AAPM Recommended Tol

Procedure Non-IMRT
Dosimetry
X-ray Output Constancy
Electron Output Constancy
Mechanical
Laser Localization 2 mm
Distance Indicator (ODI) @ Iso 2 mm
Collimator Size Indicator 2 mm
Safety
Door Interlock (Beam Off)
Door Closing Safety
Audiovisual Monitor
Stereotactic Interlocks NA
Radiation Area Monitor
Beam On Indicator

AAPM Recommended Toler

Procedure Non-IMRT
Dosimetry
X-ray Output Constancy
Electron Output Constancy
Backup Monitor Chamber Constancy
Typical Dose Rate Output Constancy NA
Photon Beam Profile Constancy
Electron Beam Profile Constancy
Electron Beam Energy Constancy
Mechanical
Light/Radiation field Coincidence
Light/Radiation field Coincidence (Asymmetric)
Distance Check Device for Lasers
Compared with Front Pointer
 Gantry/Collimator Angle Indicators
(@ Cardinal Angles)
Accessory Trays
Jaw Position Indicators (Symmetric)
Jaw Position Indicators (Asymmetric)
Cross-Hair Centering
Treatment Couch Position Indicators 2 mm/1 Degree
Wedge Placement Accuracy
Compensator Placement Accuracy
Latching of Wedges, Blocking Tray
Localizing Lasers 2 mm
Safety
Laser Guard-Interlock Test
Respiratory Gating
Beam Output Constancy
Phase, Amplitude Beam Control
In-Room Respiratory Monitoring System
Gating Interlock

AAPM Recommended Toler

Procedure Non-IMRT
Dosimetry
X-ray Output Flatness Change from Baseline
X-Ray Symmetry Change from Baseline
Electron Flatness Change from Baseline
Electron Symmetry Change from Baseline
SRS Arc Rotation Mode NA
(Range: .5-1.0 MU/Deg)

X-ray/electron Output Calibration (TG-51)

Spot Check of Field Size Dependent
Output Factors for X-Ray (2 or more FSs)
Output Factors for Electron Applicators
(Spot Check for 1 Applicator/Energy)
X-Ray Beam Quality
Electron Beam Quality
 Physical Wedge Transmission Factor Constancy
X-Ray Monitor Unit Linearity (Output Constancy) 2% 5 MU
Electron Monitor Unit Linearity (Output Constancy)
X-Ray Output Constancy vs Dose Rate
X-Ray Output Constancy vs Gantry Angle
Electron Output Constancy vs Gantry Angle
Electron and X-ray Off-Axis Factor Constancy
vs Gantry Angle
Arc Mode (expected MU, Degree)
TBI/TSET Mode
PDD or TMR and OAF Constancy 1% (TBI) or
TBI/TSET Output Calibration
TBI/TSET Accessories
Mechanical
Collimator Rotation Isocenter
Gantry Rotation Isocenter
Couch Rotation Isocenter
Electron Applicator Interlocks
Coincidence of Radiation and 2 mm From
Mechanical Isocenter Baseline
Table Top Sag
Table Angle
Travel Maximum Range
Movement in all Directions
Stereotactic Accessories, Lockouts, Etc. NA
Safety
Follow Manufacturer's Test Procedures
Respiratory Gating
Beam Energy Constancy
Temporal Accuracy of Phase/Amplitude Gate On
Calibration of Surrogate for Respiratory Phase/Amplitude
Interlock Testing

Commercially availab
ecommended Tolerances (Daily)

IMRT

3%

1.5 mm
2 mm
2 mm

Functional
Functional
Functional
NA
Functional
Functional

commended Tolerances (Monthly)

IMRT

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 Degree

2 mm
2 mm
1 mm
1 mm
2 mm/1 Degree
2 mm
1 mm
Functional
1 mm

Functional

2%
Functional
Functional
Functional

commended Tolerances (Annualy)

IMRT

1%
1%
1%
1%
NA

1% (Absolute)
2% for Field Size 4x4 cm,
1% 4x4 cm
2% From Baseline

1% From Baseline
1 mm
 2%
5% (2-4 MU), 2% 5 MU
2% 5 MU
2% From Baseline
1% From Baseline
1% From Baseline
1% From Baseline

1% From Baseline
Functional
1% (TBI) or 1 mm PDD Shift (TSET) From Baseline
2% From Baseline
2% From Baseline

1 mm From Baseline
1 mm From Baseline
1 mm From Baseline
Functional
2 mm From Baseline

2 mm From Baseline
1 Degree
2 mm

NA

Functional

2%
100 ms of Expected
100 ms of Expected
Functional

Commercially available CT-based IGRT systems

 SRS/SBRT

1 mm
2 mm
1 mm

Functional

SRS/SBRT

2% (@ Stereo Dose Rate, MU)

 2 mm/1 Degree

<1 mm

SRS/SBRT

Monitor Units Set vs Delivered:

1 MU or 2% (Whichever greater)
Gantry Arc Set vs Delivered:
1.0 Degree or 2% (Whichever greater)
 5% (2-4 MU), 2% 5 MU

m Baseline

1 mm From Baseline

Functional
Feature Elekta XVI
Image Configuration kV-CBCT
Field of view 50x50x25.6
Correction Method Translation Automatic couch motion
rotation optional
Geometric accuracy submillimeter
Dose (cGy) 0.1-3.5
Image acquisitions and reconstruction time 2 mins

Frequency
Daily

Monthly or upon upgrade

If used for dose calculation Annual

Frequency
Daily
Monthly or upon upgrade
If used for dose calculation Annual
 Commercially available CT-based IGRT systems
Varian OBI
kV-CBCT
45x45x17
Automatic couch motion
none
submillimeter
0.2-2.0
1.5 mins

