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An attempt is made to  formulate the requirements for the accuracy in the delivery of  absorbed dose to a patient during radiation therapy. These  requirements are mainly based on the relative steepness and separation  of the dose-effect curves for local tumour control and normal tissue  damage. The curves for normal tissue complications in general may be  steeper than those for local tumour control. From these data,  a standard requirement of 3.5% is proposed for the combined  uncertainty of type A (random) and type B (systematic), given as one  relative standard deviation in the absorbed dose delivery. However, it  is recognized that, in many cases, larger uncertainties are acceptable  palliative treatments). This value of 3.5% applies to the  absorbed dose at the specification point for curative treatments. As  far as the dose accuracy requirements at other points in the planning  target volume are concerned, a value of 5% (one standard  deviation) seems more appropriate. This required accuracy in the  delivery of the absorbed dose cannot always be completely achieved in  photon therapy even for simple treatment conditions. All the clinical  data which were reviewed, including some results from the  ldquo;Patterns of Care Study”, indicate a close correlation between the  outcomes of therapy (control rates, complications) and dose level,  inaccuracy or errors in dosimetry and patient-machine positioning.  This has been reported for external beam therapy as well as for  brachytherapy. Only the clinical results will allow us to select the  optimal treatment conditions (e.g. selection and definition of the  planning target volumes, dose levels and beam arrangement), but they  could be interpreted correctly only to the extent that the treatment  execution would be correct. This result strongly endorses the Quality  Assurance Programmes, in which the clinicians and physicists should be  fully involved. Lastly, the outcome of a treatment can only be  interpreted meaningfully if the parameters of the irradiation, in  particular, the distribution of dose in space and time can be  accurately correlated with the type and extent of the disease. It is  essential that clear, well defined and unambiguous concepts and  parameters be used for reporting purposes to ensure a common language  between collaborating centres. This is one of the major tasks that the ICRU undertook several years ago.

What accuracy is required and can be achieved in radiation therapy (review of radiobiological and clinical data)