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