Table Frequency Category DescriptionTolerance

Comments Date Bynon-IMRT IMRT SRS/SBRT

I Daily Dosimetry X-ray output constancy 3% All energies

I Daily Dosimetry Electron output constancy 3% Weekly except for machines with unique e- monitoring requiring daily

I Daily Mechanical Laser localization 2 mm 1.5 mm 1 mmI Daily Mechanical Distance indicator (ODI) @ iso 2 mmI Daily Mechanical Collimator size indicator 2 mm 1 mmI Daily Safety Door interlock (beam off) FunctionalI Daily Safety Door closing safely FunctionalI Daily Safety Audiovisual monitior(s) FunctionalI Daily Safety Sterotactic interlocks (lockout) NA FunctionalI Daily Safety Radiation area monitor (if used) FunctionalI Daily Safety Beam on indicator Functional

IV Daily Dynamic Wedge Checkout run for one angle Functional

VI Daily Collision interlocks Functional Daily = when devices are to be used that day

VI Daily Positioning/repositioning ≤2 mm ≤1 mm Daily = when devices are to be used that day

VI Daily Imaging and treatment coordinate concidence ≤2 mm ≤1 mm

VI Daily CBCT (kV, MV) Collision interlocks Functional Daily = when devices are to be used that day

VI Daily CBCT (kV, MV) Imaging and treatment coordinate concidence ≤2 mm ≤1 mm Daily = when devices are to be used that day

VI Daily CBCT (kV, MV) Positioning/repositioning ≤1 mm Daily = when devices are to be used that day

Planar (kV)EPID (MV)

Planar (kV)EPID (MV)

Planar (kV)EPID (MV)

Daily = when devices are to be used that daySingle gantry angle

Table Frequency Category DescriptionTolerance

Comments Date Bynon-IMRT IMRT SRS/SBRT

I Weekly Dosimetry Electron output constancy 3% Weekly except for machines with unique e- monitoring requiring daily

V Weekly MLC Qualitative test (e.g. "picket fence") NA Visual inspection fo discernable deviations, e.g. increase in interleaf transmission

Table Frequency Category DescriptionTolerance

non-IMRTII Monthly Dosimetry X-ray output constancy 3%II Monthly Dosimetry Electron output constancy 3%II Monthly Dosimetry Backup monitor chamber constancy 2%

II Monthly Dosimetry Typical dose rate output constancy NA

II Monthly Dosimetry Photon beam profile constancy 1%II Monthly Dosimetry Electron beam profile constancy 1%II Monthly Dosimetry Electron beam energy constancy 2%/2 mm

II Monthly Mechanical Light/radiation field coincidence (symmetric) 2 mm or 1% on a side

II Monthly Mechanical Light/radiation field coincidence (asymmetric) 1 mm or 1% on a side

II Monthly Mechanical 1 mm

II Monthly Mechanical

II Monthly Mechanical Accessory trays (i.e. bead tray) 2 mmII Monthly Mechanical Jaw position indicators (symmetric) 2 mmII Monthly Mechanical Jaw position indicators (asymmetric) 1 mmII Monthly Mechanical Cross-hair centering (walkout) 1 mmII Monthly Mechanical Treatment couch position indicatorsII Monthly Mechanical Wedge placement accuracy 2 mm

II Monthly Mechanical Compensator placement accuracy 1 mm

II Monthly Mechanical Latching of wedges, blocking tray Functional

II Monthly Mechanical Localizing lasers ±2 mmII Monthly Respiratory gating Beam output constancy 2%II Monthly Respiratory gating Phase, amplitude beam control FunctionalII Monthly Respiratory gating In-room respiratory monitoring system FunctionalII Monthly Respiratory gating Gating interlock FunctionalII Monthly Safety Laser guard-interlock test Functional

IV Monthly Dynamic Wedge Wedge factor for all energies < 2%

V Monthly MLC Setting vs. radiation field for two patterns 2 mmV Monthly MLC Backup diaphram speed (Elekta only) NAV Monthly MLC Travel speed NA

