1

Linear Accelerators
Tolerance

Daily
Dosimetry

Non-IMRT

IMRT

X-Ray output constancy

3%

Electron output constancy

3%

SRS/SBRT

Mechanical
Localizing lasers

2mm

1.5mm

1mm
Distance indicator

2mm

Collimator size indicator

2mm

2mm

1mm
Safety
Door interlock

Functional

Door closing safety

Functional

Audiovisual monitor

Functional

Stereotactic interlocks

N/A

N/A

Functional
Beam on indicator

Monthly
Dosimetry

Functional

Non-IMRT
SRS/SBRT

IMRT
Tolerance

X-Ray output constancy

2%

Electron output constancy

2%

Backup monitor
constancy
Typical dose rate output
constancy
Photon beam profile
constancy
Electron beam profile
constancy
Electron beam energy
constancy
Safety interlocks

2%
N/A
@sterotactic dose rate

2%
1%
1%
2%/2mm

2%

2
Emergency off switches

Functional

Wedge, electron cone

interlocks
Laser guard-interlock test

Functional
Functional

Mechanical checks
Light/radiation field
coincidence
Light/radiation field
coincidence(Assymmetric
)
Distance check device for
lasers compared with
front pointer
Gantry/collimator angle
indicators
Accessory Trays
Wedge position

2mm or 1% on a side
1mm or 1% on a side

1mm

1 degree
2mm
2mm (or 2% change in transmission factor)

Tray position

2mm

Applicator position

2mm

Field size indicators

2mm

Cross-Hair centering

1mm

Treatment couch position

indicators

2mm/1 degree
1mm/0.5degree

Compensator placement
accuracy
Latching of wedges,
blocking tray
Jaw symmetry symmetric

2mm/1degree

1mm
Functional
2mm
1mm

asymmetric
Field Light intensity

Functional

Localizing lasers

2mm

1mm

<1mm
Respiratory gating
Beam output constancy

2mm

Phase, amplitude beam

control

Functional

3
In room respiratory
monitoring system
Gating interlock

Annual

Functional
Functional

Non IMRT
SRS/SBRT

IMRT

Dosimetry
X-ray flatness change
from baseline
X-ray symmetry change
from baseline
Electron flatness change
from baseline
Electron symmetry
change from baseline
SRS arc rotation mode

Tolerance
1%
+/- 1%
1%
+/- 1%
N/A
set vs delivered

N/A

MU

1.0mu or 2%
Gantry arc set vs
Delivered:
1degree or 2%
X-ray/electron output
calibration
Spot check of field size
dependent output factors
for xray
Output factors for
electron applicators
X-ray beam quality

+/- 1%
2% for field size <4 x 4cm2, 1% >/= 4 X 4 cm2

+/- 2% from baseline

+/- 1% from baseline

Electron beam quality

X-ray MU linearity
Electron MU linearity
X-ray output constancy vs
dose rate
X-ray output constancy vs
gantry angle
Electron output constancy
vs gantry angle

+/- 1mm
+/-2% >/=5MU
2%>5mu

+/-5%(2-4 MU) +/+/-2% >/= 5MU

+/- 2% from baseline

+/- 1% from baseline
+/- 1% from baseline

4
Electron and x-ray off axis
factor constancy vs
gantry angle
Arc mode
TBI/TSET mode
PDD or TMR and OAF
constancy
TBI/TSET output
calibration
TBI/TSET accessories

+/- 1% from baseline

+/- 1% from baseline

Functional
1% (TBI) or 1mm PDD shift (TSET) from baseline
2% from baseline
2% from baseline

Safety interlocks
Follow manufacturers test
procedures
Mechanical checks

Functional

Collimator rotation
isocenter
Gantry rotation isocenter

+/- 1mm from baseline

Couch rotation isocenter

+/- 1mm from baseline

Electron applicator
interlocks
Coincidence of radiation
and mechanical isocenter

Functional

Table top sag

Vertical travel of table
Table angle

+/- 1mm from baseline

+/- 2mm from baseline

+/- 1mm from
(NONIMRT and IMRT)
baseline
2mm
2mm
1 degree

1. Kahn FM. Quality Assurance. In: Lippincott, Williams, and Wilkins, ed. The
Physics of Radiation Therapy. Philadelphia, PA; 2010: 398.
2. Klein E, Hanley J, Bayouth J, et al. Task group 142 report: quality assurance of
medical accelerators. Med. Phys. 2009;36(9):4197-4212

