Acta Oncologica, 2009; 48: 192
200

ORIGINAL ARTICLE

A beam-matching concept for medical linear accelerators

DAVID SJÖSTRÖM, ULF BJELKENGREN, WIVIANN OTTOSSON &

CLAUS F. BEHRENS
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Copenhagen University Hospital, Department of Oncology (R), Division of Radiophysics (51AA), Herlev, Denmark

Abstract
The flexibility in radiotherapy can be improved if a patient can be moved between any one of the department’s medical
linear accelerators without the need to change anything in the patient’s treatment plan. For this to be possible, the
dosimetric characteristics of the various accelerators must be the same, or nearly the same i.e. the accelerators must be
beam-matched.
During a period of nine months, eight Varian iX accelerators with 6 and 15 MV photon beams and 6
18 MeV electron
beams (only four of the eight) were installed at our clinic. All accelerators fulfilled the vendor-defined ‘‘fine beam-match’’
criteria, and a more extensive set of measurements was carried out during commissioning. The measured absorbed dose
data for each accelerator were compared with the first accelerator, chosen as reference, and the TPS calculations.
For personal use only.

Two of the eight accelerators showed a larger discrepancy for the 15 MV beam not revealed by the vendor-defined
acceptance criteria, whereas the other six accelerators were satisfactorily matched. The beam-matching acceptance criteria
defined by the vendor are not strict enough to guarantee optimal beam-match. Deviations related to dose calculations and to
beam-matched accelerators may add up. The safest and most practical way to ensure that all accelerators are within clinical
acceptable accuracy is to include TPS calculations in the evaluation. Further, comparisons between measurements and
calculations should be done in absolute dose terms.

The success of curative intended radiation therapy
largely depends on the ability to deliver the pre-
scribed dose to the patient within a narrow toler-
ance. A 5% difference in the delivered dose may
result in changes in the order of 10
20% in tumor
control probability and 20
30% in normal tissue
complication probability [1]. Thus, there is a need
for accurate treatment planning and delivery. This
imposes narrow tolerance limits on all links in the
treatment chain from planning to delivery, including
imaging and structure delineation, absorbed dose
measurements and calculations, treatment machine
performance, and patient setup. Several publications
present recommendations for such tolerance levels
[e.g. 2
5]. Ahnesjö et al. [6] estimates that with the
present techniques the uncertainty of the dose
delivered to the patient is 3.9% (1 SD) excluding
uncertainty related to dose calculation. Thus, if the
uncertainty in dose calculation is between 1.0 and
5.0% (1 SD) the total uncertainty in the dose
delivered to the patient will be between 4.0 and
6.3% (1 SD) [6]. Wambersie [7] and Mijnheer et al.
[8] recommend a total uncertainty limit of 3.5%
(1 SD) for the dose prescription point although 5%
(1SD) is considered more appropriate for other
points in the planning target volume [7]. Often cited
is the ICRU 24 [2]95% accuracy requirement that
can be interpreted as an action level [6] or as 1.5 SD
[9,10]. These recommendations on uncertainty
limits and estimations of what can be achieved
demonstrate that there is not much room for
inaccurate dose calculations. Efforts must be made
to reduce the uncertainty of every link in the
treatment chain from planning to delivery.
Treatment flexibility and efficiency of a radio-
therapy department are very important, and can be
greatly improved if several linear accelerators (linacs)
can be considered dosimetrically identical and
patients can be treated using any linac without the
need to adjust the treatment plans. In order to make
this possible, the dosimetric characteristics of the
various accelerators must be the same, or nearly the

Correspondence: David Sjöström, Copenhagen University Hospital, Herlev, Department of Oncology (R), Division of Radiophysics (51AA), Herlev Ringvej
75, DK-2730 Herlev, Denmark. Tel: 45 44 88 31 62. Fax: 45 44 88 31 10. E-mail: davsjo01@heh.regionh.dk

(Received 20 May 2008; accepted 4 June 2008)

