Frequency

Daily

Monthly

Annually

Procedure
Dosimetry
X-ray output constancy
e- output constancy
Mechanical
Localizing lasers
Collimator Size Indicator
Safety
Door Closing Safely
Door Interlock
Audiovisual monitor
Dosimetry
X-ray output constancy
e- output constancy
Backup monitor constancy
X-ray central axis dosimetry parameter (PDD, TAR) constancy
e- central axis dosimetry parameter constancy (PDD)
X-ray beam flatness constancy
e- beam flatness constancy
X-ray and e- symmetry
Safety Interlocks
Emergency off switches
Wedge, e-cone interlocks
Mechanical checks
Light/radiation field coincidence
Gantry/collimator angle indicators
Wedge position
Tray position
Applicator position
Field size indicators
Cross-hair centering
Treatment couch position indicators
Latching of wedges, blocking tray
Jaw symmetry
Localizing lasers
Field light intensity
Dosimetry
X-ray/e- output calibration constancy
Field size dependence of x-ray output constancy
Output fator constancy for e- applicators

Annually
Central axis parameter constancy (PDD, TAR)
Off-axis factor constancy
Transmission factor constancy for all treatment accessories
Wedge transmission factor constancy
Monitor chamber linearity
X-ray output constancy versus gantry angle
e- output constancy versus gantry angle
Off-axis factor constancy versus gantry angle
Arc mode
Safety interlocks
Follow manufactuer's test procedures
Mechanical checks
Collimator rotation isocenter
Gantry rotation isocenter
Couch rotation isocenter
Coincidence of collimator, gantry, and couch axes with isocenter
Coincidence of radiation and mechanical isocenter
Vertical travel of table
Respiratory Gating
Beam energy constancy
Temporal accuracy of phase/amplitude
Calibration of surrogate phase/amplitude
Interlock testing

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010
2. Klein EE Hanley J, Bayouth J, et al. Task Group 142 report: Quality Assurance of Medical Accel
2009;36(9): 4197-4212. http://dx.doi.org/10.1118/1.3190392

Non IMRT

Tolerance (+/-)
IMRT

SRS/SBRT

3%
3%
2mm
2mm

1.5 mm
2mm

1 mm
1mm

Functional
Functional
Functional

2% IMRT dose rate 2% SRS Rate

2%
2%
2%
2mm at depth
2%
3%
3%
Functional
Functional

(+/-) 2mm

2mm or 1% on side
1 degree
2mm
2mm
2mm
2mm
2mm diameter
2mm/1 degree
Functional
2mm
(+/-) 1mm
>1mm
Functional
2% 5%/2%

5%/2%
2%
2%

2%
2%
2%
2%
2%
2%
2%
2%
2%
Functional

2mm diameter

2mm diameter
2mm diameter
2mm diameter
2mm diameter
2mm diameter
2mm
2mm
2%
100 ms
100 ms
Functioning

Wilkins; 2010
Assurance of Medical Accelerators. Med Phys.

1mm diameter

Frequency
Daily

Quality Metric
Safety
System operation and accuracy

Monthly or upon upgrade

Geometric

Image quality

If used for dose calculation

Annual

Image qaulity
Dose
Imaging system performance

Geometric
System operation

Asterick (*) indicates the option to perform the quality check activity. For example, phantom localization and reposi
(*) signifies the activity substition; not an eliminiation.
Italized font indicates that test preformance can be completed semiannually after 6-8 months after commissioning (on
1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010.

Quality Check

Colision and other interlocks

Warning lights
Laser/image/treatment isocenter coincidence*
Phantom localization and repositioning with couch shift*
Geometric calibration maps*

kV, MV, laser alignment*

Couch shifts: accuracy of motions
Scale, distance, and orientation accuracy
Uniformity, noise
High contrast spatial resolution
Low contrast detectablility
CT number accuracy and stability

Imaging dose
X-ray generator
Performance (kV systems only)
Tube potential, mA, ms accuracy, linearity
Anteroposterior, mediolateral, craniocaudal orientations are maintained
Long and short term planning of resources (disk space, manpower, etc.)

vity. For example, phantom localization and repositioning with couch shifts can be preformed OR geometric calibration maps. T

iannually after 6-8 months after commissioning (only if resulting data proves stable)

& Wilkins; 2010.

Tolerance (+/-)

Functional
Functional
2 mm
2 mm
Replace/refresh
1 mm
1 mm
Baseline
Baseline
< 2 mm (or <5 lp/cm)
Baseline
Baseline
Baseline
Baseline

Accurate
Support clinical use and
current imaging policies and
procedures

rmed OR geometric calibration maps. The

CT Simulator QA
Performance Parameter
Alignment of gantry lasers with center of imaging plane

Frequency
Daily

Orientation of gantry lasers with respect to imaging plane

Monthly and post laser adj.

Spacing of lateral wall lasers with respect to lateral gantry lasers

and scan plane
Orientation of gantry lasers with respect to imaging plane

Monthly and post laser adj.

Orientation of CT scanner tabletop with to imaging plane

Monthly or when daily tests reveal issues

Table vertical and longitudinal motion

Monthly

Table indexing and position

Annually

Gantry tilt accuracy

Gantry tilt position accuracy
Scan localization
Radiation profile width
Sensivitity profile width
Generator tests

Annually
Annually
Annually
Annually
Semi-annual
Post replacement of major generator component

Monthly and post laser adj.

