Comprehensive quality assurance phantom for the small animal radiation research platform (SARRP)

PurposeTo develop and test the suitability and performance of a comprehensive quality assurance (QA) phantom for the Small Animal Radiation Research Platform (SARRP).Methods and materialsA QA phantom was developed for carrying out daily, monthly and annual QA tasks including: imaging, dosimetry and treatment planning system (TPS) performance evaluation of the SARRP. The QA phantom consists of 15 (60 × 60 × 5 mm³) kV-energy tissue equivalent solid water slabs. The phantom can incorporate optically stimulated luminescence dosimeters (OSLD), Mosfet or film. One slab, with inserts and another slab with hole patterns are particularly designed for image QA.ResultsOutput constancy measurement results showed daily variations within 3%. Using the Mosfet in phantom as target, results showed that the difference between TPS calculations and measurements was within 5%. Annual QA results for the Percentage depth dose (PDD) curves, lateral beam profiles, beam flatness and beam profile symmetry were found consistent with results obtained at commissioning. PDD curves obtained using film and OSLDs showed good agreement. Image QA was performed monthly, with image-quality parameters assessed in terms of CBCT image geometric accuracy, CT number accuracy, image spatial resolution, noise and image uniformity.ConclusionsThe results show that the developed QA phantom can be employed as a tool for comprehensive performance evaluation of the SARRP. The study provides a useful reference for development of a comprehensive quality assurance program for the SARRP and other similar small animal irradiators, with proposed tolerances and frequency of required tests.     

Investigating output and energy variations and their relationship to delivery QA results using Statistical Process Control for helical tomotherapy

The aims of this study were to investigate machine beam parameters using the TomoTherapy quality assurance (TQA) tool, establish a correlation to patient delivery quality assurance results and to evaluate the relationship between energy variations detected using different TQA modules. TQA daily measurement results from two treatment machines for periods of up to 4 years were acquired. Analyses of beam quality, helical and static output variations were made. Variations from planned dose were also analysed using Statistical Process Control (SPC) technique and their relationship to output trends were studied. Energy variations appeared to be one of the contributing factors to delivery output dose seen in the analysis. Ion chamber measurements were reliable indicators of energy and output variations and were linear with patient dose verifications.     

Triple channel analysis of Gafchromic EBT3 irradiated with clinical carbon-ion beams

Self-developing radiochromic film is widely used in radiotherapy QA procedures. To compensate for typical film inhomogeneities, the triple channel analysis method is commonly used for photon-irradiated film. We investigated the applicability of this method for Gafchromic^TMEBT3 (Ashland) film irradiated with a clinically used carbon-ion beam. Calibration curves were taken from EBT3 film specimens irradiated with monoenergetic carbon-ion beams of different doses. Measurements of the lateral field shape and homogeneity were performed in the middle of a passively modulated spread-out Bragg peak and compared to simultaneous characterization by means of a 2D ionization chamber array. Additional measurements to investigate the applicability of EBT3 for quality assurance (QA) measurement in carbon-ion beams were performed. The triple-channel analysis reduced the relative standard deviation of the doses in a uniform carbon ion field by 30% (from 1.9% to 1.3%) and reduced the maximum deviation by almost a factor of 3 (from 28.6% to 9.8%), demonstrating the elimination of film artifacts. The corrected film signal showed considerably improved image quality and quantitative agreement with the ionization chamber data, thus providing a clear rationale for the usage of the triple channel analysis in carbon-beam QA.     

Commissioning and quality assurance of HalcyonTM 2.0 linear accelerator

BackgroundVarian Medical Systems has introduced a new medical linear accelerator called Halcyon^TM 2.0, which is based on the ring delivery system (RDS). It is a true IGRT machine having 6MV FFF photon energy. In addition to the planar and MV-CBCT imaging techniques it also has an option of ultra-fast kV-iCBCT which enhances the image reconstruction and improves the visualization of soft tissue. The field portals are shaped by a unique dual layer MLC with special stacked and staggered design which enables high modulation with low radiation leakage. Recently, we have commissioned our first Halcyon 2.0 machine. The aim of this work was to systematically investigate various parameters of a newly installed Halcyon^TM 2.0 linear accelerator.Materials and methodsDetailed measurements were conducted as per various guidelines. Also, the measurements were performed to fulfil the national regulatory requirements. Commissioning data of Halcyon 6 MV-FFF beam was performed in a water tank. For absolute measurements, a 0.6-cc waterproof Farmer chamber and electrometer were used. All relative measurements (PDDs, in-line, cross-line and angular profiles) were performed with 0.0125 cc point chamber.ResultsAll the tests were within the acceptable limit. Measured data were compared with factory data as well as the existing medical linear accelerator of the same category. The obtained results were quite satisfactory.ConclusionsThis study summarizes the commissioning experience with Halcyon linear accelerator. Evaluation of mechanical, radiation safety and dosimetric parameters were performed. The obtained parameters were well below the specified tolerance limits.     

