Technical Reference Guide

Revision 1.2

Brainlab Physics

Copyright 2010, Brainlab AG Germany. All rights reserved.

Table of Contents

Table of Contents

General Information ........................................................ 9

Understanding This User Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Typographical Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Contact Details and Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Contact Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

General Notes on System Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Safety Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Training and Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Basic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Treatment Field Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Measurement for Small Radiation Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Pencil Beam: Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Pencil Beam Dose Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Pencil Beam for Dynamic Conformal Arc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Limitations of the Pencil Beam Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Extrapolation Outside the Range of Measured Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Other Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Pencil Beam: General Beam Data

Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Recommended Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
General Measurement Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Technical Reference Guide Rev. 1.2 Brainlab Physics 3

Table of Contents

Absolute Linac Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Nominal Linac Output Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Background Leakage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Depth Dose Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Scatter Factors (Output Factors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Diagonal Radial Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Transversal Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Film Dosimetry Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Measurement Using a Water Phantom and High-Resolution Detector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Dynamic Leaf Shift Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Verification of Radiologic Field Corrections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Pencil Beam: Beam Data Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Beam Data for Brainlab m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Beam Data for Elekta Beam Modulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Beam Data for Elekta MLCi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Beam Data for MHI MLC 60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Beam Data for Novalis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Beam Data for Novalis Tx (SRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Beam Data for Novalis Tx (Standard Irradiation Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Beam Data for Siemens 3-D (58 and 82 Leaves) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Beam Data for Siemens 160 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

4 Technical Reference Guide Rev. 1.2 Brainlab Physics

Table of Contents

Beam Data for Siemens ModuLeaf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Beam Data for Varian 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Beam Data for Varian 80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Beam Data for Varian 120 (SRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Beam Data for Varian 120 (Standard Irradiation Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Monte Carlo: Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Monte Carlo Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Brainlab Monte Carlo Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
The Virtual Energy Fluence Model (VEFM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Modeling of the Collimating System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
The MC Patient Dose Computation Engine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
MC Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Monte Carlo: General Beam Data

Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Recommended Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Coordinate Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Data Correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Beam Data Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Measurements in Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Technical Reference Guide Rev. 1.2 Brainlab Physics 5

Table of Contents

Monte Carlo: Beam Data Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Beam Data for Elekta Beam Modulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Beam Data for Elekta MLCi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Beam Data for MHI MLC 60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Beam Data for Novalis/Brainlab m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Beam Data for Novalis Tx (SRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Beam Data for Novalis Tx (Standard Irradiation Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Beam Data for Siemens 3-D (58 Leaves) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Beam Data for Siemens 3-D (82 Leaves) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Beam Data for Siemens 160 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Beam Data for Siemens ModuLeaf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Beam Data for Varian 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

Beam Data for Varian 80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Beam Data for Varian 120 (SRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Beam Data for Varian 120 (Standard Irradiation Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Circular Cone: Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Circular Cone Dose Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

Circular Cone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Limitations of the Circular Cone Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Other Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Circular Cone: General Beam Data Measurement . . . . . . . . . . 205

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

Recommended Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
General Measurement Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Primary Jaw Settings for the Use with Circular Cones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

6 Technical Reference Guide Rev. 1.2 Brainlab Physics

Table of Contents

Absolute Linac Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Nominal Linac Output Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Scatter Factors (Output Factors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Depth Dose Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

PDD Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
TMR Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224

Off-Axis Ratio Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Circular Cone: Beam Data Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

Entering and Processing Beam Data in Physics Administra-

tion (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Pencil Beam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Circular Cones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

IMRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Deliverability of IMRT Leaf Sequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

Dynamic IMRT Delivery and Leaf Tolerance Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Setup Light Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Dynamic Conformal Arc Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252

Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Introduction to Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Required Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Machine-Related Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

Specific Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Patient-Related Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Recommended Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

Patient-Specific Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Pre-Treatment Patient QA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
General Patient QA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

Technical Reference Guide Rev. 1.2 Brainlab Physics 7

Table of Contents

Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Circular Cone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Appendix 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Appendix 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279

List of Changes from Revision 1.1 to Revision 1.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

8 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

General Information

Overview

Contents

Topics Covered
Section See
Understanding This User Guide Page 10
Contact Details and Legal Information Page 12
General Notes on System Use Page 14
Safety Notes Page 15
Training and Documentation Page 18

Technical Reference Guide Rev. 1.2 Brainlab Physics 9

Understanding This User Guide

Understanding This User Guide

Purpose of This User Guide

Purpose and • This guide provides a background and reference for the medical physics required to
Audience correctly operate Brainlab’s radiotherapy treatment planning software.
• This guide is written for all members of the clinical team who use or handle Brainlab
radiotherapy treatment planning software, in particular medical physicists.
• You should read this guide carefully and acquaint yourself sufficiently with the soft-
ware before use.

