We report the discovery of abnormal fluctuations in the output obtained when measuring a water phantom and adjustments that reduce these outliers. Using a newly developed threedimensional scanning water phantom system, we obtained the depth dose and off-axis dose ratio required for the beam data of a medical linear accelerator (LINAC). The field and reference detectors were set such that the measured values could be viewed in real time. We confirmed the scanning data using the field detector

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... the change in the output using the reference detector while measuring by using the water phantom. Prior to output adjustment of the LINAC, we observed output abnormalities as high as 18.4%. With optimization of accelerator conditions, the average of the output fluctuation width was reduced to less than ±0.5%. Through real-time graphing of reference detector measurements during measurement of field detector, we were able to rapidly identify abnormal fluctuations. Although beam data collected during radiation treatment planning are corrected for output fluctuations, it is possible that sudden abnormal fluctuations actually occur in the output. Therefore, the equipment should be tested for output fluctuations at least once a year. Even after minimization of fluctuations, we recommend determining the potential dose administered to the human body taking into account the width of the output fluctuation.