Acceptance Tests and

Commissioning Measurements

Ehab M. Attalla; PhD

Children Cancer Hospital &

National Cancer Institute;
Cairo University
 Introduction
‰Acceptance tests and commissioning constitute a major part in this QA
program for radiotherapy.
‰ This talk is focusing on the duties of acceptance testing and commissioning.
‰Calibrations of the treatment beams are a part of the acceptance tests and
commissioning.

Acceptance tests and commissioning can be performed only if adequate

measurement equipment is available:
‰Radiation survey equipment:
¾Geiger counter
¾Large volume ionization chamber survey meter
¾Neutron survey meter (if the unit operates above 10 MeV)
‰Ionometric dosimetry equipment
‰Other dosimetric detectors (film, diodes)
‰Phantoms
¾Radiation field analyzer and water phantom
¾ Plastic phantoms
Dosimetry equipment
Phantoms
 Acceptance tests
Acceptance tests
assure that the Manufacturers protocols for acceptance
specifications
contained in the
purchase order are
fulfilled and that the
environment is free of
radiation and
electrical hazards to
staff and patients.
The tests are
performed in the
presence of a
manufacturer’s
representative.
 Acceptance tests I
• Upon satisfactory completion of the
acceptance tests, the physicist signs a
document certifying these conditions
are met.
• When the physicist accepts the unit,
the final payment is made for the unit,
owner-ship of the unit is transferred
to the institution, and the warranty
period begins.
 Acceptance tests
Acceptance tests may be divided into
three groups:

1. Safety checks,
2. mechanical checks, and
3. Dosimetry measurements.
 Safety checks
‰Interlocks.
‰ Warning lights.
‰ Patient monitoring
equipment.
‰Radiation survey.
‰ Collimator and head
leakage
 Leakage Measurements
(Gantry at 900 or 2700 )

X-ray beam directed

Horizontally
 Linear
Accelerator
Mechanical checks include:
• Collimator axis of rotation
• Photon collimator jaw motion
• Congruence of light and radiation field
• Gantry axis of rotation
• Patient treatment table axis of rotation
• Radiation isocenter
• Optical distance indicator
• Gantry angle indicators
• Collimator field size indicators
• Patient treatment table motions
Mechanical checks
1. light Field
Mechanical checks
2. collimator rotation
Mechanical checks
3. Isocentric rotation
Dosimetry Measurements
The dosimetry measurements include:
• Photon energy
• Photon beam uniformity
• Photon penumbra
• Electron energy
• Electron beam bremsstrahlung contamination
• Electron beam uniformity
• Electron penumbra
• Monitor characteristics
• Arc therapy
Dosimetry equipment
Dosimetry checks
IAEA Dose-to-water based protocol
TRS-398
 Dosimetry
checks

Photon penumbra
Photon penumbra is typically defined as the
distance between the 80% and 20% dose
points on a transverse beam profile measured
10 cm deep in a water phantom

Beam symmetry

Uniformity index
Photon beam uniformity
Beam quality
profiles
Beam quality
photon beams
Comparison of photon energy specification:
Report No.54 (Institute of physical sciences in Medicine)

Energy D80 D50 J100/J200

(MV) (cm) (cm) ratio

4 5.9 13.8 1.85

6 6.8 15.7 1.71
8 7.4 17.1 1.64
10 8.0 18.2 1.59
16 9.1 20.4 1.52
21 9.6 21.3 1.49
25 10.3 21.7 1.47
Beam quality
electron beams
Comparison of electron energy specification: Report No.54
(Institute of physical sciences in Medicine)

Energy D 80 D 50 Range
MeV cm cm cm

3.0 1.0 1.2 1.7

6.0 2.0 2.4 3.1
9.0 3.0 3.6 4.5
12.0 4.0 4.9 6.0
15.0 5.0 6.0 7.5
18.5 6.0 7.4 9.2
22.0 7.0 8.8 11.1
25.5 8.0 10.2 13.3
30.0 9.0 12.1 15.4
 Bremsstrahlung Contamination
X-ray contamination:
Report No.54 (Institute of physical sciences in Medicine)

Nominal energy Contamination

MeV %

4 3.5
6 3.8
8 4.0
10 4.3
15 5.0
20 6.3
25 7.5
30 8.8
Film dosimetry

Advantages
Spatial resolution
Permanent (archives)
Commercially easy available
Dose linearity in dose range
No dose rate dependence

Disadvantages
Development
Energy dependence
No neutron sensitivity
 Film
Radiographic film has a long history of
use for quality control measurements in
radiotherapy physics.
Example:
Congruence of radiation and light field (as
marked by pinholes)

Radiochromic film:
This film type is self-developing,
requiring neither developer nor fixer.
Principle:
Radiochromic film contains a special
dye that is polymerized and develops a
blue color upon exposure to radiation.
 Linearity
These data should produce a straight line indicating a
linear response of the monitor unit device or timer
Commissioning
Commissioning of an external beam therapy device
includes a series of tasks that generally should
consist of the following:
1. Acquiring all radiation beam data required for
treatment;
2. Organizing this data into a dosimetry data book;
3. Entering this data into a computerized
treatment planning system;
4. Developing all dosimetry, treatment planning, and
treatment procedures;
5. Verifying the accuracy of these procedures;
6. Establishing quality control tests and procedures;
and
7. Training all personnel.
 Acceptance Testing
• Conditions for TPS