Feedback Please contact us at [email protected] if you have suggestions as to how we

can improve this manual. We look forward to hearing from you.

10 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

Typographical Conventions

Warning Symbol

Warnings are indicated by triangular warning symbols. They always contain

safety-critical information regarding possible injury, death or other serious
consequences associated with misuse of the device.

Caution Symbol

Cautions are indicated by circular caution symbols. They always contain safety-
critical information regarding circumstances that could result in device mal-
function, device failure, damage to the device or damage to property.

Notes NOTE: Notes are formatted in italic type and indicate additional useful hints.

Helvetica Font The font type Helvetica Bold is used in headers, and to highlight:
• Software interface text, e.g.: Format q Page Layout
• Brainlab product names, e.g.: Brainlab Headring

Courier Font The font type Courier is used to indicate:

• System messages, e.g: Self-test completed successfully
• File names, e.g: LocalLicense.xml
• File paths, e.g: C:\BrainLab\NKB\NkbSettings.xml

Technical Reference Guide Rev. 1.2 Brainlab Physics 11

Contact Details and Legal Information

Contact Details and Legal Information

Contact Details

Support If you cannot find the information you need in this user guide, or in the event of questions
or problems, please contact Brainlab support:

Region Telephone and Fax Email

Tel: +1-800-597-5911
United States and Canada
Fax: +1-708-409-1619
Africa, Asia, Australia, Tel: +49-89-991568-44
Europe Fax: +49-89-991568-811
[email protected]
Tel: +55-11-3355-3370
Latin America
Fax: +55-11-3355-3379
Tel: +81-3-5733-6275
Japan
Fax: +81-3-5733 6276

France and French-speaking Tel: +33-800-67-60-30

[email protected]
regions Fax: +33-1-55-68-1000

Manufacturer Brainlab AG
Kapellenstr. 12
85622 Feldkirchen
Germany

12 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

Legal Information

Copyright This user guide contains proprietary information protected by copyright. No part of this
guide may be reproduced or translated without the express written permission of Brainlab.

Brainlab • BrainSCAN™ is a trademark of Brainlab AG.

Trademarks
• iPlan® is a registered trademark of Brainlab AG in Germany and/or the US.

Non-Brainlab • DosimetryPRO® is a registered trademark of VIDAR Systems Corporation.

Trademarks
• Kodak® is a registered trademark of Eastman Kodak Company.
• Microsoft® and Windows® are registered trademarks of Microsoft Corporation.

CE Label
• The CE label shows that this Brainlab product complies with the
essential requirements of the Medical Device Directive (93/42/EEC).
• According to the MDD, iPlan RT Dose and BrainSCAN are Class II b
products.

Warranty

Warranties do not apply to products that have been damaged due to accidents,
misuse, improper re-installation, or inadequate packaging in the case of return
shipments. Warranties do not apply to product components that have been
modified or replaced without the written authorization of Brainlab.

Sales in the US

U.S. federal law restricts this device to sale by or on the order of a physician.

Language All Brainlab user guides are originally drafted in English. The corresponding reference
Information number for this guide is 60911-78EN.

Technical Reference Guide Rev. 1.2 Brainlab Physics 13

General Notes on System Use

General Notes on System Use

Intended Use

Responsibility

Brainlab planning applications are solely designed to provide additional assis-

tance to medical staff. They do not substitute or replace user experience, or in-
validate user responsibility during their use.

Plausibility Review

All information input to the Brainlab planning application and all information
received from the Brainlab planning application as output must be reviewed re-
garding its plausibility before patient treatment.

Compatibility

Only medical devices and spare parts specified by Brainlab may be used with
Brainlab planning software. Using unauthorized devices or spare parts may ad-
versely affect the safety and/or effectiveness of the Brainlab planning software
and endanger the safety of the patient, user and/or environment.

Further Information For specific information on the intended use of Brainlab’s radiotherapy treatment planning
software, and on related compatibilities, refer to the Clinical User Guide, iPlan RT Dose.