ISSN 0284-186X print/ISSN 1651-226X online # 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS)
DOI: 10.1080/02841860802258794
 Beam matching concept 193

same i.e. the accelerators must be beam-matched.
Beam-match results for Varian accelerators have
previously been presented e.g. [11,12]. In addition
to beam-matched accelerators only one set of data
representing all the accelerators needs to be imple-
mented in the treatment planning system (TPS).
Due to the strict requirements on accuracy in
radiotherapy, the following two questions arises: Is it
possible to beam-match several medical accelerators
to such a degree that they can be acceptably
represented by only one set of data in the TPS? If
so, how should this be undertaken? The aim of this
study is to address these two questions using the
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vendor-defined ‘‘fine beam-matching’’ option
[11,14]. The beam-matching criteria are based on
depth ionization curves as well as inline and crossline
profiles measured in the vendor-defined prescribed
geometry. During the CAP of the accelerators, all
the vendor-defined criteria were fulfilled. Even if the
measurements were within the vendor-defined cri-
teria adjustments were made to improve the match
between each accelerator and the first accelerator,
chosen as a reference during the CAP. Primarily
adjustments were made to make both the photon
and electron profiles as symmetrical as possible, but
for some of the photon and electron beams it was

commissioning data obtained from eight newly

installed accelerators.
Material and methods
During a period of about nine months, eight Varian
2300 iX (Varian Medical Systems, Inc., Palo Alto,
CA, USA) linacs were installed at our clinic. The
linacs have two photon beams of nominal energies
6 and 15 MV and four of the eight linacs have
electron beams with nominal energies 6, 9, 12, 15,
and 18 MeV. The beam-matching procedure is
For personal use only.
necessary to tune the energy in order to improve the
match of the depth dose curves. Following the CAP
more extensive commissioning measurements were
undertaken (Tables I, II) in view of the fact that; (i)
the vendor-defined criteria does not consider full
profiles or depth dose curves to evaluate the quality
of beam-matching but instead only some points on
the curves, (ii) all vendor-specified measurements
for both electrons and photons are done with an
ionization chamber and there is no or incorrect
ionization chamber offset, (iii) the vendor-defined

described in detail in the vendor Customer Accep- criteria are limited to only a few parameters for a
tance Procedure (CAP) manual [13] and the vendor limited set of beam geometries, (iv) the beam-
accelerator specifications [14] and also by Hrbacek matching criteria do not include output factors and
et al. [11]. The accelerators were purchased with the therefore a risk of good agreement solely due to

Table I. Measurements carried out for photons.

Geometry

Measurements Equipment FSD [cm] Depth [cm] Field size [cm2]

Absolute dosimetry Farmer chamber NE2571***, electrometer 100 10 10

NE2570/1***, 41023 water fantom**
TPR2010 CC13 ionization chamber*, Blue phantom*, 100
10
OmniPro Accept v.6.5A*
Output factors (OF) open Waterproof farmer chamber 30006**, Unidos 90 10 5, 8, 10, 15, 20,
fields in water electrometer**, Blue phantom* 30, 40
Depth dose open fields CC13 ion chamber*, Blue phantom* OmniPro 90
5, 8, 10, 15, 20,
Accept v.6.5A* 30, 40
Inline and crossline Photon diode PFD-36*, Blue phantom*, and 90 10 10, 40
profiles open fields OmniPro Accept v.6.5A*
2D distribution open Seven29**, water-equivalent RW3 slab 100 5, 10, 15 5, 10, 15, 20
fields phantom**, Verisoft**
2D distribution EDW30 Seven29**, water-equivalent RW3 slab 100 5, 10, 15 5, 10, 15, 20
phantom**, Verisoft**
2D distribution EDW45 Seven29**, water-equivalent RW3 slab 100 5, 10, 15 5, 10, 15, 20
phantom**, Verisoft**
2D distribution EDW60 Seven29**, water-equivalent RW3 slab 100 5, 10, 15 5, 10, 15, 20
phantom**, Verisoft**
Head scatter factors Farmer chamber FC65-P* with brass buildup cap, 98,55/98.17 for Brass****: 0.25/0.63 2-10(step 1), 13,
(HSc) Unidos electrometer**, in air measurements 6/15 MV **** for 6/15 MV 15-40(step 5)

*IBA Dosimetry, AB, Uppsala, Sweden.