Commissioning and Acceptance Testing of the existing linear accelerator upgraded to volumetric modulated arc therapy

Aim

The RapidArc commissioning and Acceptance Testing program will test and ensure accuracy in DMLC position, precise dose-rate control during gantry rotation and accurate control of gantry speed.

Background

Recently, we have upgraded our linear accelerator capable of performing IMRT which was functional from 2007 with image guided RapidArc facility. The installation of VMAT in the existing linear accelerator is a tedious process which requires many quality assurance procedures before the proper commissioning of the facility and these procedures are discussed in this study.

Materials and methods

Output of the machine at different dose rates was measured to verify its consistency at different dose rates. Monitor and chamber linearity at different dose rates were checked. DMLC QA comprising of MLC transmission factor measurement and dosimetric leaf gap measurements were performed using 0.13 cm³ and 0.65 cm³ Farmer type ionization chamber, dose 1 dosimeter, and IAEA 30 cm × 30 cm × 30 cm water phantom. Picket fence test, garden fence test, tests to check leaf positioning accuracy due to carriage movement, calibration of the leaves, leaf speed stability effects due to the acceleration and deceleration of leaves, accuracy and calibration of leaves in producing complex fields, effects of interleaf friction, etc. were verified using EDR2 therapy films, Vidar scanner, Omnipro accept software, amorphous silicon based electronic portal imaging device and EPIQA software.^1–8

Results

All the DMLC related quality assurance tests were performed and evaluated by film dosimetry, portal dosimetry and EPIQA.⁷

Conclusion

Results confirmed that the linear accelerator is capable of performing accurate VMAT.     

Evaluations of a flat-panel based compact daily quality assurance device for proton pencil beam scanning (PBS) system

PurposeTo evaluate the flat-panel detector quenching effect and clinical usability of a flat-panel based compact QA device for PBS daily constancy measurements.Materials & MethodThe QA device, named Sphinx Compact, is composed of a 20x20 cm² flat-panel imager mounted on a portable frame with removable plastic modules for constancy checks of proton energy (100 MeV, 150 MeV, 200 MeV), Spread-Out-Bragg-Peak (SOBP) profile, and machine output. The potential quenching effect of the flat-panel detector was evaluated. Daily PBS QA tests of X-ray/proton isocenter coincidence, the constancy of proton spot position and sigma as well as the energy of pristine proton beam, and the flatness of SOBP proton beam through the 'transformed' profile were performed and analyzed. Furthermore, the sensitivity of detecting energy changes of pristine proton beam was also evaluated.ResultsThe quenching effect was observed at depths near the pristine peak regions. The flat-panel measured range of the distal 80% is within 0.9 mm to the defined ranges of the delivered proton beams. X-ray/proton isocenter coincidence tests demonstrated maximum mismatch of 0.3 mm between the two isocenters. The device can detect 0.1 mm change of spot position and 0.1 MeV energy changes of pristine proton beams. The measured transformed SOBP beam profile through the wedge module rendered as flat.ConclusionsEven though the flat-panel detector exhibited quenching effect at the Bragg peak region, the proton range can still be accurately measured. The device can fulfill the requirements of the daily QA tests recommended by the AAPM TG224 Report.     

Evaluation of application of EPID for rapid QC testing of linear accelerator

Aim

Evaluation of application of EPID for rapid QC testing of linear accelerator.

