Experimental determination of depth-scaling factors and central axis depth dose for clinical electron beams

Depth-scaling factors rho(eff) for clear polystyrene and polymethylmethacrylate (PMMA) phantoms have been determined experimentally as a function of nominal electron-beam energy in the range 6 to 22 MeV. Values of rho(eff) have been calculated from the ratio rho(eff) = R(wat)(50) / R(med)(50), where R(wat)(50) and R(med)(50) are the measured depths of 50% ionization in electron solid water and plastic (clear polystyrene and PMMA) phantoms, respectively. Measurements were made using an Attix chamber in an electron solid water phantom, a Holt chamber in a clear polystyrene phantom, and a Markus chamber in a PMMA phantom. The average value of measured rho(poly)(eff) was found to be 0.999 +/- 0.009. This is higher than the value of 0.975 recommended by Task Group 25 (TG-25) of the American Association of Physicists in Medicine (AAPM) by 2.5%. Depending on energy, the maximum differences between the AAPM TG-25-recommended and the measured values lie in the range 1% to 3.5%. Similarly, the average value of measured rho(PMMA)(eff) was found to be 1.168 +/- 0.023. This is higher than the AAPM TG-25-recommended value of 1.115, by 5%. Depending on energy, the maximum differences between the AAPM TG-25-recommended and the measured values lie in the range 3% to 8%. Central axis depth dose curves in water were generated for 6, 15, and 20 MeV electron beams from measured depth-ionization data in PMMA and clear polystyrene phantoms following the recommendations of the AAPM TG-25 report and using both TG-25-recommended and experimentally determined values of depth-scaling factors rho(eff). For both phantoms, either the TG-25-recommended value or the experimentally determined values of rho(eff) yielded agreement to within about 2 mm among all depth doses in water at the depths of clinical relevance.

A generalized film technique for the verification of vertex fields used in the treatment of brain tumors

With the availability of commercial three-dimensional (3D)-treatment planning systems, more and more treatment plans call for the use of noncoplanar conformal beams for the treatment of brain tumors. However, techniques for the verification of many noncoplaner beams, such as vertex fields which involve any combination of gantry, collimator, and table angles, do not exist. The purpose of this work is to report on the results of an algorithm and a technique that have been developed for the verification of noncoplanar vertex fields used in the treatment of brain tumors. This technique is applicable to any geometric orientation of the beam, i.e., a beam orientation that consists of any combination of gantry, table, and collimator rotations. The method consists of superimposing a central plane image of a correctly magnified vertex field on a lateral or oblique field port film. To achieve this, the 3D coordinates of the projection of the isocenter onto the film for lateral (or oblique) as well as the vertex fields are determined and then appropriately matched. Coordinate transformation equations have been developed that enable this matching precisely. A film holder has been designed such that a film cassette can be secured rigidly along the side rails of the treatment table. The technique for taking a patient treatment setup verification film consists of two steps. In the first step, the gantry, table, and collimator angles for the lateral (or oblique) field are set and the usual double exposures are made; the first exposure corresponds to that of the treatment portal with the isocenter clearly identified and the second one a larger radiation field so that the peripheral anatomy is visible on the film. In the next step, the gantry, table, and collimator angles are positioned for the vertex field and the table is moved laterally and vertically and the film longitudinally to a position that will enable precise matching of the isocenter on the film. A third exposure is then taken with the vertex portal. What is seen on the film is a superposition of a central plane image of the vertex field onto the image of the lateral or oblique field. This technique has been used on 60 patients treated with noncoplanar fields for brain tumors. In all of these cases, the coincidence of the projection of the isocenter for the lateral (or oblique) and the vertex fields was found to be within 3 mm.

Experimental determination of fluence correction factors at depths beyond dmax for a Farmer type cylindrical ionization chamber in clinical electron beams

