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Task Group 142 report: Quality assurance of medical accelerators

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Preface'to'the'Japanese'translation'of'AAPM'TG5142'Report'!In!2007!the!Radiation!Therapy!Committee!of!the!American!Association!of!Physicists!in!Medicine!improved!the!formulation!and!initiation!of!a!task!group!on!the!quality!assurance!of!medical!accelerators,!later!known!as!TGD142.!!The!charges!of!this!task!group!were!to!update,!as!needed,!recommendations!from!Table!II!of!the!AAPM!TGD40!Report!on!quality!assurance,!and!in!addition!recommendations!for!asymmetric!jaws,!multiDcollimation!and!Dynamic/Virtual!Wedges.!!The!composition!of!the!task!group!membership!included:!!Eric!Klein,!as!the!chair;!Chihray!Liu;!Chris!Serago;!Joseph!Hanley;!Lijun!Ma;!Bijan!Arjomandy;!Sean!Dresser;!Francisco!Aguirre;!John!Bayouth;!FangDFang!Yin;!William!Simon,!with!consultants!from!Elekta,!and!Varian.!!This!composition!was!important,!as!all!accelerator!manufacturers!users!were!included,!along!with!both!academic!and!community!hospital!physicists.!!The!task!group!had!a!deadline!of!2009!to!complete!the!report,!which!was!met!and!subsequent!publication!was!September,!2009!in!the!Journal!of!Medical!Physics.!!The!task!group!(TG)!for!quality!assurance!of!medical!accelerators!was!constituted!by!the!American!Association!of!Physicists!in!Medicine’s!Science!Council,!under!the!direction!of!the!Radiation!Therapy!Committee!and!the!Quality!Assurance!and!Outcome!Improvement!Subcommittee.!!The!task!group!(TG!#142)!had!two!main!charges.!!First!to!update,!as!needed,!recommendation!of!Table!II!of!the!AAPM!TGD40!Report!on!Quality!Assurance,!and!second,!to!add!recommendations!for!Asymmetric!Jaws,!Multileaf!Collimation!(MLC),!and!Dynamic/Virtual!Wedges.!!The!TG!accomplished!the!update!to!TGD40,!specifying!new!test!and!tolerances,!and!has!added!recommendations!for!not!only!the!new!ancillary!delivery!technologies,!but!also!for!imaging!devices!that!are!part!of!the!linear!accelerator.!!The!imaging!devices!include!xDray!imaging,!photon!portal!imaging,!and!coneDbeam!CT.!!The!TG!report!was!designed!to!account!for!the!types!of!treatments!delivered!with!the!particular!machine.!!For!example,!machines!that!are!used!for!radiosurgery!treatments,!or!intensity!modulated!radiotherapy!(IMRT)!require!different!tests!and/or!tolerances.!!There!are!specific!recommendations!for!MLC!quality!assurance!for!machines!performing!IMRT.!!The!report!also!gives!recommendations!as!to!action!levels!for!the!physicists!to!implement!particular!actions,!whether!they!are!inspection,!scheduled!action,!or!immediate!and!correction!action.!!The!report!is!geared!to!be!flexible!for!the!physicist!to!customize!the!QA!program!depending!on!clinical!utility.!!There!are!specific!tables!according!to!daily,!monthly,!and!annual!reviews,!along!with!unique!tables!for!wedge!systems,!MLC,!and!image!checks.!!The!report!also!gives!specific!recommendations!regarding!setup!of!a!QA!program!by!the!physicist!in!regards!to!building!a!QA!team,!establishing!procedures,!training!of!personnel,!documentation,!and!endDtoDend!system!checks.!!The!tabulated!items!of!this!report!have!been!considerably!expanded!as!compared!with!the!original!TG!40!report!and!the!recommended!tolerances!accommodate!differences!in!the!intended!use!of!the!machine!functionality!(nonDIMRT,!IMRT,!and!Stereotactic!Delivery).!!The!task!group,!and!effectively!the!AAPM,!promotes!implementation!of!the!Task!Group!142!recommendations.!!The!Radiological!Physics!Center,!which!was!responsible!for!the!beam!parameters!and!delivery!systems!that!are!used!to!treat!patients!on!clinical!trials,!quickly!adopted!TG!142!as!the!standard!for!quality!assurance!for!radiation!oncology!facilities!participating!in!clinical!trials.!!As!accelerator!technology!including!imaging!has!accelerated!over!recent!years!the!need!to!modernize!quality!assurance!programs!is!vital.!!This!along!with!the!fact!that!many!of!the!radiation!therapy!accidents!that!have!occurred!could!have!been!avoided!with!a!programmatic,!robust!quality!assurance!program!such!as!outlined!TG!142.!!It!is!therefore,!strongly!encouraged!that!all!societies!internationally!adopt!programs!similar!to!TG!142.!!Though!the!workload!seems!excessive,!the!task!group!report!does!point!out!that!physicists,!who!should!be!the!charge!person!for!the!technical!quality!assurance!program!of!the!

radiation!oncology!department,!has!the!leeway!to!decide!on!the!frequency!of!such!testing!depending!on!the!prioritization!of!the!most!important!aspects!of!the!program!where!a!patient!is!going!to!be!harmed!the!most,!along!with!the!dependability!of!the!particular!aspect!of!the!accelerator.!!Thank!you,!

!!!!!!!

Eric!E.!Klein,!Ph.D.!!Professor!of!Medical!Physics!Department!of!Radiation!Oncology!Washington!University!School!of!Medicine!in!St.!Louis,!USA!

