Purpose Body Phantom Quality Assurance Worksheet Name: Date: Nondosimetric Measurements CT Scanning Scan Parameters Energy: Tube current: Slice spacing: Slice thickness: Image Acquistion And Transfer Geometric Accuracy: Oval height: Oval width: Copyright 2010 Modus Medical Devices Inc. 25 QBDP-MP UGR9 All rights reserved

Cylindrical Inserts Area Determination Material Measured Area Actual Area (cm^2) 20 deg. Air Wedge 8.0 10 mm Rod 0.78 5 mm Rod 0.20 Delrin cube 25.0 or 16.0 Acrylic cube 9.0 Volume Determination Material Measured Volume Actual Volume (cm^3) 20 deg. Air Wedge 40.0 10 mm Rod 3.9 5 mm Rod 0.98 Delrin cube 125.0 Acrylic cube 27.0 10 mm Sphere 0.5 20 mm Sphere 4.2 40 mm Sphere 33.5 60 deg. Air Wedge 116.0 Surface Expansion Copyright 2006 Modus Medical Devices Inc. 26 QBDP-MP UGR9

3-D Display Material 20 deg. Air Wedge 10 mm Rod 5 mm Rod Delrin cube Acrylic cube Correct 3-D Display? 3 Spheres (10, 20 and 40 mm) 60 deg. Air Wedge Dose Volume Histograms Material Dose Measured Volume DVH Volume Delrin cube Material Dose Measured Volume DVH Volume Acrylic cube Copyright 2006 Modus Medical Devices Inc. 27 QBDP-MP UGR9

CT Number To Relative Electron Density Conversion Conversion curve: Material CT Number Measured RED Actual RED Lung (inhale) 0.253 Polyethylene 0.945 Water equivalent 1.007 Inner bone 1.09 Dense bone 1.362 Light Field Alignment Verification Template Location Light Field Note any misalignment Left 5 x 5 cm 2 10 x 10 cm 2 Top 5 x 5 cm 2 10 x 10 cm 2 Right 5 x 5 cm 2 10 x 10 cm 2 Copyright 2006 Modus Medical Devices Inc. 28 QBDP-MP UGR9

Dosimetric Measurements Insert Selection Solid acrylic throughout with the following exceptions Lung Equivalent inserts Bone Equivalent insert depth CT Scanning Scan Parameters Energy: Tube current: Slice spacing: Slice thickness: Plan Designation or Description Indicate the plan that is imported or describe the plan that is created and applied to the phantom images. Copyright 2006 Modus Medical Devices Inc. 29 QBDP-MP UGR9