AAPM REPORT No.62-TG53 1998 临床放射治疗计划的QA

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American Association of Physicists in Medicine

Radiation Therapy Committee Task Group 53:

Quality assurance for clinical radiotherapy treatment planning

Benedick Fraassa)

University of Michigan Medical Center, Ann Arbor, Michigan

Karen Doppke

Massachusetts General Hospital, Boston, Massachusetts

Margie Hunt

Fox Chase Cancer Center, Philadelphia, Pennsylvania

and Memorial Sloan Kettering Cancer Center, New York, New York

Gerald Kutcher

Memorial Sloan Kettering Cancer Center, New York, New York

George Starkschall

M. D. Anderson Cancer Center, Houston, Texas

Robin Stern

University of California, Davis Medical Center, Sacramento, California

Jake Van Dyke

London Regional Cancer Center, London, Ontario, Canada

~Received 15 December 1997; accepted for publication 4 August 1998!

In recent years, the sophistication and complexity of clinical treatment planning and treatment

planning systems has increased signiﬁcantly, particularly including three-dimensional ~3D!treat-

ment planning systems, and the use of conformal treatment planning and delivery techniques. This

has led to the need for a comprehensive set of quality assurance ~QA!guidelines that can be applied

to clinical treatment planning. This document is the report of Task Group 53 of the Radiation

Therapy Committee of the American Association of Physicists in Medicine. The purpose of this

report is to guide and assist the clinical medical physicist in developing and implementing a

comprehensive but viable program of quality assurance for modern radiotherapy treatment plan-

ning. The scope of the QA needs for treatment planning is quite broad, encompassing image-based

deﬁnition of patient anatomy, 3D beam descriptions for complex beams including multileaf colli-

mator apertures, 3D dose calculation algorithms, and complex plan evaluation tools including dose

volume histograms. The Task Group recommends an organizational framework for the task of

creating a QA program which is individualized to the needs of each institution and addresses the

issues of acceptance testing, commissioning the planning system and planning process, routine

quality assurance, and ongoing QA of the planning process. This report, while not prescribing

speciﬁc QA tests, provides the framework and guidance to allow radiation oncology physicists to

American Association of Physicists in Medicine. @S0094-2405~98!03410-5#

Key words: treatment planning, quality assurance, 3D treatment planning

PREFACE

This document is the report of Task Group 53 of the Ra-

diation Therapy Committee of the American Association of

Physicists in Medicine ~AAPM!. The purpose of this report

is to guide and assist the radiation oncology physicist in

developing and implementing a comprehensive but viable

program of quality assurance for radiotherapy treatment

planning. This report is the ﬁrst guidance on the topic of

treatment planning quality assurance ~QA!from the AAPM,

although there are several related reports,1including the re-

cent report from Task Group 40 on Comprehensive QA for

Radiation Oncology.2Further expansion of AAPM recom-

mendations regarding treatment planning quality assurance is

likely after the radiation oncology community accumulates

some experience with the approach recommended in this re-

port.

In recent years, the increased complexity of the treatment

planning process required to support such procedures as con-

formal radiotherapy has led to the need for a comprehensive

set of quality assurance guidelines that can be applied to

treatment planning systems that support this complex pro-

cess. This Task Group has been charged by the AAPM to

prepare this report recommending the scope and content of

necessary quality assurance procedures and the frequency of

tests, from acceptance testing, characterization and commis-

sioning to routine quality assurance of clinical system use.

These procedures will be tailored to the complexity and

functionality of the treatment planning procedures used clini-

cally. This report provides the overall framework within

which individualized quality assurance programs may be de-

signed and implemented.

This report on treatment planning quality assurance at-

tempts to aid the radiation oncology physicist in creating a

quality assurance program for the clinical use of treatment

planning in the physicist’s department. In general, except for

recommendations summarized in one appendix, this report

does not discuss quality assurance activities that should be

carried out by vendors or other providers of treatment plan-

ning systems. The numerous important quality assurance

tasks associated with the design, software engineering, test-

ing, validation, packaging, marketing, and other preparation

of a commercial treatment planning system for safe use are

beyond the scope of the current task group. This document

considers only the responsibility of the radiation oncology

physicist in establishing and maintaining a quality assurance

program for the clinical use of radiotherapy treatment plan-

ning.

