Table Frequency I I I I I I I I I I I IV VI VI VI VI VI VI Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily

Daily Daily Daily Daily Daily

Category Dosimetry Dosimetry Mechanical Mechanical Mechanical Safety Safety Safety Safety Safety Safety Dynamic Wedge Planar (kV) EPID (MV) Planar (kV) EPID (MV) Planar (kV) EPID (MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV)

Description X-ray output constancy Electron output constancy Laser localization Distance indicator (ODI) @ iso Collimator size indicator Door interlock (beam off) Door closing safely Audiovisual monitior(s) Sterotactic interlocks (lockout) Radiation area monitor (if used) Beam on indicator Checkout run for one angle Collision interlocks Positioning/repositioning Imaging and treatment coordinate concidence Collision interlocks Imaging and treatment coordinate concidence Positioning/repositioning

non-IMRT

Tolerance IMRT 3% 3%

SRS/SBRT All energies

Comments

Date

By

Weekly except for machines with unique e- monitoring requiring daily 1 mm

2 mm 2 mm

1.5 mm 2 mm

1 mm Functional Functional Functional

NA Functional Functional Functional Functional 2 mm 2 mm Functional 2 mm 1 mm

Functional

Daily = when devices are to be used that day 1 mm 1 mm Daily = when devices are to be used that day Daily = when devices are to be used that day Single gantry angle Daily = when devices are to be used that day Daily = when devices are to be used that day Daily = when devices are to be used that day

1 mm

Table Frequency I V Weekly Weekly

Category Dosimetry MLC

Description Electron output constancy Qualitative test (e.g. "picket fence")

non-IMRT

Tolerance IMRT 3%

SRS/SBRT

Comments Weekly except for machines with unique e- monitoring requiring daily

Date

By

NA

Visual inspection fo discernable deviations, e.g. increase in interleaf transmission

Table Frequency II II II II II II II II II II II II II II II II II II Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

Category Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical

Description X-ray output constancy Electron output constancy Backup monitor chamber constancy Typical dose rate output constancy Photon beam profile constancy Electron beam profile constancy Electron beam energy constancy Light/radiation field coincidence (symmetric) Light/radiation field coincidence (asymmetric) Distance check device for lasers compared with front pointer Gantry/collimator angle indicators (@ cardinal angles) (Digital only) Accessory trays (i.e. bead tray) Jaw position indicators (symmetric) Jaw position indicators (asymmetric) Cross-hair centering (walkout) Treatment couch position indicators Wedge placement accuracy Compensator placement accuracy

Tolerance non-IMRT 3% 3% 2% NA

1% 1% 2%/2 mm 2 mm or 1% on 1 mm or 1% on 1 mm 1.0 2 mm 2 mm 1 mm 1 mm 2 mm / 1.0 2 mm 1 mm

II II II II II II II IV V V V V V VI VI VI VI VI

Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

Mechanical Mechanical Respiratory gating Respiratory gating Respiratory gating Respiratory gating Safety Dynamic Wedge MLC MLC MLC MLC MLC EPID (MV) EPID (MV) EPID (MV) EPID (MV) EPID (MV)

Latching of wedges, blocking tray Localizing lasers Beam output constancy Phase, amplitude beam control In-room respiratory monitoring system Gating interlock Laser guard-interlock test Wedge factor for all energies Setting vs. radiation field for two patterns Backup diaphram speed (Elekta only) Travel speed Leaf position accuracy MLC transmission, all energies Imaging and treatment coordinate concidence Scaling Spatial resolution Contrast Uniformity and noise 2 mm 2 mm NA NA NA 2 mm

Functiona

2% Functiona Functiona Functiona Functiona < 2%

0.5% from bas

2 mm Baseline Baseline Baseline

VI VI VI VI VI VI VI VI VI VI

Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

Planar (kV) Planar (kV) Planar (kV) Planar (kV) Planar (kV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV)

Imaging and treatment coordinate concidence Scaling Spatial resolution Contrast Uniformity and noise Geometric distortion Spatial resolution Contrast HU Constancy Uniformity and noise

