Simplified "on-couch" daily quality assurance procedure for CT simulators

Abstract

For most computed tomography (CT) simulators, radiation therapists must first remove the flat couch top in order to perform daily CT quality assurance (QA), and then use separate tools to perform localization-laser QA. This process wastes time and effort, and creates the opportunity for accidents to occur. In this study, we tested a simple, yet comprehensive, daily QA program and phantom designed for CT simulators used in radiation oncology that would enable us to use only one tool to perform both laser and imaging QA on a flat couch. To construct a modified QA phantom, we attached three adjustable legs and fastened two metric scales (one vertically and one horizontally) to a commercial CT QA phantom. The adjustable legs helped to position and level the phantom conveniently in the needed position. The two metric scales were used for localization-laser QA, while the phantom body was used for CT imaging QA. We evaluated five different CT scanners from two manufacturers with their designated couches to evaluate this phantom system. Since the couch is scanned along with the phantom, we evaluated the couch's effect on image quality. We found that the presence of the couch top changed the uniformity of water's CT number slightly, but did not change the visual image resolution. The couch top also produced different, yet reproducible, effects on image quality. The effects were greatest in the section of the phantom closest to the couch top. For a commercial carbon fiber couch top, the variation was within 3 Hounsfield Units (HU). The effect was couch- and scanner-specific, and could be incorporated into the QA acceptability criteria for each CT scanner. By using the proposed QA program and phantom, we have been able to implement more thorough QA while decreasing the amount of effort and time the simulation therapists spend performing laser and imaging QA.