Sensitivity of the IQM and MatriXX detectors in megavolt photon beams

AimThis study focused on evaluating the sensitivity of integral quality monitoring (IQM^®) system and MatriXX detectors. These two detectors are recommended for radiotherapy pre-treatment quality assurance (QA).BackgroundIQM is a large wedged-shaped ionisation chamber mounted to the linear accelerator (linac) head in practice. MatriXX consists of an array of ionisation chambers also attached to the linac head.Materials and methodsIn this study, the dosimetric performance and sensitivity of MatriXX and IQM detectors were evaluated using the following characteristics: reproducibility, linearity, error detection capability and three-dimensional conformal radiotherapy (3D-CRT) plans of the head and neck, thorax and pelvic regions.ResultsThis study indicates that the signal responses of the large ionisation chamber device (IQM) and the small pixel array of ionisation chambers device (MatriXX) are reproducible, linear and sensitive to MLC positional errors, backup jaw positional errors and dose errors. The local percentage differences for dose errors of 1%, 2%, and 3% were, respectively, within 0.35–8.23%, 0.78–16.21%, and 1.10–24.41% for the IQM device. While for the MatriXX detector, the ranges were between 0.24–3.19, 0.57–6.43 and 0.81–12.95, respectively. Since IQM is essentially a double wedge-shaped large ionisation chamber, its reproducibility and detection capability are competitive to that of MatriXX. In addition, the sensitivity of the two QA systems increases with an increase in escalation percentage, and the signal responses are patient plan specific.ConclusionsThe two detectors response signals have good correlations and they are accurate for pre-treatment QA. Statistically, (P < 0.05) there is a significant difference between the IQM and MatriXX response to dose errors.     

Usefulness of a new online patient-specific quality assurance system for respiratory-gated radiotherapy

PurposeThe accuracy of gated irradiation may decrease when treatment is performed with short “beam-on” times. Also, the dose is subject to variation between treatment sessions if the respiratory rate is irregular. We therefore evaluated the impact of the differences between gated and non-gated treatment on doses using a new online quality assurance (QA) system for respiratory-gated radiotherapy.MethodsWe generated dose estimation models to associate dose and pulse information using a 0.6 cc Farmer chamber and our QA system. During gated irradiation with each of seven regular and irregular respiratory patterns, with the Farmer chamber readings as references, we evaluated our QA system’s accuracy. We then used the QA system to assess the impact of respiratory patterns on dose distribution for three lung and three liver radiotherapy plans. Gated and non-gated plans were generated and compared.ResultsThere was agreement within 1.7% between the ionization chamber and our system for several regular and irregular motion patterns. For dose distributions with measured errors, there were larger differences between gated and non-gated treatment for high-dose regions within the planned treatment volume (PTV). Compared with a non-gated plan, PTV D_95% for a gated plan decreased by −1.5% to −2.6%. Doses to organs at risk were similar with both plans.ConclusionsOur simple system estimated the radiation dose to the patient using only pulse information from the linac, even during irregular respiration. The quality of gated irradiation for each patient can be verified fraction by fraction.     

Retrospective study on performance of constancy check device in Linac beam monitoring using Statistical Process Control

AimTo examine the application of Statistical Process Control (SPC) and Ishikawa diagrams for retrospective evaluation of machine Quality Assurance (QA) performance in radiotherapyBackgroundSPC is a popular method for supplementing the performance of QA techniques in healthcare. This work investigates the applicability of SPC techniques and Ishikawa charts in machine QA.Materials and MethodsSPC has been applied to recommend QA limits on the particular beam parameters using the QUICKCHECK^webline QA portable constancy check device for 6 MV and 10 MV flattened photon beams from the Elekta Versa HD linear accelerator (Linac). Four machine QA parameters – beam flatness, beam symmetry along gun target direction and left-right direction, and beam quality factor (BQF) – were selected for retrospective analysis. Shewhart charts, Exponentially Weighted Moving Average (EWMA) charts and Cumulative Sum (CUSUM) charts were obtained for each parameter. The root causes for a failure in machine QA were broken down into an Ishikawa diagram enabling the user to identify the root cause of error and rectify the problem subsequently.ResultsShewhart charts and EWMA charts applied could detect loss in control in one variable in the 6 MV beams and in all four variables in 10 MV beams. CUSUM charts detected offsets in the readings. The Ishikawa chart exhaustively included the possible errors that lead to loss of control.ConclusionSPC is proven to be effective for detection of loss in control in machine QA. The Ishikawa chart provides the set of probable root causes of machine error useful while troubleshooting.     

