Plan checking and Verification
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This survey is about plan checking and verification and should take about 10 minutes to complete.

Most questions are just a matter of ticking boxes, however if there is not a appropriate answer for your department please add any additional information in text box below

This first question is about the purpose of the Physicist's Plan Review/Check.
Answer
'Yes' if checked by physics,
'No' if not checked at all
If checked by another profession select Dosimetrist, Radiation Therapist or Clinician as appropriate.

1. What is checked as part of a physics plan check/review?

	Yes	No	Dosimetrist	Clinician	Radiation Therapist
Plan has been review by physician and approval/ signature in place as per departmental protocol	*What is checked as part of a physics plan check/review? Plan has been review by physician and approval/ signature in place as per departmental protocol Yes	Plan has been review by physician and approval/ signature in place as per departmental protocol No	Plan has been review by physician and approval/ signature in place as per departmental protocol Dosimetrist	Plan has been review by physician and approval/ signature in place as per departmental protocol Clinician	Plan has been review by physician and approval/ signature in place as per departmental protocol Radiation Therapist
Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription	Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription Yes	Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription No	Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription Dosimetrist	Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription Clinician	Plan agrees with the approved prescription i.e. dose, beam energy, fractionation and dose point location are consistent with physicians intended prescription Radiation Therapist
That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable	That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable Yes	That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable No	That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable Dosimetrist	That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable Clinician	That the intended treatment is appropriate based on the patient's medical history and the plan is clinically reasonable Radiation Therapist
Patient details; e.g. ID, DOB	Patient details; e.g. ID, DOB Yes	Patient details; e.g. ID, DOB No	Patient details; e.g. ID, DOB Dosimetrist	Patient details; e.g. ID, DOB Clinician	Patient details; e.g. ID, DOB Radiation Therapist
Contouring of targets and OARs	Contouring of targets and OARs Yes	Contouring of targets and OARs No	Contouring of targets and OARs Dosimetrist	Contouring of targets and OARs Clinician	Contouring of targets and OARs Radiation Therapist
ROI margins	ROI margins Yes	ROI margins No	ROI margins Dosimetrist	ROI margins Clinician	ROI margins Radiation Therapist
The quality of the plan meets department standards	The quality of the plan meets department standards Yes	The quality of the plan meets department standards No	The quality of the plan meets department standards Dosimetrist	The quality of the plan meets department standards Clinician	The quality of the plan meets department standards Radiation Therapist
Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus	Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus Yes	Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus No	Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus Dosimetrist	Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus Clinician	Appropriateness of plan; e.g. beam energy, gantry angles, beam weighting, use of bolus Radiation Therapist
Dose distribution	Dose distribution Yes	Dose distribution No	Dose distribution Dosimetrist	Dose distribution Clinician	Dose distribution Radiation Therapist
Coverage of target volumes	Coverage of target volumes Yes	Coverage of target volumes No	Coverage of target volumes Dosimetrist	Coverage of target volumes Clinician	Coverage of target volumes Radiation Therapist
Dose to OARs	Dose to OARs Yes	Dose to OARs No	Dose to OARs Dosimetrist	Dose to OARs Clinician	Dose to OARs Radiation Therapist
Appropriate algorithm used	Appropriate algorithm used Yes	Appropriate algorithm used No	Appropriate algorithm used Dosimetrist	Appropriate algorithm used Clinician	Appropriate algorithm used Radiation Therapist
Appropriateness of calculation point / dose specification point/ normalisation point	Appropriateness of calculation point / dose specification point/ normalisation point Yes	Appropriateness of calculation point / dose specification point/ normalisation point No	Appropriateness of calculation point / dose specification point/ normalisation point Dosimetrist	Appropriateness of calculation point / dose specification point/ normalisation point Clinician	Appropriateness of calculation point / dose specification point/ normalisation point Radiation Therapist
Independent Monitor Unit Verification	Independent Monitor Unit Verification Yes	Independent Monitor Unit Verification No	Independent Monitor Unit Verification Dosimetrist	Independent Monitor Unit Verification Clinician	Independent Monitor Unit Verification Radiation Therapist
Correct application of correction factors (e.g. couch correction, trays, cut-outs)	Correct application of correction factors (e.g. couch correction, trays, cut-outs) Yes	Correct application of correction factors (e.g. couch correction, trays, cut-outs) No	Correct application of correction factors (e.g. couch correction, trays, cut-outs) Dosimetrist	Correct application of correction factors (e.g. couch correction, trays, cut-outs) Clinician	Correct application of correction factors (e.g. couch correction, trays, cut-outs) Radiation Therapist
Verification of radiological depth	Verification of radiological depth Yes	Verification of radiological depth No	Verification of radiological depth Dosimetrist	Verification of radiological depth Clinician	Verification of radiological depth Radiation Therapist
Data Transfer from TPS to R&V/treatment machine	Data Transfer from TPS to R&V/treatment machine Yes	Data Transfer from TPS to R&V/treatment machine No	Data Transfer from TPS to R&V/treatment machine Dosimetrist	Data Transfer from TPS to R&V/treatment machine Clinician	Data Transfer from TPS to R&V/treatment machine Radiation Therapist
Patient set up information	Patient set up information Yes	Patient set up information No	Patient set up information Dosimetrist	Patient set up information Clinician	Patient set up information Radiation Therapist
Verification of MLC shape/Blocks	Verification of MLC shape/Blocks Yes	Verification of MLC shape/Blocks No	Verification of MLC shape/Blocks Dosimetrist	Verification of MLC shape/Blocks Clinician	Verification of MLC shape/Blocks Radiation Therapist
Reference DRR or IGRT baseline image	Reference DRR or IGRT baseline image Yes	Reference DRR or IGRT baseline image No	Reference DRR or IGRT baseline image Dosimetrist	Reference DRR or IGRT baseline image Clinician	Reference DRR or IGRT baseline image Radiation Therapist
Invivo dosimetry information	Invivo dosimetry information Yes	Invivo dosimetry information No	Invivo dosimetry information Dosimetrist	Invivo dosimetry information Clinician	Invivo dosimetry information Radiation Therapist

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