Task Group 51 (TG-51) of the Radiation Therapy Committee of the American

Association of Physicists in Medicine (AAPM) developed a new protocol for clinical

reference dosimetry. The new protocol is superior to past protocols because it is
more easily understood and simpler to implement. For example, early protocols
were based on measurements using ion chambers in 60Co beams, and conversion
factors needed to be used for x-ray and electron beams.1 These factors did not take
into account the type of chamber used or beam quality, which could lead to beam
calibration errors of up to 5%.1 A later protocol, TG-21, used complex calculations
to improve dose calibration accuracy, but the complexity of the calculations left an
increased chance for errors.1
TG-51 is able to improve upon past protocols by continuing to use ion
chambers, but requires absorbed dose to water calibration factors instead of
exposure or air kerma calibration of the ion chamber, which eliminates the need to
calculate any theoretical dosimetry factors or use large tables of stopping power
ratios and mass energy absorption coefficients.2 The improvements in dose
accuracy from the TG-21 to the TG-51 protocol is only 1%-2%; however, the
improvement in simplicity is substantial.2
The TG-51 protocol is widely used in the United States; however, other
countries may use other protocols such as The International Atomic Energy Agency
Technical Report Series No. 398 (IAEA TRS-398) and the Japan Society of Medical
Physics (JSMP 12), which was published in 2012.3 The new publication of JSMP 12,
as well as an addendum to TG-51, were released with more accurate beam quality
conversion factors since earlier releases provided factors for only cylindrical
chambers and did not include the 30 plus designs for ionization chambers that have
recently become available.3
My clinical site currently uses the TG-51 protocol due to its increased
accuracy and ease of use in comparison to TG-21. When speaking to our physics
staff they stated that they felt this protocol was more accurate and provided added
confidence in beam calibration compared to past models because the calibrations
are done in water, which gives the most accurate measurement of absorbed dose.

1. Almond PR, Biggs PJ, Coursey BM, et al. AAPMs TG-51 protocol for clinical
reference dosimetry of high-energy photon and electron beams. Medical
Physics. 1999; 26(9):1847-1888.

2. Khan, FM. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014: 107

3. Kinoshita N, Oguchi H, Nishimoto Y, et al. Comparison of AAPM addendum to

TG-51 IAEA TRS-398, and JSMP 12: calibration of photon beams in water.
2017;18(5):271-278.
http://onlinelibrary.wiley.com/doi/10.1002/acm2.12159/full. Published
September 2017. Accessed October 2, 2017.