DOS 542 QA Chart
October 19, 2016
Joanne Li
Table1: Daily QA for linear accelerators (AAPM TG-142 recommendation and institutional
guidelines).1
Machine-type tolerance
Daily QA Procedure
X-ray output constancy (all
energies)
6 MeV daily
9 MeV daily
12 MeV daily
16 MeV daily
20 MeV daily
6 MV daily
16 MV daily
6 MV SRS Mode daily
Electron output constancy
Non-IMRT
Dosimetry
3%
IMRT
SRS/SBRT
3%
3%
3%
3%
3%
Laser localization (ceiling,
3%
Mechanical
2mm
1.5mm
1mm
sagittal, and coronal @ iso)
Optical Distance indicator
2mm
2mm
2mm
(ODI)
Collimator size indicator (FS
2mm
2mm
2mm
20cmx20 cm)
Safety
OBI automatic couch
2mm
positioning test
OBI interlocks and alarms
Functional
(beam off/on)
Touch guard interlock
Audiovisual monitors
Dose timer interlock
Beam on indicator
Door sensor functionality
Interlock functionality
Functional
Functional
Functional
Functional
Functional
Functional
Ensure pitch/Role set to zero
Verify Exac Trak localization
Functional
Functional
accuracy
In-room respiratory monitoring
Functional
system
Respiratory gating
Phase, amplitude beam control
SRS interlocks
Functional
2%
NA
NA
Functional
Table2: Monthly QA for linear accelerators (AAPM TG-142 recommendation and institutional
guidelines).1
Monthly QA Procedure
X-ray output constancy (all
Machine-type tolerance
Non-IMRT
IMRT
Dosimetry
2%
2%
SRS/SBRT
2%
energies)
6 MeV daily
9 MeV daily
12 MeV daily
16 MeV daily
20 MeV daily
6 MV daily
16 MV daily
6 MV SRS Mode daily
Electron output constancy
Backup monitor chamber
2%
2%
2%
2%
2%
2%
constancy
MLC QA
Typical dose rate output
NA
1 mm
2% (@ IMRT dose rate)
2% (@ stereo
constancy
Photon beam profile constancy
Electron beam profile constancy
Electron beam energy constancy
Laser localization
Distance check device for lasers
compared with front pointer
Light/radiation field
coincidence
2%
1%
1%
2%/2mm
Mechanical
2mm
1mm
1%
1%
2%/2mm
dose rate)
1%
1%
2%/2mm
1mm
1mm
<1mm
1mm
2mm/1% on a side
Light/radiation field
1mm/1% on a side
coincidence (asymmetric)
Gantry/collimator angel
indicators (digital level)
Accessory trays (port film
2mm
graticle tray)
Jaw position indicator
2mm
(asymmetric, 6X, 16 X)
Jaw position indicator
1mm
(symmetric, 6 X, 16 X)
Cross-hair centering (walkout)
Treatment couch position
2mm/1
1mm
2mm/1
indicators
Wedge placement accuracy
Compensator test tray
2mm
1mm
placement accuracy
Latching of wedges, blocking
Functional
tray
Exac Trac monthly calibration
1mm/0.5
1 mm
Safety
Laser guard-interlock test
OBI imaging QA
Winston Lutz Cube MV
Winston Lutz Cube kV
Beam output constancy
Phase, amplitude beam control
In-room respiratory monitoring
system
Gating interlock
Functional
Functional
Radiation safety engineer direction
Radiation safety engineer direction
Respiratory gating
2%
Functional
Functional
Functional
Table3: Annual QA for linear accelerators (AAPM TG-142 recommendation).1
Annual QA Procedure
Electron output constancy
X-ray flatness change from
Machine-type tolerance
Non-IMRT
IMRT
Dosimetry
3%
3%
1%
SRS/SBRT
3%
baseline
x-ray symmetry change from
1%
baseline
Electron flatness change from
1%
baseline
Electron symmetry change from
1%
baseline
SRS arc rotation mode (0.5-
NA
NA
10MU/deg)
Monitor units set
vs delivered: 1.0
MU/2%
Gantry arc set vs
delivered: 1.0/2%
x-ray/electron output calibration
1% (absolute)
(TG-51)
Spot check of field size
2% for FS < 4x4 cm2
dependent output factors for x-
1% 4x4 cm2
ray (2 or more FSs)
Output factor for electron
2% from baseline
applicators (sport check of one
applicator/energy)
x-ray beam quality (PDD10 or
1% from baseline
TMR1020)
Electron beam quality (R50)
Physical wedge transmission
1mm
2%
factor constancy
X-ray monitor unit linearity
2% 5MU
5% (2-4MU),
5% (2-4MU),
(output constancy)
Electron monitor unit linearity
2% 5MU
2% 5MU
2% 5MU
(output constancy)
X ray output constancy vs dose
2% from baseline
rate
X ray output constancy vs
1% from baseline
gantry angle
Electron output constancy vs
1% from baseline
gantry angle
Electron and x-ray off=axis
1% from baseline
factor constancy vs gantry angle
Arc mode (expected MU,
1% from baseline
degrees)
TBI/TSET mode
PDD or TMR and OAF
Functional
1% (TBI) or 1mm
constancy
PDD shift (TSET)
TBI/TSET output calibration
TBI/TSET accessories
from baseline
2% from baseline
2% from baseline
Mechanical
Collimator rotation isocenter
Gantry rotation isocenter
1mm from baseline
1mm from baseline
Couch rotation isocenter
1mm from baseline
Electron applicator interlocks