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010.

y tests reveal issues

Tolerances (+/-)
2mm
2mm over length of laser projection
2mm
2mm over length of laser projection
2mm over length and width of tabletops
1mm over the range of table motion
1 mm over the scan range

1 deg. Over the gantry tilt range

1 deg, or 1mm from nominal position
1mm over scan range
Manufacturer specifics
1mm of nominal value
major generator component Manufacturer specifics

Brachytherapy Sources
Source
Long half-life (description)

Long half-life (calibration)

Short half-life (description)

Short half-life (calibration)

Performance Test
Physical/chemical form
Source encapsulation
Radionuclide distribution and
source uniformity
Location of radionuclide
Mean of batch
Deviation from mean
Calibration Vertificiation
Physical/chemical form
Source encapsulation
Mean of batch
Deviation from mean
Radionuclide distribution and
source uniformity

Frequency
Initial purchase
Initial purchase
Initial purchase
Initial purchase
Initial purchase
Initial purchase
Every use
Initial purchase
Initial purchase
Every use
Every use
Every use

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010.

Tolerance
Recorded
Recorded
Recorded
1mm
3%
5%
Visual Check
Recorded
Recorded
3%
5%
Visual Check

Daily QA for HDR (Afterloading)

Performance Testing
Viewing and intercom system
Emergency container and stop watch
TCS self test
TCS console lights
TCS console date and time
Decayed source activity in TCS
Survey meter battery, meter
Door interlock
Source exposure indicators on TCS
Source positioning accuracy
Interrupt button
Emergency off button
Timer ends treatment
Timer/Stopwatch

Tolerance (+/-)
Functional
Present
Functional
Functional
Accurate
Accurate
Functional
Functional
Functional
1 mm
Functional
Functional
Functional/Accurate
Functional/Accurate

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010

Treatment Planning System

Frequency
Commissioning/Updates

Monthly

Annual

Performance Tested
Understand algorithm
Single field/source isodose distribution
MU calculation
Test cases
I/O system
Checksum
Subset of reference QA
I/O system
MU calculation
Reference QA test
I/O system

1. Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins; 2010

Tolerance (+/-)
Functional
2% or 2mm
2%
2% or 2mm
1mm
No charge
2% or 2mm
1mm
2%
2% or 2mm
1 mm

TPS QA
Parameters Tested
Entry of Axial Contours
Creation of PTV Axial Contours, Given a CTV

Use of MR Images for Target Delineation

Beam Location Resolution

Collimator Setting

Aperture Definition

Collimation and Aperture Display

Gantry Angle
Table and/or Collimator Angle
Dose, Central 80% of Beam Width, Central Axis Slice

Dose, Central 80% of Beam Width, Non-Axial Slice

Dose in Penumbra (80% to 20%) Open Field

Dose to Normalization Point in Blocked Field

Dose Under Block

Dose in Block Penumbra Region

DVH Accuracy

Predicted NTCP Value

Traditional Planning
0.3cm

3D Planning
0.1cm

0.5-10cm

0.3cm

1.0-2.0cm

0.2-0.5cm

0.5cm

<0.1cm

0.5cm

0.1cm

0.3cm or more

0.1cm

May Range Up to Many cm*

0.1cm

1.00o
N/A

<1.00o
<1.00o

1.00%

1.00%

>10.00%

1.00%

2.00-5.00cm
10.00%

1.00-5.00mm
2.00% is Achievable

>100.00%

2.00%

>1.00cm
N/A

1.00mm
Depedant on Many Factors*

N/A

Dependant on Model and Input Data

Reasoning
Traditional contour typically obtained mechanically. 3-D contour typically obtained
from CT.
Traditional system uses a 2-D PTV drawn by hand around the CTV expansion onto
other 2-D contours is quite inaccurate, as it is totally manual. In3-D system, PTV
can be created by 3-D expansion around the CTV through the software.
Traditional system involves totally manual registration and countour transfer. 3-D
system registration has at best about 2.00mm reproducibility, plus additional
distortions, plus transfer of MRI contours to CT dataset.
Traditiona; system may force beam center to be on axial calculation plane or CT
slice. 3-D system allows any specified isocenter coordinates
Resolution of jaw positions typically 1.00mm, although traditional system will
usually specify field width and length with resolution of 0.5cm at best
Block shape not modeled in prototype traditional system, but may be entered with
digitizer for some types of systems. 3-D system may use computer-generated
aperture.
Traditional system may not display aperture shape and may not display divergence
effects
Resolution of gantry angle typically 0.1 degrees in 3-D system.
Table and/or collimator angles often not allowed or displayed in traditional system
Traditional beam models reproduce measured data. 3-D models may do no better
since they are not directly based on measurements of this situation.
Traditional beam models do not handle non-axial behavior. 3-D models are just as
accurate in non-acial directions as axial directions.
Depends on grid effects, models.
Traditional beam normalization depends only on central axis of beam on axial slice
for the open rectangular field in a water phantom. 3-D normalization includes all
effects, including scatter under blocks and inhomogeneity effects.
Traditional system cannot handle blocks, so it can make large errors under blocks.
3-D model accurately handles dose under blocks, perhaps with an accuracy of 1.002.00%.

Block penumbra not modeled in traditional system.

DVH accuracy depends on dose calculation grid, volumtric region of interest grid,
accuracy of object segmentation, bin size of histogram, plan normalization
Given a DVH and an NTCP model, NTCP calculation can be verified. However,
clinical accuracy or relevancy is beyond the scope of this report.