CT Simulator
Tests for electromechanical components
Daily
Alignment of gantry
lasers with the center of
imaging plane
Monthly and after
laser adjustments
Orientation of gantry
lasers with respect to the
imaging plane
Spacing of lateral wall
lasers with respect to
lateral
gantry lasers and scan
plane

Tolerance
+/- 2mm

+/-2 mm over the

length of laser
projection

+/-2mm

Orientation of wall lasers

with respect to the
imaging plane

+/-2 mm over the

length of laser
projection

Orientation of the ceiling

laser with respect to the
imaging plane

+/-2 mm over the

length of laser projection

Orientation of the CTscanner tabletop with

respect to the
imaging plane

+/-2 mm over the

length and width of
the tabletop

Table vertical and

longitudinal motion

+/-1 mm over the

range of table
motion

Annually
Table indexing and
position

+/-1 mm over the scan range

Gantry tilt accuracy

+/-1 over the gantry tilt range

Gantry tilt position

accuracy

+/-1 or +/-1 mm from nominal position

Scan localization
Radiation profile width

+/-1 mm over the scan range

Manufacturer specifications

Test specifications for image performance

Daily
CT number accuracy
Image noise
In plane spatial integrity

For water, 0 +/-5HU

Manufacturers pecifications
X or Y direction
+/-1mm

Monthly
CT number accuracy
In plane spatial integrity

Field uniformity

4 to 5 difference materials For water, 0 +/-5HU

Both directions
+/-1mm
Monthlymost commonly used kVp
Within +/-5HU

Annually
Field uniformity

Electron density to CT
number

Annuallyother used kVp setting

Within +/-5HU
Consistent with commissioning results
and test phantom manufacturer

7
conversion

specifications

Spatial resolution

Manufacturer specifications

Contrast resolution

Manufacturer specifications

1. Mutic S, Palta J, Butker E, et al. Quality assurance for computed-tomography

simulators and the computed-tomography-simulation process: report of the
AAPM radiation therapy committee task group No. 66. Med. Phys.
2003;30(10): 2762-2791

Imaging QA (KV, MV, Cone-beam CT)

Daily

Non SRS/SBRT

SRS/SBRT

Planar kV and MV
(EPID)imaging
Collision interlocks

Functional

Positioning/repositioning

</= 2mm

</=1mm

Imaging and treatment

coordinate coincidence
(single gantry angle)

</= 2mm

</=1mm

Cone-beam CT (kV
and MV)
Collision interlocks

Imaging and treatment

coordinate coincidence
Positioning/repositioning

Functional
</= 2mm
</=1mm
</= 1mm
</=1mm

Monthly
Planar MV imaging
(EPID)
Imaging and treatment
coordinate coincidence
Scaling

</= 2mm
</=1mm
</= 2mm
</=2mm

8
Spatial resolution
Contrast
Uniformity and noise

Baseline
Baseline
Baseline

Planar kV imaging
Imaging and treatment
coordinate coincidence
Scaling

</= 2mm
</=1mm
</= 2mm
</=1mm

Spatial resolution
Contrast
Uniformity and noise

Baseline
Baseline
Baseline

Cone-beam CT (kV
and MV)
Geometric distortion

</= 2mm
</=1mm

Spatial resolution
Contrast
HU constancy
Uniformity and Noise

Baseline
Baseline
Baseline
Baseline

Annually
Planar MV imaging
(EPID)
Full range of travel SDD
Imaging Dose

+/- 5mm
Baseline

Planar kV imaging
Beam quality/energy
Imaging Dose

Baseline
Baseline

Cone-beam CT (kV
and MV)
Imaging dose

Baseline

1. Klein E, Hanley J, Bayouth J, et al. Task group 142 report: quality assurance of
medical accelerators. Med. Phys. 2009;36(9):4197-4212