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The Association’s Journals are Medical Physics and Journal of Applied Clinical Medical Physics Member Society of the American Institute of Physics and the International Organization of Medical Physics

American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846 (301) 209-3350 Fax (301) 209-0862 http://www.aapm.org

http://www.aapm.org

Office of the Executive Director Angela R. Keyser Phone: 301-209-3385 Fax: 301-209-0862 E-mail: [email protected]

VIA EMAIL 5 March 2012 Jun Itami, M.D., Ph.D. Principal Investigator for the National Cancer Center Research and Development Fund Chairman, Department of Radiation Oncology National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 JAPAN Dear Dr. Itami: The American Association of Physicists in Medicine hereby grants permission to Dr. Jun Itami, the Principal Investigator for the National Cancer Center Research and Development, to coordinate translating the report indicated below into Japanese. It will be published and distributed through the website for the members of the Japanese Society of Medical Physics, Japanese Organization of Radiotherapy Quality Management and Japanese College of Medical Physics.

Eric E. Klein, Joseph Hanley, John Bayouth, Fang-Fang Yin, William Simon, Sean Dresser, Christopher Serago, Francisco Aguirre, Lijun Ma, Bijan Arjomandy, Chihray Liu, Carlos Sandin, andTodd Holmes, “Task Group 142 report: Quality assurance of medical accelerators.” Med. Phys. 36(9) 4197-4212 (2009)

Authors seeking permission must also notify the first author of the article from which permission is being sought. Sincerely,

Angela R. Keyser

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1

Med. Phys. 36(9), 4197-4212 (September 2009)

Task Group 142 report: Quality assurance of medical accelerators

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eaWX��z��l 142úȸȮí˰ģ2ĝ˘Äˁ

Eric E. Klein

Washington University, St. Louis, Missouri

Joseph Hanley

Hackensack University Medical Center, Hackensack, New Jersey

John Bayouth

University of Iowa, Iowa City, Iowa

Fang-Fang Yin

Duke University, Durham, North Carolina

William Simon

Sun Nuclear Corp., Melbourne, Florida

Sean Dresser

Northside Hospital, Atlanta, Georgia

Christopher Serago

Mayo Clinic, Jacksonville, Florida

Francisco Aguirre

M. D. Anderson Cancer Center, Houston, Texas

Lijun Ma

University of California, San Francisco, San Francisco, California

Bijan Arjomandy

M. D. Anderson Cancer Center, Houston, Texas

Chihray Liu

University of Florida, Gainesville, Florida

Consultants:

Carlos Sandin

Elekta Oncology, Crawley, United Kingdom

Todd Holmes

Varian Medical Systems, Palo Alto, California


2

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TABLE OF CONTENTS

I 3�=1� INTRODUCTIONªp.4«

� I.A. ȿȼ� Purposeªp.4«

I.B. ʒǒ Backgroundªp.4«

II úȸȮí˰ʩʆ2ĝ˘Äˁ� QUALITY ASSURANCE OF MEDICAL ACCELERATORSªp.6«

II.A. Ƕʮ Generalªp.6«

II.B. ˃2Ŷ Test frequenciesªp.7«

II.C. ʾœÈ2TMm�M� Guidelines for tolerance valuesªp.8«

II.C.1. ǹȘȼ0ĉÖE˃ƞ� Acceptance testing procedure standardsªp.8«

II.C.2. [�h_�o�X2ıȘÈ� Commissioning baseline valuesªp.9«

II.C.3. ʾœ�|�.¬Ö�|�� Tolerances and action levelsªp.9«

II.C.4. �ɉ��ÜȩƑɫŶ� Uncertainties, repeatability, and precisionªp.10«

II.D. TG-4013ĕ:E,�0�Ȋȸʩʆ2¯šĝ Ancillary treatment devices not in TG-40ªp.11«

II.D.1. Řɓ0 jawȟŚ� Asymmetric jawsªp.11«

II.D.2. fMn�hW/s�g��/�os�]�NOh`� Dynamic/virtual/universal wedgeªp.11«

II.D.3. Ļßë[��e� MLCªp.12«

II.D.4. ×˞ȟŚ/×˞ȽʗņʀȟŚ� TBI/TSETªp.13«

II.D.5. XʀȲÐĈƈ_aj�� Radiographic imagingªp.14«

II.D.5.a. ů(2D)2 MVȲÐĈƈ_aj�� Planar MV imaging (Portal imagers) ªp.15«

II.D.5.b. ů(2D)2 kVȲÐĈƈ_aj�� Planar kV imagingªp.15«

II.D.5.c.� ˯ŭ CT.[��v�� CT� Serial and cone-beam CTªp.15«

II.D.6. ĚĖĒǜ� Respiratory gatingªp.16«

III õė2:.=/ŜÖʹȲ� SUMMARY OF RECOMMENDATIONS/IMPLEMENTATION SCHEMEªp.18«

QAȿ�A5ʾœÈ�ʳʧ

ʧ I.� ȃǊ2 QA� Daily QAªp.21«

ʧ II.� ȃǙ2 QA� Monthly QAªp.22«

ʧ III.� ȃŰ2 QA� Annual QAªp.24«

ʧ IV.� fMn�hW/�os�]�/s�g��NOh`� Dynamic/universal/virtual wedgeªp.26«

ʧ V.� ��g��x[��e� Multileaf collimationªp.27«

ʧ VI.� ƽŚʀȲÐ� Imagingªp.28«

ĄʍǄȦªp.30«

ʋʿʎ�ʋʿþìʎ�ʳ�ː˦ªp.35«


4

I ��ªINTRODUCTION«

I.A. ��ªPurpose«

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12

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13

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14

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15

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GE,�C�0C2ʨǔʀHƓʎ1��DċʓƑ� D&=ʨǔʀ?ʀ˘/Pp�V�HŞ0�.>