2 mm 2 mm Baseline Baseline Baseline 2 mm Baseline Baseline Baseline Baseline

Tolerance IMRT 3% 3% 2% 2% (@ IMRT dose rate) 1% 1% 2%/2 mm 2 mm or 1% on a side 1 mm or 1% on a side 1 mm 1.0 2 mm 2 mm 1 mm 1 mm 2 mm / 1.0 2 mm 1 mm

SRS/SBRT

2% (@ Stereo dose rate, MU)

1 mm / 0.5

Functional 1 mm 2% Functional Functional Functional Functional < 2% NA 2 mm Loss of leaf speed >0.5 cm/s 1 mm 0.5% from baseline 2 mm 2 mm Baseline Baseline Baseline 1 mm < 1 mm

2 mm 2 mm Baseline Baseline Baseline 2 mm Baseline Baseline Baseline Baseline

1 mm 1 mm

1 mm

Comments

Date

By

Dose monitoring as a function of dose rate.

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

a.k.a. port film graticle tray Tolerance is summation of total for each width or length Should be checked at settings of 0.0 and 10.0 Lateral, longitudinal and rotational Compensator based IMRT (solid compensators) require a quantitative value for tray position (wedge or blocking tray shot) set at a maximum deviation of 1.0 mm from the center of the compensator tray mount and the cross hairs. Check at collimator/gantry angle combinatin that places the latch toward the floor.

Dynamic & Universal: Central axis 45 or 60 WF Virtual: 5% from unity non-IMRT patterns

For leaf positions of an IMRT field for four cardinal gantry angles (Picket fence test may be used, test depends on clinical planning segment size) Average of leaf and inter-leaf transmission 4 cardinal angles Measured at SSD typically used for imaging Measured data consistent with or beter than ATP data

2D Fluoroscopic and radiographic imaging 4 cardinal angles 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging

Table Frequency III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III IV V V Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual

Category Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Respiratory gating Respiratory gating Respiratory gating Respiratory gating Safety Dynamic Wedge MLC MLC

Description X-ray flatness from baseline X-ray symmetry change from baseline Electron flatness change from baseline Electron symmetry change from baseline SRS arc rotation mode (range: 0.5-10 MU/deg) X-ray output calibration (TG-51) Electron output calibration (TG-51) Spot check of field size dependent output factors (Sc, Sf) for X-rays Output factors for electron applicators X-ray beam quality (PDD10 or TMR2010) Electron beam quality (R50) Physical wedge transmission factor constancy X-ray MU linearity (output constancy) Electron MU linearity (output constancy) X-ray output constancy vs. dose rate X-ray output constancy vs. gantry angle Electron output constancy vs. gantry angle X-ray OAF constancy vs. gantry angle Electron OAF constancy vs. gantry angle Arc mode (expected MU, degrees) TBI/TSET mode PDD or TMR and OAF constancy TBI/TSET output calibration TBI/TSET accessories Collimator rotation isocenter Gantry rotation isocenter Couch rotation isocenter Electron applicator interlocks Coincidence of radiation and mechanical isocenter Table top sag Table angle Table travel maximum range Sterotactic accessories, lockouts, etc. Beam energy constancy Temporal accuracy of phase/amplitude gate on Calibration of surrogate for respiratory phase/amplitude Interlock testing Follow manufacturer's test procedures Check of 60 angle, full field and spot check for an intermediate angle, field size Leaf position repeatability MLC Spoke shot

Tolerance non-IMRT 1% 1% 1% 1% NA

1% 1% 2% for < 4x4c 1% for 4x4 2% from base 1% from base 1 mm 2% 2% 5 MU

5 MU: 2% 2% from base 1% from base 1% from base 1% from base 1% from base 1% from base Functiona TBI: 1% 2% from base 2% from base 1 mm from ba 1 mm from ba 1 mm from ba Functiona 2 mm from baseline