1.Functionality of hardware (speed,

connections, interfacing, networking).
2.Functionality of software.
3.Functionality of input & output of data.
4.Functionality of calculation algorithms.
5.Test of calculation algorithms.
Treatment Planning System
checks
• Commissioning measurements
• Virtual machine representation
• Output checks
• Dosimetry checks
1. Dose in different points
2. Relative dose distributions
• Special commissioning for IMRT
Input data for TPS
1. General information
2. Collimator geometries
3. rotational geometries
4. wedge description
5. water phantom geometries
6. Dosimetric data photon beams
7. Dosimetric data electron beams
8. Photon beam characteristics
H u m a n e r r o r s in d a ta tr a n s fe r d u r in g th e p r e p a r a tio n
a n d d e liv e r y o f r a d ia tio n tr e a tm e n t a ffe c tin g th e fin a l
r e s u lt: " g a r b a g e in , g a r b a g e o u t"
L e u n e n s, G ; V e r str a e te , J ; V a n d e n B o g a e r t, W ; V a n D a m , J ; D u tr e ix , A ; v a n d e r S c h u e r e n , E
D e p a rtm e n t o f R a d io th e ra p y , U n iv e rsity H o sp ita l, S t. R a fa ë l, L e u v e n , B e lg iu m

A b str a c t
D u e to th e la rg e n u m b e r o f s te p s a n d th e n u m b e r o f p e rso n s in v o lv e d in th e p re p a ra tio n o f a ra d ia tio n
tre a tm e n t, th e tra n sfe r o f in fo rm a tio n fro m o n e ste p to th e n e x t is a v e ry c ritic a l p o in t. E rro rs d u e to
in a d e q u a te tra n sfe r o f in fo rm a tio n w ill b e re fle c te d in e v e ry n e x t s te p a n d c a n s e rio u sly a ffe c t th e fin a l
re su lt o f th e tre a tm e n t. W e stu d ie d th e fre q u e n c y a n d th e s o u rc e s o f th e tra n sfe r e rro rs. A to ta l n u m b e r o f
4 6 4 n e w tre a tm e n ts h a s b e e n c h e c k e d o v e r a p e rio d o f 9 m o n th s (Ja n u a ry to O c to b e r 1 9 9 0 ). E rro n e o u s d a ta
tra n s fe r h a s b e e n d e te c te d in 1 3 9 /2 4 ,1 2 8 (le ss th a n 1 % ) o f th e tra n sfe rre d p a ra m e te rs; th e y a ffe c te d 2 6 %
(1 1 9 /4 6 4 ) o f th e c h e c k e d tre a tm e n ts. T w e n ty -fiv e o f th e se d e v ia tio n s c o u ld h a v e le d to la rg e g e o g ra p h ic a l
m iss o r im p o rta n t o v e r- o r u n d e rd o sa g e (m u c h m o re th a n 5 % ) o f th e o rg a n s in th e irra d ia te d v o lu m e , th u s
in c re a sin g th e c o m p lic a tio n s o r d e c re a sin g th e tu m o u r c o n tro l p ro b a b ility , if n o t c o rre c te d . S u c h m a jo r
d e v ia tio n s , o n ly o c c u rrin g in 0 .1 % o f th e tra n sfe rre d p a ra m e te rs, a ffe c te d 5 % (2 5 /4 6 4 ) o f th e n e w
tre a tm e n ts. T h e s o u rc e s o f th e se la rg e d e v ia tio n s w e re n e a rly a lw a y s h u m a n m ista k e s, w h e re a s a
c o n sid e ra b le n u m b e r o f th e sm a lle r d e v ia tio n s w e re , in fa c t, c o n sc io u sly ta k e n d e c isio n s to d e v ia te fro m th e
in te n d e d tre a tm e n t. N e a rly h a lf o f th e m a jo r d e v ia tio n s w e re in tro d u c e d d u rin g in p u t o f th e d a ta in th e
c h e c k -a n d -c o n firm sy ste m , d e m o n s tra tin g th a t a sy ste m a im e d to p re v e n t a c c id e n ta l e rro rs, c a n le a d to a
c o n sid e ra b le n u m b e r o f s y s te m a tic e rro rs if u se d a s a n u n c o n tro lle d s e t-u p sy ste m . T h e re s u lts o f th is stu d y
sh o w th a t h u m a n m ista k e s c a n se rio u sly a ffe c t th e o u tc o m e o f p a tie n t tre a tm e n ts .(A B S T R A C T
T R U N C A T E D A T 2 5 0 W O R D S ) [Jo u rn a l A rtic le ; In E n g lish ; N e th e rla n d s]
Radiother. Oncol. 1992: > 50 occasions of data transfer
from one point to another for each patient!
If one of them is wrong - the overall outcome is affected
• Thank you