V Monthly MLC Leaf position accuracy NA

V Monthly MLC MLC transmission, all energies 0.5% from baseline

VI Monthly EPID (MV) ≤2 mm

VI Monthly EPID (MV) Scaling ≤2 mmVI Monthly EPID (MV) Spatial resolution BaselineVI Monthly EPID (MV) Contrast Baseline

Distance check device for lasers compared with front pointer

Gantry/collimator angle indicators (@ cardinal angles) (Digital only)

1.0º

2 mm / 1.0º

Imaging and treatment coordinate concidence

VI Monthly EPID (MV) Uniformity and noise Baseline

VI Monthly Planar (kV) ≤2 mm

VI Monthly Planar (kV) Scaling ≤2 mmVI Monthly Planar (kV) Spatial resolution BaselineVI Monthly Planar (kV) Contrast BaselineVI Monthly Planar (kV) Uniformity and noise BaselineVI Monthly CBCT (kV, MV) Geometric distortion ≤2 mmVI Monthly CBCT (kV, MV) Spatial resolution BaselineVI Monthly CBCT (kV, MV) Contrast BaselineVI Monthly CBCT (kV, MV) HU Constancy BaselineVI Monthly CBCT (kV, MV) Uniformity and noise Baseline

Imaging and treatment coordinate concidence

ToleranceIMRT SRS/SBRT

3%3%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

2 mm2 mm1 mm1 mm

1 mm / 0.5º2 mm

1 mm

Functional

±1 mm < ±1 mm2%

FunctionalFunctionalFunctionalFunctional

< 2%

NA2 mm

Loss of leaf speed >0.5 cm/s

1 mm

0.5% from baseline

≤2 mm ≤1 mm

≤2 mmBaselineBaseline

2% (@ Stereo dose rate, MU)

1.0º

2 mm / 1.0º

Baseline

≤2 mm ≤1 mm

≤2 mm ≤1 mmBaselineBaselineBaseline

≤2 mm ≤1 mmBaselineBaselineBaselineBaseline

Comments Date By

Dose monitoring as a function of dose rate.

a.k.a. port film graticle trayTolerance is summation of total for each width or lengthShould be checked at settings of 0.0 and 10.0

Lateral, longitudinal and rotational

non-IMRT patterns

Average of leaf and inter-leaf transmission

4 cardinal angles

Measured at SSD typically used for imagingMeasured data consistent with or beter than ATP data

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

Compensator based IMRT (solid compensators) require a quantitative value for tray position (wedge or blocking tray shot) set at a maximum deviation of 1.0 mm from the center of the compensator tray mount and the cross hairs.

Check at collimator/gantry angle combinatin that places the latch toward the floor.

Dynamic & Universal: Central axis 45° or 60° WFVirtual: 5% from unity

For leaf positions of an IMRT field for four cardinal gantry angles (Picket fence test may be used, test depends on clinical planning segment size)

2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging

2D Fluoroscopic and radiographic imaging4 cardinal angles

Table Frequency Category DescriptionTolerance

non-IMRTIII Annual Dosimetry X-ray flatness from baseline 1%III Annual Dosimetry X-ray symmetry change from baseline ±1%III Annual Dosimetry Electron flatness change from baseline 1%III Annual Dosimetry Electron symmetry change from baseline ±1%

III Annual Dosimetry NA

III Annual Dosimetry X-ray output calibration (TG-51) ±1%III Annual Dosimetry Electron output calibration (TG-51) ±1%

III Annual Dosimetry

III Annual Dosimetry Output factors for electron applicators ±2% from baseline

III Annual Dosimetry ±1% from baseline

III Annual Dosimetry ±1 mm

III Annual Dosimetry ±2%

III Annual Dosimetry X-ray MU linearity (output constancy) ±2% ≥5 MUIII Annual Dosimetry Electron MU linearity (output constancy)III Annual Dosimetry X-ray output constancy vs. dose rate ±2% from baselineIII Annual Dosimetry X-ray output constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Electron output constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry X-ray OAF constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Electron OAF constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Arc mode (expected MU, degrees) ±1% from baselineIII Annual Dosimetry TBI/TSET mode FunctionalIII Annual Dosimetry PDD or TMR and OAF constancyIII Annual Dosimetry TBI/TSET output calibration 2% from baselineIII Annual Dosimetry TBI/TSET accessories 2% from baselineIII Annual Mechanical Collimator rotation isocenter ±1 mm from baselineIII Annual Mechanical Gantry rotation isocenter ±1 mm from baselineIII Annual Mechanical Couch rotation isocenter ±1 mm from baselineIII Annual Mechanical Electron applicator interlocks Functional