**PTW, Freiburg, Germany.
***Nuclear Enterprises, Beenham, Reading, England.
****Effective point of measurement at the isocenter, brass buildup cap different for 6 and 15 MV.
 194 D. Sjöström et al.
Table II. Measurements carried out for electrons.
Measurements Equipment
Absolute dosimetry Roos ionization chamber TW34001**,
Unidos electrometer**, 41023 water
fantom**
Output factors Electron diode EFD-36*, Blue phantom*
Depth dose Electron diode EFD-36*, Blue phantom*,
OmniPro Accept v.6.5A*
Inline and crossline profiles Electron diode EFD-36*, Blue phantom*,
OmniPro Accept v.6.5A*
*IBA Dosimetry, AB, Uppsala, Sweden.
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**PTW, Freiburg, Germany.
normalization may exist, (v) only open static fields
are included in the CAP.
To ensure that the beam-matching was clinically
acceptable for photons the commissioning measure-
ments were compared with the TPS, Eclipse
8.0 (Varian Medical Systems), pencil beam algo-
rithm (PBC) calculations. Furthermore, all data
were compared in absolute terms, i.e. depth dose
curves and profiles for both open and wedged beams
were not relatively normalized to the same value at a
For personal use only.
specific point but to the output factors for each
individual accelerator. The 2D array measurements
were normalized by defining a calibration factor for
each depth for the open 10 10 cm2 field size that
gave the same value as the reference conditions i.e.
measurements in water. In that way, any possible
differences in attenuation between the solid water
and the water were eliminated. Three of the linacs
were prepared and used for IMRT treatments and as
a further test of the beam-matching the same IMRT
plans were delivered with these accelerators, mea-
sured with the 2D array and compared with TPS
calculation.
The input data for the TPS were obtained from
the first accelerator, and in the TPS only one set of
data is used to represent all accelerators. The
commissioning of the TPS will not be described in
detail in this paper.
All electron beam treatment plans utilized at our
clinic today are calculated manually using the output
factors and depth dose curves and without sophis-
ticated calculation algorithms such as TPS calcula-
tions. Hence, the commissioning measurements
were not compared with TPS calculations but
instead with the average of the measured values for
all four accelerators. The reference depth (zref) used
for absolute calibration and output factor measure-
ments is defined in IAEA TRS 398 [15] and the
same zref was used for all linacs. The reference depth
for 6, 9, 12, 15, and 18 MeV are 13.9, 21.2, 29.8,
37.4 and 45.0 mm, respectively. On the basis of the
Geometry
FSD [cm] Depth [cm] Applicator [cm2]
100 Zref 10
100 Zref 6, 10, 15, 20, 25
100
6, 10, 15, 20, 25
100 zref 6, 10, 15, 20, 25
output factors at zref and the depth dose curves the
output at dose maximum (dmax) can be calculated.
Other parameters such as the 85% depth (R85) and
the 50% depth (R50) can also be extracted from the
depth dose curves.
Isodose plots for IMRT were taken directly from
Verisoft version 3.1 (PTW, Freiburg, Germany) as
screen dumps. All other figures were created in
Matlab R2006a. TPS calculations were exported as
DICOM and imported in Matlab using functional-
ities in the Matlab Image Processing Toolbox and
Emiliano Spezis DICOM
RT toolbox [16]. 2D
array measurements were saved as bitmap files in
Verisoft and depth dose and profile measurements
were converted to and saved as ASCII files in
OmniPro Accept (IBA Dosimetry, AB, Uppsala,
Sweden) and imported into Matlab.
Results
Photons
All results are output factor normalized using the
calibration geometry for each specific beam energy.
Hence, the normalization retains all absolute dose
properties and avoids any ambiguities related to
normalization. The calibration geometry used is a
10 10 cm2 field, FSD 100 cm at depth 10 cm for
both the 6 and 15 MV beam. The TPR20,10 and the
percentage depth dose at 10 cm depth (PDD10) vary
slightly between the accelerators for the calibration
geometry. For both the 6 and 15 MV beam the mean
values BPDD10 and BTPR20,10 of all eight
accelerators are used for absolute dose calibration.
The mean values were also used as reference for the
output factor normalization. For the 6 MV beam the
mean values and intervals ([min;max]) are:
BPDD1066.3%, [66.2;66.4]% and BTPR2010
0.669, [0.666; 0.670]. For the 15 MV beam the
corresponding numbers are BPDD10 76.5%,

