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/åë9J:LQÝĥ µöÊßéı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!TGD
40!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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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

Office of the Executive Director
Angela R. Keyser
Phone: 301-209-3385 Fax: 301-209-0862
E-mail: akeyser@aapm.org

ww.aapm.org
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, tocoordinate translating the report indicated below into Japanese. It will be published anddistributed 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

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

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Task Group 142 report: Quality assurance of medical acceleratorsɩĪúŉȢȫŉµeaWXzl 142̷úȸȮí˰ģ2ĝ˘ÄˁEric 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

1ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿúȸȮí˰ʩʆ2ĝ˘Äˁ̯Quality Assurance; QA̰1*,2eaWXz̯TG̰3̲ƽŚʀȊȸŅĞµ?ĝ˘ÄˁʙŴɵǫƼġŝŅĞµ̯Quality Assurance and Outcome Improvement Subcommitteḛ2ɤȫ
D American Association of Physicists in Medicine̯AAPM̰2ŉʤŗ˒µ̯Science Council̰2s11A),ǷƚE&̴2eaWXz̯TG-142̰13 2 *2ļ0Ɓëˌ"BE,D̴1 *ȿ3ƍʮ1Ǝ, QA 1̋

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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. ˃̪2̢Ŷ Test frequenciesªp.7«
II.C. ʾœÈ2TMmM Guidelines for tolerance valuesªp.8«
II.C.1.

ǹȘȼ0ĉÖE˃̪ƞ̝ 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̲ÜȩƑ̲ɫŶ Uncertainties, repeatability, and precisionªp.10«

II.D. TG-40 13ĕ:E,0Ȋȸʩʆ2¯šĝ Ancillary treatment devices not in TG-40ªp.11«
II.D.1.

̘Řɓ0 jaw ȟŚ̂ Asymmetric jawsªp.11«

II.D.2.

fMnhW/sg

II.D.3.

Ļßë[e MLCªp.12«

II.D.4.

×˞ȟŚ/×˞Ƚʗ̗ņʀȟŚ TBI/TSETªp.13«

II.D.5.

X ʀȲÐĈƈ_aj Radiographic imagingªp.14«

/os]NOh` Dynamic/virtual/universal wedgeªp.11«

II.D.5.a.

ů̙(2D)2 MV ȲÐĈƈ_aj Planar MV imaging (Portal imagers) ªp.15«

II.D.5.b.

ů̙(2D)2 kV ȲÐĈƈ_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«

QA ̜ȿ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«

3ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿI 

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I.A. ª Purpose«
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D.>CƈD̴ɀʀí˰ʩʆ½

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10

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II.D. TG-40 [Gmª Ancillary treatment devices not in TG-40«

AAPM TG-40 l3̲1994 Ű±̎1ȺĵDǆʩʆ1*,3Ž˄Ĵėǖ2ɦħĺ-

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NOh`̲MLC HƟ),0̴̲EB2ǆơʤHƟeaWXz3ɵƚE!̲TG-40 ȹʧE&
1̋

41

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15

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fMnhW/sg

D

D QA zXHȹʧ&̴$2 QA zX3̘Řɓ0 jaw ȟŚ̲̂

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D̜ȿHˬ

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D&=

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)&̴±2̜-3EB2Úºȼõė1*,ǶˊD̴

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DfMnhW/sgNOh`ȟŚHǿɉ1ŏǈ

D&=1Ǖ0DɫǮƍʮ-

43

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D.HƲł

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11DÇ

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II.D.3. eQS'?:C,ª MLC«
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54

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12

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D.-ûß-D.HƲł,D̴vPp

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13

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 SUMMARY OF RECOMMENDATIONS/IMPLEMENTATION SCHEME 2l-ʧ1âʼE&̜ȿ3̲TG-401 .Ȅˣ,ļŮ1ƨŻE,C̲ƲłEDʾœÈ3½
Ȯ

Dʩʆ2Ǽʓ1Ǝ,ȳ0D̯non-IMRT, IMRT, Ŏ¸ȟŚ̴̰

1.

×,2 QA ȐôH]l̲ƍʮ0Ǉ̄?ƞ̝HʽʹHƲł

D&=1̲ǈʽ2 QA gHʁƚD.

D̴2Ǉ̄?ƞ̝3̲ǈʽ2 QA g2×ĞœǍ1rm[w?RM-ƕĴHÙǚ0E40B0̴2Ǉ̄2-̲QA 1ƸGDaehx2Ɓë.˕´Hɉɜ
QA ȖŎ1,̲Ǽģ2½Ȯ̲Ǽģ2WaU

y_̲ȖŎ̢Ŷ1̋

D7-

D̴

D˅ɱ0ˊǌǖ?̲ɵǫ2Ǆǖ÷Ȉ=BED̴QA ȖŎǼģ2ƾ̓ȴGEDĵđ̲Ǉ̄.ƞ̝2-̲QA ȖŎ2°ǗǇ
ȍHƳ¿

2.

Dƍʮ

Ʋł̜ȿHŏʣȘÈHɉɜD̴

Dǘã2ajhz3̲×,2 QA ȖŎ1ŘD.-

D̴QA g3

Dǈʽȥʚ2ıȘÈ̯baselinḛ.ɹŘıʩʆ2ƑʓHÄˁD&=̲

ȊȸʹȲ2ʹɣɵǫB2́ļ0̖Hʯ*D&=1̲Ŏǜȼ1µ˒Hƪ(̲ɉɜ&ÈHıȘ.,ȖŎɵǫHoeX
D̴ȃǊ̲˳.̲Ǚ.2 QA -½ȮDƍʮ

D&=2ǼģĻū˔E,D̴EB2

Ǽģ2ʬ˱ǵʎ3̲^ QA ǼģHǿȐȮ-DA1ƞ̝ǖHƳ¿Dè1̲ʬ˱ǵʎ2TMmM1ı+&Ǽģ2ɫŶ.Ƒʓ2ŌŎƑHɉˆ˻ǿ1Ǽģ3½ȮE,D̲QA ˃̪3ŃŽ-

3.

D̴QA ¼ǵHŏǈ
D.HƲł

D̴

D1*,>˂ÁE0E40B0̴

˖ǱˆŎHĉ&úŉȢȫĸ̯QMP̰3 QA gHÔŜ0E40B0̴QMP 3ƽŚʀȊȸơŬ?ʀ̃ʹȖĸ QA 2Ǉ̄?ƞ̝Hǌɉ1ȫʶD&=1̲ƂB1Ř,˻à0ǀʐʻʂHǈ0E

40B0̴¾4̲QA ʩʆ2½Ȯ2ʻʂ-3̲˻ǿ0NQKhzǐ̲̊ȖŎke2ʶ̀2­
Ǉ̲ʾœ|H˚&ĵđ2ŘÝȍ0/Hɽʈ0E40B0̴QMP 3˻à0¬Ö|2ʽŎ?̲ʾœ|H˚&ĵđ2˲ɷºçHʽŎ4.

