AAPM Medical Physics Practice Guideline 18.a: Superficial radiation therapy using low-energy kilovoltage x-rays
In brief
New guideline sets safety checks for superficial skin radiation therapy
The medical physics guideline outlines commissioning and daily, monthly, and annual quality checks for superficial radiation therapy using low-energy x-rays. It also covers treatment planning and delivery, regulatory requirements, shielding, and staff monitoring to support consistent, safe practice. The report sets minimum standards, but does not assess whether treatment improves patient outcomes.
- Journal
- Journal of applied clinical medical physics (Q2)
- Published
- 1 November 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Yongsook C Lee, Seng Boh Lim, Peter M Mondalek, Sergio O Reilly, David G Saez, Ren-Dih Sheu, et al.
- PMID
- 42963823
- DOI
- 10.1002/acm2.70857
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 1 November 2026): AAPM guidance covers superficial therapy commissioning, QA, and shielding
Abstract
Superficial radiation therapy (SRT), utilizing low-energy kilovoltage (kV) x-rays typically in the 50-100 kVp range, is a well-established modality in dermatology and radiation oncology clinics for the management of non-melanoma skin cancer and various benign dermatological conditions. The comprehensive medical physics practice guidelines presented in this report are designed to facilitate adherence to minimum standards for SRT delivery. A technical overview of commercially available SRT systems in the United States is provided. Detailed guidelines for commissioning and routine quality assurance are presented, specifying daily, monthly, and annual tests, alongside established action limits. The SRT clinical workflow is delineated, encompassing patient simulation, treatment time or monitor unit calculations, data entry, independent treatment plan review, and radiation delivery. A summary of typical state regulatory requirements for x-ray machines is included. Adherence to relevant state regulations is emphasized and radiation safety considerations, comprising structural shielding, radiation surveys, personnel monitoring, signage, periodic spot checks, and machine operation, are discussed to ensure a safe and effective clinical environment. References to relevant societal practice guidance are provided to support standardized clinical implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.