2 mm from bas 1 2 mm NA 2%

100 ms of expe

100 ms of expe

Functiona Performed < 2% 1 mm 1 mm radius

V V V VI VI VI VI VI

Annual Annual Annual Annual Annual Annual Annual Annual

MLC MLC MLC CBCT (kV, MV) Planar (kV) Planar (kV) EPID (MV) EPID (MV)

Coincidence of light field and X-ray field Segmental IMRT (step and shoot) test Moving window IMRT (four cardinal gantry angles) Imaging dose Beam quality/energy Imaging dose Full range of travel SSD Imaging dose

2 mm NA NA Baseline Baseline Baseline 5 mm Baseline

Tolerance IMRT 1% 1% 1% 1% NA

SRS/SBRT

MU (Gantry arc) set vs. Delivered: Greater of 1.0 MU (1.0) or 2% 1% 1% 2% for < 4x4cm2 1% for 4x4 cm2 2% from baseline 1% from baseline 1 mm 2% 2-4 MU: 5% 5 MU: 2% 2% from baseline 1% from baseline 1% from baseline 1% from baseline 1% from baseline 1% from baseline Functional TBI: 1% 2% from baseline 2% from baseline 1 mm from baseline 1 mm from baseline 1 mm from baseline Functional

2 mm from baseline

1 mm from baseline

2 mm from baseline 1 2 mm NA 2% 100 ms of expected 100 ms of expected Functional Performed < 2% 1 mm 1 mm radius Functional

2 mm < 0.35 cm max error RMS < 0.35 cm max error RMS Baseline Baseline Baseline 5 mm Baseline

Comments

Date

By

Absolute Absolute 2 or more field sizes Spot check of one applicator/energy

OAF = Off-axis factor OAF = Off-axis factor

Checked with each use & as warm-up SRS/SBRT: 1 mm from baseline

All directions

OAR @ 80% field width, depth of 10 cm

All energies 95% of error counts < 0.35 cm 95% of error counts < 0.35 cm Effective dose for measured doses per TG-75 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging Effective dose for measured doses per TG-75 Effective dose for measured doses per TG-75

Table Frequency I I I I I I I I I I I II II II II II II II II II II II II II II II II II II Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

Category Dosimetry Dosimetry Mechanical Mechanical Mechanical Safety Safety Safety Safety Safety Safety Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical

Description X-ray output constancy Electron output constancy Laser localization Distance indicator (ODI) @ iso Collimator size indicator Door interlock (beam off) Door closing safely Audiovisual monitior(s) Sterotactic interlocks (lockout) Radiation area monitor (if used) Beam on indicator X-ray output constancy Electron output constancy Backup monitor chamber constancy Typical dose rate output constancy Photon beam profile constancy Electron beam profile constancy Electron beam energy constancy Light/radiation field coincidence (symmetric) Light/radiation field coincidence (asymmetric) Distance check device for lasers compared with front pointer Gantry/collimator angle indicators (@ cardinal angles) (Digital only) Accessory trays (i.e. bead tray) Jaw position indicators (symmetric) Jaw position indicators (asymmetric) Cross-hair centering (walkout) Treatment couch position indicators Wedge placement accuracy Compensator placement accuracy

Tolerance non-IMRT 3% 3% 2 mm 2 mm 2 mm

Functiona Functiona Functiona NA

Functiona Functiona 3% 3% 2% NA

1% 1% 2%/2 mm 2 mm or 1% on 1 mm or 1% on 1 mm 1.0 2 mm 2 mm 1 mm 1 mm 2 mm / 1.0 2 mm 1 mm

II II II II II II II III III III III

Monthly Monthly Monthly Monthly Monthly Monthly Monthly Annual Annual Annual Annual

Mechanical Mechanical Respiratory gating Respiratory gating Respiratory gating Respiratory gating Safety Dosimetry Dosimetry Dosimetry Dosimetry

Latching of wedges, blocking tray Localizing lasers Beam output constancy Phase, amplitude beam control In-room respiratory monitoring system Gating interlock Laser guard-interlock test X-ray flatness from baseline X-ray symmetry change from baseline Electron flatness change from baseline Electron symmetry change from baseline 2 mm

