Table 1.

Recommended minimum practices for commissioning and QA of an IGRT system

Acceptance Testing and Commissioning
Procedure
Customer acceptance procedures
TPS integration
OIS integration
Establish routine QA baselines
QA documentation
Routine Quality Assurance
Procedure	Tolerance
Daily
Safety/interlocks	Functional
Imaging‐treatment isocenter coincidence (SRS only)	1 mm
Positioning/repositioning (SRS only)	1 mm
Imaging‐treatment isocenter coincidence (SBRT only)	2 mm
Positioning/repositioning (SBRT only)	2 mm
Weekly
Imaging‐treatment isocenter coincidence (non‐SRS/SBRT)	2 mm
Positioning/repositioning (non‐SRS/SBRT)	2 mm
Semi‐annually
Image scaling	2 mm
Annually
Imaging dose
2D MV	$\pm 1\text{cGy}$ of baseline value
2D kV (static imaging mode)	$\pm 3\text{mGy}$ of baseline value
2D kV (fluoroscopy mode)	$\pm 1\text{cGy}/\text{min}$ of baseline value
All 3D imaging modes	$\pm 1\text{cGy}$ of baseline value
Image quality
2D (spatial resolution, contrast)	Baseline value
3D (uniformity, spatial resolution, contrast)
Upgrade/Repair/Service
Verify / Reestablish QA baselines (as appropriate)

^a $\text{SRS}=\text{stereotactic radiosurgery}$; $\text{SBRT}=\text{stereotactic body radiation therapy}$.