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1 R m {!y ` }r Y:845 GLB142 HCL> American Association of Physicists in Medicine Task Group 142 report: Quality assurance of medical accelerators W /9J:L y ` aS q r } r 9J:L U} / 9J:L / 23-A-13 e . , [k , W XR } / 9J:LQ Preface'to'the'Japanese'translation'of'A APM'TG5142'Report'!In!2007!the!Radiation !Therapy!Committee!of!the!American!Assoc iation!of!Physicists!in!Medicine!improve d!the!formulation!and!initiation!of!a!ta sk!group!on!the!quality!assurance!of!med ical!accelerators,!later!known!as!TGD142 .!!The!charges!of!this!task!group!were!t o!update,!as!needed,!recommendations!fro m!Table!II!of!the!AAPM!TGD40!Report!on!]

2 Quality!assurance,!and!in!addition!recom mendations!for!asymmetric!jaws,!multiDco llimation!and!Dynamic/Virtual!Wedges.!!T he!composition!of!the!task!group!members hip!included:!!Eric!Klein,!as!the!chair; !Chihray!Liu;!Chris!Serago;!Joseph!Hanle y;!Lijun!Ma;!Bijan!Arjomandy;!Sean!Dress er;!Francisco!Aguirre;!John!Bayouth;!Fan gDFang!Yin;!William!Simon,!with!consulta nts!from!Elekta,!and!Varian.!!This!compo sition!was!important,!as!all! accelerator !manufacturers!users!were!included,!alon g!with!both!academic!and!community!hospi tal!physicists.!!The!task!group!had!a!de adline!of!2009!to!complete!the!report,!w hich!was!met!and!subsequent!publication! was!September,!2009!in!the!Journal!of!Me dical!Physics.!!The!task!group!(TG)!for! quality!assurance!of! medical ! accelerator s!

3 Was!constituted!by!the!American!Associat ion!of!Physicists!in!Medicine s!Science!Council,!under!the!direction!o f!the!Radiation!Therapy!Committee!and!th e!Quality!Assurance!and!Outcome!Improvem ent!Subcommittee.!!The!task!group!(TG!#1 42)!had!two!main!charges.!!First!to!upda te,!as!needed,!recommendation!of!Table!I I!of!the!AAPM!TGD40!Report!on!Quality!As surance,!and!second,!to!add!recommendati ons!for!Asymmetric!Jaws,!Multileaf!Colli mation!(MLC),!and!Dynamic/Virtual!Wedges .!!The!TG!accomplished!the!update!to!TGD 40,!specifying!new!test!and!tolerances,! and!has!added!recommendations!for!not!on ly!the!new!ancillary!delivery!technologi es,!but!also!for!imaging!devices!that!ar e!part!of!the!linear! accelerator .!!The!i maging!devices!include!xDray!imaging,!ph oton!portal!

4 Imaging,!and!coneDbeam!CT.!!The!TG!repor t!was!designed!to!account!for!the!types! of!treatments!delivered!with!the!particu lar!machine.!!For!example,!machines!that !are!used!for!radiosurgery!treatments,!o r!intensity!modulated!radiotherapy!(IMRT )!require!different!tests!and/or!toleran ces.!!There!are!specific!recommendations !for!MLC!quality!assurance!for!machines! performing!IMRT.!!The!report!also!gives! recommendations!as!to!action!levels!for! the!physicists!to!implement!particular!a ctions,!whether!they!are!inspection,!sch eduled!action,!or!immediate!and!correcti on!action.!!The!report!is!geared!to!be!f lexible!for!the!physicist!to!customize!t he!QA!program!depending!on!clinical!util ity.!!There!are!specific!tables!accordin g!to!daily,!monthly,!and!annual!reviews, !

5 Along!with!unique!tables!for!wedge!syste ms,!MLC,!and!image!checks.!!The!report!a lso!gives!specific!recommendations!regar ding!setup!of!a!QA!program!by!the!physic ist!in!regards!to!building!a!QA!team,!es tablishing!procedures,!training!of!perso nnel,!documentation,!and!endDtoDend!syst em!checks.!!The!tabulated!items!of!this! report!have!been!considerably!expanded!a s!compared!with!the!original!TG!40!repor t!and!the!recommended!tolerances!accommo date!differences!in!the!intended!use!of! the!machine!functionality!(nonDIMRT,!IMR T,!and!Stereotactic!Delivery).!!The!task !group,!and!effectively!the!AAPM,!promot es!implementation!of!the!Task!Group!142! recommendations.!!The!Radiological!Physi cs!Center,!which!was!responsible!for!the !beam!parameters!and!delivery!systems!