ʜ1̲ȃǊ̯daily̰2 QA ˃̪3WaU

D.ƲłED̴y_E&ȖŎģH½Ȯ,̲ƽŚʀȊȸơŬ1A),ŏǈED̴2A0¼ǵ13̞-chlKhzœǍ0Ǽģ2½ȮHƲł
4̲ƫ̠į̗̖ɥʀ̃ʹHƮÖD-DzaghWʬxJl3̲Þì2ŌŎƑHɉˆD̴¾

D21½Ȯ-

F̴8.I/2ĵđ̲xJl2Ph`.ʧ̙3ŐÛ2^2KMlHɉˆ

D21½Ȯ-D̴˻Ŷ0vmKhzǢHǚ

DxhltpǴÞģ3ȃǊ̯daily̰2 QA 1½Ȯ

-D̴EB2Ǽģ2æț3̲ʅC˪ǼģHchlKhz
0/2ɖ

2vteHóȧȼ1ɉˆ

D.0̲v2ůĮŶ?ŘɓƑD.-D.-D̴ȃǊ̯daily̰2 QA ʩʆ

3½Ȯ̢ŶĻ&=̲ǴÞģƎɡ1ƀ̛HDʫǿÂǂ3ȏƖȑʼ̅ED72ʫǿÂǂ13̲ļȅ̉ƽį̗̖ɥ1ŘDȕŶȅīʫǿÂǂ̲̗¸ʹʫǿÂǂ̲ș̗ʫǿ0/ĕ:ED̴×,2ɵǫ3̗ņxJM.rm[w.,ȇ1ʼ̅̲ƍʮ1ɉˆ-DA1,

D̴˃̪ɵǫʾœ|H˚&ĵđ1˻à0ʣôHĈD&=1̲ŏǈʎʣ7ʣôHǌɉ1ʰŎ&TMmMH¼ƚ>ĕ<7-

D̴EB

D7-

D̴EB2TMmM3úŉȢȫĸ62Ĵė

D̴:& QMP 3ǘ¹->Ǚĥ3ɵǫHɉˆ̲lHƠˆ

18

D7-

D̴

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ5.

Ǚ.̯monthly̰2 QA 3 QMP >3 QMP 1A),ɀƱƫŜE&ʎŏǈD7-Ǌ̯daily̰Ǚ.̯monthly̰Ű.̯annual̰2 QA 2̊-́ʭD̴2ŏǈ̢ŶD˃̪̜ȿ

D̴ȃ

2́ʭ3̲Ǚ.̯monthly̰2 QA ȃǊ̯daily̰2 QA 2A1ÿɰ-30.)&A0ȥɜƑ
2|ƍʮ-D̴E3½ȮDȖŎģȳ0D.-˸ƚED̲ȃǊ̯daily̰2 QA B

2Ǚ.̯monthly̰2 QA 2ȥɜ1*,2ƨŻ3 QMP 1A),ȉŎED̴2&=13̘ŭ1Ļ
2ȖŎH˯&ȖŎģ2Ǵˁ?̲˃̪ʼ̅HǴǮEDƍʮ

D.-ȃǊ̯daily̰2 QA ¼ǵ2Ǵˁ>ŏǈ

D̴¾4̲ȃǊ2ÞìȖŎ1ĻǽÓǴÞģH½Ȯ,C̲:&Ǚ.̯monthly̰2Ȗ

Ŏ->ĒǴÞģH½Ȯ,Dĵđ̲˷ă2ıȘ̯baselinḛHxJa.,̲ĻǽÓǴÞģ2
ȖŎ.̲̗̖ɥ-xJlHæȮ&ȖŎ.HŰ1 1 ĥȄˣ
2ȖŎ1Ř

D7-

D̴E1ACȖŎģ2Ǌ

DẠ̊ƑH̲:& 1 Ű.)&̆ǜ̊2˷ɕ2-ŖɆE!1DÎĔHˆˑD

.ċʓ.0D̴2A0Ȅˣ˃̪3̲̏BE&da2̲ǘŝ̏2Ǽģ2óȧȼ0½ȮHċ
ʓ1D̴ȃǊ̯daily̰2 QA 1̋,3̲×,2ɵǫ3̗ņA5rm[w2Ǉ-ȇ1Ǆǖ

÷E̲

1ɉˆ-DƍʮjH½Ȯ,

D̴úŉȢȫĸ1.),Ēɠ2_aj>3°Ǘ.0D_a

B@DǼģ2WaU

y_Hŏǈ˚&ĵđ1̲˻à0ʣôĈEDA1ÇªŏǈD.3́ʮ-D˃̪1̋

D̴ʾœ|H

Dǌɉ0TMmMƍʮ-D̴EB2TMmM13ʜ1 2 Ȃ̑ɉˆ̯secondary check̰? QMP 62Ĵė1*,>ĕ:E
Dƍʮ

6.

D̴í, QMP 3˃̪ō¢B 15 Ǌ±Û1ɵǫHɉˆ̲lHƠˆD7-l1Ɍ&Ű.̯annual̰2 QA ̜ȿ3̲ʩʆ2Ƒʓ1*,ǘ>ųɦħ0˃̪Hʧ
B2˃̪3Ɠʎ?ȬĶ62Ō×Hʍƙ&ɀʀí˰ģ2˻ǿ0ǼʓƑHÄˁ
E&Ǽ̋1A),ƠˆED.>s..>1 QMP ŏǈ
Ǽģ3̲

D̴

̴E

D&=1̲ū?Ũ1ØˆD̴2ȫȰ1ACŰ.̯annual̰2ȖŎ3 QA gD.ƲłED̴̗̖ɥʀ̃ʹ? 3 ǽÓȆxJl0/2A0 QA

B@DȖŎHŏǈ

Dè1˻à1ɉˆED.HżƲł

D̴ȖŎ3̲˩á£Ŏ2

7

TG-106 ̯ȏ̸ȩĬȹáȒ;̰-ƲłEDA0[h_oXĝ˘ʩʆH½Ȯ,ŏǈED7
-

7.

D̴

ɝǟ˲ɵ_aj˃̪̯end-to-end system check̰3̲_ajHǆʰ1ŜÖ&ĵđ>3ǕǆE&ǐ3*->̲_aj×º2ĳĩƑHÄˁD&=1ŏǈ

D.HƲł

D̴E3ǈʽ2˯ŭ2ȊȸʹȲ2]zzH¼ƚ,̲phlWH¬,zHˠ˭̲Ȋȸʩʆ-ȟŚ
.-ɉˆ

D

D.-D̴> record and verify̯R&V̰_aj1ACke¬ED0B4̲

2_aj3ɝǟ˲ɵ_aj˃̪̯end-to-end system check̰1ĕ:0E40B0̴ɝǟ˲ɵ_aj˃̪̯end-to-end system check̰3̲ȊȸʹȲʩʆ̲R&V _aj̲ȟŚ_aj2dxlNOK
1ĹǕȭ&ĵđ13̲ŭ1ƍʮƑHÄˁ

D̴ȣ1̲ȊȸʹȲ1̋,̲ʀ̃ʹɣ.ȟŚ˷ɕ2̊2ŌŎ

D&=13Mlʀ̃ȖŎHŏǈ

D7-D̴ɝǟ˲ɵ_aj˃̪̯end-to-end

system check̰-3Đɖ_aj2ɗÏřěǄǖ÷ED7-8.