III Annual Mechanical ±2 mm from baseline

III Annual Mechanical Table top sag 2 mm from baselineIII Annual Mechanical Table angleIII Annual Mechanical Table travel maximum range ±2 mmIII Annual Mechanical Sterotactic accessories, lockouts, etc. NAIII Annual Respiratory gating Beam energy constancy 2%

III Annual Respiratory gating 100 ms of expected

III Annual Respiratory gating 100 ms of expected

III Annual Respiratory gating Interlock testing FunctionalIII Annual Safety Follow manufacturer's test procedures Performed

IV Annual Dynamic Wedge < 2%

V Annual MLC Leaf position repeatability 1 mm

SRS arc rotation mode(range: 0.5-10 MU/deg)

Spot check of field size dependent output factors (Sc, Sf) for X-rays

2% for < 4x4cm2

1% for ≥ 4x4 cm2

X-ray beam quality (PDD10 or TMR2010)

Electron beam quality (R50)

Physical wedge transmission factor constancy

≥5 MU: ±2%

Coincidence of radiation and mechanical isocenter

Temporal accuracy of phase/amplitude gate on

Calibration of surrogate for respiratory phase/amplitude

Check of 60º angle, full field and spot check for an intermediate angle, field size

V Annual MLC MLC Spoke shot 1 mm radiusV Annual MLC Coincidence of light field and X-ray field 2 mmV Annual MLC Segmental IMRT (step and shoot) test NA

V Annual MLC NA

VI Annual CBCT (kV, MV) Imaging dose BaselineVI Annual Planar (kV) Beam quality/energy Baseline

VI Annual Planar (kV) Imaging dose Baseline

VI Annual EPID (MV) Full range of travel SSD ± 5 mmVI Annual EPID (MV) Imaging dose Baseline

Moving window IMRT (four cardinal gantry angles)

ToleranceIMRT SRS/SBRT

1%±1%1%±1%

NA

±1%±1%

±2% from baseline

±1% from baseline

±1 mm

±2%

±2% from baseline±1% from baseline±1% from baseline±1% from baseline±1% from baseline±1% from baseline

Functional

2% from baseline2% from baseline

±1 mm from baseline±1 mm from baseline±1 mm from baseline

Functional

±2 mm from baseline ±1 mm from baseline

2 mm from baseline

±2 mmNA Functional

2%

100 ms of expected

100 ms of expected

FunctionalPerformed

< 2%

1 mm

MU (Gantry arc) set vs. Delivered: Greater of 1.0

MU (1.0º) or 2%

2% for < 4x4cm2

1% for ≥ 4x4 cm2

2-4 MU: ±5%≥5 MU: ±2%

≥5 MU: ±2%

TBI: 1%TSET: 1 mm PDD shift from baseline

1º

1 mm radius2 mm

< 0.35 cm max error RMS

< 0.35 cm max error RMS

BaselineBaseline

Baseline

± 5 mmBaseline

Comments Date By

AbsoluteAbsolute

2 or more field sizes

Spot check of one applicator/energy

OAF = Off-axis factorOAF = Off-axis factor

Checked with each use & as warm-up

SRS/SBRT: ±1 mm from baseline

All directions

OAR @ 80% field width, depth of 10 cm

All energies95% of error counts < 0.35 cm

95% of error counts < 0.35 cm

Effective dose for measured doses per TG-752D Fluoroscopic and radiographic imaging

Effective dose for measured doses per TG-75

2D Fluoroscopic and radiographic imagingEffective dose for measured doses per TG-75