6 That!are!used!to!treat!patients!on!clini cal!trials,!quickly!adopted!TG!142!as!th e!standard!for!quality!assurance!for!rad iation!oncology!facilities!participating !in!clinical!trials.!!As! accelerator !tec hnology!including!imaging!has!accelerate d!over!recent!years!the!need!to!moderniz e!quality!assurance!programs!is!vital.!! This!along!with!the!fact!that!many!of!th e!radiation!therapy!accidents!that!have! occurred!could!have!been!avoided!with!a! programmatic,!robust!quality!assurance!p rogram!such!as!outlined!TG!142.!!It!is!t herefore,!strongly!encouraged!that!all!s ocieties!internationally!adopt!programs! similar!to!TG!142.!!Though!the!workload! seems!excessive,!the!task!group!report!d oes!point!out!that!physicists,!who!shoul d!be!the!charge!person!for!the!technical !

7 Quality!assurance!program!of!the!radiati on!oncology!department,!has!the!leeway!t o!decide!on!the!frequency!of!such!testin g!depending!on!the!prioritization!of!the !most!important!aspects!of!the!program!w here!a!patient!is!going!to!be!harmed!the !most,!along!with!the!dependability!of!t he!particular!aspect!of!the! accelerator . !!Thank!you,!!!!!!!!Eric!E.!Klein,! !!Professor!of! medical !Physics!Departmen t!of!Radiation!Oncology!Washington!Unive rsity!School!of!Medicine!in!St.!Louis,!U SA! }r Y :845 GLB142 HCL> r m {!y ` h / !k ( / ! )+IJ ! / *# .u+ p % ij% ! 'IJ Z IJ IJ c (xw o IJ ! ` t -IJ / , $! % % ij / IJr !6E=02G8:;A! u+N *-, ' IJ ! ! IJ T ,8:;A!)

8 , IJ !y ` K ! ' -,) +% ij -% ! "IJ Y * h - ,Quality Assurance (QA)78<D31?F1J ( !` BI5FD - % ij -*!31?F1J" h * IJ ! ! - g *- % ij !) QIJ2009 }r Y American Association of Physicists in Medicine; AAPM )+IJ ! IJ ! BI5FD ,:845 GLBHCL>142 TG-142 -% ij !HCL>"IJ ~! -, K . g , IJ -% ! BI5FD. '! +IJV ! ! !y ` K BI5FD. ,N IJ ! . , , % ij "IJ !TG-142 }f ' n -,) IJ !j_ . IJ r Y r Y i !y ` Ky 78<D! W Sd } / 9J:LQ !EJ@L! sl!O \ . & % ij ! IJ U} / 9J:L / 23-A-13 e . , [k , W XR d } / 9J:LQ ! , !' IJ !]

9 P h , Y. % ij !TG-142 HCL> IJ ! -IJMU ' ! /$ . e ^ ,r ! b -, . )+ % ij AAPM TG-142 HCL> \ 5 GLB W /9J:L y ` r The Association s Journals are medical Physics and Journal of Applied Clinical medical Physics Member Society of the American Institute of Physics and the International Organization of medical Physics American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846 (301) 209-3350 Fax (301) 209-0862 Office of the Executive Director Angela R. Keyser Phone: 301-209-3385 Fax: 301-209-0862 E-mail: VIA EMAIL 5 March 2012 Jun Itami, , Principal Investigator for the National Cancer Center Research and Development Fund Chairman, Department of Radiation Oncology National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 JAPAN Dear Dr.

10 Itami: The American Association of Physicists in Medicine hereby grants permission to Dr. Jun Itami, the Principal Investigator for the National Cancer Center Research and Development, to coordinate translating the report indicated below into Japanese. It will be published and distributed through the website for the members of the Japanese Society of medical Physics, Japanese Organization of Radiotherapy Quality Management and Japanese College of medical Physics. Eric E. Klein, Joseph Hanley, John Bayouth, Fang-Fang Yin, William Simon, Sean Dresser, Christopher Serago, Francisco Aguirre, Lijun Ma, Bijan Arjomandy, Chihray Liu, Carlos Sandin, andTodd Holmes, Task Group 142 report: Quality assurance of medical accelerators. Med. Phys. 36(9) 4197-4212 (2009) Authors seeking permission must also notify the first author of the article from which permission is being sought.