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Figure 1. Head scatter factors (HSc) and output factors in water
(OF) versus field size for 15 MV photon beams.
[76.3;76.7]% and BTPR2010  0.762, [0.760;
0.763].
For accelerators no. 1 to 6, the measured output
factors (OF) are within 0.2% of the mean
For personal use only.
Figure 2. The deviations between measured and TPS calculated depth dose data for each individual accelerator for the 5 5 and 4040
cm2 field size for the 6 MV and 15 MV open beams. The solid (thin) lines represent accelerator 1
6 and the dotted (thick) lines represent
accelerator 7
8.
Beam matching concept 195
(BOF 1
6). Accelerators 7 and 8 are the most
recently installed and not yet taken into clinical use.
Larger discrepancies for these two accelerators are
found for the 15 MV beam ranging from 7 1.2%
to 0.9% relative to BOF 1
6 for field size 5 5
cm2 and 30 30 cm2, respectively (Figure 1). The
discrepancies in OF between these two accelerators
and the rest reflect a difference in head scatter
(Figure 1). Further investigations into the cause and
possible solution to the problem remains and will be
undertaken in the near future. Based on a pre-
liminary analysis of the data for accelerator 7 and 8,
however, we expect the results presented bellow to
apply also to these two accelerators except where
explicit noted.
The relative depth dose data for the various
accelerators are within 1%, when the measured
output factors for the different accelerators are
ignored. Larger systematic deviations are noticed in
the comparison between the measured and calcu-
lated depth dose data, owing to the differences in
calculated and measured OF (Figure 2). The largest
 196 D. Sjöström et al.
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Figure 3. Comparison between measured and calculated dose profiles at 10 cm depth for 6 and 15 MV open field. The lines correspond to
the result of a g2%,2mm evaluation between the measured and calculated dose profiles for each accelerator. The solid (thin) lines represent
accelerator 1
6 and the dotted (thick) lines represent accelerator 7
8.
For personal use only.
deviation found is for 15 MV 55 cm2 field size for
accelerator 7 and 8, where the measured output
factor are around 2% lower than the calculated
(Figure 2). For field sizes larger than 10 10 cm2,
the measured output factors increase for accelerators
7 and 8 relative to the other accelerators, resulting in
slightly better agreement with the TPS calculations
for these accelerators. Except for 15 MV 5 5 cm2
field size, all points in the output factor normalized
depth dose data beyond the depth of dmax are within
92% compared with the TPS calculations. The
percentage deviations are larger at shallower depths.
However, all data points for all field sizes and depths
for all accelerators for both the 6 and 15 MV beams
pass a 2%/2 mm gamma evaluation criteria, i.e.
g2%,2mm 51.
In most cases, the result of a gamma evaluation
between measured and calculated profiles for open
beams along the major axes (gun-target and A
B:
perpendicular to and crossing the central axis) pass
the g2%,2mm. However, close to the field edges for
larger field sizes only some of the accelerators pass
the criteria (Figure 3). The comparison of relative
dose profile measurements from one accelerator with
another, normalized to 100% at the central axis
show that the profiles generally are within 1% except
for larger field sizes close to the field edges were the
largest deviation between two accelerators generally
are around 1.5% for both the 6 and 15 MV beams.
Comparing the measured and calculated 2D dose
distribution for open beams the 6 MV does not fulfill
the g2%,2mm for all accelerators for 15 15 cm2 nor a
g3%,2mm for the 20 20 cm2 field size. Only data
points that are off-axis fail. Along the major axes
data agree well with the results of measurements in
water. A comparison between the 2D measurements
and calculated 2D dose distribution for the 15 MV
open beams reveal a better result since all the
accelerators pass g3%,2mm and only a few points for
two accelerators for the 20x20 cm2 field size fail
g2%,2mm for all depths.
The penumbra (20%
80%) for the eight accel-
erators were determined from the measured profiles
for the 10 10 cm2 field size. For the 6 MV beams the
values are 4.490.4 mm for the upper jaws and 3.89
0.2 mm for the lower jaws. For 15 MV the corre-
sponding values are 5.390.3 mm and 4.990.3 mm.
For wedged beams, the deviations among the
accelerators are larger than for open beams. The
measured data are generally within 2
3% for both
the 6 MV and the 15 MV beams (Figure 4B, D). For
the 608 enhanced dynamic wedge (EDW60), 6 MV
beams, 15 15 and 20 20 cm2 field sizes, most of
the accelerators fail g3%,3mm in both the low and the
high dose region (Figure 4A) when compared to the
TPS calculations. Agreement is better for smaller
wedge angles and smaller field sizes. For 15 MV, all
the accelerators pass g3%,3mm for 15 15 cm2 field
size or smaller but fail in the low dose region for the
20 20 cm2 field size (Figure 4C).
The comparison of a measured and a calculated
dynamic IMRT field for three accelerators is
 Beam matching concept 197
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For personal use only.