Table Frequency Category DescriptionTolerance

non-IMRTI Daily Dosimetry X-ray output constancy 3%

I Daily Dosimetry Electron output constancy 3%

I Daily Mechanical Laser localization 2 mmI Daily Mechanical Distance indicator (ODI) @ iso 2 mmI Daily Mechanical Collimator size indicator 2 mmI Daily Safety Door interlock (beam off) FunctionalI Daily Safety Door closing safely FunctionalI Daily Safety Audiovisual monitior(s) FunctionalI Daily Safety Sterotactic interlocks (lockout) NAI Daily Safety Radiation area monitor (if used) FunctionalI Daily Safety Beam on indicator FunctionalII Monthly Dosimetry X-ray output constancy 3%II Monthly Dosimetry Electron output constancy 3%II Monthly Dosimetry Backup monitor chamber constancy 2%

II Monthly Dosimetry Typical dose rate output constancy NA

II Monthly Dosimetry Photon beam profile constancy 1%II Monthly Dosimetry Electron beam profile constancy 1%II Monthly Dosimetry Electron beam energy constancy 2%/2 mm

II Monthly Mechanical Light/radiation field coincidence (symmetric) 2 mm or 1% on a side

II Monthly Mechanical Light/radiation field coincidence (asymmetric) 1 mm or 1% on a side

II Monthly Mechanical 1 mm

II Monthly Mechanical

II Monthly Mechanical Accessory trays (i.e. bead tray) 2 mmII Monthly Mechanical Jaw position indicators (symmetric) 2 mmII Monthly Mechanical Jaw position indicators (asymmetric) 1 mmII Monthly Mechanical Cross-hair centering (walkout) 1 mmII Monthly Mechanical Treatment couch position indicatorsII Monthly Mechanical Wedge placement accuracy 2 mm

II Monthly Mechanical Compensator placement accuracy 1 mm

II Monthly Mechanical Latching of wedges, blocking tray Functional

II Monthly Mechanical Localizing lasers ±2 mmII Monthly Respiratory gating Beam output constancy 2%II Monthly Respiratory gating Phase, amplitude beam control FunctionalII Monthly Respiratory gating In-room respiratory monitoring system FunctionalII Monthly Respiratory gating Gating interlock FunctionalII Monthly Safety Laser guard-interlock test FunctionalIII Annual Dosimetry X-ray flatness from baseline 1%III Annual Dosimetry X-ray symmetry change from baseline ±1%

Distance check device for lasers compared with front pointer

Gantry/collimator angle indicators (@ cardinal angles) (Digital only) 1.0º

III Annual Dosimetry Electron flatness change from baseline 1%III Annual Dosimetry Electron symmetry change from baseline ±1%

III Annual Dosimetry NA

III Annual Dosimetry X-ray output calibration (TG-51) ±1%III Annual Dosimetry Electron output calibration (TG-51) ±1%

III Annual Dosimetry

III Annual Dosimetry Output factors for electron applicators ±2% from baseline

III Annual Dosimetry ±1% from baseline

III Annual Dosimetry ±1 mm

III Annual Dosimetry ±2%

III Annual Dosimetry X-ray MU linearity (output constancy) ±2% ≥5 MUIII Annual Dosimetry Electron MU linearity (output constancy)III Annual Dosimetry X-ray output constancy vs. dose rate ±2% from baselineIII Annual Dosimetry X-ray output constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Electron output constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry X-ray OAF constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Electron OAF constancy vs. gantry angle ±1% from baselineIII Annual Dosimetry Arc mode (expected MU, degrees) ±1% from baselineIII Annual Dosimetry TBI/TSET mode FunctionalIII Annual Dosimetry PDD or TMR and OAF constancyIII Annual Dosimetry TBI/TSET output calibration 2% from baselineIII Annual Dosimetry TBI/TSET accessories 2% from baselineIII Annual Mechanical Collimator rotation isocenter ±1 mm from baselineIII Annual Mechanical Gantry rotation isocenter ±1 mm from baselineIII Annual Mechanical Couch rotation isocenter ±1 mm from baselineIII Annual Mechanical Electron applicator interlocks Functional