Functiona

2% Functiona Functiona Functiona Functiona 1% 1% 1% 1%

III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III IV IV IV V V V V

Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Annual Daily Monthly Annual Annual Annual Annual

Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Dosimetry Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Respiratory gating Respiratory gating Respiratory gating Respiratory gating Safety Dynamic Wedge Dynamic Wedge Dynamic Wedge MLC MLC MLC MLC

SRS arc rotation mode (range: 0.5-10 MU/deg) X-ray output calibration (TG-51) Electron output calibration (TG-51) Spot check of field size dependent output factors (Sc, Sf) for X-rays Output factors for electron applicators X-ray beam quality (PDD10 or TMR2010) Electron beam quality (R50) Physical wedge transmission factor constancy X-ray MU linearity (output constancy) Electron MU linearity (output constancy) X-ray output constancy vs. dose rate X-ray output constancy vs. gantry angle Electron output constancy vs. gantry angle X-ray OAF constancy vs. gantry angle Electron OAF constancy vs. gantry angle Arc mode (expected MU, degrees) TBI/TSET mode PDD or TMR and OAF constancy TBI/TSET output calibration TBI/TSET accessories Collimator rotation isocenter Gantry rotation isocenter Couch rotation isocenter Electron applicator interlocks Coincidence of radiation and mechanical isocenter Table top sag Table angle Table travel maximum range Sterotactic accessories, lockouts, etc. Beam energy constancy Temporal accuracy of phase/amplitude gate on Calibration of surrogate for respiratory phase/amplitude Interlock testing Follow manufacturer's test procedures Check of 60 angle, full field and spot check for an intermediate angle, field size Checkout run for one angle Wedge factor for all energies Leaf position repeatability MLC Spoke shot Coincidence of light field and X-ray field Segmental IMRT (step and shoot) test 1 mm radius

NA

1% 1% 2% for < 4x4c 1% for 4x4 2% from base 1% from base 1 mm 2% 2% 5 MU

5 MU: 2% 2% from base 1% from base 1% from base 1% from base 1% from base 1% from base Functiona TBI: 1% 2% from base 2% from base 1 mm from ba 1 mm from ba 1 mm from ba Functiona 2 mm from baseline

2 mm from bas 1 2 mm NA 2%

100 ms of expe

100 ms of expe

Functiona Performed < 2%

Functiona < 2% 1 mm 2 mm NA

V V V V V V V VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI VI

Annual Monthly Monthly Monthly Monthly Monthly Weekly Daily Daily Daily Daily Daily Daily Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Annual Annual Annual Annual Annual

MLC MLC MLC MLC MLC MLC MLC Planar (kV) EPID (MV) Planar (kV) EPID (MV) Planar (kV) EPID (MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) EPID (MV) EPID (MV) EPID (MV) EPID (MV) EPID (MV) Planar (kV) Planar (kV) Planar (kV) Planar (kV) Planar (kV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) CBCT (kV, MV) Planar (kV) Planar (kV) EPID (MV) EPID (MV)

Moving window IMRT (four cardinal gantry angles) Setting vs. radiation field for two patterns Backup diaphram speed (Elekta only) Travel speed Leaf position accuracy MLC transmission, all energies Qualitative test (e.g. "picket fence") Collision interlocks Positioning/repositioning Imaging and treatment coordinate concidence Collision interlocks Imaging and treatment coordinate concidence Positioning/repositioning Imaging and treatment coordinate concidence Scaling Spatial resolution Contrast Uniformity and noise Imaging and treatment coordinate concidence Scaling Spatial resolution Contrast Uniformity and noise Geometric distortion Spatial resolution Contrast HU Constancy Uniformity and noise Imaging dose Beam quality/energy Imaging dose Full range of travel SSD Imaging dose