The report also concentrates on quality assurance for the

treatment planning process, and not just QA or commission-

ing of the treatment planning system. Although a treatment

planning system ~software and hardware!may be tested ex-

tensively, a QA program for treatment planning must also

consider how the treatment planning system is used as well

as how it interacts with the treatment planning process.

Therefore, creation of a treatment planning process that in-

corporates self-consistency and procedural checks is a major

component of a quality assurance program for treatment

planning.

In order to successfully implement an appropriate quality

assurance program for treatment planning, adequate re-

sources must be allocated. The radiation oncology physicist

must be afforded adequate time to ascertain the extent and

complexity of the treatment planning needs of the radiation

oncology clinic, and based upon this information, the physi-

cist must design and implement an appropriate quality assur-

ance program. For a treatment planning process of a given

complexity, the quality assurance requirements in a small

radiation oncology facility should be no less than those in a

large, academic medical center.

The report begins with a summary intended for radiation

oncology administrators ~Part A!. Part B is directed to the

radiation oncology physicist, and comprises the bulk of the

report. Part B begins with an introduction which delineates

the scope of the task, introduces some deﬁnitions and terms,

and establishes targets for the accuracy of treatment planning

results. Chapter 2 describes speciﬁcations and acceptance

testing for the treatment planning system. The most exten-

sive part of the report is contained in Chaps. 3 and 4, which

describe commissioning of the nondosimetric and dosimetric

parts of the planning system, respectively. Routine testing of

the treatment planning system is described in Chap. 5. Chap-

ter 6 discusses ways to apply QA to the entire planning pro-

cess, while Chap. 7 lists computer-system management ac-

tivities which are an important part of the treatment planning

quality assurance process. Finally, the last chapter summa-

rizes some of the important recommendations of the task

group. Appendix 1 contains some recommendations and

comments about both vendor and user responsibilities. Ap-

pendix 2 contains examples of some nondosimetric test pro-

cedures, to give the reader an idea of how to design and

implement test procedures. Appendices 3, 4, and 5 give ex-

amples of dose calculation commissioning tests for photon

beams, electron beams, and brachytherapy, respectively.

Terminology used in this report will be similar to that

used in other AAPM task group reports:

•Shall or must are used when the activity is required by

various regulatory agencies.

•Recommend is used when the task group expects that

the procedure should normally be followed as de-

scribed. However, there may prove to be instances

where other issues, techniques or priorities could force

the modiﬁcation of the recommendation of the task

group.

•Should is used when it is expected that local analysis of

the situation may change the way a particular activity is

performed.

This report recommends the institution of a comprehen-

sive quality assurance program for treatment planning in

each radiation oncology clinic. As will be seen, this encom-

passes a large amount of work, requiring the attention par-

ticularly of the radiation oncology physicist, but also includ-

ing dosimetrists/treatment planners, radiation oncologists,

radiation therapists and, if available, computer support staff.

Particularly at this time of downsizing and major restructur-

ing of the way the practice of clinical medicine works, it is

very important for hospital administrators and providers of

medical care reimbursement to understand the critical nature

of appropriate quality assurance for a procedure that is such

an important part of the way high quality radiotherapy is

performed. If compromises must be made in the interest of

cost reduction, these compromises should be made initially

in establishing the complexity and efﬁciency of the treatment

planning process in the clinic. Once a particular type of pro-

cess has been established, then it is imperative for the safety

and well-being of the patient that an appropriate quality as-

surance program be implemented to support that process. In

this report, we have tried to balance the need to be cost

effective and efﬁcient with the need for high quality care. As

the recommendations of this task group are used throughout

the community, it will be important for radiation oncology

physicists to improve their quality assurance tools and pro-

grams, so that the quality of treatments can be improved

while also keeping the costs as low as feasible.

OUTLINE

Preface

Part A: INFORMATION FOR RADIATION

ONCOLOGY ADMINISTRATORS

Part B: QUALITY ASSURANCE FOR CLINICAL

RADIOTHERAPY TREATMENT

PLANNING

1774 Fraass

et al.

: Task Group 53 report on quality assurance 1774

Medical Physics, Vol. 25, No. 10, October 1998

Chapter 1: Introduction

1.1. Introduction

1.2. General deﬁnitions and aims

1.3. Scope

1.4. Initial recommendations ~how to use this

report!