III Annual Mechanical ±2 mm from baseline

III Annual Mechanical Table top sag 2 mm from baselineIII Annual Mechanical Table angleIII Annual Mechanical Table travel maximum range ±2 mmIII Annual Mechanical Sterotactic accessories, lockouts, etc. NAIII Annual Respiratory gating Beam energy constancy 2%

III Annual Respiratory gating 100 ms of expected

III Annual Respiratory gating 100 ms of expected

III Annual Respiratory gating Interlock testing FunctionalIII Annual Safety Follow manufacturer's test procedures Performed

IV Annual Dynamic Wedge < 2%

IV Daily Dynamic Wedge Checkout run for one angle Functional

IV Monthly Dynamic Wedge Wedge factor for all energies < 2%

V Annual MLC Leaf position repeatability 1 mmV Annual MLC MLC Spoke shot 1 mm radius

SRS arc rotation mode(range: 0.5-10 MU/deg)

Spot check of field size dependent output factors (Sc, Sf) for X-rays

2% for < 4x4cm2

1% for ≥ 4x4 cm2

X-ray beam quality (PDD10 or TMR2010)

Electron beam quality (R50)

Physical wedge transmission factor constancy

Coincidence of radiation and mechanical isocenter

Temporal accuracy of phase/amplitude gate on

Calibration of surrogate for respiratory phase/amplitude

Check of 60º angle, full field and spot check for an intermediate angle, field size

V Annual MLC Coincidence of light field and X-ray field 2 mmV Annual MLC Segmental IMRT (step and shoot) test NA

V Annual MLC NA

V Monthly MLC Setting vs. radiation field for two patterns 2 mmV Monthly MLC Backup diaphram speed (Elekta only) NAV Monthly MLC Travel speed NA

V Monthly MLC Leaf position accuracy NA

V Monthly MLC MLC transmission, all energies 0.5% from baseline

V Weekly MLC Qualitative test (e.g. "picket fence") NA

VI Daily Collision interlocks Functional

VI Daily Positioning/repositioning ≤2 mm

VI Daily ≤2 mm

VI Daily CBCT (kV, MV) Collision interlocks Functional

VI Daily CBCT (kV, MV) ≤2 mm

VI Daily CBCT (kV, MV) Positioning/repositioning ≤1 mm

VI Monthly EPID (MV) ≤2 mm

VI Monthly EPID (MV) Scaling ≤2 mmVI Monthly EPID (MV) Spatial resolution BaselineVI Monthly EPID (MV) Contrast BaselineVI Monthly EPID (MV) Uniformity and noise Baseline

VI Monthly Planar (kV) ≤2 mm

VI Monthly Planar (kV) Scaling ≤2 mmVI Monthly Planar (kV) Spatial resolution BaselineVI Monthly Planar (kV) Contrast BaselineVI Monthly Planar (kV) Uniformity and noise BaselineVI Monthly CBCT (kV, MV) Geometric distortion ≤2 mmVI Monthly CBCT (kV, MV) Spatial resolution BaselineVI Monthly CBCT (kV, MV) Contrast BaselineVI Monthly CBCT (kV, MV) HU Constancy BaselineVI Monthly CBCT (kV, MV) Uniformity and noise BaselineVI Annual CBCT (kV, MV) Imaging dose BaselineVI Annual Planar (kV) Beam quality/energy Baseline

VI Annual Planar (kV) Imaging dose Baseline

VI Annual EPID (MV) Full range of travel SSD ± 5 mmVI Annual EPID (MV) Imaging dose Baseline

Moving window IMRT (four cardinal gantry angles)

Planar (kV)EPID (MV)

Planar (kV)EPID (MV)

Planar (kV)EPID (MV)