An audit of a hospital-based Doppler ultrasound quality control protocol using a commercial string Doppler phantom

Results from a four-year audit of a Doppler quality assurance (QA) program using a commercially available Doppler string phantom are presented. The suitability of the phantom was firstly determined and modifications were made to improve the reliability and quality of the measurements. QA of Doppler ultrasound equipment is very important as data obtained from these systems is used in patient management. It was found that if the braided-silk filament of the Doppler phantom was exchanged with an O-ring rubber filament and the velocity range below 50 cm/s was avoided for Doppler quality control (QC) measurements, then the maximum velocity accuracy (MVA) error and intrinsic spectral broadening (ISB) results obtained using this device had a repeatability of 18 ± 3.3% and 19 ± 3.5%, respectively. A consistent overestimation of the MVA of between 12% and 56% was found for each of the tested ultrasound systems. Of more concern was the variation of the overestimation within each respective transducer category: MVA errors of the linear, curvilinear and phased array probes were in the range 12.3–20.8%, 32.3–53.8% and 27–40.7%, respectively. There is a dearth of QA data for Doppler ultrasound; it would be beneficial if a multicentre longitudinal study was carried out using the same Doppler ultrasound test object to evaluate sensitivity to deterioration in performance measurements.     

Statistical process control for electron beam monitoring

PurposeTo assess the electron beam monitoring statistical process control (SPC) in linear accelerator (linac) daily quality control. We present a long-term record of our measurements and evaluate which SPC-led conditions are feasible for maintaining control.MethodsWe retrieved our linac beam calibration, symmetry, and flatness daily records for all electron beam energies from January 2008 to December 2013, and retrospectively studied how SPC could have been applied and which of its features could be used in the future. A set of adjustment interventions designed to maintain these parameters under control was also simulated.ResultsAll phase I data was under control. The dose plots were characterized by rising trends followed by steep drops caused by our attempts to re-center the linac beam calibration. Where flatness and symmetry trends were detected they were less-well defined. The process capability ratios ranged from 1.6 to 9.3 at a 2% specification level. Simulated interventions ranged from 2% to 34% of the total number of measurement sessions. We also noted that if prospective SPC had been applied it would have met quality control specifications.ConclusionsSPC can be used to assess the inherent variability of our electron beam monitoring system. It can also indicate whether a process is capable of maintaining electron parameters under control with respect to established specifications by using a daily checking device, but this is not practical unless a method to establish direct feedback from the device to the linac can be devised.     

Comparison of two different EPID-based solutions performing pretreatment quality assurance: 2D portal dosimetry versus 3D forward projection method

PurposeThe aim of this paper is to characterize two different EPID-based solutions for pre-treatment VMAT quality assurance, the 2D portal dosimetry and the 3D projection technique. Their ability to catch the main critical delivery errors was studied.MethodsMeasurements were performed with a linac accelerator equipped with EPID aSi1000, Portal Dose Image Prediction (PDIP), and PerFRACTION softwares. Their performances were studied simulating perturbations of a reference plan through systematic variations in dose values and micromultileaf collimator position. The performance of PDIP, based on 2D forward method, was evaluated calculating gamma passing rate (%GP) between no-error and error-simulated measurements. The impact of errors with PerFRACTION, based on 3D projection technique, was analyzed by calculating the difference between reference and perturbed DVH (%ΔD). Subsequently pre-treatment verification with PerFRACTION was done for 27 patients of different pathologies.ResultsThe sensitivity of PerFRACTION was slightly higher than sensitivity of PDIP, reaching a maximum of 0.9. Specificity was 1 for PerFRACTION and 0.6 for PDIP. The analysis of patients’ DVHs indicated that the mean %ΔD was (1.2 ± 1.9)% for D2%, (0.6 ± 1.7)% for D95% and (−0.0 ± 1.2)% for Dmean of PTV. Regarding OARs, we observed important discrepancies on DVH but that the higher dose variations were in low dose area (<10 Gy).ConclusionsThis study supports the introduction of the new 3D forward projection method for pretreatment QA raising the claim that the visualization of the delivered dose distribution on patient anatomy has major advantages over traditional portal dosimetry QA systems.     

Calibration of 192Ir high dose rate brachytherapy source using different calibration procedures

Aim

To calibrate Ir-192 high dose rate (HDR) brachytherapy source using different calibration methods and to determine the accuracy and suitability of each method for routine calibrations.

Background

The source calibration is an essential part of the quality assurance programme for dosimetry of brachytherapy sources. The clinical use of brachytherapy source requires an independent measurement of the air kerma strength according to the recommendations of medical physics societies.

Materials and methods

The Ir-192 HDR brachytherapy source from Gammamed plus machine (Varian Medical Systems, Palo Alto, CA) was calibrated using three different procedures, one using the well-type ionization chamber, second by the in-air calibration method and third using solid water phantoms. The reference air kerma rate (RAKR) of the source was determined using Deutsche Gesellschaft fur Medizinische Physik (DGMP) recommendations.