D̴

Ű.̯annual̰2 QA Hɉˆ,D̲̊ʩʆ2Þì3 NIST̯National Institutes of Standard andTechnology̸KSĪɜǹȘơʤɈəƝ̰2l]y0ʫǿÂǂHƪ)&̗̖ɥʀ̃ʹHȮ,̲

19ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

TG-51 1Ƈ),ǯǿED7-Dʿʎȏ8̴Ŷʩʆ2ÞìǯǿE&B̲ȃǊ̯daily̰2 QA ?Ǚ

.̯monthly̰2 QA -½ȮED×,2¥ǽ QA ȖŎģ3̲$2ǯǿ1Ř,WagOhWED
7-

D̴ƛ

2l-3ǆʰʩʆ2ĉÖE˃̪1̋ÖE˃̪?ʾœÈHɉˆ
QA ˃̪HæȮ

D̒1̲ʜȼ0TMm.,½ȮEƈDǠl-Ʋł&Ű.2

D.Hłñ

D̴ȖŎō¢ǽɟ̲Ű.2 QA lH¼ƚ
EDʾœÈ1ı+,ȣʼ¤̜Hʼˤ
ȲÐ̲̯5̰ȣåǼģ̵Ǉȍ2A1ß̥

D7-

D.ƲłED̴l13ʧ1ɌE&Ʋł
D̴l3̯1̰ʀ̲̯̃2̰Ų»ŉȼ̲̯3̰Ō×̲
̯4̰

D.-D̴QA l3 QMP 1A),ɉˆ̲ʇēE̲

śǥ2ʩʆ2jna?ǴǮ2&=1xJMED7-ʿʎȏ 8

DƲł3ʣG0)&̲|f2ĉ

̷ǊǠ-3ǹȘȖŎȍ 01̯ǊǠúŉȢȫŉµʁ̰1Ƈ̴

20

D̴ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ I. ȃǊ2 QA̯Daily̰ȊȸǼeMzå2ʾœÈ̯Machine-type tolerancḛ̜ȿ˯ŭȊȸ̯Non-IMRT̰IMRTSRS/SBRTʀ̃ɤȫ̯Disimetry̰X ʀÞìĹƑ̯×PpV̰
X-ray output constancy (all energy)̗ņʀÞìĹƑ̯ȃ˳̲&'ȣå0­Ǹ-oeX,Dʩʆ3ȃǊ̰
Electron output constancy (weekly, except formachines with unique e-monitoring requiring
daily)

3%Ų»ŉȼɤȫ̯Mechanical̰^¸ʆ
Laser localization
KMdce¸ʆ-2˝̖ʹʧɌDistance indicator (ODI) @ iso[e]MbʧɌ
Collimator size indicator

2 mm

1.5 mm

1 mm

2 mm

2 mm

2 mm

2 mm

2 mm

1 mm

Ō×ɤȫ̯Safety̰
mKMehW̯v˼ǅED̰
Door interlock (beam off)mKŌ×1̈:D
Door closing safetyʱʏʲoeAudiovisual monitor(s)Ŏ¸ȟŚMehW̯ȟŚç̰̏
Stereotactic interlock (lockout)PKoe̯½Ȯ,E4̰
Radiation area monitor (if used)ȟŚȚ
Beam on indicator

NA

21

ô¼

D

ô¼

D

ô¼

D

NA

ô¼

ô¼

D

ô¼

D

D

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ II. ȃǙ2 QA̯Monthly̰ȊȸǼeMzå2ʾœÈ̯Machine-type tolerancḛ̜ȿ˯ŭȊȸ̯Non-IMRT̰IMRTSRS/SBRTʀ̃ɤȫ̯Disimetry̰X ʀÞìĹƑ
X-ray output constancy̗ņʀÞìĹƑ
Electron output constancy
shWKhzoeʀ̃ʹĹƑ
Backup monitor chamber constancy°ʧȼ0ʀ̃ȧ a 1DÞìʀ̃2ĹƑTypical dose rate output constancy

2%NAX ʀzxJMĹƑ
Photon beam profile constancy̗ņʀzxJMĹƑ
Electron beam profile constancy̗ņʀPpVĹƑElectron energy constancy

2%̯IMRT -½Ȯ Dʀ̃ȧ1,̰

2%̯SRS/SBRT -½Ȯ
Dʀ̃ȧ̲MU 1
,̰

1%
1%
2%/2 mmŲ»ŉȼɤȫ̯Mechanical̰Õ/ƽŚʀȟŚ̂2ʛ b
Light/radiation field coincidence
Õ/ƽŚʀȟŚ̂2ʛ̯̘ŘɓȟŚ̰̂b
Light/radiation field coincidence (asymmetric)^ƫɌɫŶɉˆȮǼģ2ƫɌ¸ʆ.xlMeƫɌ¸ʆ2˝̖Ū
Distance check device for lasers compared withfront pointerTl/[eʵŶ2ʧɌÈ.ŏ̒2¸ʆ2Ū̯ʮ0ʵŶ̰̯k`eʧɌÈ2;̰
Gantry/collimator angle indicators (@ cardinalangles) (digital only)
KWc]lM̯¾4lxL2&=2ûŇʀ¯
lM0/̰
Accessory trays (i.e., port film graticle tray)
Jaw ¸ʆ2ʧɌÈ.ŏ̒2¸ʆ2Ū̯ŘɓȟŚ̰̂c
Jaw position indicators (symmetric)
Jaw ¸ʆ2ʧɌÈ.ŏ̒2¸ʆ2Ū̯̘ŘɓȟŚ̰̂d
Jaw position indicators (asymmetric)Wa{Kƌ¸ʆ̯walkout ʿʎȏ 1̰
Cross-hair centering (walkout)ȊȸŕČ¸ʆ2ƫɌÈ.ŏ̒2¸ʆ2Ū eTreatment couch position indicatorsNOh`¸ʆɫŶ
Wedge placement accuracyʫÑº¸ʆɫŶ fCompensator placement accuracy
NOh`̲yhW2ˆˑ gLatching of wedges, block tray^¸ʆ
Localizing lasers˧1* 2 mm or 1%˧1* 2 mm or 1%

1 mm

1.0°

2 mm

2 mm

1 mm
1 mm
2 mm/1°2 mm/1°2 mm/0.5°

2 mm
1 mm
ô¼
2 mm

D

1 mm

Ō×ɤȫ̯Safety̰^TmMehW
Laser guard-interlock test

ô¼

22

D

< 1 mmɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ II. ȃǙ2 QA̯Monthly̰̯ɻ̰
ȊȸǼeMzå2ʾœÈ̯Machine-type tolerancḛ̜ȿ˯ŭȊȸ̯Non-IMRT̰IMRTSRS/SBRTĚĖĒǜ̯Respiratory gating̰vÞìĹƑ
Beam output constancy¸Ɂ̲ƭŮvçƉPhase, amplitude beam control
ŐÛĚĖȾʱ_aj
In-room respiratory monitoring systemĒǜMehW
Gating interlock