Imaging and treatment coordinate concidence

Imaging and treatment coordinate concidence

Imaging and treatment coordinate concidence

Imaging and treatment coordinate concidence

ToleranceIMRT SRS/SBRT

3%

3%

1.5 mm 1 mm2 mm

2 mm 1 mmFunctionalFunctionalFunctional

NA FunctionalFunctionalFunctional

3%3%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

2 mm2 mm1 mm1 mm

1 mm / 0.5º2 mm

1 mm

Functional

±1 mm < ±1 mm2%

FunctionalFunctionalFunctionalFunctional

1%±1%

2% (@ Stereo dose rate, MU)

1.0º

2 mm / 1.0º

1%±1%

NA

±1%±1%

±2% from baseline

±1% from baseline

±1 mm

±2%

±2% from baseline±1% from baseline±1% from baseline±1% from baseline±1% from baseline±1% from baseline

Functional

2% from baseline2% from baseline

±1 mm from baseline±1 mm from baseline±1 mm from baseline

Functional

±2 mm from baseline ±1 mm from baseline

2 mm from baseline

±2 mmNA Functional

2%

100 ms of expected

100 ms of expected

FunctionalPerformed

< 2%

Functional

< 2%

1 mm1 mm radius

MU (Gantry arc) set vs. Delivered: Greater of 1.0

MU (1.0º) or 2%

2% for < 4x4cm2

1% for ≥ 4x4 cm2

2-4 MU: ±5%≥5 MU: ±2%

≥5 MU: ±2%

TBI: 1%TSET: 1 mm PDD shift from baseline

1º

2 mm< 0.35 cm max error RMS

< 0.35 cm max error RMS

NA2 mm

Loss of leaf speed >0.5 cm/s

1 mm

0.5% from baseline

Functional

≤2 mm ≤1 mm

≤2 mm ≤1 mm

Functional

≤2 mm ≤1 mm

≤1 mm

≤2 mm ≤1 mm

≤2 mmBaselineBaselineBaseline

≤2 mm ≤1 mm

≤2 mm ≤1 mmBaselineBaselineBaseline

≤2 mm ≤1 mmBaselineBaselineBaselineBaselineBaselineBaseline

Baseline

± 5 mmBaseline

Visual inspection fo discernable deviations, e.g. increase in interleaf transmission

Comments Date By

All energies

Weekly except for machines with unique e- monitoring requiring daily

Dose monitoring as a function of dose rate.

a.k.a. port film graticle trayTolerance is summation of total for each width or lengthShould be checked at settings of 0.0 and 10.0

Lateral, longitudinal and rotational

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

Light radiation field coincidence need only be checked monthly if light field is used for clinical setups

Compensator based IMRT (solid compensators) require a quantitative value for tray position (wedge or blocking tray shot) set at a maximum deviation of 1.0 mm from the center of the compensator tray mount and the cross hairs.

Check at collimator/gantry angle combinatin that places the latch toward the floor.

AbsoluteAbsolute

2 or more field sizes

Spot check of one applicator/energy

OAF = Off-axis factorOAF = Off-axis factor

Checked with each use & as warm-up

SRS/SBRT: ±1 mm from baseline

All directions

OAR @ 80% field width, depth of 10 cm

Dynamic & Universal: Central axis 45° or 60° WFVirtual: 5% from unity

All energies95% of error counts < 0.35 cm

95% of error counts < 0.35 cm

non-IMRT patterns

Average of leaf and inter-leaf transmission

Daily = when devices are to be used that day

Daily = when devices are to be used that day

Daily = when devices are to be used that day

Daily = when devices are to be used that day

Daily = when devices are to be used that day

4 cardinal angles

Measured at SSD typically used for imagingMeasured data consistent with or beter than ATP data

2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging2D Fluoroscopic and radiographic imaging

Effective dose for measured doses per TG-752D Fluoroscopic and radiographic imaging

Effective dose for measured doses per TG-75

For leaf positions of an IMRT field for four cardinal gantry angles (Picket fence test may be used, test depends on clinical planning segment size)

Daily = when devices are to be used that daySingle gantry angle

2D Fluoroscopic and radiographic imaging4 cardinal angles

2D Fluoroscopic and radiographic imagingEffective dose for measured doses per TG-75