1.5. The treatment planning process

1.6. Sources of uncertainties

1.7. Required and/or desired tolerances and

accuracy

Chapter 2: Acceptance tests for treatment planning

systems

2.1. Acceptance testing

2.2. Determination of speciﬁcations

2.3. Acceptance testing procedure

Chapter 3: Nondosimetric commissioning

3.1. Introduction

3.2. Patient positioning and immobilization

3.2.1. Immobilization

3.2.2. Positioning and simulation

3.3. Image acquisition

3.3.1. Imaging parameters

3.3.2. Artifacts and distortion in image

acquisition systems

3.4. Anatomical description

3.4.1. Image conversion and input

3.4.2. Anatomical structures

3.4.2.1. 3D structures

3.4.2.2. Contours

3.4.2.3. 3D points and lines

3.4.3. Density representation

3.4.3.1. Bolus and editing the 3D

density distribution

3.4.4. Image use and display

3.4.5. Dataset registration

3.5. Beams

3.5.1. Beam arrangements and deﬁnition

3.5.2. Machine description, limits and

readouts

3.5.3. Geometric accuracy

3.5.4. Field shape design

3.5.4.1. Manual aperture entry

3.5.4.2. Automatic aperture deﬁnition

3.5.4.3. Special MLC features

3.5.5. Wedges

3.5.6. Beam and aperture display

3.5.7. Compensators

3.6. Operational aspects of dose calculations

3.6.1. Methodology and algorithm use

3.6.2. Inhomogeneity correction effects

3.7. Plan evaluation

3.7.1. Dose display

3.7.2. Dose volume histograms

3.7.3. Use of NTCP/TCP and other tools

3.7.4. Composite plans

3.8. Hardcopy output

3.9. Plan implementation and veriﬁcation

3.9.1. Coordinate systems and scale

conventions

3.9.2. Data transfer

3.9.3. Portal image veriﬁcation

3.10. Brachytherapy issues

Chapter 4: Dose calculation commissioning

4.1. Introduction

4.2. Measurement of self-consistent dataset

4.2.1. Self-consistency

4.2.2. Data analysis, handling, and storage

4.3. Data input into the RTP system

4.3.1. General considerations

4.3.2. Computer transfer of data from a

water phantom

4.3.3. Manual data entry

4.3.4. Veriﬁcation of input data

4.4. Dose calculation algorithm parameter

determination

4.5. Methods for dosimetric comparison and

veriﬁcation

4.6. External beam calculation veriﬁcation

4.6.1. Introduction

4.6.2. Required and/or achievable accuracy

4.6.3. Photon calculation veriﬁcation

experiments

4.6.4. Electron calculation veriﬁcation

experiments

4.7. Brachytherapy calculation veriﬁcation

4.8. Absolute dose output and plan normalization

4.8.1. General guidelines for QA for

normalization and MU calculation

4.8.2. Veriﬁcation of the steps in the process

4.9. Clinical veriﬁcations

Chapter 5: Periodic quality assurance testing

Chapter 6: QA as part of the daily planning process

Chapter 7: System management and security

7.1. Management personnel

7.1.1. Responsible physicist

7.1.2. Computer systems manager

7.2. Computer system management tasks

7.3. Data management tasks

7.4. Computer networks

7.5. System security

Chapter 8: Summary of recommendations

Chapter 9: Conclusions

Appendix 1: Vendor and user responsibilities

A1.1. Vendor responsibilities

A1.1.1. Documentation

A1.1.2. User training

A1.1.3. Software quality assurance

A1.1.4. Version updates

A1.1.5. Release of data formats

A1.1.6. Communication with users

A1.1.7. Suggestions for vendors

A1.2. User responsibilities

A1.2.1. Responsible physicist

A1.2.2. Documentation

A1.2.3. User training

1775 Fraass

et al.

: Task Group 53 report on quality assurance 1775

Medical Physics, Vol. 25, No. 10, October 1998

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摘要：

本文档介绍了1998年发布的AAPM REPORT No.62（TG53）中关于临床放射治疗计划的质量保证（QA）标准与实施指南。该报告由美国医学物理学家协会（AAPM）特别工作组TG53制定，旨在为放射治疗计划的验证过程提供系统化的QA方法，涵盖剂量计算准确性、治疗计划系统（TPS）验收测试、患者特定计划验证以及数据一致性检查等内容。作为临床放射物理领域的经典参考文献，该报告强调了从设备调试到日常临床使用的全流程质量控制，为保障放疗安全与疗效奠定了技术基础。对于从事放射治疗物理、计划设计及质量

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