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    Tongue and groove effect is a design feature of multileaf collimators (MLC) where the leaves have interlocking edges to reduce radiation leakage between closed leaves. This can reduce dose leakage by 14-33% depending on the linear accelerator manufacturer. MLCs are used extensively in intensity modulated radiation therapy (IMRT) which requires higher monitor units and more potential for leaked dose, making tongue and groove important. While MLC edges cannot perfectly conform to tumor shapes, secondary electrons and scatter photons help produce a smooth dose distribution rather than one that exactly matches the irregular leaf edges.

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    Tongue and groove effect is a design feature of multileaf collimators (MLC) where the leaves have interlocking edges to reduce radiation leakage between closed leaves. This can reduce dose leakage by 14-33% depending on the linear accelerator manufacturer. MLCs are used extensively in intensity modulated radiation therapy (IMRT) which requires higher monitor units and more potential for leaked dose, making tongue and groove important. While MLC edges cannot perfectly conform to tumor shapes, secondary electrons and scatter photons help produce a smooth dose distribution rather than one that exactly matches the irregular leaf edges.

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    Tongue and groove effect is a design feature of multileaf collimators (MLC) where the leaves have interlocking edges to reduce radiation leakage between closed leaves. This can reduce dose leakage by 14-33% depending on the linear accelerator manufacturer. MLCs are used extensively in intensity modulated radiation therapy (IMRT) which requires higher monitor units and more potential for leaked dose, making tongue and groove important. While MLC edges cannot perfectly conform to tumor shapes, secondary electrons and scatter photons help produce a smooth dose distribution rather than one that exactly matches the irregular leaf edges.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    288 views3 pages

    Term

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    api-308717184
    Tongue and groove effect is a design feature of multileaf collimators (MLC) where the leaves have interlocking edges to reduce radiation leakage between closed leaves. This can reduce dose leakage by 14-33% depending on the linear accelerator manufacturer. MLCs are used extensively in intensity modulated radiation therapy (IMRT) which requires higher monitor units and more potential for leaked dose, making tongue and groove important. While MLC edges cannot perfectly conform to tumor shapes, secondary electrons and scatter photons help produce a smooth dose distribution rather than one that exactly matches the irregular leaf edges.

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    Tongue and groove effect and scalloped effect help reduce radiation leakage and ensure smooth dose distributions even with MLC leaf edges.

    Tongue and groove effect is when MLC leaves fit tightly together via notches to reduce radiation leakage by 14-33%. It controls extra dose from monitor units used in IMRT.

    Scalloped effect was more a concern in the past but MLC edges are now small enough to not affect plans. Secondary electrons and scatter make dose distributions remain smooth despite MLC edges.

    Tongue and Groove

    Tongue and groove effect is when MLC leaves slide against each other via this
    tongue and groove design in order to reduce the amount of leakage or
    transmission of radiation through closed leaves. The leaves have notches in them to
    tightly fit next to each other which create almost a maze type look that the beam
    cannot easily penetrate through. Tongue and groove can reduce dose leakage by
    about 14% to 33% in Siemens, Varian, and Elekta machines in that order. 1 They
    each have their own method of tongue and groove MLC arrangement but they all
    serve the same purpose.
    IMRT plans use MLC segments for shaping dose and requires about ten times the
    amount of monitor units a standard 3D plan would use. Because of this, leaking
    through the leaves can add up quickly. This tongue and groove design better
    controls the amount of extra dose that is possible.

    Figure 1: Different MLC tongue and groove methods per manufacture 2


    Scalloped Effect
    Scalloped effect is when the edges of the MLCs are not even and dose distribution
    can follow this jagged pattern. As our linear accelerators and understanding of the
    mechanics advances, the scalloped effect is something we typically are not
    concerned with in terms of it affecting our isodose distributions. The edges of the
    MLCs will not be able to conform perfectly to round edges of PTV/tumors; they will
    overcover and undercover spots due to the square leaf edge.
    Secondary electrons and scatter photons make up for the harsh edges that MLC
    fields create. The dose pattern will not follow the rigged edges of the leaves; this
    allows the dose distribution to still remain smooth and more rounded than it would
    be rigged. It has been tested that even with a single field the 90% line does not

    show a differences between MLC use (in terms of scalloped field edge) and the use
    of a cerrobend cutout. 3

    Figure 2: Differences in dose distribution in MLC sizes as recorded with


    radiographic film at 6MV4
    Scalloped effect was more of a concern when converting from cerrobend shapes to
    MLCs was being introduced. Studies on different anatomical treatment sites have
    been done and all have concluded that MLCs were an acceptable replacement with
    insignificant differences in dose distribution. Now, MLCs are even smaller and the
    motions of the machine are even smoother; jagged edges in MLCs are small enough
    that they are not noticeable when planning today. One MLC setting found in Pinnacle
    is to push the leaves inbound, outbound, or average (crossbound) to the edge of the
    target. This means the MLC corners will stop inside the edge of the target,
    completely at the end contours of the target, or the commonly used average in

    between the inside and out. This is what can help create adequate (or inadequate if
    the wrong setting it chosen) coverage and dose distribution of the target. 3

    Figure 3: Inbound, outbound, and cross-bound options for MLC leave


    pushing3
    1. Washington CM. Principles and Practice of Radiation Therapy. 3rd ed. St.
    Louis, Mo.: Mosby Elsevier; 2010:339.
    2. Hariri S, Shahriari M. Suggesting a new design for multileaf collimator leaves
    based on Monte Carlo simulation of two commercial systems. J Appl Clin Med
    Phy. 2010;11(3). doi:10.1120/jacmp.v11i3.3101.
    3. Khan FM. Potish RA. Treatment Planning in Radiation Oncology. Philadelphia,
    PA: Lippincott Williams & Wilkins; 2000: 160-163.
    4. Liu Y, Shi C, Tynan P, Papanikolaou N. Dual layer MLC dosimetric
    characteristics for small field and IMRT applications. J Appl Clin Med Phy.
    2008;9(2). doi:10.1120/jacmp.v9i2.2709

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