Recently, it has been recommended that electron beam calibrations be performed at a new reference depth [Burns et al., Med. Phys. 23, 383 (1996)] given by dref = 0.6R50-0.1 cm, where R50 is the depth of 50% depth dose. In order to calibrate electron beams at dref with a Farmer type cylindrical ionization chamber, the values of the perturbation correction factors Pwall and Pfl at dref are required. Using a parallel plate Holt chamber as a reference chamber, the product PwallPfl has been determined for a 6.1-mm-diameter PTW cylindrical ionization chamber at dref as a function of R50 of clinical electron beams (6 < or = nominal energy E < or = 22 MeV). Assuming that Pwall for the PTW chamber is unity in electron beams, the measured Pfl values ranged from 0.96 to 0.98 as the energy is increased. These results are in close agreement with recently reported calculated values. Determination of dref requires the knowledge of R50. A relation between I50 and R50 is given in the IAEA Protocol [TRS No. 277 (IAEA, Vieńna, 1987), pp. 1-98] for broad beams at SSD = 100 cm. It has been shown experimentally that the equation R50 = 1.029 x I50-0.063 cm, derived by Ding et al. [Med. Phys. 22, 489 (1995)] from Monte Carlo simulations of realistic clinical electron beams, can be used satisfactorily to obtain R50 from I50, where I50 is the depth of 50% ionization. The largest difference between the measured value of R50 and that calculated by using the above equation has been found to be about 1 mm at 22 MeV.

Anisotropy of an 192iridium high dose rate source measured with a miniature ionization chamber

The anisotropy of a high dose rate (HDR) 192Ir source was measured in air and in water using a miniature (0.147 cm3) ionization chamber. Measurements were made at a distance of 5 cm from the source center at polar angles from 10 degrees-170 degrees. The anisotropy was found to be less pronounced in water, and the anisotropy is asymmetric about the transverse axis. The results agree with previous ionization chamber and TLD measurements to within +/- 4%. Mean anisotropy factors were determined at each angle from all existing data at 5 cm distance, and compared to published Monte Carlo calculations, and to the values used in the microSelectron HDR brachytherapy planning system (BPS). The Monte Carlo photon transport code appears to systematically underestimate the anisotropy factor by up to 4% in the forward direction and overestimate it by up to 3% in the backward direction. The mean anisotropy factors also indicate that the BPS systematically underestimates the anisotropy factor by up to 3% in the forward direction, and overestimates it by up to 15% in the backward direction. However, the 15% difference occurs at 180 degrees where it is not likely to be clinically significant.

Efficient CT simulation of the four-field technique for conformal radiotherapy of prostate carcinoma

PURPOSE

Conformal radiotherapy of prostate carcinoma relies on contouring of individual CT slices for target and normal tissue localization. This process can be very time consuming. In the present report, we describe a method to more efficiently localize pelvic anatomy directly from digital reconstructed radiographs (DRRs).

MATERIALS AND METHODS

Ten patients with prostate carcinoma underwent CT simulation (the spiral mode at 3 mm separation) for conformal four-field "box" radiotherapy. The bulbous urethra and bladder were opacified with iodinated contrast media. On lateral and anteroposterior DRRs, the volume of interest (VOI) was restricted to 1.0-1.5 cm tissue thickness to optimize digital radiograph reconstruction of the prostate and seminal vesicles. By removing unessential voxel elements, this method provided direct visualization of those structures. For comparison, the targets of each patient were also obtained by contouring CT axial slices.

RESULTS

The method was successfully performed if the target structures were readily visualized and geometrically corresponded to those generated by contouring axial images. The targets in 9 of 10 patients were reliable representations of the CT-contoured volumes. One patient had 18 mm variation due to the lack of bladder opacification. Using VOIs to generate thin tissue DRRs, the time required for target and normal tissue localization was on the average less than 5 min.

CONCLUSION

In CT simulation of the four-field irradiation technique for prostate carcinoma, thin-tissue DRRs allowed for efficient and accurate target localization without requiring individual axial image contouring. This method may facilitate positioning of the beam isocenter and provide reliable conformal radiotherapy.

Differential dose delivery using a nondocking applicator for intraoperative radiation therapy

PURPOSE

Although treatment of a field within a field to deliver a boost dose is quite common with external photon beam radiation therapy, the same is not always true with electron beam radiation or in intraoperative radiation therapy (IORT). The purpose of this work is to report the results and details of a new technique developed to treat a field within a field in intraoperative radiation therapy.

METHODS AND MATERIALS

This technique makes use of the nondocking IORT system currently used at our institution. Treatment is given in two segments: the large field is first treated by using standard circular lucite cones; the second dose segment is delivered using a new circular brass cone designed to fit concentrically within the large lucite cone.

RESULTS

Central axis depth dose, surface dose, output factors, and two-dimensional beam profiles have been measured for a 7 cm inner diameter (i.d.) flat lucite cone and 3.8 and 5 cm i.d. flat brass cones for electron beam energies ranging from 4-22 MeV. For different clinical target volumes, summed dose distributions differentially weighted in both energy and dose are presented.