Results

The RAKR determined using different calibration methods are in good agreement with the manufacturer stated value. The mean percentage variations of 0.21, −0.94, −0.62 and 0.58 in RAKR values with respect to the manufacturer quoted values were observed with the well-type chamber, in-air calibration, cylindrical phantom and slab phantom measurements, respectively.

Conclusion

Measurements with a well-type chamber are relatively simple to perform. For in-air measurements, the indigenously designed calibration jig provides an accurate positioning of the source and chamber with minimum scatter contribution. The slab phantom system has an advantage that no additional phantom and chamber are required other than those used for external beam therapy dosimetry. All the methods of calibration discussed in this study are effective to be used for routine calibration purposes.     

Characterization of a commercial scintillation detector for 2-D dosimetry in scanned proton and carbon ion beams

IntroductionPencil beam scanning technique used at CNAO requires beam characteristics to be carefully assessed and periodically checked to guarantee patient safety. This study aimed at characterizing the Lynx® detector (IBA Dosimetry) for commissioning and periodic quality assurance (QA) for proton and carbon ion beams, as compared to EBT3 films, currently used for QA checks.Methods and materialsThe Lynx® is a 2-D high-resolution dosimetry system consisting of a scintillating screen coupled with a CCD camera, in a compact light-tight box. The scintillator was preliminarily characterized in terms of short-term stability, linearity with number of particles, image quality and response dependence on iris setting and beam current; Lynx® was then systematically tested against EBT3 films. The detector response dependence on radiation LET was also assessed.ResultsPreliminary results have shown that Lynx is suitable to be used for commissioning and QA checks for proton and carbon ion scanning beams; the cross-check with EBT3 films showed a good agreement between the two detectors, for both single spot and scanned field measurements. The strong LET dependence of the scintillator due to quenching effect makes Lynx® suitable only for relative 2-D dosimetry measurements.ConclusionLynx® appears as a promising tool for commissioning and periodic QA checks for both protons and carbon ion beams. This detector can be used as an alternative of EBT3 films, allowing real-time measurements and analysis, with a significant time sparing.     

Analyzing the performance of ArcCHECK diode array detector for VMAT plan

Aim

The aim of this study is to evaluate performance of ArcCHECK diode array detector for the volumetric modulated arc therapy (VMAT) patient specific quality assurance (QA). VMAT patient specific QA results were correlated with ion chamber measurement. Dose response of the ArcCHECK detector was studied.

Background

VMAT delivery technique improves the dose distribution. It is complex in nature and requires proper QA before its clinical implementation. ArcCHECK is a novel three dimensional dosimetry system.

Materials and methods

Twelve retrospective VMAT plans were calculated on ArcCHECK phantom. Point dose and dose map were measured simultaneously with ion chamber (IC-15) and ArcCHECK diode array detector, respectively. These measurements were compared with their respective TPS calculated values.

Results

The ion chamber measurements are in good agreement with TPS calculated doses. Mean difference between them is 0.50% with standard deviation of 0.51%. Concordance correlation coefficient (CCC) obtained for ion chamber measurements is 0.9996. These results demonstrate a strong correlation between the absolute dose predicted by our TPS and the measured dose. The CCC between ArcCHECK doses and TPS predictions on the CAX was found to be 0.9978. In gamma analysis of dose map, the mean passing rate was 98.53% for 3% dose difference and 3 mm distance to agreement.

Conclusions

The VMAT patient specific QA with an ion chamber and ArcCHECK phantom are consistent with the TPS calculated dose. Statistically good agreement was observed between ArcCHECK measured and TPS calculated. Hence, it can be used for routine VMAT QA.     

Quality assurance of carbon ion and proton beams: A feasibility study for using the 2D MatriXX detector

PurposeThe quality assurance (QA) procedures in particle therapy centers with active beam scanning make extensive use of films, which do not provide immediate results. The purpose of this work is to verify whether the 2D MatriXX detector by IBA Dosimetry has enough sensitivity to replace films in some of the measurements.MethodsMatriXX is a commercial detector composed of 32 × 32 parallel plate ionization chambers designed for pre-treatment dose verification in conventional radiation therapy. The detector and GAFCHROMIC® films were exposed simultaneously to a 131.44 MeV proton and a 221.45 MeV/u carbon-ion therapeutic beam at the CNAO therapy center of Pavia – Italy, and the results were analyzed and compared.ResultsThe sensitivity MatriXX on the beam position, beam width and field flatness was investigated. For the first two quantities, a method for correcting systematic uncertainties, dependent on the beam size, was developed allowing to achieve a position resolution equal to 230 μm for carbon ions and less than 100 μm for protons. The beam size and the field flatness measured using MatriXX were compared with the same quantities measured with the irradiated film, showing a good agreement.ConclusionsThe results indicate that a 2D detector such as MatriXX can be used to measure several parameters of a scanned ion beam quickly and precisely and suggest that the QA would benefit from a new protocol where the MatriXX detector is added to the existing systems.     