14 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

Safety Notes

Important Notes on System Safety

General
Information

This chapter contains important information that must be considered for the
safe and effective operation of the treatment planning system.
It is your responsibility to establish a comprehensive quality assurance program suitable for
detecting errors, limitations or inaccuracies of the treatment planning and treatment delivery
systems. For more details please consult the quality assurance chapter in this technical ref-
erence guide.
Measure the absolute accuracy of the Brainlab treatment planning system in combination
with the used treatment delivery systems using phantoms. The measured accuracy must be
taken into account when configuring plan parameters in order to ensure accurate treatment
delivery.
Ensure proper delivery of the treatment plan to the patient. It is strongly recommended to
perform a phantom verification for every treatment plan using exactly the same parameter
settings that will be used for the real patient during actual treatment.
All treatment plan reports must be approved by a qualified person before the information
they contain is used for radiotherapy treatment purposes.
It is recommended to use the treatment plan reports to verify all treatment parameters, in-
cluding, but not limited to, collimator size and positions, device angles and dose specifica-
tions, directly at the treatment delivery system.
Ensure that individuals authorized to perform treatment planning functions are appropriate-
ly trained for the function they perform.
Always be aware that the quality of the output depends critically on the quality of the input
data. Any irregularities or uncertainties about input data units, identification, or quality is-
sues of any other nature must be thoroughly investigated before the data is used.
Ensure that your imaging devices (e.g. CT scanner) are properly configured and calibrated.
Regularly check the calibration by imaging and verifying test phantoms.
Check the accuracy of the resulting outer contour and tissue model used for dose calcula-
tions. The entirety of the area relevant for treatment must be included within the contour.
Ensure during the complete planning process that you are working on the correct patient
data set. The patient information is displayed in main screen of the Brainlab treatment plan-
ning system.
Always make sure that the treatment delivery systems used for treating a patient are the
same as intended during the planning process.

Technical Reference Guide Rev. 1.2 Brainlab Physics 15

Safety Notes

Ensure that any treatment accessories, such as conical collimator mount and conical colli-
mator of the size which is required by the treatment plan, are installed properly in the beam
path before delivery. Your treatment delivery systems may not be able to assert a beam in-
terlock in case of missing or wrong accessories. Also refer to the documentation provided
for the accessories.
Prior to treatment, it is your responsibility to appropriately verify from inside the treatment
room that the selected gantry and couch angles can be used to perform the treatment without
resulting in injury to patients or damage to equipment such as the treatment delivery system.
It is recommended to verify and confirm the patient setup with an appropriate position ver-
ification method before treatment. Sample plans may be generated using phantoms and the
accuracy of the actual patient setup method tested.
Ensure that the Brainlab treatment planning system is correctly configured and that the con-
figuration reflects the parameters of the treatment delivery systems.These parameters in-
clude, but are not limited to, the linac scale convention, mechanical limits or dosimetric
parameters such as linac energy or fluence modes like SRS and FFF (Flattening-Filter Free).
It is your responsibility to ensure that the machine configurations are synchronized between
the different configuration locations (e.g. treatment planning system, record and verify sys-
tem and treatment delivery system) at any time. A mismatch in the machine configuration
used for planning and the one used for treatment can lead to unintended treatment delivery
or a disruption in the clinical workflow.
Brainlab provides up-to-date measurement instructions. Ensure that the latest measurement
instructions are used during beam data acquisition. For more information contact your
Brainlab support specialist.
Make sure that your beam data measurements are up-to-date and that dose algorithms are
properly configured and calibrated. Regularly check the configuration and calibration using
phantom measurements.
If one or more components of the treatment delivery system have been modified, exchanged
or recalibrated, a revalidation of the treatment planning system in combination with the
treatment delivery system must be performed in accordance with your quality assurance
procedures. If components have been modified that influence the dosimetric parameters of
the system, the beam data measurements must be repeated and the revised data entered into
the system using the Beam Profile Editor/Physics Administration.
The Brainlab beam data (e.g. Novalis Tx) installed during system acceptance is for test pur-
poses only and is not suitable for clinical use.
When measured data is sent to Brainlab, the following applies:
• Brainlab has no possibility to verify the correctness of
- any data received from a user
- any data returned to a user.
• Any feedback or recommendations provided by Brainlab based on the data received
depend on the correctness of the data itself.
• If received data has been processed by Brainlab and returned to the user, this in no way
ensures that the returned data is correct.
• The user is fully responsible for verifying the correctness of the data returned by Brain-
lab and is also fully responsible for verifying the correctness of any feedback or recom-

16 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

mendations provided by Brainlab. The user must validate the safety and effectiveness
of the data returned by Brainlab before performing any patient treatment.
• The fact that Brainlab may have processed certain data does not affect the overall
responsibility of the user for the correctness of the final beam profile.