QA tests recommended for CT-based IGRT systems

Quality Metric
Safety

System operation and accuracy

Geometric

Image quality

Image quality
Dose
Imaging system performance

Geometric

System operation and accuracy

Simulation QA

Procedure
Alignment of gantry lasers with center of imaging plane
Orientation of gantry lasers in respect to imaging plane
Spacing of lateral wall laser in resect to lateral gantry lasers
ans scan plane
Orientation of wall lasers with respect to the imaging plane
Orientation of ceiling laser with respect to imaging plane
Orientation of CT-scanner tabletop with respect to imgaing plane
Table vertical and longitudinal motion
Table indexing and position
Gantry tilt accuracy
Gantry tilt position accuracy
Scan localiztion
Radiation profile
ble CT-based IGRT systems
Siemens Artiste
Mv-CBCT
40x40x27
Automatic couch motion
none
submillimeter
3.0-10.0
1.5 mins

d for CT-based IGRT systems

Quality Check
Collision and other interlocks
Warning lights
Laser/image/trreatment isocentre coincidence OR
Phantom localization and repositioning with couch shif
Geometric clibration maps OR
kV/MV/laser alignment
Couch shifs: accuracy of motions
Scale, distance, and orientation accuracy
Uniformity, noise
High contrast spatial resolution
Low contrast detectability
CT number accuracy and stability
Imaging dose
X-ray generator
performance (kV systems only):
tube potential, mA, ms accuracy, and linearity
Anteroposterior, mediolateral, and
craniocaudal orientation are maintained
(upon upgrade from CT to IGRT system)
Long and short term planning of
resources (disk space, manpower, etc.

ulation QA

Tolerance
plus or minus 2mm
plus or minus 2mm over length projection
plus or minus 2mm
plus or minus 2mm over length projection
plus or minus 2mm over length projection
plus or minus 2mm over length projection and width of tabletop
plus or minus 1mm over the range of table motion
plus or minus 1mm over scan range
plus or minus 1 degree over gantry tilt range
plus or minus 1 degree or 1mm from nominal position
plus or minus 1mm over scan range
Manufacturer specifications
Tomotherapy Siemens Primatom
MVCT kVCT-on rails
40 50
Automatic in 2 directions Manual couch motion
optional optional
submillimeter submillimeter
0.7-3.0 0.05-1
5 s per slice 3 s per slice

Tolerance
Functional
Functional
plus or minus 2mm
plus or minus 2mm
Replace/ refresh
plus or minus 1mm
plus or minus 1mm
Baseline
Baseline
less than or equal to 2mm
Baseline
Baseline
Baseline
Baseline

Accurate

Support clinical use and current

Imaging policies and procedures
 TPS QA
Frequency Item

Daily Error log

Daily Change log

Weekly Digitizer
Weekly Hardcopy output

Weekly Computer files

Weekly Review clinical planning

Monthly CT data input into RTP system

Monthly Problem Review

Monthly Review of RTP system

Annual Dose calculations

Annual Data and I/O devices

Annual Critical sofwaer tools

Variable Beam parameterization

Variable Sofware changes, including operating system

 TPS QA
Details

Review repor log listing system failures, error messages, hardware malfunctions, and other problems. Triage list and
emedy any serious problmes that occur durinng the day.

Keep log of hardware/sofware changes.

Review digitizer accuracy.

Review all hardcopy output, including scaling for plotter and other graphis-type output
Verify integrity of all RTP system data files and executables using checksums or other simple sofware checks.
Checking sofware should be provided by the vendor.

Review clinical treatment planning activity. Discuss errors, problems, complications, dificulties. Resolve problems.

Review the CT data within the planning system of geometrical accuracy, CT number consistency ( also dpendent on
the QA and use the scanner), and derived electron denisty.
Review all RTP problems (both for RTP system and clinical treatment planning) and prioritize problems to be
resolved.
Review current configuration and status of all RTP system sofware, hardware, and data files.

Annual checks. Review acceptability of agreement between measured and calculated doses for each beam/source.

Review functioning and accuracy of digitizer tablet, video/laser digitizer, CT input, MR input, printers, plotters, and
other imaing output devices.
Review BEV/DRR generation and plot accuracy, CT geometry, density conversions, DVH calculations, other critical
tools, machine-specific conversions, data files, and other critical data.
Checks and/or recommissioning may be due to machine changes or problems.
Checks and/or recommissioning may be required due to changes in the RTP sofware, any support/additional
sofware such as image transfer sofwer, or the operating system.
 Brachytherapy QA
Inspect the applicator parts to make sure they fit and work
Applicators properly
Radiograph should be taken to verify aplicator positional
accuracy, geometry and dummy markers
Testing should be documented with images for regulatory
purposes and positional references

Radioactive sources Location should be tracked at all times

Periodic inventory of radioactive sources
Systematic program of record keeping is essential
Cesium sources inspected for curvature to ensure they
wont get caught in drawer and leak material
Leak testing of sources required before initial use and on
regular basis afer that
Leak Testing semi-annnualy unless specified

Safety procedure set in place to avoid unintended

Remote Aferloading Equipme exposure of patient or personnel
Close attention to high activity sources
Ensure equipment functions as intended
Employees must be trained in safety procedures
Radiation monitor must be in the room

Physician and physicist required to be present during HDR

Daily QA Testing of all safety equipment

Testing of proper operation of the aferloading equipment

Presence of equipment need to retrieve a detached

source
Verification of source activity checked against a decay
Monthly QA chart
Measurement of source transit time
Timer linearity