Week 5 Discussion

Question: Discuss the role of AAPM TG-51. Why did AAPM TG-51 replace TG-21 protocol,
and what calibration protocol came before TG-21?  What protocol do other countries use to
calibrate their linear accelerators.  Be specific in your answer. This may take some additional
research.  Which protocol does your facility follow?  Why?

Answer: The role of AAPM TG-51 is to set a standard for linear accelerator protocol for dose
calibration of photon and electron beams in radiation centers within the U.S.1 The point of the
protocol is to make sure it is known from one center to another that all patients are getting the
same dose. This is an updated protocol from the previous protocol TG-21 and was published in
1999. The TG-51 protocol replaced TG-21 because of some key differences. TG-51 is not based
on air kirma of the ion chamber, instead it is based on absorbed dose-to-water calibration factor.
Also, theoretical dosimetry factors do not need to be calculated and there is no need for large
tables of stopping power ratios or mass energy absorption coefficients. Summed up, this protocol
is (1) only for high energy photon and electron beams (basically clinical beams), (2) must be
measured in actual water, (3) with only selected chambers for photons, and (4) with a standard
field size and depth.1 The TG-51 is overall simplified and has a 1-2% dosimetric accuracy
compared to TG-21.1
Other countries such as Australia use the protocol TRS-398 which was published in 2000
by the International Atomic Energy Agency (IAEA).2 There is only a minor difference in beam
quality and specification.1 These protocols are nearly the same and one is not better than the
other.
Orlando Health Cancer Institute uses AAPM’s Task Group 51 for calibration protocols
for photons and electrons. They adopted this protocol because the expectation was that if
everyone in clinical physics uses the same protocol, errors in calibration of the machine would be
reduced and consistency can be found across many clinics as mentioned before. They can be
confident they are following the most up to date protocol found across the U.S.

References

1. Gibbons, JP. Khan’s the Physics of Radiation Therapy. Wolter’s Kluwer Health; 2020.

2. Lye JE, Butler DJ, Oliver CP, et al. Comparison between the TRS-398 code of practice
and the TG-51 dosimetry protocol for Flattening Filter Free Beams. Physics in Medicine
and Biology. 2016;61(14). doi:10.1088/0031-9155/61/14/n362