QA Radiation Instruments
Ionization
chambers/Electrometers

Beam Scanning Systems

Submission to Accredited Dosimetry Calibration

Laboratory
At intervals no more than 2years
apart
Upon receipt: response is constant
throughout the day, remain waterproof,
leakage current does not change significantly

9
or exceed tolerance values
Yearly: test linearity and stem effect
Each use: mechanical integrity
Ancillary Equipment
Devices used for
positioning calibration
equipment in the phantom
(rulers, chamber positioning
devices, solid phantom
materials)
Environmental condition
devices (Thermometers)
Electronic devices
intercompared frequently
Mercury in glass
thermometers
Barometers

Positioning and scanning

equiment

Relative dose measuring

equipment
Dosimeters (diodes and
TLDs)
Survey meters

Inspected on a regular basis

Inspected on a regular basis

Weekly or monthly intervals

Intercompared prior to first use
frequency depends on the type of instrument;
aneroid and electronic devices should be
intercompared at weekly or monthly intervals;
mercury barometers should be compared with
a similar device before first use; suitable
instrument for comparison may be located at a
nearby weather station
Reproducible to within 1mm and should report
the detector position to within 1mm accuracy

Do not require calibration

If used to measure dose around patients: Yearly

calibration
Frequently check batteries if needed

QA Brachytherapy Equipment and Sources

Applicators

Inspect & Radiograph before 1st use

Remote afterloaders: verify with
dummy markers using autoradiograph

10

Radioactive Sources

Remote Afterloading
equipment

dwell positions before 1st use.

Clean applicators and carefully inspect
for flaws after every use.
Inspected annually
Cesium sources inspect curvature
Leak Tests done before 1st use/ semannually/may be only done every 3
years

Safety procedures:
Proper shielding design and installation
for HDR
Door interlock
Functioning radiation area monitor
Trained staff in emergency procedures
present

QA procedures:
Source change
Radiation safety surveys done to
ensure correct shielding of the source
when it is housed
Areas adjacent to room should be
surveyed with source exposed
If reading is above background area
is surveyed with source retracted
Source Calibration
Source activity measures prior to
patient usage

Daily QA completed prior to

pt treatment
Monitors and interlocks checked
Door, emergency off, treatment
interrupt, audiovisual, room radiation
monitors, missing or misconnected
applicator interlocks, transfer tubes
Displays of time, date source
strength verified for accuracy
Source position accuracy, dwell time
accuracy, normal termination of
treatment tested

Monthly QA
Source positioning accuracy
Source activity vs calculated activity
Integrity of applicator; to include
kinks, mechanical deformation

11
Timer accuracy and linearity verified
Power failure test to verify source
retraction

Treatment Planning QA

Ensure target coverage is

adequately reflected by the isodose
surface
Ensure dose prescription is correct
and external beam treatments are
accounted for
Normal structure doses are within
tolerance
Total strength is consistent with the
dose specified at the surface
Application time calculated correctly
Independent dose check verification

QA Treatment Planning System

Commissioning

Ongoing QA after
commissioning

Confirming measured data entry

encompasses a large range of clinical
conditions
Required:
Understanding of TPS algorithms and
dependence on measured data
Collection and entry of appropriate
data into the TPS
Additional data collection
representing a range of clinical
situations
Calculation of dose distributions,
point doses and MU and comparison of
these with measured data
Areas to address:
Inaccuracies of measured beam data
Inaccuracies of patient specific data
Inaccuracies in manually entered
data (digitized data and its accuracy
should be checked weekly and agree
within 2mm)

12
Inaccuracies of Data Output
Inaccuracies with Algorithm
information done by reproducing
standard treatment plans (at minimum
performed monthly). Comparing
calculations against measured data
originally stored in computer (Yearly or
when changes are made) ICRU
recommendations : calculated data
should agree within 2% or 2mm of high
dose gradient.

Vann, A.M. Quality Assurance of TPS, IMRT,SRS. La Crosse, WI:UW-L Medical Dosimetry
Program; 2015.