�Ű�.1ɀƱȖŎ D�.HƲł DkV ȲÐ1�,ĉÖE˃ǐ1ɉɜ�EDıȘÈbaseline

k�eůĭɦħ>��3ȖŎÈ$EB2��Hĕ<3$E±2 QA-2äŎıȘcriteria

. D�.HƲł DTG-75 �IGRT22ȲÐĈƈ1ADʨǔʀ2ɤȫ� 2Ʋłȿ.�ʛ�,ʨ

ǔʀ.v��Pp�V�2ĉÖE˃ǐ2ıȘÈbaseline�B2Ĺ÷1Ř DʾœÈ3Ȳ˘t��

eHɼƪ D&='�-0�Ɠʎ2ɉȧȼɉŎȼ0�aWHʙŴȼ1Ġ.0B0�ɕŶ1./=DA

�1ȉŎ�ED7�- Dʨǔʀ2ɉˆ3×ȟŚʀ1Ř�,ƀ�ŝ��1ʀ1ƀ Dt

��e2Ĺ÷HǊ�./Ǚ�.1ɉˆ�,�D2-Ű�.2ɉˆ-ûß'F�Siemens2 MVCT1�


16

,3�ʜ1v��U��y��_��t��e3Ȋȸv��1ŭ1·�,�D�$EB3ĩǚ-

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V�2ȖŎŶ3_aj�2ŌŎƑ.æȮȤȌ1AD¾�4ȲÐĈƈ1ADʨǔʀ�Ȋȸʀ1ĕ:

ED�$E�ÝǇʀ2 10%±�- D0B4²1ʨǔʀ� 20%Ĺ÷�&ĵđ->ɵǫ.�,ÝǇ

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ł D�E3ʙŴæȮȤȌ._aj�2ŌŎƑ1ı+�,��^��.1>).ʃ0˂Á�ƍʮ.ʯ

0�ED�>�E0�

II.D.6. ^\ZzªRespiratory gating«

�

ȩǐț-3ĚĖĒǜ3ǆ��ơʤ- D ĒǸ1 QAǇȍ>ơʤ2Ǒą..>1ȹ˸ Dƍʮ� D AAPM

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Hŏǈ D&=2Ǹ�0ǼģǷƚ.ơʤ1*�,>ʼ˫�E,�D:&TG-76 ��l-3ĚĖɤȫ

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_��Xǐ1ŏǈ�EDĚĖ.˲ô�,ªºʘģ2ô�HǺƻŏ D&=2ôºxJ�l�3ǹȼ2

¸ʆȉ=?ĚĖĒǜȊȸ2ɫŶHɉˆ D&=1½Ȯ�ED�.HƲł D ʧ II,III3ĚĖĒǜ2í˰ʩʆ

ƺ¼2&=2˃Hĕ<$2˃3v��Pp�V�2�ĹƑv��Þì2�ĹƑĒǜ1½Ȯ�ED

¸ɁŮ?ƭŮ2ǐȼɫŶĚĖ2¸Ɂ/ƭŮ2]�Z�lʿʎȏ72U��y��_��˅ɱ3ƅ˫ M�

e��hW˃Hĕ<Bayouth81B3�EB2ȖŎHʣ�Ǉȍ2�*.�,250 ms1500 ms2ĒǜŮH

Ǵʺ�Ĵė�&v��Pp�V�.Þì2�ĹƑ3$E%E2ĒǜŮ- 10 cm 20 cm2ȑ�-Ēǐ1�Ř

2ɥH½Ȯ�,˂Á�E&×,2ʀȖŎ2t��e3 Siemensí˰ģ1�, 500 ms±�2Ēǜ

Ů-�2%±Û1 )& ǐȼɫŶ.½Ȯ�ED¸Ɂ/ƭŮĒǜ.2Â3 ôºxJ�l�1¯š�E&ƽ

Śʀ�ˮ˷Ƒ2ǹȼHĒǜȟŚ D�.-ŏˁ�E&$2ôºxJ�l�-3$E%E2¸Ɂ/ƭŮ1�

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20 mmH˚�0�ô�-3Ȣº2ô�HƯB�DǐȼɫŶ2ʾœÈH 100 ms. D.ɵǫȼ1 2 mm

2¸ʆ2�ɉŎ�10D˖ǱˆŎHĉ�&úŉȢȫĸQMP3ȊȸʹȲ-ʹ��EDɚȼ0�ɉŎ�

1�ʛ�&ʾœÈHÄƪ�0�E40B0�ǈʽĩǚȟŚơʤĩǚ2˃3�EB2�ʜȼ0Ʋł

ȿHʫ�&=1ʣ�7�- D¾�4ĚĖte��HĈƈ D&=1ȳ0)&eMzÕŉȼ0>2

īìc�]�HÍ�&īŹ0|�lʑȐȖŎ2]�Z�l�ʙŴ-½Ȯ�ED˖ǱˆŎHĉ�&

úŉȢȫĸQMP3ǐ�ɴ˷�,>ǚƖ1Ĺ÷�0�]�Z�lHɌ ¸Ɂ.ƭŮHȮ�,¸Ɂ.

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�1 DǄȦ30��ǉɆ2]�Z�l2¸ʆ/ô�.$2�a��a�Ĺ÷�0��.Hɉˆ Dī

ìc�]�2ɉˆ˃¾.�,c�]�2�1�Ŏ2ʞH��,ǜƄ�EDƭŮ¾�4 50%10

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ʿʎȏ7 ��2ÈH¶),˶ô DÅď2�.


17

2¸ʆ1ıȘ��S�]�Z�lHʆ�ǉɆ2È.ʼ�E&¸ʆˉŪHȄˣ DǇȍ� Dɚ

ȼɫŶ2ɉˆ2ƅ1¸Ɂ2ɉˆ�ôºxJ�l�HæȮ�,ʣGED

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18

IIIU]�� /lN�� SUMMARY OF RECOMMENDATIONS/IMPLEMENTATION SCHEME

� �2��l-ʧ1âʼ�E&ȿ3TG-401.Ȅˣ�,ļŮ1ƨŻ�E,�CƲł�EDʾœÈ3½

Ȯ Dʩʆ2Ǽʓ1Ǝ�,ȳ0Dnon-IMRT, IMRT, Ŏ¸ȟŚ

1. ×,2 QA ȐôH]��l�ƍʮ0Ǉ?ƞHʽʹ D&=1ǈʽ2 QA g��Hʁƚ D�.

