Professional Documents
Culture Documents
Tolerance
Non-IMRT IMRT
Source: Klein EE, Hanley J, Bayouth J, et al. Task group 142 Report: Quality assurance of medical accelerators. Med Phys. 200
SRS/SBRT
1 mm
2 mm
1 mm
Functional?
non-IMRT
Dosimetry
X-ray Output Constancy
Electron Output Constancy
Backup Monitor Chamber Constancy
Typical Dose Rate Output Constancy N/A
Photon Beam Profile Constancy
Electron Beam Profile Constancy
Electron Beam Energy Constancy
Safety
Emergency off Switches
Laser guard-interlock test
Latching of wedges, blocking tray
Mechanical
Light / Radiation field Coincidence
Light / Radiation field Coincidence (Asymmetric)
Distance Check device for lasers compared with front pointer
Gantry / Collimator Angle Indicators (digital only)
Accessory Trays (i.e., port film graticule tray) position
Jaw Position indicators (symmetric)
Jaw Position indicators (asymmetric)
Cross-hair centering (walkout)
Treatment couch position indicators 2mm / 1 degree
Wedge placement accuracy
Compensator placement accuracy
Localizing Lasers 2 mm
Respiratory gating
Beam Output Constancy
Phase, amplitude beam control
in-room respiratory monitoring system
Gating interlock
Source: Klein EE, Hanley J, Bayouth J, et al. Task group 142 Report: Quality assurance of medical accelerators. Med Phys. 200
Tolerance
IMRT SRS/SBRT
2%
2%
2%
2% (@ IMRT dose rate) 2% (@ SRS dose rate)
1%
1%
2%, 2mm
Functional: Y/N?
Functional: Y/N?
Functional: Y/N?
2 mm, or 1% on a side
1 mm, or 1% on a side
1 mm
1 degree
2 mm
2 mm
1 mm
1 mm
2mm / 1 degree 1mm / 0.5 degree
2 mm
1 mm
1 mm < 1mm
2%
Functional: Y/N?
Functional: Y/N?
Functional: Y/N?
ce of medical accelerators. Med Phys. 2009; 36(9)4197-4212
Linear Accelerator QA Tolerances - Annual
non-IMRT
Dosimetry
X-ray flatness change from baseline
X-ray symmetry change from baseline
Electron flatness change from baseline
Electron symmetry change from baseline
Spot check of field size dependent output factors for x-rays (for two
or more field sizes)
Safety
Follow manufacturer's test procedures
Respiratory gating
Beam Energy Constancy
Temporal accuracy of Phase/amplitude gate on
Calibration of surrogate for respiratory phase/amplitude
Gating interlock testing
Source: Klein EE, Hanley J, Bayouth J, et al. Task group 142 Report: Quality assurance of medical accelerators. Med Phys. 200
Tolerance
IMRT SRS/SBRT
1%
1%
1%
1%
MU set vs delivered: 1.0
MU or 2% (whichever is
greater)
N/A
1% (absolute)
2% from baseline
1% from baseline
1 mm
2%
5% for 2-4 MU; 2% for > 5% for 2-4 MU; 2%
5MU for > 5MU
2% for > 5MU
2% from baseline
1% from baseline
1% from baseline
1% from baseline
Functional: Y/N?
Functional: Y/N?
2%
100 ms of expected
100 ms of expected
Functional: Y/N?
Monthly
Planar kV imaging
Imaging and treatment coordinate coincidence (4 cardinal angles)
Scaling
Spatial Resolution
Contrast
Uniformity and Noise
Planar kV imaging
Beam quality/energy
Imaging dose
Source: Klein EE, Hanley J, Bayouth J, et al. Task group 142 Report: Quality assurance of medical accelerators. Med Phys. 200
Tolerance
non-SRS/SBRT SRS/SBRT
Tolerance
non-SRS/SBRT SRS/SBRT
< 2 mm < 1 mm
< 2 mm < 2 mm
Baseline Baseline
Baseline Baseline
Baseline Baseline
< 2 mm < 1 mm
< 2 mm < 1 mm
Baseline Baseline
Baseline Baseline
Baseline Baseline
< 2 mm < 1 mm
Baseline Baseline
Baseline Baseline
Baseline Baseline
Baseline Baseline
Tolerance
non-SRS/SBRT SRS/SBRT
5 mm 5 mm
Baseline Baseline
Baseline Baseline
Baseline Baseline
Baseline Baseline
Daily
I/O devices 1 mm
Monthly
Checksum No change
Subset of reference QA test set 2% or 2mm
(when checksums not available)
I/O system 1 mm
Annual
MU Calculations 2%
Reference QA test set 2% or 2mm
I/O system 1 mm
Source: Kutcher GL, Coia L, Gillin M, et al. Comprehensive QA for Radiation Oncology. AAPM Report No. 46.