NA 2 mm NA NA NA

0.5% from bas NA

Functiona 2 mm 2 mm

Functiona 2 mm 1 mm 2 mm 2 mm Baseline Baseline Baseline 2 mm 2 mm Baseline Baseline Baseline 2 mm Baseline Baseline Baseline Baseline Baseline Baseline Baseline 5 mm Baseline

Tolerance IMRT 3% 3% 1.5 mm 2 mm 2 mm Functional Functional Functional NA Functional Functional 3% 3% 2% 2% (@ IMRT dose rate) 1% 1% 2%/2 mm 2 mm or 1% on a side 1 mm or 1% on a side 1 mm 1.0 2 mm 2 mm 1 mm 1 mm 2 mm / 1.0 2 mm 1 mm

SRS/SBRT

1 mm 1 mm

Functional

2% (@ Stereo dose rate, MU)

1 mm / 0.5

Functional 1 mm 2% Functional Functional Functional Functional 1% 1% 1% 1% < 1 mm

NA

MU (Gantry arc) set vs. Delivered: Greater of 1.0 MU (1.0) or 2% 1% 1% 2% for < 4x4cm2 1% for 4x4 cm2 2% from baseline 1% from baseline 1 mm 2% 2-4 MU: 5% 5 MU: 2% 2% from baseline 1% from baseline 1% from baseline 1% from baseline 1% from baseline 1% from baseline Functional TBI: 1% 2% from baseline 2% from baseline 1 mm from baseline 1 mm from baseline 1 mm from baseline Functional

2 mm from baseline

1 mm from baseline

2 mm from baseline 1 2 mm NA 2% 100 ms of expected 100 ms of expected Functional Performed < 2% Functional < 2% 1 mm 1 mm radius 2 mm < 0.35 cm max error RMS Functional

< 0.35 cm max error RMS NA 2 mm Loss of leaf speed >0.5 cm/s 1 mm 0.5% from baseline Visual inspection fo discernable deviations, e.g. increase in interleaf transmission Functional 2 mm 2 mm Functional 2 mm 1 mm 2 mm 2 mm Baseline Baseline Baseline 2 mm 2 mm Baseline Baseline Baseline 2 mm Baseline Baseline Baseline Baseline Baseline Baseline Baseline 5 mm Baseline 1 mm 1 mm 1 mm 1 mm 1 mm 1 mm 1 mm

Comments All energies Weekly except for machines with unique e- monitoring requiring daily

Date

By

Dose monitoring as a function of dose rate.

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

a.k.a. port film graticle tray Tolerance is summation of total for each width or length Should be checked at settings of 0.0 and 10.0 Lateral, longitudinal and rotational Compensator based IMRT (solid compensators) require a quantitative value for tray position (wedge or blocking tray shot) set at a maximum deviation of 1.0 mm from the center of the compensator tray mount and the cross hairs. Check at collimator/gantry angle combinatin that places the latch toward the floor.

Absolute Absolute 2 or more field sizes Spot check of one applicator/energy

OAF = Off-axis factor OAF = Off-axis factor

Checked with each use & as warm-up SRS/SBRT: 1 mm from baseline

All directions

OAR @ 80% field width, depth of 10 cm Dynamic & Universal: Central axis 45 or 60 WF Virtual: 5% from unity

All energies 95% of error counts < 0.35 cm

95% of error counts < 0.35 cm non-IMRT patterns

For leaf positions of an IMRT field for four cardinal gantry angles (Picket fence test may be used, test depends on clinical planning segment size) Average of leaf and inter-leaf transmission

Daily = when devices are to be used that day Daily = when devices are to be used that day Daily = when devices are to be used that day Single gantry angle Daily = when devices are to be used that day Daily = when devices are to be used that day Daily = when devices are to be used that day 4 cardinal angles Measured at SSD typically used for imaging Measured data consistent with or beter than ATP data

2D Fluoroscopic and radiographic imaging 4 cardinal angles 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging

Effective dose for measured doses per TG-75 2D Fluoroscopic and radiographic imaging 2D Fluoroscopic and radiographic imaging Effective dose for measured doses per TG-75 Effective dose for measured doses per TG-75