CONCLUSIONS

A simple technique for delivering differential dose in intraoperative radiation therapy is presented. The technique provides a method for escalating dose to higher values for a defined target volume.

A dosimetry system for 192IR interstitial breast implants performed at the time of lumpectomy

PURPOSE

192Ir interstitial breast implants performed at the time of lumpectomy present a unique problem because they cannot be preplanned, and yet they are expected to produce a treatment dose rate (TDR) from 0.3 to 0.5 Gy/h using sources already procured. The purpose of this work is to describe a system of dosimetry that works within these constraints and has been used to perform more than 600 such implants.

METHODS AND MATERIALS

The underlying principle is to fix the ribbon spacing, the interplaner separation, and the linear activity (1 mCi/cm) so that the TDR will depend only on the area (L x W) implanted. The ribbons are spaced 1.5 cm and 2.0 cm apart in single plane and double implants, respectively. Idealized implants were used to study the TDR as a function of the implant dimensions, and to study the effects of varying the ribbon spacing and interplanar separation. Volume-dose histograms were generated to study the homogeneity of dose.

RESULTS

The TDRs of single plane implants range from 0.3 Gy/h for small 4 x 4 cm2 implants to 0.4 Gy/h for large 10 x 10 cm2 implants. The TDRs for double plane implants are similar for the same range of dimensions.

CONCLUSIONS

Implants with a TDR between 0.3 and 0.5 Gy/h can be performed for a wide range of geometries without preplanning using fixed ribbons spacings of 1.5 and 2.0 cm for single and double plane implants, respectively, and a linear activity of 1 mCi/cm.

Limitations of the minimum peripheral dose as a parameter for dose specification in permanent 125I prostate implants

PURPOSE

The objective of this work is to investigate whether the minimum peripheral dose is a practical parameter for dose specification in permanent 125I implants of the prostate.

METHODS AND MATERIALS

The investigation was carried out by use of a computer model of ellipsoidal 125I implants in which the average dimension and elongation factor were varied to provide a wide range of geometries. Both ideal and nonideal implants were investigated. The 125I seeds were confined to the target volume except for a portion of the study in which the effect of placing seeds outside the target volume was investigated.

RESULTS

The minimum peripheral dose was found to be very sensitive to the seed placement. The irregularities in the seed spacing that inevitably occur in actual implants tend to lower the minimum peripheral dose. As a result, the minimum peripheral dose is generally significantly less than planned by an amount that is unpredictable, and often exceeds 25%. However, the percentage of the target volume that receives a dose less that the prescribed minimum peripheral dose is generally less than 10%. Implanting seeds outside the target volume improves the dose uniformity, but does not appear to offer any advantage in dose coverage, and increases the volume of normal tissue irradiated.

CONCLUSION

If a minimum peripheral dose is prescribed for a permanent 125I prostate implant, and the implant is planned using an idealized implant having precisely spaced seeds, the prescribed dose will rarely, if ever, be achieved. Reasonable agreement with the prescribed dose can be achieved only if the requirement for coverage is relaxed from 100 to 90%, or if the total source strength is increased by 20% to compensate for the anticipated imperfections in seed placement.

Dosimetric properties of megavoltage grid therapy

PURPOSE

Grid therapy is a technique used to deliver a high dose of radiation (15-20 Gy) in a single fraction to many small volumes within a large treatment field. This treatment modality is used for the palliative treatment of large, deeply seated tumors, which have either been treated to tolerance with conventional radiation, or, due to massive tumor bulk, would most likely not benefit from a conventional course of radiation therapy. As the dose distribution from megavoltage grid therapy differs significantly from that of conventional radiation therapy (i.e., many large dose gradients exist within the tumor volume), we have measured various dosimetric properties inherent in this unique treatment modality.

METHODS AND MATERIALS

The grid is a 16 x 16 array of 1-cm diameter holes in a 7-cm thick piece of custom blocking material. The ratio of shielded to open surface area is 1:1. Depth dose, valley-to-peak ratios, and output factors for this square array grid were measured in a water phantom for several field sizes, as well as for a 1-cm diameter narrow beam using 6 MV and 25 MV photon beams.