TG-40. Med Phys. 1994;21(4):581-618. https://doi.org/10.1118/1.597316.
Periodic RTP Process QA Check
Recommended
Frequency Item
Change log
Weekly Digitizer
Hardcopy output
Computer Files
Problem Review
Software Changes
including Operating
System
Fraass B, Doppke K, Hunt M, et al. American Association of Physicists in Medicine Radiation Therapy Committee T
Quality assurance for clinical radiotherapy treatment planning. Med Phys. 1998;25(10):1773-1828.
Source: https://doi.org/10.1118/1.598373.
Comments/Details
Review all hardcopy output, including scaling for plotter and other
graphics-type output.
Verify integrity of all RTP system data files and executables using
checksums or other simple software checks. Checking software
should be provided by the vendor.
Review all RTP problems ~both for RTP system and clinical
treatment planning! and prioritize problems to be resolved.
can Association of Physicists in Medicine Radiation Therapy Committee Task Group 53:
py treatment planning. Med Phys. 1998;25(10):1773-1828.
CT Simulator: Test Specifications QA for Electromechanical Components
Source: Khan FM, Gibbons JP. Khans The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkin
ponents
Tolerance limits
+/- 2mm
+/- 2mm
Manufacturer specifications
luation
Tolerance limits
Manufacturer specification
+/- 1mm
Within +/- 5HU
Daily
Procedure Tolerance
Localizing lasers 2 mm
Distance Indicators 2 mm
Monthly
Procedure Tolerance
Field size Indicator 2 mm
Gantry/Collimator angle Indicators 1 degree
Cross-hair Centering 2 mm diameter
Focal Spot Axis Indicator 2 mm
Fluoroscopic Image Quality baseline
Emergency/Collision Avoidance Functional
Light/RadiationField Coincidence 2 mm or 1%
Film Processor Sensitometry Baseline
Annually
Procedure Tolerance
Mechanical Checks
Collimator rotation isocenter 2 mm diameter
Gantry rotation isocenter 2 mm diameter
Couch rotation isocenter 2 mm diameter
Coincidence of radiation and mechanical isocenter 2 mm diameter
Table top sag 2 mm
Vertical travel of Couch 2 mm
Radiographic Checks
Exposure rate Baseline
Table-top Exposure with Fluoroscopy Baseline
kVp and mAs Calibration Baseline
High & Low Contrast Resolution Baseline
Khan FM, Gibbons JP. Khans The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014:396-398.
Source:
Multileaf Collimation QA
Frequency Test
Quarterly Setting vs. light field vs. radiation field for two
designated patterns
Check of Interlocks
Source: Khan FM, Gibbons JP. Khan's The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2014:396-398.
Tolerance
2 mm
Expected Field
Physician's discretion
Physician's discretion
1 mm
1 mm
Procedure End-point
Procedure End-point
Evaluate spacing and Ribbon geometry and seed quantity
number of seeds/ ribbon
Nath R, Anderson LL, Meli JA, et al. Code of practice for brachytherapy physics: Report of the AAPM
Source: Radiation Therapy Committee Task Group No. 56. Med Phys. 1997;24(10):1557-1598.
https://doi.org/10.1118/1.597966.
Frequency
Initially
Initially
Initially, Annually
Initially
Initially, Annually
Initially, Annually
Quarterly
As needed
Frequency
Initially
Initially
Initially, Annually
Initially, Annually
Quarterly
Quarterly
Quarterly
Test Frequency
Room safety door interlocks, lights, and alarms Each treatment day
Source positioning
Calibration
At each source change
or quarterly
Timer Function
Source: Kutcher GL, Coia L, Gillin M, et al. Comprehensive QA for Radiation Oncology. AAPM Report No.
46. TG-40. Med Phys. 1994;21(4):581-618. https://doi.org/10.1118/1.597316.
Tolerance
Documented
Documented
Documented
1 mm
3%
5%, Documented
A*
Documented
Documented
3%
5%
V**
rapy physics: Report of the
s. 1997;24(10):1557-1598.
Tolerance
Functional
Functional
Autoradiograph
1 mm
1 mm
3%
1%
Source: Klein EE, Hanley J, Bayouth J, et al. Task group 142 Report: Quality assurance of medical accelerators. Me
Virtual
5% from unity,
otherwise 2%
Check of off-center
ratios @ 80% field
width @ 10 cm to be
within 2%