Figure 4. Comparison between measured and calculated 2D absorbed dose distributions for the EDW60 beams at 10 cm depth for the 6
MV and 15 MV beams. Each square (I) in A and C corresponds to one of the 729 ionization chambers in the 2D array. The numbers
within the squares correspond to the number of accelerators that fails the g3%,3mm for that specific chamber. The dotted line indicates the
field size. The percentage deviations between the measured and calculated dose distributions along the arrows in A and C, i.e. in the wedge
direction at the center of the beam, are presented in B and D, respectively.

presented in Figure 5. Both the profile (Figure 5B) Electrons

and the 2D dose distribution (Figure 5A) demon-
strate that measurements and the calculation agree
well and that the accelerators are well matched.
The g3%,3mm fail at exactly the same point in the
high dose region for the three accelerators. Two
additional points fail for accelerator 1 as compared
to accelerator 2 and 3 in the lower dose area
(Figure 5A). However, the dose in this area
corresponds to about 5% of the maximum and
the measurements are therefore very sensitive.
The largest deviation (MR85, MR50) is 0.7 mm for all
electron energies and applicators when comparing
the depth of the 85% (R85) and the depth of the 50%
dose (R50) with the mean value (Table III). Also the
output factors at dmax are in good agreement. The
largest deviation of OF between any two accelerators
is about 1% and compared to the mean OF the largest
deviation (MOF) is 0.6% (Table III). In addition, the
profiles agree within a clinically acceptable level.
 198 D. Sjöström et al.

Table III. The maximum deviation (MR50, MR85, and MOF) between the individual values for R50, R85 and output factors (OF) for all accelerators compared to the mean value of the four

BOF

0.932
1.006

0.965

0.950

0.942
MOF
[%]

0.3
0.5

90.4

0.4

0.4
[]
BR85 
[mm]

[mm]

52.5

61.4
20.4

30.6

42.5
90.3

0.3
0.6

90.4

0.6
MR85
255

BR50 
[mm]

[mm]

0.7

90.4

0.6

90.3

90.3
25.1

37.2

51.4

64.0

76.9
MR50

BOF

1.010

0.984

0.977

0.973

0.962
MOF
[%]

0.3

90.1

0.4

90.3

90.2
[]
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BR85 
[mm]

[mm]

61.0
20.4

30.4

42.3

52.0
0.1
90.3

90.1

0.1

90.1
MR85
2020

BR50 
[mm]

[mm]

90.1

0.1
0.4

0.2

90.2

63.6

76.6
25.0

37.0

51.2
MR50

BOF

1.000

0.997

0.994

0.989

0.982
MOF
[%]

0.2

90.1

0.2

0.3

0.3
[]
Applicator size [cmcm]
For personal use only.

BR85 
[mm]

[mm]

0.2

90.1

0.2

0.3

0.2
20.1

30.5

42.4

52.4

61.1
MR85
1515

Figure 5. Comparison between measured and calculated 2D dose

distributions for an 15 MV IMRT field for three different
accelerators measured at 5.5 cm depth and SSD94.5 cm. The BR50 
[mm]

[mm]

76.6
24.8

37.1

51.3

63.9
0.2
0.3

90.1

0.2

0.4
MR50

squares (I) in A corresponds to ionization chambers in the 2D

array that fails g3%,3mm. Solid and dashed lines in A corresponds
to the measured and calculated data, respectively. The calculated
and the measured dose profiles along arrows in A, perpendicular
MOF [%]

BOF

1.000

1.000
1.000

1.000

1.000
to the MLC, are presented in B.
[]

Better agreement is generally found for smaller
applicators (Figure 6). The largest deviation between
BR85 
[mm]

[mm]
MR85

90.2

90.1

0.2

90.3

0.3
20.2

30.4

42.3

52.2

60.7
1010

profiles for any of two accelerators is less than 2%, and

the agreement is generally within 1% for applicators
smaller than 20 20 cm2.
BR50 
[mm]

[mm]

24.8

37.0

51.2

63.8

76.4
0.3

90.1

0.3

90.3

0.1
MR50

Discussion
accelerators (BR50, BR85 , and BOF).

We conclude that all photon and electron beams,

BOF

0.970

0.984

0.980

0.985

0.997
MOF

except the 15 MV photon beam from accelerators

[%]

90.5

90.1

90.1

0.6

0.3
[]

no. 7 and 8, can be represented by one set of data.

For 15 MV it might be necessary to implement an
BR85 

additional set of data in the TPS to represent the two

[mm]

[mm]

0.4

0.3

90.3

90.5

0.4
20.3

30.3

41.9

50.7

57.1
MR85
6 6

deviant accelerators. To ensure a satisfactory beam-

match the dose prediction (e.g. TPS calculations)
must be adopted in the beam-matching procedure.
BR50 

Further, comparisons between measurements and

[mm]

[mm]

24.9

36.8

51.1

63.1

74.8
0.6

90.3
0.5

0.3

0.5
MR50

calculations should be done in absolute dose terms.

