Commissioning and quality assurance of treatment planning computers

The process of radiation therapy is complex and involves many steps. At each step, comprehensive quality assurance procedures are required to ensure the safe and accurate delivery of a prescribed radiation dose. This report deals with a comprehensive commissioning and ongoing quality assurance program specifically for treatment planning computers. Detailed guidelines are provided under the following topics: (a) computer program and system documentation and user training, (b) sources of uncertainties and suggested tolerances, (c) initial system checks, (d) repeated system checks, (e) quality assurance through manual procedures, and in vivo dosimetry, and (f) some additional considerations including administration and manpower requirements. In the context of commercial computerized treatment planning systems, uncertainty estimates and achievable criteria of acceptability are presented for: (a) external photon beams, (b) electron beams, (c) brachytherapy, and (d) treatment machine setting calculations. Although these criteria of acceptability appear large, they approach the limit achievable with most of today's treatment planning systems. However, developers of new or improved dose calculation algorithms should strive for the goal recommended by the International Commission of Radiation Units and Measurements of 2% in relative dose accuracy in low dose gradients or 2 mm spatial accuracy in regions with high dose gradients. For brachytherapy, the aim should be 3% accuracy in dose at distances of 0.5 cm or more at any point for any radiation source. Details are provided for initial commissioning tests and follow-up reproducibility tests. The final quality assurance for each patient is to perform an independent manual check of at least one point in the dose distributions, as well as the machine setting calculation. As a check of the overall treatment planning process, in vivo dosimetry should be performed on a select number of patients.