RESULTS

The depth dose curves for the grid fields lie between those for an open portal and a narrow beam. For the 6-MV beam at dmax, the ratios of the doses delivered to the center of the shielded regions to that under the center of the holes, expressed as valley-to-peak ratios, range from 15 to 40%. At 10 cm, the ratios increase to between 25 and 45%. At 25 MV at both dmax and 10 cm, the valley-to-peak ratios are between 40 and 60%. The output factors, 0.89 for 6 MV and 0.77 for 25 MV, do not depend on field size.

CONCLUSION

Megavoltage grid therapy is a unique treatment modality where the dose is delivered differentially to a large volume in one fraction. Characterization of the dosimetric properties has allowed clinical implementation of the grid.

Dosimetric characteristics of a commercial multileaf collimator

The dosimetric characteristics of a multileaf collimator (MLC) retrofitted to a SL25 linear accelerator have been investigated. Central-axis depth dose, surface dose, penumbra, beam flatness and symmetry, field size factors, beam transmission through leaves and/or diaphragms, and leakage between the leaves were measured. Quantitative measurements of all beam parameters show good agreement with the design specifications of the manufacturer. No changes were observed in flatness, symmetry, penumbra, and penetration for both 6- and 25-MV photon beams when compared to the values for the standard collimator. No significant differences were observed in the penumbra as a function of leaf position. Transmission measurements in areas shielded by either X diaphragms or leaves plus diaphragms are less than 1% of dose within open field. The average leakage between leaves is about 2.5% for 6-MV and 3.5% for 25-MV photon beams. The peak value of the leakage at any point between leaves is less than 5%. The dosimetric features of shaped fields using the MLC are comparable to those of alloy shaped fields with the standard SL25 collimator.

Concept of dose nonuniformity in interstitial brachytherapy

PURPOSE

Evaluation of the 3-dimensional dose distributions of interstitial implants using the dose uniformity ratio.

METHODS AND MATERIALS

Single source, two sources, three and four sources arranged both linearly and in the form of a triangle or a square, ribbons with different seed spacings, a single-plane and double-plane implants were evaluated. The evaluations involved the use of differential dose volume histograms and the dose nonuniformity ratio defined as the ratio of the high dose volume to the reference volume.

RESULTS

For a single source, the dose nonuniformity is the same regardless which dose rate is selected as the treatment dose rate. For any multi-source implant, the dose nonuniformity is altered depending on the selection of the reference dose rate. In addition, the dose nonuniformity curve exhibited three characteristics zones.

CONCLUSION

The dose nonuniformity ratio can be a useful tool in assessing and optimizing interstitial implants.

Experimental verification of a three-dimensional dose calculation algorithm using a specially designed heterogeneous phantom

A solid heterogeneous phantom made up of 25- and 50-mm cubes of materials with different electron densities was used to verify the accuracy of a three-dimensional (3-D) dose calculation algorithm. This algorithm uses 3-D information obtained from contiguous CT (computed tomography) slices, spaced 5 mm apart. Primary and scatter doses at a point are calculated by using information from ray-tracing CT voxels. The algorithm was developed on a Stardent model 1500 Supergraphic workstation. Cubes of materials with different electron densities were stacked up to simulate finite heterogeneities in three dimensions. This design allows verification of the algorithm for surface contour corrections and finite heterogeneities in the treatment field. Thermoluminescent lithium fluoride chips were placed in grooves milled on the cubes for dose measurement at various points. Different experiments were performed to investigate both the accuracy of the dose calculation algorithm and the utility of the versatile test phantom.

Quantitative assessment of interstitial implants

Quantitative assessment of interstitial implants is proposed using volume versus dose curves and four well-defined dosimetric parameters. The volume versus dose curves, both differential and cumulative, provide quantitative data on the volumes of tissues irradiated to different doses. They also offer a qualitative assessment of the variations in dose delivery. The dose nonuniformity ratio (DNR) quantitatively determines the degree of dose nonuniformity specific to the implant configuration. The dose rate at which the DNR shows a minimum value, if selected as the treatment dose rate, gives an optimized dose distribution. The three volumetric irradiation indices are formulated with respect to a well-defined target volume. They offer quantitative data on the extent to which the implant delivers the prescribed dose to the target volume. These dosimetric parameters determine the degree of coverage of the target volume, dose homogeneity within the target volume, and irradiation of tissues outside the target volume. The method of quantitative assessment is demonstrated using, as examples, an ideal Ir-192 double-plane implant and an actual clinical Ir-192 double-plane breast implant.