Coincidence of radiation and
mechanical isocenter
Table top sag
Table angle
Table travel maximum range
movement in all directions
Stereotactic accessories,
2 mm from
Functional
2 mm from baseline
baseline
1mm from
baseline
2 mm from baseline
1
2 mm
NA
NA
lockouts
Safety
OBI automatic couch
Functional
positioning test
Door interlocks and alarms
Functional
(beam off)
Audiovisual monitors
Dose timer interlock
Beam on indicator
Beam output constancy
Ensure pitch/Role set to zero
Verify Exac Trak localization
Functional
Functional
Functional
Functional
Functional
Functional
accuracy
In-room respiratory monitoring
Functional
system
Respiratory gating
Functional
Beam energy constancy
Temporal accuracy of
2%
100 ms of expected
phase/amplitude gate on
Calibration of surrogate for
100 ms of expected
respiratory phase/amplitude
Table 4: Published Imaging QA guidelines other than AAPM TG-1422
Frequency
Quality metric
Quality check
Tolerance
Daily
Safety
Collision and other interlocks
Warning lights
Laser/imager/treatment isocenter
coincidence
Functional
Functional
2mm
Phantom localization and repositioning
with couch shift
2mm
Geometric
Geometric calibration maps
Image quality
kV/MV/laser alignment
Couch shifts: accuracy of motions
Scale, distance, and orientation accuracy
Uniformity, noise
High contrast spatial resolution
Replace/refres
h
1mm
1mm
Baseline
Baseline
2mm or 5
lp/cm
Baseline
System
operation and
accuracy
Monthly or
upon
upgrade
Low contrast detectability
Annual
Image quality
Dose
Imaging system
performance
Geometric
System
operation
CT number accuracy and stability
Imaging dose
X-ray generator
Performance (kV system only):
Tube potential, mA, ms accuracy, and
linearity
Anteroposterior, mediolateral, and
craniocaudal orientations are maintained
(upon upgrade from CT to IGRT system)
Long and short term planning of
resources (disk space, manpower, etc.)
Baseline
Baseline
Baseline
Baseline
Accurate
Support
clinical use and
current
imaging
policies and
procedures
Table 5 AAPM TG-40 recommendation ongoing QA for treatment planning system and monitor
unit calculation3
Frequency
Test
Tolerance
Commissioning and
following software update
understand algorithm
Functional
Single field or source isodose
distributions
2%a or 2 mmb
MU calculations
2%
Test cases
2% or 2mm
I/O system
1 mm
Daily
I/O devices
1 mm
Monthly
Checksum
No change
Subset of reference QA test
set (when checksums not
available )
I/O system
2% or 2 mmc
MU calculations
2%
Reference QA test set
2% or 2 mmd
I/O system
1 mm
Annual
1 mm
% difference between calculation of computer treatment planning system and measurement (or
independent calculation)
b
In the region of high dose gradients the distance between isodose lines is more appropriate than
% difference. In addition, less accuracy may be obtained near the end of single sources.
c
These limits refer to the comparison of dose calculation at commissioning to the same
calculations subsequently.
d
These limits refer to comparison of calculation with measurements in a water tank.
Table 6: QA of remote afterloading brachytherapy units (AAPM TG-40 recommendation).3
Frequency
Test
Each treatment day Room safety door interlocks, light, and alarms
At each source
change or
quarterly
Annual
Functional
Console functions, switches, batteries, printer
Functional
Visual inspection of source guides
Free of kinks and
firmly attached
Autoradiograph
Verify accuracy of ribbon preparation
Weekly
Tolerance
Accuracy of source and dummy loading
(dummies used for spacing and/or
simulation/verification)
Source positioning
1mm
Calibration
3%
Timer function
Check accuracy of source guides and
connectors
Mechanical integrity of applicators (by x ray if
appropriate)
1%
1 mm
Dose calculation algorithm (at least one
standard source configuration for each isotope)
3%, 1 mm
1 mm
Functional
Simulate emergency conditions
Verify source inventory
References:
1
Klein E, Hanley J, Bayouth J, et al. AAPM TG-142 Report: QA of Medical Accelerators.
Med Phys. 2009;36(9):4197-4212. http://dx.doi.org/10.1118/1.3190392
Bissonnette JP, Balter PA, Dong L, et al. Quality assurance for image-guided radiation
therapy utilizing CT-based technologies: A report of the AAPM TG-179. Med Phys. 2012;
39(4):1946-1962. http://dx.doi.org/10.1118/1.13690466
Kutcher GJ, Goia L, Gillin M, et al. Comprehensive QA for radiation oncology: Report of
AAPM Radiation Therapy Committee Task Group 40. Med Phys. 1994;21(4):595.
http://dx.doi.org/10.1118/1.597316