2%
ô¼

D

ô¼

D

ô¼

D

a

ʀ̃ȧ1Ǝ&ʀ̃oeXÕȟŚ̂HʙŴ2chlKhz1½Ȯ,Dĵđ2;̲Õ/ƽŚʀȟŚ̂2ʛHȃǙɉˆ Dƍʮ D̴cʾœÈ3ɝ̯̆ǇĔ̲ŮǇĔ/(B>̰2đʹ̴d̘Řɓ jaw 3 0.0 . 10.0 2ʽŎ1*,ɉˆ D7- D̴eũĎǇĔ̲̆ˡǇĔ̲ĥˠǇĔ̴fʫÑº IMRT 3̲ʫÑºlMNlA5Wa{KƌBǘļ 1mm 2ÊŪ-ʽʆEDlM¸ʆ1Ř̃ÈHƍʮ. D̴gŴ̙1Ĕ,ĈC¯D[e/TlʵŶ2ɳ;đG"-ɉˆ D̴
b

23

DŎ

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ III. ȃŰ2 QA̯Annual̰ȊȸǼeMzå2ʾœÈ̯Machine-type tolerancḛ̜ȿ˯ŭȊȸ̯Non-IMRT̰IMRTSRS/SBRTʀ̃ɤȫ̯Disimetry̰X ʀůĮŶ2ıȘÈB2Ĺ÷
X-ray flatness change from baselineX ʀŘɓƑ2ıȘÈB2Ĺ÷
X-ray symmetry change from baseline̗ņʀůĮŶ2ıȘÈB2Ĺ÷
Electron flatness change from baseline̗ņʀŘɓƑ2ıȘÈB2Ĺ÷
Electron symmetry change from baseline
SRS ĥˠm
̯0.5 – 10 MU/deg 2ɦħ̰
SRS arc rotation mode (range: 0.5–10 MU/deg)X ʀ/̗ņʀÞìǯǿ̯TG-51̰
X-ray/electron output calibration (TG-51)
X ʀÞìÂǂ2ȟŚ̂ÀňƑ
̯2 *±2ȟŚ̂1*,ƤĈC˃̪̰
Spot check of field size dependent output factors
for x-ray (two or more FSs)
̗ņʀKzYe2ÞìÂǂ̶̯*2KzYe/PpV2ƤĈC˃̪̰
Output factors for electron applicators (spot checkof one applicator/energy)
X ʀʀ˘̯PDD10 >3 TMR20,10̰
X-ray beam quality (PDD10 or TMR20,10)̗ņʀʀ˘̯R50̰
Electorn beam quality (R50)ȢȫNOh`Âǂ2ĹƑ
Physical wedge transmission factor constancy
X ʀ MU ɀʀƑ̯ÞìĹƑ̰
X-ray monitor unit linearity (output constancy)̗ņʀ MU ɀʀƑ̯ÞìĹƑ̰
Electron monitor unit linearity (output constancy)X ʀÞì2ʀ̃ȧÀňƑ
X-ray output constancy vs. dose rate
X ʀÞì2TlʵŶÀňƑ
X-ray output constancy vs. gantry angle̗ņʀÞì2TlʵŶÀňƑ
Electron output constancy vs. gantry angle̗ņʀ̲X ʀˡĺʀ̃Ȅ2TlʵŶÀňƑ
Electron and x-ray off-axis factor constancy vs.
gantry angleĥˠȟŚ̯ʰŎ MU̲ʵŶ̰
Arc mode (expected MU, degrees)
TBI/TSET m
TBI/TSET mode
PDD̲TMR̲OAF ĹƑ
PDD, TMR, OAF constancy
TBI/TSET Þìǯǿ
TBI/TSET output constancy
TBI/TSET Ȯ2vÆ̦ȮģÚHÖE&v
2ÞìĹƑ
TBI/TSET accessories

1%
1%
1%
1%

NA

MU ʽŎÈ vs. ȟŚÈ̷1.0 MU  2%̯/(BļǇ̰
TlĥˠʽŎÈvs. ȟŚÈ̷1.0° 2%
̯/(BļǇ̰

NA

1%̯ɹŘʀ̰̃2%̯ȟŚ̂]Mb < 4x4 cm2̰
1%̯ȟŚ̂]Mb  4x4 cm2̰2%̯ıȘÈB2Ĺ÷̰1%̯ıȘÈB2Ĺ÷̰
1 mm
2%
2%5 MU

5% (2-4 MU)
2%5 MU

5% (2-4 MU)
2%5 MU

2%5 MU
2%
̯ıȘÈB2Ĺ÷̰1%̯ıȘÈB2Ĺ÷̰1%̯ıȘÈB2Ĺ÷̰1%̯ıȘÈB2Ĺ÷̰1%̯ıȘÈB2Ĺ÷̰ô¼

D

TBI: 1%̲TSET: 1 mm̯ıȘÈB2Ĺ÷̰
2%̯ıȘÈB2Ĺ÷̰
2%̯ıȘÈB2Ĺ÷̰24ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ III. ȃŰ2 QA̯Annual̰̯ɻ̰
ȊȸǼeMzå2ʾœÈ̯Machine-type tolerancḛ̜ȿ˯ŭȊȸ̯Non-IMRT̰IMRTSRS/SBRTŲ»ŉȼɤȫ̯Mechanical̰
[eĥˠKMdceCollimator rotation isocenterTlĥˠKMdceGantry rotation isocenter
ŕČĥˠKMdce
Couch rotation isocenter̗ņʀKzYeMehWElectron applicator interlocks
ƽŚʀKMdce.ǼǳȼKMdce2ʛCoincidence of radiation and mechanical isocenterȊȸĽǧ2&G;
Table top sagȊȸĽǧ2ʵŶ
Table angle
×ǇĔ1Ř DȊȸĽǧ2ǘļċôİ
Table travel maximum range movement in all
directionsŎ¸ȟŚKWc]̲hWɠ
Stereotactic accessories, lockout, etc.

1 mm̯ıȘÈB2Ĺ÷̰1 mm
̯ıȘÈB2Ĺ÷̰1 mm
̯ıȘÈB2Ĺ÷̰
ô¼

D

2 mm
2 mm
1 mm
̯ıȘÈB2Ĺ÷̰ ̯ıȘÈB2Ĺ÷̰ ̯ıȘÈB2Ĺ÷̰
2 mm
̯ıȘÈB2Ĺ÷̰
1°
2 mm
NA

NA

ô¼

Ō×ɤȫ̯Safety̰|f˃̪̜ȿ
Follow manufacturer’s test procedureô¼DĚĖĒǜ̯Respiratory gating̰vPpVĹƑ
Beam energy constancy¸Ɂ/ƭŮĒǜǐ̊ǿɉƑTemporal accuracy of phase/amplitude gate onĚĖ¸Ɂ/ƭŮ]Zl2ǯǿ
Calibrationofsurrogatefor
respiratory
phase/amplitude
MehW˃̪
Interlock testing2%£ȖÈB2Ĺ¸ 100 ms£ȖÈB2Ĺ¸ 100 ms
ô¼