Evaluation of the ArcCHECK QA system for IMRT and VMAT verification

The purposes of this study were to perform tests for the ArcCHECK QA system, and to evaluate the suitability of this system for IMRT and VMAT verification. The device was tested for short term reproducibility, dose linearity, dose rate dependence, dose per pulse dependence, field size dependence, out of field dependence and directional dependence. Eight simple plans that each used four beams of different field sizes as well as IMRT and VMAT plans for various organs of 10 patients were measured by ArcCHECK. The phantom data was then compared with ion chamber measurements and planned results. The ArcCHECK diodes performed well for all tests except directional dependence, which varies from a minimum of ?4.9% (seen only when the beam is incident on the diode at 180°) to a maximum of 9.1% (approximately at 105°). For simple plan verification, the absolute dose pass rates of γ index (3%/3 mm) were almost identical. They had an average pass rate of 94.6% ± 1.3% when the field size was ≤20 cm in the X direction (right to left direction), but the pass rate fell rapidly when the field size was >20 cm in the X direction. For all patient-specific IMRT and VMAT QA, the pass rates exceeded 95% and 93%, respectively, and high reproducibility of these results has been observed from week to week. The comparative measurements show that the ArcCHECK QA system is completely suitable for clinical IMRT and VMAT verification.     

Patient-specific tumor and respiratory monitoring phantom design for quality controls of stereotactic ablative body radiotherapy in lung cancer cases

The design, production and adaptability to clinical routine of a patient-specific tumor and respiratory monitoring phantom (TRMP) was investigated using 3D printer technology. TRMP and GTV modelling were done using 4D-CT images of the inhalation phase. The model was converted to STL (Stereolithography) format and printed with STH (Strong Herbal) biopolymer with HU (Hounsfield Unit) suitable for imaging purposes. The assembly of TRMP motorized parts and mechanical equipment has been completed and made suitable for clinical use. In the first part of the study, the deviations of radio-opaque markers attached to the TRMP sternum to perform mechanical quality control tests and T1-7 costal vertebrae in CC, AP, and LAT directions were evaluated. In the second part of the study, in order to evaluate the usability of the TRMP in quality assurance (QA), point dose measurements with BeO OSL dosimetry and EBT3 gafchromic film measurements were taken in Trilogy® radiotherapy accelerator and CyberKnife® robotic radiosurgery accelerator. In this study, we present a highly flexible TMRP capable of performing independent internal and external motions. TRMP was successfully tested in different treatment accelerators, both mechanically and dosimetrically.     

Phantom development for daily checks in electron intraoperative radiotherapy with a mobile linac

PurposeIORT with mobile linear accelerators is a well-established modality where the dose rate and, therefore, the dose per pulse are very high. The constancy of the dosimetric parameters of the accelerator has to be checked daily. The aim of this work is to develop a phantom with embedded detectors to improve both accuracy and efficiency in the daily test of an IORT linac at the surgery room.MethodsThe developed phantom is manufactured with transparent polymethyl methacrylate (PMMA), allocating 6 parallel-plate chambers: a central one to evaluate the on-axis beam output, another on-axis one placed at a fixed depth under the previous one to evaluate the energy constancy and four off-axis chambers to evaluate the flatness and symmetry. To analyse the readings a specific application has been developed.ResultsFor all chambers and energies, the mean saturation and polarization corrections were smaller than 0.7%. The beam is monitored at different levels of the clinical beam. Output, energy constancy and flatness correlate very well with the correspondent values with the complete applicator. During the first six months of clinical use the beam dosimetric parameters showed excellent stability.ConclusionsA phantom has been developed with embedded parallel plate chambers attached to the upper applicator part of an IORT linac. The phantom allows a very efficient setup reducing the time to check the parameters. It provides complete dosimetric information (output, energy and flatness) with just one shot and using ionization chambers with minimum saturation effect, as this highly pulsed beam requires.