HƲł D�2Ǉ?ƞ3ǈʽ2 QA g��2×Ğ�œǍ1r�m[w�?R��M�-ƕĴH

Ùǚ�0�E40B0� �2Ǉ2�- QA1ƸGDaehx2Ɓë.˕´Hɉɜ D7�- D

QAȖŎ1��, Ǽģ2½Ȯ Ǽģ2W�aU��y��_�� ȖŎŶ1 D˅ɱ0ˊǌǖ?

ɵǫ2Ǆǖ÷�Ȉ=BEDQAȖŎǼģ2ƾ�ȴGEDĵđǇ.ƞ2�-QAȖŎ2°ǗǇ

ȍHƳ¿ Dƍʮ� D

2. ƲłȿHŏʣ Dǘã2ajhz3×,2 QAȖŎ1Ř Dǈʽȥʚ2ıȘÈbaseline.ɹŘı

ȘÈHɉɜ D�.- DQA g��3ʩʆ2ƑʓHÄˁ D&=ȊȸʹȲ2ʹɣɵǫ�B2

ļ0�Hʯ*�D&=1Ŏǜȼ1µ˒Hƪ(ɉɜ�&ÈHıȘ.�,ȖŎɵǫH�oe��X

Dƍʮ� DȃǊ˳�.Ǚ�.2 QA -½Ȯ D&=2Ǽģ�Ļ�ū˔�E,�D�EB2

Ǽģ2ʬ˱ǵʎ3��^�� QA ǼģHǿ��ȐȮ-�DA�1ƞǖHƳ¿ DQA ¼ǵHŏǈ

Dè1ʬ˱ǵʎ2TMm�M�1ı+�&Ǽģ2ɫŶ.Ƒʓ2ŌŎƑHɉˆ D�.HƲł D

˻ǿ1Ǽģ3½Ȯ�E,�D�QA˃3ŃŽ- D�1*�,>˂Á�E0�E40B0�

3. ˖ǱˆŎHĉ�&úŉȢȫĸQMP3 QAg��HÔŜ�0�E40B0� QMP3ƽŚʀȊȸơŬ

?ʀʹȖĸ� QA 2Ǉ?ƞHǌɉ1ȫʶ D&=1ƂB1Ř�,˻à0ǀʐʻʂHǈ�0�E

40B0�¾�4QA ʩʆ2½Ȯ2ʻʂ-3˻ǿ0NQ��KhzǐȖŎk�e2ʶ2

Ǉʾœ�|�H˚�&ĵđ2ŘÝȍ0/Hɽʈ�0�E40B0� QMP3˻à0¬Ö�|�2ʽŎ

?ʾœ�|�H˚�&ĵđ2˲ɷºçHʽŎ D�.�Ʋł�ED

4. �ʜ1ȃǊdaily2 QA ˃3W�aU��y��_��E&ȖŎģH½Ȯ�,ƽŚʀȊȸơ

Ŭ1A),ŏǈ�ED�2A�0¼ǵ13�-chlKhz�œǍ0Ǽģ2½ȮHƲł D¾�

4ƫįɥʀʹHƮÖ Dz�aghWʬxJ�l�3Þì2ŌŎƑHɉˆ D21½Ȯ-

�D- F�8.I/2ĵđxJ�l�2Ph`.ʧ3ŐÛ2��^�2K�M��lHɉˆ

D21½Ȯ-�D˻Ŷ0v�mKhzǢHǚ Dx�hltp�ǴÞģ3ȃǊdaily2 QA 1½Ȯ

-�D�EB2Ǽģ2æț3ʅC˪�ǼģHchlKhz D�.0�v��2ůĮŶ?ŘɓƑ

0/2ɖ�2v��t��eHóȧȼ1ɉˆ D�.�-�D�.- DȃǊdaily2 QA ʩʆ

3½ȮŶ�Ļ�&=ǴÞģƎɡ1ƀH��DʫǿÂǂ3ȏƖȑ�ʼ�ED7�- D�EB

2ʫǿÂǂ13ļȅƽįɥ1Ř DȕŶ�ȅīʫǿÂǂ¸ʹʫǿÂǂșʫǿ0/�ĕ

:ED×,2ɵǫ3ņxJM�.r�m[w�.�,ȇ�1ʼ� �1ɉˆ-�DA�1�,

��ƍʮ� D˃ɵǫ�ʾœ�|�H˚�&ĵđ1˻à0ʣôHĈD&=1ŏǈʎ�ʣ�7�ʣ

ôHǌɉ1ʰŎ�&TMm�M�H¼ƚ D7�- D�EB2TMm�M�3úŉȢȫĸ62Ĵė

>ĕ<7�- D:& QMP3ǘ¹->Ǚ�ĥ3ɵǫHɉˆ��lHƠˆ D7�- D


19

5. Ǚ�.monthly2 QA 3 QMP >��3 QMP 1A),ɀƱƫŜ�E&ʎ�ŏǈ D7�- Dȃ

Ǌdaily �Ǚ�.monthly �Ű�.annual2 QA 2-ʭ D˃ȿ� D�2ŏǈŶ

2ʭ3Ǚ�.monthly2 QA�ȃǊdaily2 QA2A�1ÿɰ-30�.�)&A�0ȥɜƑ

2�|��ƍʮ- D�E3½Ȯ DȖŎģ�ȳ0D�.-˸ƚ�ED�ȃǊdaily2 QA �B

2Ǚ�.monthly2 QA 2ȥɜ1*�,2ƨŻ3 QMP1A),ȉŎ�ED�2&=13ŭ1Ļ

�2ȖŎH˯�&ȖŎģ2Ǵˁ?˃ʼHǴǮ D�.-ȃǊdaily2 QA ¼ǵ2Ǵˁ>ŏǈ�

EDƍʮ� D¾�4ȃǊ2ÞìȖŎ1ĻǽÓǴÞģH½Ȯ�,�C:&Ǚ�.monthly2Ȗ

Ŏ->Ē�ǴÞģH½Ȯ�,�Dĵđ˷ă2ıȘbaselineH�xJ��a.�,ĻǽÓǴÞģ2

ȖŎ.ɥ-xJ�l�HæȮ�&ȖŎ.HŰ1 1ĥȄˣ D7�- D�E1ACȖŎģ2Ǌ�

2ȖŎ1Ř DÅƑH��:& 1 Ű.�)&ǜ2˷ɕ2�-ŖɆ�E!1�DÎĔHˆˑ D

�.�ċʓ.0D�2A�0Ȅˣ˃3BE&�d�a2�ǘŝ2Ǽģ2óȧȼ0½ȮHċ

ʓ1 DȃǊdaily2 QA 1�,3×,2ɵǫ3ņ�A5r�m[w�2�Ǉ-ȇ�1Ǆǖ

÷�E �1ɉˆ�-�Dƍʮ� DúŉȢȫĸ1.),Ēɠ2_aj�>��3°Ǘ.0D_a

j�H½Ȯ�, B@DǼģ2W�aU��y��_��Hŏǈ D�.3ʮ- Dʾœ�|�H

˚�&ĵđ1˻à0ʣô�ĈEDA�1Çª�ŏǈ D˃1 Dǌɉ0TMm�M��ƍʮ-

D�EB2TMm�M�13�ʜ1 2Ȃɉˆsecondary check? QMP62Ĵė1*�,>ĕ:E

Dƍʮ� D í�, QMP3˃ō¢�B 15Ǌ±Û1ɵǫHɉˆ� ��lHƠˆ D7�- D

6. ��l1Ɍ�&Ű�.annual2 QA ȿ3ʩʆ2Ƒʓ1*�,ǘ>ųɦħ0˃Hʧ �E

B2˃3Ɠʎ?ȬĶ62Ō×Hʍƙ�&ɀʀí˰ģ2˻ǿ0ǼʓƑHÄˁ D&=1ū?Ũ1Øˆ

�E&Ǽ1A),Ơˆ�ED�.> D�2ȫȰ1ACŰ�.annual2ȖŎ3 QA g��

s�..>1 QMP�ŏǈ D�.�Ʋł�ED ɥʀʹ? 3ǽÓȆxJ�l�0/2A�0 QA

Ǽģ3 B@DȖŎHŏǈ Dè1˻à1ɉˆ�ED�.Hż�Ʋł DȖŎ3˩á£Ŏ2

TG-1067ȏȩĬȹáȒ;-Ʋł�EDA�0[�h_�o�Xĝ˘ʩʆH½Ȯ�,ŏǈ�ED7�

- D

7. ɝǟ˲ɵ_aj�˃end-to-end system check3_aj�Hǆʰ1ŜÖ�&ĵđ>��3Ǖǆ�E

&ǐ3�*->_aj�×º2ĳĩƑHÄˁ D&=1ŏǈ D�.HƲł D�E3ǈʽ2˯ŭ

2ȊȸʹȲ2]�z�z��H¼ƚ�,phl��WH¬�,z��Hˠ˭�Ȋȸʩʆ-ȟŚ D

�.-ɉˆ D�.�-�D>� record and verifyR&V_aj�1ACk�e�¬�ED0B4

�2_aj�3ɝǟ˲ɵ_aj�˃end-to-end system check1ĕ:0�E40B0�ɝǟ˲ɵ_

aj�˃end-to-end system check3ȊȸʹȲʩʆR&V_aj�ȟŚ_aj�2dxlNOK

1ĹǕ�ȭ�&ĵđ13ŭ1ƍʮ- Dȣ1ȊȸʹȲ1�,ʀʹɣ.ȟŚ˷ɕ22ŌŎ

ƑHÄˁ D&=13�M�lʀȖŎHŏǈ D7�- Dɝǟ˲ɵ_aj�˃end-to-end

system check-3Đɖ_aj�2ɗÏřě�Ǆǖ÷�ED7�- D

8. Ű�.annual2 QA Hɉˆ�,�Dʩʆ2Þì3 NISTNational Institutes of Standard and

Technology K��SĪɜǹȘơʤɈəƝ 2l��]y�0ʫǿÂǂHƪ)&ɥʀʹHȮ�,


20

TG-511Ƈ),ǯǿ�ED7�- Dʿʎȏ8�Ŷʩʆ2Þì�ǯǿ�E&BȃǊdaily2 QA ?Ǚ

�.monthly2 QA-½Ȯ�ED×,2¥ǽ QAȖŎģ3$2ǯǿ1Ř�,W�agOhW�ED

7�- Dƛ�2��l-3ǆʰʩʆ2ĉÖE˃1 DƲł3ʣG0�)&�|�f�2ĉ

ÖE˃?ʾœÈHɉˆ D1�ʜȼ0TMm.�,½Ȯ�EƈDǠ��l-Ʋł�&Ű�.2

QA˃HæȮ D�.Hłñ D

ȖŎ�ō¢ǽɟŰ�.2 QA ��lH¼ƚ D�.�Ʋł�ED��l13ʧ1Ɍ�E&Ʋł�

EDʾœÈ1ı+�,ȣʼ¤Hʼˤ D7�- D ��l3 1 ʀ 2 Ų»ŉȼ 3 Ō× 4

ȲÐ 5ȣåǼģǇȍ2A�1ß D�.�-�DQA ��l3 QMP 1A),ɉˆʇē�E

śǥ2ʩʆ2��jn�a?ǴǮ2&=1xJM��ED7�- D

ʿʎȏ8 ǊǠ-3ǹȘȖŎȍ 01ǊǠúŉȢȫŉµʁ1Ƈ�


21

ʧ I. ȃǊ2 QADaily

ȊȸǼeMzå2ʾœÈMachine-type tolerance

ȿ ˯ŭȊȸ Non-IMRT IMRT SRS/SBRT

ʀɤȫDisimetry

XʀÞì�ĹƑ×Pp�V� X-ray output constancy (all energy)