The beam-matching performed during the CAP
far from ensures that the linacs are matched to a
[MeV]

clinically acceptable degree. The discrepancy in

12

15

18
E

measured OF for accelerators no. 7 and 8 compared

6

9

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Figure 6. 12 MeV electron beam inline profiles from four linacs.
Profiles are at zref for the 66, 1010, 1515, 2020, and
2525 cm2 applicators. The profiles were first normalized to
100% at the central axis (CAX) then multiplied by the output
factors. The curves are separated by shifting the 66, 1010,
1515, 2020, and 2525 cm2 applicator and the difference at
the CAX for one applicator corresponds to the difference in
output factors between the different linacs.
to the other accelerators is one example proving this.
For personal use only.
These two accelerators passed all tests in the CAP
and showed results similar to all other accelerators.
This illustrates that even if all relative comparisons,
e.g. during the acceptance procedure, indicate a
high-quality beam-match the result might turn
out to be unacceptable when compared in absolute
dose terms. Since the discrepancies in OF between
accelerator no.7 and 8 and the other six are evident
only for 15 MV our hypothesis is that this is due to a
difference in the flattening filter.
A systematic deviation between TPS calculations
and measurements is caused by a difference in the
measured and calculated OF (Figure 2). However,
this was expected. The OF was measured for FSD  uncertainties add up. Therefore we advocate for the
90 cm, at 10 cm depth. If isocentric OF is used as
input to Eclipse the deviation between the calculated
and measured dose for the calibration geometry
(FSD 100, 10 cm depth) will be around 0.5%.
According to personal communication with the
vendor, zero deviation for the calibration geometry
can only be achieved if Eclipse OF are defined at dmax
for FSD 100 cm. Several possibilities exist to over-
come the discrepancy. The OF can be found at dmax
by direct measurements or calculations. The OF can
be manually adjusted in the TPS until the match is
improved. Alternatively, the calibration of the accel-
erators can be changed to minimize the difference.
Since we will implement the Eclipse AAA calculation
algorithm in the near future we expect to do neither.
Larger differences among the linacs for the
measured profiles were observed for EDW60 beams
Beam matching concept 199
than for open beams. The EDW delivery is more
complicated than open beam delivery and the EDW
beam profiles are more likely to be influenced by
variations in beam spectrum and jaw calibration
than open beams. Thus, slight difference in jaw
calibration may cause some of the differences seen
between the linacs for EDW delivery. However, any
difference in jaw calibration between the accelerators
used in this study reflects what one can expect in
clinical practice since all jaws were well calibrated.
All electron beams utilized at our clinic today are
calculated manually. In practice, the profiles are not
used directly for selecting an applicator or insert
although the necessary margins needed to achieve
full coverage laterally are considered. The measure-
ments for electrons reveals deviations smaller than
1% in OF and 1 mm in depth compared to the
mean values of all accelerators. If more sophisti-
cated treatment planning calculations are used to
predict the dose, e.g. the Eclipse Electron Monte
Carlo calculation algorithm, the matching of elec-
tron profiles with TPS calculations might be a
matter of concern.
One approach to ensure a satisfactory beam-
match could be to use one set of beam data from
one linear accelerator as a reference. The other
linac(s) should then be matched to this data set as
closely as possible and within certain tolerance
levels. However, it is equally important that the
TPS calculated dose closely resembles the delivered
dose from all accelerators. When one accelerator is
used as a reference there is a risk that another
accelerator will be considered well matched while it
does not fulfill the requirements in terms of accuracy
when compared with the TPS. For instance, if the
TPS predicts a slightly higher dose than delivered
by the reference linac and the other linac delivers a
dose slightly lower than the reference linac, the two
approach to include the TPS calculations in the
beam-matching procedure as presented in this work.
In future QA procedures, we recommend using
the TPS as reference. If the QA procedures reveal
deviations that are too large to be ignored the
procedure is to adjust the accelerator to fit the
TPS instead of vice versa. Obviously, also compar-
isons between the different accelerators can be
included in the QA procedures but either much
narrower tolerance levels must be applied or a direct
comparison with the TPS is needed in order to
ensure that the deviations between calculated and
delivered dose stay within acceptable limits.
Declaration of interest: The authors report no
conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
 200 D. Sjöström et al.
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