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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!]

2 Group!on!the!quality!assurance!of!medica l!accelerators,!later!known!as!TGD142.!! The!charges!of!this!task!group!were!to!u pdate,!as!needed,!recommendations!from!T able!II!of!the!AAPM!TGD40!Report!on!qual ity!assurance,!and!in!addition!recommend ations!for!asymmetric!jaws,!multiDcollim ation!and!Dynamic/Virtual!Wedges.!!The!c omposition!of!the!task!group!membership! included:!!Eric!Klein,!as!the!chair;!Chi hray!Liu;!Chris!Serago;!Joseph!Hanley;!L ijun!Ma;!Bijan!Arjomandy;!Sean!Dresser;! Francisco!Aguirre;!John!Bayouth;!FangDFa ng!Yin;!William!Simon,!with!consultants!

3 From!Elekta,!and!Varian.!!This!compositi on!was!important,!as!all!accelerator!man ufacturers!users!were!included,!along!wi th!both!academic!and!community!hospital! physicists.!!The!task!group!had!a!deadli ne!of!2009!to!complete!the!report,!which !was!met!and!subsequent!publication!was! September,!2009!in!the!Journal!of!Medica l!Physics.!!The!task!group!(TG)!for!qual ity!assurance!of!medical!accelerators!wa s!constituted!by!the!American!Associatio n!of!Physicists!in!Medicine s!Science!Council,!under!the!direction!o f!the!Radiation!Therapy!Committee!and!th e!Quality!Assurance!

4 And!Outcome!Improvement!Subcommittee.!!T he!task!group!(TG!#142)!had!two!main!cha rges.!!First!to!update,!as!needed,!recom mendation!of!Table!II!of!the!AAPM!TGD40! Report!on!Quality!Assurance,!and!second, !to!add!recommendations!for!Asymmetric!J aws,!Multileaf!Collimation!(MLC),!and!Dy namic/Virtual!Wedges.!!The!TG!accomplish ed!the!update!to!TGD40,!specifying!new!t est!and!tolerances,!and!has!added!recomm endations!for!not!only!the!new!ancillary !delivery!technologies,!but!also!for!ima ging!devices!that!are!part!of!the!linear !accelerator.!!The!imaging!devices!inclu de!

5 XDray!imaging,!photon!portal!imaging,!an d!coneDbeam!CT.!!The!TG!report!was!desig ned!to!account!for!the!types!of!treatmen ts!delivered!with!the!particular!machine .!!For!example,!machines!that!are!used!f or!radiosurgery!treatments,!or!intensity !modulated!radiotherapy!(IMRT)!require!d ifferent!tests!and/or!tolerances.!!There !are!specific!recommendations!for!MLC!qu ality!assurance!for!machines!performing! IMRT.!!The!report!also!gives!recommendat ions!as!to!action!levels!for!the!physici sts!to!implement!particular!actions,!whe ther!they!are!inspection,!scheduled!acti on,!

6 Or!immediate!and!correction!action.!!The !report!is!geared!to!be!flexible!for!the !physicist!to!customize!the!QA!program!d epending!on!clinical!utility.!!There!are !specific!tables!according!to!daily,!mon thly,!and!annual!reviews,!along!with!uni que!tables!for!wedge!systems,!MLC,!and!i mage!checks.!!The!report!also!gives!spec ific!recommendations!regarding!setup!of! a!QA!program!by!the!physicist!in!regards !to!building!a!QA!team,!establishing!pro cedures,!training!of!personnel,!document ation,!and!endDtoDend!system!checks.!!Th e!tabulated!items!of!this!report!have!be en!

7 Considerably!expanded!as!compared!with!t he!original!TG!40!report!and!the!recomme nded!tolerances!accommodate!differences! in!the!intended!use!of!the!machine!funct ionality!(nonDIMRT,!IMRT,!and!Stereotact ic!Delivery).!!The!task!group,!and!effec tively!the!AAPM,!promotes!implementation !of!the!Task!Group!142!recommendations.! !The!Radiological!Physics!Center,!which! was!responsible!for!the!beam!parameters! and!delivery!systems!that!are!used!to!tr eat!patients!on!clinical!trials,!quickly !adopted!TG!142!as!the!standard!for!qual ity!assurance!for!radiation!oncology!fac ilities!

8 Participating!in!clinical!trials.!!As!ac celerator!technology!including!imaging!h as!accelerated!over!recent!years!the!nee d!to!modernize!quality!assurance!program s!is!vital.!!This!along!with!the!fact!th at!many!of!the!radiation!therapy!acciden ts!that!have!occurred!could!have!been!av oided!with!a!programmatic,!robust!qualit y!assurance!program!such!as!outlined!TG! 142.!!It!is!therefore,!strongly!encourag ed!that!all!societies!internationally!ad opt!programs!similar!to!TG!142.!!Though! the!workload!seems!excessive,!the!task!g roup!report!does!point!out!that!physicis ts,!

9 Who!should!be!the!charge!person!for!the! technical!quality!assurance!program!of!t he!radiation!oncology!department,!has!th e!leeway!to!decide!on!the!frequency!of!s uch!testing!depending!on!the!prioritizat ion!of!the!most!important!aspects!of!the !program!where!a!patient!is!going!to!be! harmed!the!most,!along!with!the!dependab ility!of!the!particular!aspect!of!the!ac celerator.!!Thank!you,!!!!!!!!Eric!E.!Kl ein,! !!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 {!

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