25

D

D

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ IV. fMnhW/os]/sgNOh`̯Dynamic/universal/virtual wedgḛʾœÈ̯Tolerancḛ̜ȿ

fMnhWos]sgȃǊ̯Daily̰ńǵțǴǐ1 1 *2ʵŶ2ȟŚŏǈ
Morning check-out run for one angle

ô¼

DȃǙ̯Monthly̰
×PpV2NOh`Âǂ
Wedge factor for all energies

45, 60°2vƌˡ2NOh`Âǂ̯2%±Ṵ̂a45, 60°2vƌˡ2NOh`Âǂ̯2%±Ṵ̂aNOh`Âǂ 1.0 B2Ĺ¸ 5%>3
2%

ȃŰ̯Annual̰ȟŚ̂×̉-NOh`ʵŶ 60 Ŷ.̲̊2ʵ
ŶA5ȟŚ̂]MbHƤĈC˃̪
Check of wedge angle for 60°, full field and spot
check for intermediate angle, field sizea60 Ŷ±ĺ2ʵŶH½Ȯ

Dĵđ3̲45 ŶHƲł10 cm ȑ̲ȟŚ̂]Mb2 80%-ʰŎEDɦħÛ2ˡĺʀ̃Ȅ2Ĺ÷
 2%±Û

D̴

26

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ V. gx[e̯IMRT 2ŏǈǚȝ-ʩʆHùå&̰
Multileaf collimation (with differentiation of IMRT vs non-IMRT machines)̜ȿʾœÈ̯Tolerancḛȃ˳̯Weekly̰ŎƑȼ˃̪̯vYhlxOa2A0hgXcXl̰x̊ˮ˷ʀ̃2ķí0/Hʱʲȼ1äŎ

ȃǙ̯Monthly̰ʽŎȟŚ̂.ƽŚʀȟŚ̂2ʛ
̯2 *2ȟŚ̰̂
Setting vs. radiation field for two patterns(non-(MRT)shWKhzɶCʽŎ̯Elekta 2;̰
Backup diagraph setting (Elekta only)x̨ô˰Ŷ̯IMRT̰Travel speed (IMRT)x¸ʆɫŶ̯IMRT̰Leaf position accuracy (IMRT)

2 mm

2 mm
x˰ŶƶĿ < 0.5 cm/s
4 *2TlʵŶ2 IMRT ȟŚ̂- 1 mm 2x¸ʆɫŶ̯wYh
lxOa˃̪ưȮED'F̴˃̪3ʙŴ2cXl]Mb1
Àň D̰

ȃŰ̯Annual̰
MLC ˮ˷ʀ̃
̯xA5x̊ˮ˷ʀ̃2ůḭ̲̆×PpV
MLC transmission (average of leaf and interleaf
transmission), all energyx¸ʆÜȩƑ
Leaf position repeatability
MLC aW_hl
MLC spoke shotÕȟŚ̂.ƽŚʀȟŚ̂2ʛ
̯×PpV̰
Coincidence of light field and x-ray field (allenergies)
SMLC-IMRT jal
Segmental IMRT (step and shoot) test
DMLC-IMRT jal
̯4 *2ʮ0TlʵŶ̰
Moving window IMRT (four cardinal gantry
angles)0.5%̯ıȘÈB2Ĺ÷̰1.0 mmýƃ 1.0 mm

2.0 mmˉŪ2 RMS ǘļÈ < 0.35 cm
0.35 cm Ǟȗ2ˉŪ 95%±ˉŪ2 RMS ǘļÈ < 0.35 cm
0.35 cm Ǟȗ2ˉŪ 95%±27ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ VI. ƽŚʀȲÐ̯Imaging̰ȊȸǼeMzå2ʾœÈ̯Application-type Tolerancḛ
̜ȿ

Non-SRS/SBRTSRS/SBRTȃǊ̯Daily̰ aů̙ kV, MV̯EPID̰ȲÐʦɛ̍ǾMehWCollision interlocks
ǘɲȼ0¸ʆȉ=ɫŶʿʎȏPositioning/repositioningȲÐɬȊȸɬŷǹ2ʛ̯1 *2TlʵŶ̰Imaging and treatment coordinate coincidence

ô¼

D

2 mm

1 mm

2 mm

1 mm

[v CT̯kV, MV̰ʦɛ̍ǾMehWCollision interlocks
ȲÐɬȊȸɬŷǹ2ʛ
Imaging and treatment coordinate coincidenceǘɲȼ0¸ʆȉ=ɫŶ
Positioning/repositioning

ô¼

D

2 mm

1 mm

1 mm

1 mm

2 mm

1 mm

2 mm

2 mm

ıȘÈ c

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

2 mm

1 mm

2 mm

1 mm

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

2 mm

1 mm

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ȃǙ̯Monthly̰ů̙ MV ȲÐ̯EPID̰ȲÐɬȊȸɬŷǹ2ʛ
̯4 *2TlʵŶ̰Imaging and treatment coordinate coincidence (fourcardinal angles)aYX b
Scalingɚ̊ßʶʓSpatial resolution[lalContrastĭƑ.qMb
Uniformity and noiseů̙ kV ȲÐ dȲÐɬȊȸɬŷǹ2ʛ̯4 *2TlʵŶ̰Imaging and treatment coordinate coincidence (fourcardinal angles)aYX
Scalingɚ̊ßʶʓSpatial resolution[lalContrastĭƑ.qMb
Uniformity and noise[v CT̯kV, MV̰Ų»ŉȼȀ;
Geometric distortionɚ̊ßʶʓ
Spatial resolution[lalContrast
HU ĹƑ
HU constancyĭƑ.qMb
Uniformity and noise28

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ʧ VI. ƽŚʀȲÐ̯Imaging̰̯ɻ̰
ȊȸǼeMzå2ʾœÈ̯Application-type Tolerancḛ
̜ȿ

Non-SRS/SBRTSRS/SBRT

5 mm

5 mm

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ıȘÈ

ȃŰ̯Annual̰ů̙ MV ȲÐ̯EPID̰
SSD ʽŎÈ.ŏ̒2È̯ċô×ɦħ̰
Full range of travel SSD
ʨǔʀ̃ eImaging doseů̙ kV ȲÐʀ˘/PpV
Beam quality/energyʨǔʀ̃Imaging dose[v CT̯kV, MV̰ʨǔʀ̃
Imaging doseʿʎȏȲÐĈƈ_aj-¸ʆĹ¸̃HʹȖ̲$2Ĺ¸̃HÆǿ&¸ʆ-ÜŶ¸ʆȟđȲÐHĈƈ,̲¸ʆÆǿɫŶ
Hɉˆ D˃̪Hƫ ̴a>3̲Ş0.>̲ȲÐʩʆȊȸ1½ȮED.̴
ȲÐĈƈ1˯ŭ½ȮED SDD -aYXHŏǈ D̯dxlNOK2Ǽʓ-ʹȖED˝̖ɫŶHɉˆcıȘÈ̯baselinḛ.3̲ĉÖE˃̪ǐ2ke.Ēɠ>3$EACÒE&ȖŎkeHɌ ̴dkV ȲÐ3 2 ǽÓ2ˮʱȲÐ.ƽŚʀȲÐ2ĆǇHƖę D̴
e
TG75 -ŏóʀ̯̃effective dosḛ.,ĴėEDȖŎʀ̴̃
b

29

D̴̰

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

ĄʍǄȦ
1.