3%

ņʀÞì�ĹƑ ȃ˳ &'�ȣå0Ǹ-�oe��X�,

�Dʩʆ3ȃǊ Electron output constancy (weekly, except for machines with unique e-monitoring requiring daily) Ų»ŉȼɤȫMechanical

��^�¸ʆ Laser localization 2 mm 1.5 mm 1 mm

KMdc�e¸ʆ-2˝ʹʧɌ Distance indicator (ODI) @ iso 2 mm 2 mm 2 mm

[��e]MbʧɌ Collimator size indicator 2 mm 2 mm 1 mm

Ō×ɤȫSafety

mKM�e��hW v��˼ǅ�ED� Door interlock (beam off)

ô¼ D

mK�Ō×1:D� Door closing safety ô¼ D

ʱʏʲ�oe Audiovisual monitor(s) ô¼ D

Ŏ¸ȟŚM�e��hWȟŚç Stereotactic interlock (lockout)

NA NA ô¼ D

P�K�oe½Ȯ�,�E4 Radiation area monitor (if used)

ô¼ D

ȟŚȚ Beam on indicator ô¼ D


22

ʧ II. ȃǙ2 QAMonthly



ʀɤȫDisimetry

XʀÞì�ĹƑ X-ray output constancy

2% ņʀÞì�ĹƑ Electron output constancy shWKhz�oeʀʹ�ĹƑ Backup monitor chamber constancy °ʧȼ0ʀȧ a1��DÞìʀ2�ĹƑ Typical dose rate output constancy NA

2% IMRT-½Ȯ Dʀȧ1��,

2% SRS/SBRT-½Ȯ DʀȧMU1�

�, Xʀz�xJM��ĹƑ Photon beam profile constancy

1%

ņʀz�xJM��ĹƑ Electron beam profile constancy 1%

ņʀPp�V��ĹƑ Electron energy constancy 2%/2 mm

Ų»ŉȼɤȫMechanical

Õ/ƽŚʀȟŚ2�ʛ b Light/radiation field coincidence �˧1*� 2 mm or 1%

Õ/ƽŚʀȟŚ2�ʛŘɓȟŚb Light/radiation field coincidence (asymmetric) �˧1*� 2 mm or 1%

��^�ƫɌɫŶɉˆȮǼģ2ƫɌ¸ʆ.x

��l�M�eƫɌ¸ʆ2˝Ū Distance check device for lasers compared with front pointer

1 mm

T�l�/[��eʵŶ2ʧɌÈ.ŏ2¸ʆ2Ū �ʮ0ʵŶ k`e�ʧɌÈ2; Gantry/collimator angle indicators (@ cardinal angles) (digital only)

1.0°

KWc]�l�M ¾�4��lxL��2&=2ûŇʀ¯�

l�M0/ Accessory trays (i.e., port film graticle tray)

2 mm

Jaw¸ʆ2ʧɌÈ.ŏ2¸ʆ2Ū ŘɓȟŚc Jaw position indicators (symmetric)

2 mm

Jaw¸ʆ2ʧɌÈ.ŏ2¸ʆ2Ū ŘɓȟŚd Jaw position indicators (asymmetric)

1 mm

W�a{K�ƌ¸ʆwalkout ʿʎȏ 1 Cross-hair centering (walkout)

1 mm

ȊȸŕČ¸ʆ2ƫɌÈ.ŏ2¸ʆ2Ū e Treatment couch position indicators 2 mm/1° 2 mm/1° 2 mm/0.5°

NOh`¸ʆɫŶ Wedge placement accuracy 2 mm

ʫÑº¸ʆɫŶ f Compensator placement accuracy 1 mm

NOh`y�hW2ˆˑ g Latching of wedges, block tray ô¼ D

��^�¸ʆ Localizing lasers

�2 mm �1 mm < �1 mm

Ō×ɤȫSafety

��^�T�mM�e��hW Laser guard-interlock test ô¼ D


23

ʧ II. ȃǙ2 QAMonthly ɻ�



ĚĖĒǜRespiratory gating

v��Þì�ĹƑ Beam output constancy 2%

¸ɁƭŮv��çƉ Phase, amplitude beam control ô¼ D

ŐÛĚĖȾʱ_aj� In-room respiratory monitoring system

ô¼ D

ĒǜM�e��hW Gating interlock

ô¼ D

aʀȧ1Ǝ�&ʀ�oe��X bÕȟŚHʙŴ2chlKhz1½Ȯ�,�Dĵđ2;Õ/ƽŚʀȟŚ2�ʛHȃǙɉˆ Dƍʮ� D cʾœÈ3�ɝ�ǇĔŮǇĔ/(B>2đʹ dŘɓ jaw3 0.0. 10.02ʽŎ1*�,ɉˆ D7�- D eũĎǇĔˡǇĔĥˠǇĔ fʫÑº IMRT3 ʫÑºl�M�N�l�A5W�a{K�ƌ�Bǘļ 1mm2ÊŪ-ʽʆ�EDl�M¸ʆ1Ř DŎÈHƍʮ. D gŴ1Ĕ�,ĈC¯�D[��e/T�l�ʵŶ2ɳ;đG"-ɉˆ D


24

ʧ III. ȃŰ2 QAAnnual



ʀɤȫDisimetry

XʀůĮŶ2ıȘÈ�B2Ĺ÷ X-ray flatness change from baseline 1%

XʀŘɓƑ2ıȘÈ�B2Ĺ÷ X-ray symmetry change from baseline �1%

ņʀůĮŶ2ıȘÈ�B2Ĺ÷ Electron flatness change from baseline

1%

ņʀŘɓƑ2ıȘÈ�B2Ĺ÷ Electron symmetry change from baseline

�1%

SRSĥˠ��m 0.5 – 10 MU/deg2ɦħ SRS arc rotation mode (range: 0.5–10 MU/deg)

