Commissioning of Medical Linear Accelerators in India: A Survey of Regulatory Compliance, Clinical Implementation, and Professional Challenges
Abstract
Purpose: This study evaluated current clinical practices, regulatory compliance, and professional challenges encountered during the commissioning of advanced Linear Accelerators (LINACs) in India. Materials and Methods: A nationwide survey using a structured 20-item questionnaire was conducted from August 2025 to March 2026. The questionnaire covered commissioning practices, staffing and vendor support, quality assurance (QA) procedures, clinical implementation, and participant opinions and suggestions. Responses were analyzed to assess trends in technology adoption and variations in commissioning workflows. Results: Data were obtained for 75 LINACs commissioned between 2020 and 2025 across 67 institutions. Frequently commissioned systems included Varian TrueBeam (37.3%), Varian Halcyon (18.7%), and Elekta Versa HD (16%). Advanced treatment techniques such as Volumetric Modulated Arc Therapy (VMAT), Stereotactic Radio Surgery (SRS), and Stereotactic Body Radiotherapy (SBRT) were commonly implemented; however, Total Skin Electron Therapy (TSET) and Total Body Irradiation (TBI) commissioning remained limited. More than one-fourth of the participants (26.7%) had no prior experience in LINAC commissioning. 87.8% participants considered the existing Atomic Energy Regulatory Board’s QA requirements adequate, 89.3% supported mandatory inclusion of Treatment Planning System QA within the licensing process. Small-field dosimetry following International Atomic Energy Agency (IAEA) TRS-483 guidelines was performed by 60.8% of centers, while 77.3% had not participated in external dosimetric audits. Major challenges included workforce shortages and balancing commissioning with routine clinical responsibilities. Independent peer review before clinical implementation was recommended by 81.3% of respondents. Conclusion: Advanced LINAC technologies are being successfully adopted in India; however, greater standardization, structured training, external audit participation, and independent verification frameworks are required to strengthen commissioning quality and patient safety across radiotherapy centers nationwide.
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BibTeX
@article{anaz2026commissioning,
title = {{Commissioning of Medical Linear Accelerators in India: A Survey of Regulatory Compliance, Clinical Implementation, and Professional Challenges}},
author = {R. C. Muhammed Anaz and Shrikant Kale and Ritu Raj Upreti and Raghavendra Hajare and Shubham Gadge and Avdhoot Sutar and Udita Upreti and Yogesh Ghadi and Priyadarshini Sahoo and Ritesh Mhatre and Jai Prakash Agarwal},
journal = {Journal of Medical Physics},
year = {2026},
month = jul,
doi = {10.4103/jmp.jmp_124_26},
url = {https://doi.org/10.4103/jmp.jmp_124_26},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Commissioning of Medical Linear Accelerators in India: A Survey of Regulatory Compliance, Clinical Implementation, and Professional Challenges
AU - R. C. Muhammed Anaz
AU - Shrikant Kale
AU - Ritu Raj Upreti
AU - Raghavendra Hajare
AU - Shubham Gadge
AU - Avdhoot Sutar
AU - Udita Upreti
AU - Yogesh Ghadi
AU - Priyadarshini Sahoo
AU - Ritesh Mhatre
AU - Jai Prakash Agarwal
PY - 2026
DA - 2026/07/01
JO - Journal of Medical Physics
DO - 10.4103/jmp.jmp_124_26
UR - https://doi.org/10.4103/jmp.jmp_124_26
AB - Purpose: This study evaluated current clinical practices, regulatory compliance, and professional challenges encountered during the commissioning of advanced Linear Accelerators (LINACs) in India. Materials and Methods: A nationwide survey using a structured 20-item questionnaire was conducted from August 2025 to March 2026. The questionnaire covered commissioning practices, staffing and vendor support, quality assurance (QA) procedures, clinical implementation, and participant opinions and suggestions. Responses were analyzed to assess trends in technology adoption and variations in commissioning workflows. Results: Data were obtained for 75 LINACs commissioned between 2020 and 2025 across 67 institutions. Frequently commissioned systems included Varian TrueBeam (37.3%), Varian Halcyon (18.7%), and Elekta Versa HD (16%). Advanced treatment techniques such as Volumetric Modulated Arc Therapy (VMAT), Stereotactic Radio Surgery (SRS), and Stereotactic Body Radiotherapy (SBRT) were commonly implemented; however, Total Skin Electron Therapy (TSET) and Total Body Irradiation (TBI) commissioning remained limited. More than one-fourth of the participants (26.7%) had no prior experience in LINAC commissioning. 87.8% participants considered the existing Atomic Energy Regulatory Board’s QA requirements adequate, 89.3% supported mandatory inclusion of Treatment Planning System QA within the licensing process. Small-field dosimetry following International Atomic Energy Agency (IAEA) TRS-483 guidelines was performed by 60.8% of centers, while 77.3% had not participated in external dosimetric audits. Major challenges included workforce shortages and balancing commissioning with routine clinical responsibilities. Independent peer review before clinical implementation was recommended by 81.3% of respondents. Conclusion: Advanced LINAC technologies are being successfully adopted in India; however, greater standardization, structured training, external audit participation, and independent verification frameworks are required to strengthen commissioning quality and patient safety across radiotherapy centers nationwide.
SN - 0971-6203
SN - 1998-3913
ER -