G. J. Kutcher, “Comprehensive QA for radiation oncology: Report of AAPM Radiation Therapy Committee Task
Group 40,” Med. Phys. 21, 581–618, 1994.

2.

“Determination of absorbed dose in a patient irradiated by beams of x- or gamma-rays in radiotherapy procedures,”International Commission on Radiation Units and Measurement Bethesda Report 24, 1976.

3.

R. Nath, P. J. Biggs, F. J. Bova, C. C. Ling, J. A. Purdy, J. van de Geijn, and M. S. Weinhous, “AAPM code ofpractice for radiotherapy accelerators: Report of AAPM Radiation Therapy Task Group No. 45,” Med. Phys. 21,
1093–1121, 1994.

4.

“Medical electron accelerators-functional performance characteristics,” International ElectrotechnicalCommission Publication 976, 1989.

5.

“Medical electron accelerators in the range 1 MeV-50 MeV—Guidelines for functional performance
characteristics,” International Electrotechnical Commission Publication 977, 1989.

6.

“Physical aspects of quality assurance in radiation therapy,” American Association of Physicists in Medicine Task
Group Report 13, American Institute of Physics, New York, 1984.

7.

I. Das, J. C. Cheng, R. J. Watts, A. Ahnesjo, J. P. Gibbons, X. A. Li, J. Lowenstein, R. K. Mitra, W. E. Simon,
and T. C. Zhu, “Accelerator beam data commissioning equipment and procedures: Report of the TG-106 of the
Therapy Physics Committee of the AAPM,” Med. Phys. 35, 4186– 4215, 2008.

8.

“Radiation control and quality assurance in radiation oncology: A suggested protocol,” American College ofMedical Physics Report Series No. 2, American College of Medical Physics, Reston, VA, 1986.

9.

J. E. Bayouth, D. Wendt, and S. M. Morrill, “MLC quality assurance techniques for IMRT applications,” Med.
Phys. 30, 743–750, 2003.

10.

L. Berger, P. Francois, G. Gaboriaud, and J. C. Rosenwald, “Performance optimization of the Varian aS500 EPID
system,” J. Appl. Clin. Med. Phys. 7, 105–114, 2006.

11.

H. Bouchard and J. Seuntjens, “Ionization chamber-based reference dosimetry of intensity modulated radiation
beams,” Med. Phys. 31, 2454– 2465, 2004.

12.

M. G. Davis, C. E. Nyerick, J. L. Horton, and K. R. Hogstrom, “Use of routine quality assurance procedures todetect the loss of a linear accelerator primary scattering foil,” Med. Phys. 23, 521–522, 1996.

13.

R. E. Drzymala, E. E. Klein, J. R. Simpson, K. M. Rich, T. H. Wasserman, and J. A. Purdy, “Assurance of highquality linac-based stereotactic radiosurgery,” Int. J. Radiat. Oncol., Biol., Phys. 30, 459–472, 1994.

14.

A. Gonzalez, I. Castro, and J. A. Martinez, “A procedure to determine the radiation isocenter size in a linear
accelerator,” Med. Phys. 31, 1489– 1493, 2004.

15.

E. E. Klein, D. A. Low, D. Maag, and J. A. Purdy, “A quality assurance program for ancillary high technology
devices on a dual-energy accelerator,” Radiother. Oncol. 38, 51–60, 1996.

16.

T. LoSasso, C. S. Chui, and C. C. Ling, “Comprehensive quality assurance for the delivery of intensity modulated
radiotherapy with a multileaf collimator used in the dynamic mode,” Med. Phys. 28, 2209–2219, 2001.

17.

D. A. Low, E. E. Klein, D. K. Maag, W. E. Umfleet, and J. A. Purdy, “Commissioning and periodic quality
assurance of a clinical electronic portal imaging device,” Int. J. Radiat. Oncol., Biol., Phys. 34, 117–123, 1996.

18.

W. R. Lutz and B. E. Bjarngard, “A test object for evaluation of portal films,” Int. J. Radiat. Oncol., Biol., Phys.
11, 631–634, 1985.

30

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

19.

W. R. Lutz, R. D. Larsen, and B. E. Bjarngard, “Beam alignment tests for therapy accelerators,” Int. J. Radiat.
Oncol., Biol., Phys. 7, 1727–1731, 1981.

20.

L. Ma, P. B. Geis, and A. L. Boyer, “Quality assurance for dynamic multileaf collimator modulated fields using afast beam imaging system,” Med. Phys. 24, 1213–1220, 1997.

21.

C. D. Mubata, P. Childs, and A. M. Bidmead, “A quality assurance procedure for the Varian multi-leaf collimator,”Phys. Med. Biol. 42, 423– 431, 1997.

22.

J. Rassow, “Quality control of radiation therapy equipment,” Radiother. Oncol. 12, 45–55, 1988.

23.

J. Rassow and E. Klieber, “Quality assurance procedures in radiotherapy—IEC specifications for equipment,”
Strahlenther. Onkol. 162, 496–502, 1986.

24.

R. J. Watts, “Evaluation of a diode detector array for use as a linear accelerator QC device,” Med. Phys. 25, 247–
250, 1998.

25.

M. S. Al-Ghazi, B. Arjune, J. A. Fiedler, and P. D. Sharma, “Dosimetric aspects of the therapeutic photon beams
from a dual-energy linear accelerator,” Med. Phys. 15, 250–257, 1988.

26.

M. S. Al-Ghazi, D. Lingman, B. Arjune, L. D. Gilbert, and J. Thekkumthala, “Characteristic parameters of 6–21
MeV electron beams from a 21 MeV linear accelerator,” Med. Phys. 18, 821–828, 1991.

27.

C. Constantinou and E. S. Sternick, “Reduction of the ‘horns’ observed on the beam profiles of a 6-MV linear
accelerator,” Med. Phys. 11, 840–842, 1984.

28.

P. B. Dunscombe and J. M. Nieminen, “On the field-size dependence of relative output from a linear accelerator,”Med. Phys. 19, 1441–1444, 1992.

29.

B. A. Faddegon, P. O’Brien, and D. L. Mason, “The flatness of Siemens linear accelerator x-ray fields,” Med.
Phys. 26, 220–228, 1999.

30.

M. N. Graves, A. V. Thompson, M. K. Martel, D. L. McShan, and B. A. Fraass, “Calibration and quality
assurance for rounded leaf-end MLC systems,” Med. Phys. 28, 2227–2233, 2001.

31.

S. W. Hadley and K. Lam, “Light field and crosshair quality assurance test using a simple lens system,” Med.
Phys. 33, 930–932, 2006.

32.

Y. Mandelzweig and V. Feygelman, “Evaluation of electron-beam uniformity during commissioning of a linear
accelerator,” Med. Phys. 20, 1233–1236, 1993.

33.

