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Guideline on Acceptance Test and Commissioning of High-Precision External Radiation Therapy Equipment
Prog. Med. Phys. 2018;29(4):123-136
Published online December 31, 2018
© 2018 Korean Society of Medical Physics.

Juhye Kim*, Dong Oh Shin, Sang Hyoun Choi, Soonki Min, Nahye Kwon§, Unjung Jung*, Dong Wook KimΙΙ

*Research Institute of Clinical Medicine, Kyung Hee University Hospital at Gangdong, Department of Radiation Oncology, Kyung Hee University Hospital, Division of Medical Radiation Equipment, Korea Institute of Radiological and Medical Sciences, Seoul, §Department of Nuclear Engineering, Kyung Hee University, Yongin, ΙΙDepartment of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
Correspondence to: Dong Wook Kim ( 
Tel: 82-2-440-7398  Fax: 82-2-440-7393
Received November 20, 2018; Revised December 13, 2018; Accepted December 14, 2018.
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The complex dose distribution and dose transfer characteristics of intensity-modulated radiotherapy increase the importance of precise beam data measurement and review in the acceptance inspection and preparation stages. In this study, we propose a process map for the introduction and installation of high-precision radiotherapy devices and present items and guidelines for risk management at the acceptance test procedure (ATP) and commissioning stages. Based on the ATP of the Varian and Elekta linear accelerators, the ATP items were checked step by step and compared with the quality assurance (QA) test items of the AAPM TG-142 described for the medical accelerator QA. Based on the commissioning procedure, dose quality control protocol, and mechanical quality control protocol presented at international conferences, step-by-step check items and commissioning guidelines were derived. The risk management items at each stage were (1) 21 ionization chamber performance test items and 9 electrometer, cable, and connector inspection items related to the dosimetry system; (2) 34 mechanical and dose-checking items during ATP, 22 multileaf collimator (MLC) items, and 36 imaging system items; and (3) 28 items in the measurement preparation stage and 32 items in the measurement stage after commissioning. Because the items presented in these guidelines are limited in terms of special treatment, items and practitioners can be modified to reflect the clinical needs of the institution. During the system installation, it is recommended that at least two clinically qualified medical physicists (CQMP) perform a double check in compliance with the two-person rule. We expect that this result will be useful as a radiation safety management tool that can prevent radiation accidents at each stage during the introduction of radiotherapy and the system installation process.
Keywords : External radiation therapy equipment, Acceptance test, Commissioning, IMRT, Risk management

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