NA NA

MUʽŎÈ vs. ȟŚÈ1.0 MU� 2%/(B�ļ��Ǉ T�l�ĥˠʽŎÈ

vs. ȟŚÈ1.0°� 2%/(B�ļ��Ǉ

Xʀ/ņʀÞìǯǿTG-51 X-ray/electron output calibration (TG-51) �1%ɹŘʀ

XʀÞìÂǂ2ȟŚÀňƑ 2*±�2ȟŚ1*�,Ƥ�ĈC˃ Spot check of field size dependent output factors for x-ray (two or more FSs)

2%ȟŚ]Mb < 4x4 cm2

1%ȟŚ]Mb � 4x4 cm2

ņʀKz�Y�e2ÞìÂǂ *2Kz�Y�e/Pp�V�2Ƥ�ĈC˃ Output factors for electron applicators (spot check of one applicator/energy)

�2%

ıȘÈ�B2Ĺ÷

Xʀʀ˘PDD10>��3 TMR20,10 X-ray beam quality (PDD10 or TMR20,10)

�1% ıȘÈ�B2Ĺ÷

ņʀʀ˘R50 Electorn beam quality (R50)

�1 mm

ȢȫNOh`Âǂ2�ĹƑ Physical wedge transmission factor constancy �2%

Xʀ MUɀʀƑÞì�ĹƑ X-ray monitor unit linearity (output constancy) �2%�5 MU

�5% (2-4 MU) �2%�5 MU

�5% (2-4 MU) �2%�5 MU

ņʀ MUɀʀƑÞì�ĹƑ Electron monitor unit linearity (output constancy) �2%�5 MU

XʀÞì2ʀȧÀňƑ X-ray output constancy vs. dose rate


XʀÞì2T�l�ʵŶÀňƑ X-ray output constancy vs. gantry angle


ņʀÞì2T�l�ʵŶÀňƑ Electron output constancy vs. gantry angle


ņʀ XʀˡĺʀȄ2T�l�ʵŶÀňƑ Electron and x-ray off-axis factor constancy vs. gantry angle


ĥˠȟŚʰŎ MUʵŶ Arc mode (expected MU, degrees)


TBI/TSET��m TBI/TSET mode ô¼ D

PDDTMROAF�ĹƑ PDD, TMR, OAF constancy TBI: 1%TSET: 1 mmıȘÈ�B2Ĺ÷

TBI/TSETÞìǯǿ TBI/TSET output constancy

2% ıȘÈ�B2Ĺ÷

TBI/TSET Ȯ2v��ÆȮģÚHÖE&v��2Þì�ĹƑ TBI/TSET accessories

2% ıȘÈ�B2Ĺ÷


25

ʧ III. ȃŰ2 QAAnnual ɻ�



Ų»ŉȼɤȫMechanical

[��eĥˠKMdc�e Collimator rotation isocenter

�1 mm ıȘÈ�B2Ĺ÷

T�l�ĥˠKMdc�e Gantry rotation isocenter


ŕČĥˠKMdc�e Couch rotation isocenter


ņʀKz�Y�eM�e��hW Electron applicator interlocks ô¼ D

ƽŚʀKMdc�e.ǼǳȼKMdc�e2

�ʛ Coincidence of radiation and mechanical isocenter




ȊȸĽǧ2&G; Table top sag

2 mm ıȘÈ�B2Ĺ÷

ȊȸĽǧ2ʵŶ Table angle 1°

×ǇĔ1Ř DȊȸĽǧ2ǘļċôİ Table travel maximum range movement in all directions

�2 mm

Ŏ¸ȟŚKWc]��hWɠ Stereotactic accessories, lockout, etc. NA NA ô¼ D

Ō×ɤȫSafety

|�f�˃ȿ Follow manufacturer’s test procedure ô¼ D

ĚĖĒǜRespiratory gating

v��Pp�V��ĹƑ Beam energy constancy

2%

¸Ɂ/ƭŮĒǜǐǿɉƑ Temporal accuracy of phase/amplitude gate on £ȖÈ�B2Ĺ¸� 100 ms

ĚĖ¸Ɂ/ƭŮ]�Z�l2ǯǿ Calibration of surrogate for respiratory phase/amplitude

£ȖÈ�B2Ĺ¸� 100 ms

M�e��hW˃ Interlock testing ô¼ D


26

ʧ IV. fMn�hW/�os�]�/s�g��NOh`Dynamic/universal/virtual wedge

ʾœÈTolerance

ȿ fMn�hW �os�]� s�g��

ȃǊDaily

ńǵțǴǐ1 1*2ʵŶ2ȟŚŏǈ Morning check-out run for one angle ô¼ D

ȃǙMonthly

×Pp�V�2NOh`Âǂ Wedge factor for all energies

45, 60°2v��ƌˡ2NOh`Âǂ

2%±Ûa

45, 60°2v��ƌˡ2NOh`Âǂ

2%±Ûa

NOh`Âǂ 1.0�B2Ĺ¸� 5%>��3

2%

ȃŰAnnual

ȟŚ×-NOh`ʵŶ 60 Ŷ.�2ʵŶ�A5ȟŚ]MbHƤ�ĈC˃ Check of wedge angle for 60°, full field and spot check for intermediate angle, field size

10 cmȑ ȟŚ]Mb2 80%-ʰŎ�EDɦħÛ2ˡĺʀȄ2Ĺ÷� 2%±Û

a60Ŷ±ĺ2ʵŶH½Ȯ Dĵđ345ŶHƲł D


27

ʧ V. ��g��x[��eIMRT2ŏǈǚȝ-ʩʆHùå�&

Multileaf collimation (with differentiation of IMRT vs non-IMRT machines)