R. Rajapakshe and S. Shalev, “Output stability of a linear accelerator during the first three seconds,” Med. Phys.
23, 517–519, 1996.

34.

A. S. Shiu, S. S. Tung, C. E. Nyerick, T. G. Ochran, V. A. Otte, A. L. Boyer, and K. R. Hogstrom,“Comprehensive analysis of electron beam central axis dose for a radiotherapy linear accelerator,” Med. Phys. 21,
559–566, 1994.

35.

M. K. Woo, P. O’Brien, B. Gillies, and R. Etheridge, “Mechanical and radiation isocenter coincidence: An
experience in linear accelerator alignment,” Med. Phys. 19, 357–359, 1992.

36.

M. J. Murphy, J. Balter, S. Balter, J. A. BenComo, Jr., I. J. Das, S. B. Jiang, C. M. Ma, G. H. Olivera, R. F.
Rodebaugh, K. J. Ruchala, H. Shirato, and F. F. Yin, “The management of imaging dose during image- guided
radiotherapy: Report of the AAPM Task Group 75,” Med. Phys. 34, 4041–4063, 2007.

37.

T. E. Schultheiss, A. L. Boyer, J. L. Horton, and R. J. Gastorf, “Calibration frequency as determined by analysis
of machine stability,” Med. Phys. 16, 84–87, 1989.

31

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ38.

M. Rozenfeld and D. Jette, “Quality assurance of radiation dosage: Usefulness of redundancy,” Radiology 150,
241–244, 1984.

39.

T. Pawlicki, M. Whitaker, and A. L. Boyer, “Statistical process control for radiotherapy quality assurance,” Med.
Phys. 32, 2777–2786, 2005.

40.

“Method for evaluating QA needs in radiation therapy,” American Association of Physicists in Medicine Task
Group Report 100, 2009, (unpublished).

41.

A. Boyer, P. Biggs, J. Galvin, E. Klein, T. LoSasso, D. Low, K. Mah, and C. Yu, “Basic applications of multileaf
collimators,” AAPM Radiation Therapy Committee Task Group No. 50 Report No. 72, 2001.

42.

E. D. Slessinger, R. L. Gerber, W. B. Harms, E. E. Klein, and J. A. Purdy, “Independent collimator dosimetry fora dual photon energy linear accelerator,” Int. J. Radiat. Oncol., Biol., Phys. 27, 681–687, 1993.

43.

E. E. Klein, M. Taylor, M. Michaletz-Lorenz, D. Zoeller, and W. Umfleet, “A mono isocentric technique forbreast and regional nodal therapy using dual asymmetric jaws,” Int. J. Radiat. Oncol., Biol., Phys. 28, 753–760,
1994.

44.

P. K. Kijewski, L. M. Chin, and B. E. Bjarngard, “Wedge-shaped dose distributions by computer-controlledcollimator motion,” Med. Phys. 5, 426–429, 1978.

45.

E. E. Klein, R. Gerber, X. R. Zhu, F. Oehmke, and J. A. Purdy, “Multiple machine implementation of enhanced
dynamic wedge,” Int. J. Radiat. Oncol., Biol., Phys. 40, 977–985, 1998.

46.

C. Liu, Z. Li, and J. R. Palta, “Characterizing output for the Varian enhanced dynamic wedge field,” Med. Phys.
25, 64–70, 1998.

47.

C. Liu, T. C. Zhu, and J. R. Palta, “Characterizing output for dynamic wedges,” Med. Phys. 23, 1213–1218, 1996.

48.

A. W. Beavis, S. J. Weston, and V. J. Whitton, “Implementation of the Varian EDW into a commercial RTP
system,” Phys. Med. Biol. 41, 1691–1704, 1996.

49.

X. R. Zhu, M. T. Gillin, P. A. Jursinic, F. Lopez, D. F. Grimm, and J. J. Rownd, “Comparison of dosimetriccharacteristics of Siemens virtual and physical wedges,” Med. Phys. 27, 2267–2277, 2000.

50.

M. H. Phillips, H. Parsaei, and P. S. Cho, “Dynamic and omni wedge implementation on an Elekta SL linac,”Med. Phys. 27, 1623–1634, 2000.

51.

E. E. Klein, W. B. Harms, D. A. Low, V. Willcut, and J. A. Purdy, “Clinical implementation of a commercial
multileaf collimator: Dosimetry, networking, simulation, and quality assurance,” Int. J. Radiat. Oncol., Biol., Phys.
33, 1195–1208, 1995.

52.

J. M. Galvin et al., “Evaluation of multileaf collimator design for a photon beam,” Int. J. Radiat. Oncol., Biol.,Phys. 23, 789–801, 1992.

53.

J. M. Galvin, A. R. Smith, and B. Lally, “Characterization of a multi-leaf collimator system,” Int. J. Radiat.
Oncol., Biol., Phys. 25, 181–192, 1993.

54.

T. J. Jordan and P. C. Williams, “The design and performance characteristics of a multileaf collimator,” Phys.
Med. Biol. 39, 231–251, 1994.

55.

I. J. Das, G. E. Desobry, S. W. McNeeley, E. C. Cheng, and T. E. Schultheiss, “Beam characteristics of a
retrofitted double-focused multileaf collimator,” Med. Phys. 25, 1676–1684, 1998.

56.

A. L. Boyer and S. Li, “Geometric analysis of light-field position of a multileaf collimator with curved ends,”
Med. Phys. 24, 757–762, 1997.

32

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ57.

A. Burman, C. S. Chui, G. Kutcher, S. Leibel, M. Zelefsky, T. LoSasso, S. Spirou, Q. Wu, J. Yang, J. Stein, R.
Mohan, Z. Fuks, and C. C. Ling, “Planning, delivery, and quality assurance of intensity-modulated radio- therapy
using dynamic multileaf collimator: A strategy for large-scale implementation for the treatment of carcinoma of
the prostate,” Int. J. Radiat. Oncol., Biol., Phys. 39, 863–873, 1997.

58.

S. C. Vieira, M. L. Dirkx, K. L. Pasma, and B. J. Heijmen, “Fast and accurate leaf verification for dynamic
multileaf collimation using an electronic portal imaging device,” Med. Phys. 29, 2034–2040, 2002.

59.

M. Sastre-Padro, U. A. van der Heide, and H. Welleweerd, “An accurate calibration method of the multileaf
collimator valid for conformal and intensity modulated radiation treatments,” Phys. Med. Biol. 49, 2631–2643,
2004.

60.

J. J. Sonke, L. S. Ploeger, B. Brand, M. H. Smitsmans, and M. van Herk, “Leaf trajectory verification during
dynamic intensity modulated radio- therapy using an amorphous silicon flat panel imager,” Med. Phys. 31, 389–
395, 2004.

61.

S. J. Baker, G. J. Budgell, and R. I. MacKay, “Use of an amorphous silicon electronic portal imaging device formultileaf collimator quality control and calibration,” Phys. Med. Biol. 50, 1377–1392, 2005.

62.

V. P. Cosgrove, U. Jahn, M. Pfaender, S. Bauer, V. Budach, and R. E. Wurm, “Commissioning of a micro
multi-leaf collimator and planning system for stereotactic radiosurgery,” Radiother. Oncol. 50, 325–336, 1999.