Electron beam characteristics on a Philips SL25

Dosimetry measurements at nominal electron energies of 4, 6, 8, 10, 12, 15, 17, 20, and 22 MeV were made for different sized, open-sided applicators on two Philips SL25 linear accelerators. Measurements include beam flatness, percentage depth dose, surface dose, isodose curves, field size dependence, output at extended distances, virtual source position, and required low melting point alloy thickness for field shaping. These measurements are presented to document the characteristics of electron beams with a new type of applicator design on this series of Philips accelerators.

Characteristics of photon beams from Philips SL25 linear accelerators

The Philips SL25 accelerator is a multimodality machine offering asymmetric collimator jaws and a new type of beam bending and transport system. It produces photon beams, nominally at 6 and 25 MV, and a scattered electron beam with nine selectable energies between 4 and 22 MeV. Dosimetric characteristics for the 6- and 25-MV photon beams are presented with respect to field flatness, surface and depth dose characteristics, isodose distribution, field size factors for both open and wedged fields, and narrow beam transmission data in different materials.

Optimization of parameters for fitting linear accelerator photon beams using a modified CBEAM model

Measured beam profiles and central-axis depth-dose data for 6- and 25-MV photon beams are used to generate a dose matrix which represents the full beam. A corresponding dose matrix is also calculated using the modified CBEAM model. The calculational model uses the usual set of three parameters to define the intensity at beam edges and the parameter that accounts for collimator transmission. An additional set of three parameters is used for the primary profile factor, expressed as a function of distance from the central axis. An optimization program has been adapted to automatically adjust these parameters to minimize the chi 2 between the measured and calculated data. The average values of the parameters for small (6 X 6 cm2), medium (10 X 10 cm2), and large (20 X 20 cm2) field sizes are found to represent the beam adequately for all field sizes. The calculated and the measured doses at any point agree to within 2% for any field size in the range 4 X 4 to 40 X 40 cm2.

Asymmetric field arc rotations

Optimal treatment planning of target volume that surrounds a vital critical structure is often very difficult. Treatment techniques using moving beam therapy with fields asymmetric with respect to rotational axis of the collimator head allow treatment of such target volumes with minimal dose to critical structures. The availability of independent motion of the collimator jaws on new medical accelerators allows easy setting up of asymmetric treatment portals. Therefore, treatment techniques utilizing asymmetric field arc rotations with acceptable dose distributions have been possible.

Dosimetric considerations of stereotactic brain implants

Dose distributions of stereotactic brain implants performed by four institutions were analyzed. In these implants 192Ir or 125I sources were used. The analyses involved an evaluation of the isodose distributions in two orthogonal planes, the dose gradient outside, and the dose homogeneity within the target volume. Quantitative evaluation of the dose homogeneity was performed using three volumetric irradiation indices. The dose homogeneity was observed to improve as the number of catheters increased. However, the number of catheters used is influenced by neurosurgical considerations. Thus, it is necessary to make a compromise between dose homogeneity and the maximum number of catheters to be used. The dose gradient, a centimeter outside the target volume, was found to depend on the geometry of the implant and at distances beyond, it was found to depend on the type of radioisotopes used.

A non-docking intraoperative electron beam applicator system

A non-docking intraoperative radiation therapy electron beam applicator system for a linear accelerator has been designed to minimize the mechanical, electrical, and tumor visualization problems associated with a docking system. A number of technical innovations have been used in the design of this system. These include: (a) a new intraoperative radiation therapy cone design that gives a better dose uniformity in the treatment volume at all depths; (b) a collimation system which reduces the leakage radiation dose to tissues outside the intraoperative radiation therapy cone; (c) a non-docking system with a translational accuracy of 2 mm and a rotational accuracy of 0.5 degrees; and (d) a rigid clamping system for the cones. A comprehensive set of dosimetric characteristics of the intraoperative radiation therapy applicator system is presented.

Field size dependence of wedge factors

The radiation output in the presence of wedge filters is characterized by the wedge transmission factor and open beam field size factors. Conventionally, the wedge factor for high-energy photons is measured in a water phantom at depth of maximum dose for a reference field size. Experimental measurements on different wedges indicate that the wedge factors are a function of field size. An analysis of these data show that this is primarily caused by the change in scattered radiation from the treatment head in the presence of wedge filters. The change in phantom scatter and radiation backscattered to the monitor chamber are minimal. For 4- or 6-MV x rays with a 60 degrees wedge, the use of a single wedge factor measured for 10 cm X 10 cm field introduces errors of up to 3.5%, for a 16-cm-wide field. For a 20-cm-wide field with this wedge, the error is 7%. Thinner wedges exhibit less differences.