ȿ ʾœÈTolerance

ȃ˳Weekly

ŎƑȼ˃ vYhlxO�a2A�0�hg�XcX

��l ��xˮ˷ʀ2ķí0/Hʱʲȼ1äŎ

ȃǙMonthly

ʽŎȟŚ.ƽŚʀȟŚ2�ʛ 2*2ȟŚ Setting vs. radiation field for two patterns (non-(MRT)

2 mm

shWKhzɶCʽŎElekta2; Backup diagraph setting (Elekta only) 2 mm

��xô˰ŶIMRT Travel speed (IMRT)

��x˰ŶƶĿ < 0.5 cm/s

��x¸ʆɫŶIMRT Leaf position accuracy (IMRT)

4*2T�l�ʵŶ2 IMRTȟŚ- 1 mm2��x¸ʆɫŶwYhlxO�a˃�ưȮ�ED'F�˃ 3ʙŴ2cX��l]Mb1

Àň D

ȃŰAnnual

MLCˮ˷ʀ ��x�A5��xˮ˷ʀ2ůĭ ×

Pp�V� MLC transmission (average of leaf and interleaf transmission), all energy

�0.5% ıȘÈ�B2Ĺ÷

��x¸ʆÜȩƑ Leaf position repeatability �1.0 mm

MLCa��W_�hl MLC spoke shot �ýƃ 1.0 mm

ÕȟŚ.ƽŚʀȟŚ2�ʛ ×Pp�V� Coincidence of light field and x-ray field (all energies)

�2.0 mm

SMLC-IMRTjal Segmental IMRT (step and shoot) test

ˉŪ2 RMSǘļÈ < 0.35 cm 0.35 cmǞȗ2ˉŪ� 95%±�

DMLC-IMRTjal 4*2�ʮ0T�l�ʵŶ Moving window IMRT (four cardinal gantry angles)

ˉŪ2 RMSǘļÈ < 0.35 cm 0.35 cmǞȗ2ˉŪ� 95%±�


28

ʧ VI. ƽŚʀȲÐImaging

ȊȸǼeMzå2ʾœÈApplication-type Tolerance

ȿ Non-SRS/SBRT SRS/SBRT

ȃǊDailya

ů kV, MVEPIDȲÐ

ʦɛǾM�e��hW Collision interlocks ô¼ D

ǘɲȼ0¸ʆȉ=ɫŶʿʎȏ Positioning/repositioning �2 mm �1 mm

ȲÐɬ�Ȋȸɬŷǹ2�ʛ 1*2T�l�ʵŶ Imaging and treatment coordinate coincidence

�2 mm �1 mm

[��v�� CTkV, MV

ʦɛǾM�e��hW Collision interlocks ô¼ D

ȲÐɬ�Ȋȸɬŷǹ2�ʛ Imaging and treatment coordinate coincidence �2 mm �1 mm

ǘɲȼ0¸ʆȉ=ɫŶ Positioning/repositioning �1 mm �1 mm

ȃǙMonthly

ů MVȲÐEPID

ȲÐɬ�Ȋȸɬŷǹ2�ʛ 4*2T�l�ʵŶ Imaging and treatment coordinate coincidence (four cardinal angles)

�2 mm �1 mm

aY��X b Scaling �2 mm �2 mm

ɚßʶʓ Spatial resolution ıȘÈ c ıȘÈ

[�l�al Contrast ıȘÈ ıȘÈ

ĭ�Ƒ.qMb Uniformity and noise

ıȘÈ ıȘÈ

ů kVȲÐ d

ȲÐɬ�Ȋȸɬŷǹ2�ʛ4*2T�l�ʵŶ Imaging and treatment coordinate coincidence (four cardinal angles)

�2 mm �1 mm

aY��X Scaling �2 mm �1 mm

ɚßʶʓ Spatial resolution ıȘÈ ıȘÈ


ĭ�Ƒ.qMb Uniformity and noise ıȘÈ ıȘÈ


Ų»ŉȼȀ; Geometric distortion

�2 mm �1 mm

ɚßʶʓ Spatial resolution ıȘÈ ıȘÈ


HU�ĹƑ HU constancy ıȘÈ ıȘÈ

ĭ�Ƒ.qMb Uniformity and noise ıȘÈ ıȘÈ


29

ʧ VI. ƽŚʀȲÐImaging ɻ�

ȊȸǼeMzå2ʾœÈApplication-type Tolerance

ȿ Non-SRS/SBRT SRS/SBRT

ȃŰAnnual

ů MVȲÐEPID

SSDʽŎÈ.ŏ2Èċô×ɦħ Full range of travel SSD �5 mm �5 mm

ʨǔʀ e Imaging dose ıȘÈ ıȘÈ

ů kVȲÐ

ʀ˘/Pp�V� Beam quality/energy

ıȘÈ ıȘÈ

ʨǔʀ Imaging dose ıȘÈ ıȘÈ


ʨǔʀ Imaging dose ıȘÈ ıȘÈ

ʿʎȏȲÐĈƈ_aj�-¸ʆĹ¸HʹȖ�$2Ĺ¸HÆǿ�&¸ʆ-ÜŶ¸ʆȟđȲÐHĈƈ�,¸ʆÆǿɫŶ

Hɉˆ D˃Hƫ a>��3Ş0�.>ȲÐʩʆ�Ȋȸ1½Ȯ�ED�. bȲÐĈƈ1˯ŭ½Ȯ�ED SDD-aY��XHŏǈ DdxlNOK2Ǽʓ-ʹȖ�ED˝ɫŶHɉˆ D cıȘÈbaseline.3ĉÖE˃ǐ2k�e.Ēɠ>��3$EACÒE&ȖŎk�eHɌ dkVȲÐ3 2ǽÓ2ˮʱȲÐ.ƽŚʀȲÐ2ĆǇHƖę D eTG75-�ŏóʀeffective dose �.�,Ĵė�EDȖŎʀ


30

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