63.

J. Chang, C. H. Obcemea, J. Sillanpaa, J. Mechalakos, and C. Burman, “Use of EPID for leaf position accuracy
QA of dynamic multi-leaf collimator (DMLC) treatment,” Med. Phys. 31, 2091–2096, 2004.

64.

J. E. Bayouth and S. M. Morrill, “MLC dosimetric characteristics for small field and IMRT applications,” Med.
Phys. 30, 2545–2552, 2003.

65.

E. E. Klein and D. A. Low, “Interleaf leakage for 5 and 10 mm dynamic multileaf collimation systems
incorporating patient motion,” Med. Phys. 28, 1703–1710, 2001.

66.

T. Losasso, “IMRT delivery performance with a varian multileaf collimator,” Int. J. Radiat. Oncol., Biol., Phys.
71, S85–S88, 2008.

67.

C. D. Venencia and P. Besa, “Commissioning and quality assurance for intensity modulated radiotherapy withdynamic multileaf collimator: Experience of the Pontificia Universidad Catolica de Chile,” J. Appl. Clin. Med.
Phys. 5, 37–54, 2004.

68.

A. M. Stell, J. G. Li, O. A. Zeidan, and J. F. Dempsey, “An extensive log-file analysis of step-and-shoot intensity
modulated radiation therapy segment delivery errors,” Med. Phys. 31, 1593–1602, 2004.

69.

S. S. Samant, W. Zheng, N. A. Parra, J. Chandler, A. Gopal, J. Wu, J. Jain, Y. Zhu, and M. Sontag, “Verificationof multileaf collimator leaf positions using an electronic portal imaging device,” Med. Phys. 29, 2900–2912,
2002.

70.

M. Mamalui-Hunter, H. Li, and D. A. Low, “MLC quality assurance using EPID: A fitting technique with
subpixel precision,” Med. Phys. 35, 2347–2355, 2008.

71.

J. Van Dyk, J. M. Galvin, G. P. Glasgow, and E. B. Podgorsak, “The physical aspects of total and half bodyphoton irradiation,” AAPM Radiation Therapy Committee Task Group 29 Report No. 17, 1986.

72.

C. J. Karzmark, J. Anderson, A. Buffa, F. P, F. Khan, G. Svensson, K. Wright, P. Almond, F. B, K. Hogstrom, R.
Loevinger, R. Morton, and B. Palos, “Total skin electron therapy: Technique and dosimetry,” AAPM Radiation
Therapy Committee Task Group 30 Report No. 23, 1987.

33

ɩĪúŉȢȫŉµ eaWXz 142 l̷úȸȮí˰ģ2ĝ˘Äˁ ǊǠˈʿ

73.

“Kilo voltage localization in therapy,” American Association of Physicists in Medicine Task Group Report 104,
2009, (unpublished).

74.

M. G. Herman, J. M. Balter, D. A. Jaffray, K. P. McGee, P. Munro, S. Shalev, M. Van Herk, and J. W. Wong,“Clinical use of electronic portal imaging: Report of AAPM Radiation Therapy Committee Task Group 58,” Med.
Phys. 28, 712–737, 2001.

75.

R. Rajapakshe, K. Luchka, and S. Shalev, “A quality control test for electronic portal imaging devices,” Med.
Phys. 23, 1237–1244, 1996.

76.

A. L. Boyer, L. Antonuk, A. Fenster, M. Van Herk, H. Meertens, P. Munro, L. E. Reinstein, and J. Wong, “Areview of electronic portal imaging devices (EPIDs),” Med. Phys. 19, 1–16, 1992.

77.

M. G. Herman, J. J. Kruse, and C. R. Hagness, “Guide to clinical use of electronic portal imaging,” J. Appl. Clin.
Med. Phys. 1, 38–57, 2000.

78.

D. A. Jaffray, J. H. Siewerdsen, J. W. Wong, and A. A. Martinez, “Flat- panel cone-beam computed tomography
for image-guided radiation therapy,” Int. J. Radiat. Oncol,. Biol., Phys. 53, 1337–1349, 2002.

79.

J. Pouliot, A. Bani-Hashemi, J. Chen, M. Svatos, F. Ghelmansarai, M. Mitschke, M. Aubin, P. Xia, O. Morin, K.
Bucci, M. Roach, 3rd, P. Hernandez, Z. Zheng, D. Hristov, and L. Verhey, “Low-dose megavoltage cone-beam
CT for radiation therapy,” Int. J. Radiat. Oncol., Biol., Phys. 61, 552–560, 2005.

80.

P. J. Keall, G. S. Mageras, J. M. Balter, R. S. Emery, K. M. Forster, S. B. Jiang, J. M. Kapatoes, D. A. Low, M. J.
Murphy, B. R. Murray, C. R. Ramsey, M. B. Van Herk, S. S. Vedam, J. W. Wong, and E. Yorke, “Themanagement of respiratory motion in radiation oncology report of AAPM Task Group 76,” Med. Phys. 33, 3874–
3900, 2006.

81.

J. Bayouth, J. Sample, T. Waldron, and R. Siochi, “Evaluation of 4DRT: CT acquisition and gated delivery
system,” Med. Phys. 33, 2188–2189, 2006.

82.

P. R. Almond, P. J. Biggs, B. M. Coursey, W. F. Hanson, M. S. Huq, R. Nath, and D. W. Rogers, “AAPM’s
TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams,” Med. Phys. 26,
1847–1870, 1999.

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ɏŀŧɂɜIce ƽŚʀȊȸĝ˘ÄˁŐ úŉȢȫĸ

ʋʿþìʎ̯§û̝̰̚ŤǠʪ  ĪɜIɈəceľȵ̐ ƽŚʀȊȸɑ úŉȢȫĸ
ǝʢğč  IƗǬȶce˿ɜ̩˨ȵ̐ ƽŚʀˀȸɑ úŉȢȫĸ
˺ţşɭ  üʠɂIce ƽŚʀȊȸ˾ȢȫŐ úŉȢȫĸǩ ɀǻ  ʢȯÄËʥȭļŉ úȸɑŉ˾ ƽŚʀŉɑ ˏŬĊ˓Ǔ  IƗǬȶce˿ɜ̩˨ȵ̐ ƽŚʀˀȸɑ úŉȢȫĸ
ťǣÃʣ  ĪɜIɈəce IŘɢƕĴce ɈəĞʔȯǌş  ĪɜIɈəceľȵ̐ ƽŚʀȊȸɑ úŉȢȫĸː˦ Ǡʋʿȡ2¼ƚ1&C̲Department of Radiation Oncology, School of Medicine, Washington University in St.

Louis, Clinical Fellow 2Ŋ˿őƒÔȭ̯ȩ ©˿ļŉļŉ̐úŉɈəɑ̰.̮ʢǌȺÔȭ̯ȩ ʉ̧ļŉ́ɪņʀúŉɈəce̰13̲TG-142 l2 First author -D Eric E. Klein Ôȭ.2ʋʿȡ¼ƚ2¨ȓ

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