Reference dose rates for single- and double-plane 192Ir implants

The proper selection of the reference dose rate is critical in the irradiation of a tumor or tumor bed using interstitial implant. The selected reference dose rate should result in the delivery of highly homogeneous dose throughout the target volume, adequately cover the target volume, and minimize irradiation of the surrounding normal tissues. In this paper, the influence of the reference dose rate on the adequacy of the irradiation of idealized target volumes using single- and double-plane 192Ir implants was studied in terms of three volumetric irradiation indices. The results show that maximum relative dose homogeneity can be attained if the proper reference dose rate is chosen. This isodose rate contour exhibits a width larger than the thickness of the target volume in the central plane. The lowest dose rate within the idealized target volume is not recommended as the reference dose rate to avoid a large volume of the surrounding tissues from receiving dose rates equal to or greater than this dose rate, and also the inhomogeneous irradiation of the target volume.

Dosimetric characteristics of a 6 MV photon beam from a linear accelerator with asymmetric collimator jaws

Dosimetric measurements have been made of a 6 MV photon beam from a linear accelerator equipped with asymmetric jaws. The field size factors for asymmetrically set fields are compared to those for symmetrically set fields. The change of beam quality has been measured as a function of off-axis position of the asymmetric fields to assess its effect on depth dose. Additional measurements include beam penumbra and shape of isodose curves for open and wedge fields as the field opening is moved asymmetrically from the central ray.

Coordinate transformations and calculation of the angular and depth parameters for a stereotactic system

Stereotactic systems have been used to assist in the precise implantation of radioactive sources in selected brain tumors. Use of such systems requires an algorithm that transforms spatial points in computed tomography coordinates into stereotactic frame coordinates. A simple algorithm performing the coordinate transformations, intended for inclusion in treatment-planning software packages for interstitial brain implants, has been developed. This algorithm was formulated using the geometrical configurations of the Brown-Roberts-Wells (BRW) stereotactic system. After the transformations, the BRW angular coordinates and depth specifying the probe direction, defined from the entry point to the target point, are determined from their respective cartesian coordinates. These angular coordinates and depth on the BRW stereotactic system allow accurate neurosurgical implantations of catheters into the brain, and thereafter the insertion of radioactive sources.

Clarification of the AAPM Task Group 21 protocol

In light of recent questions and comments from the physics community, a review is made of the AAPM protocol for high-energy x-ray and electron beam dosimetry.

Radiation oncology. Programs for the present and future

Radiation oncology in 1984 continues to make major advances in the multidisciplinary clinical programs. This has been possible by virtue of the radiation oncologist, who is an active participant in these clinical programs. The changing role for the radiation oncologist has dictated a greater participation in the primary management of the patient's disease process and also participation in multidisciplinary research programs.

Quality assurance in radiation therapy: future plans in physics

Modern day radiation therapy has seen the impact of high technology resulting in more sophisticated computer augmented treatment delivery systems, treatment planning procedures and diagnostic imaging techniques. Much work has already been reported in the area of physics efforts related to quality assurance in radiation therapy. Future efforts in physics will have to address the new developments in each component of the whole radiation treatment process. Certain new developments, using both computer and imaging technologies, show promise in providing tools to verify the accuracy of the delivered radiation treatment. Areas receiving careful attention are: integration and registration of information from multiple sources of diagnostic studies; validation of the accuracy of treatment planning systems; assessment of relative merits of alternate dose distributions; improvement of portal and verification film image quality; real time monitoring using light emitting screens and coupled with TV systems; monitoring of treatment and machine parameters using "record and verify" computer systems. The medical physics community, primarily through the American Association of Physicists in Medicine (AAPM), will continue the development of methodologies for technology transfer in the area of quality assurance. Committees and task groups within the AAPM will address the new developments impacting on quality assurance and prepare appropriate protocols and documents to assist the practicing physicist. By necessity, the national Radiological Physics Center (RPC) and the regional Centers for Radiological Physics (CRP) will have to take a major role in the development of new quality assurance programs.