Technical Reference Guide Rev. 1.2 Brainlab Physics 17

Training and Documentation

Training and Documentation

Training

Brainlab Training In order to ensure safe and appropriate use of the system, Brainlab recommends that before
using a Brainlab planning application for the first time, all users should participate in an ex-
tensive training program held by a Brainlab representative.

Operator Profile

Brainlab planning software and accessory devices may only be operated by

qualified medical professionals.

18 Technical Reference Guide Rev. 1.2 Brainlab Physics

General Information

Documentation

Reading the User Successful and safe treatment using Brainlab planning software requires careful procedural
Guides planning.
It is therefore important that:
• The relevant user guides are read carefully before using the system
• Access is provided to these user guides at all times

Available User
Guides
User Guide Contents

Detailed instructions on using the BrainSCAN planning

Software Guide
application.

Detailed instructions on using the iPlan RT planning

Clinical User Guides
applications.

Detailed information on beam data measurement,

Technical Reference
quality assurance and on the dose algorithms used in
Guide (Brainlab Physics)
Brainlab’s radiotherapy treatment planning software.

Technical Reference Guide Rev. 1.2 Brainlab Physics 19

Training and Documentation

20 Technical Reference Guide Rev. 1.2 Brainlab Physics

Basic Information

Basic Information

General Information

Contents

Topics Covered
Section See
Treatment Field Setup Page 22
Measurement for Small Radiation Fields Page 24

Technical Reference Guide Rev. 1.2 Brainlab Physics 21

Treatment Field Setup

Treatment Field Setup

Skin Dose Build-Up

Background If irradiation is directed through a solid carbon fiber layer, attenuation and dose build-up oc-
cur.
• These effects can be observed in all sandwich design couch tops, similarly designed
couch inserts, and immobilization devices with solid carbon fiber panels.
• They are due to the high-density properties of carbon fiber, and can vary, e.g. depend-
ing on the beam energy and the entry angle to the couch top.

Comparison of In order to illustrate the effect of couch top usage on patient dose, the following example
Dose Build-Up compares the dose build-up and dose attenuation in a water phantom when treatment is per-
formed with the Brainlab Imaging Couch Top, and when no couch top is used.

Figure 1: Comparison of Dose Build-Up at 6 MV (Monte Carlo Calculation)

22 Technical Reference Guide Rev. 1.2 Brainlab Physics

Basic Information

Explanation of In Figure 1, the couch top begins at 0.1 cm with a 0.2 cm carbon fiber layer. This is followed
Dose Build-Up by 4.5 cm of plastic foam and then by another 0.2 cm of carbon fiber. The water layer rep-
Diagram resenting the patient begins at a depth of 5 cm.
• The red curve a shows the depth dose for a given number of monitor units in the water
phantom when no couch top is used.
• The blue curve s shows the depth dose for the same number of monitor units in the
water phantom when the Brainlab Imaging Couch Top is used.
• Both curves are calculated with a Monte Carlo algorithm for a 6 MV photon beam.
Note that the blue curve s indicates an increase in dose (skin dose) when the beam reaches
the water phantom representing the patient. This is due to the large number of secondary
electrons that is generated as a result of the relatively high density of the carbon fiber mate-
rial. These electrons hit the skin surface, resulting in the high dosage shown.

Verification As most radiotherapy treatment planning software assumes that only air is present between
the linac and the skin surface, they are unable to model effects of this kind or take them into
consideration. These effects must therefore be verified experimentally with appropriate
measurements, for example using a phantom with PMMA slabs. The attenuation and dose
build-up results obtained from such experiments must then be taken into account during
treatment planning.
In iPlan RT Dose, a couch top can be selected during surface segmentation so that effects
such as attenuation and dose build-up can be taken into account during treatment planning.

In general, treating patients through a couch top from a posterior angle should
be avoided. However, if treatments of this kind are deemed necessary, bear in
mind that the calculated dose distribution does not include the additional atten-
uation or the increased skin dose close to the couch top. This must be taken into
account during treatment planning, e.g. by selecting the appropriate table top
in your treatment planning system (iPlan RT Dose only).

Safety Notes

Inaccurate determination of the skin surface due to poor or incomplete image

data can result in incorrect calculation of the equivalent depth. The entry region
of each beam or arc must therefore be verified in your planning software using
the depth view provided.

Technical Reference Guide Rev. 1.2 Brainlab Physics 23

Measurement for Small Radiation Fields

Measurement for Small Radiation Fields

Overview

General Specific measurements must be completed before performing stereotactic treatments with
Recommendations very small field sizes. Assuming that averaging of the inhomogeneous dose within the sen-
sitive detector volume results in a reduced detector signal, higher values from smaller de-
tectors are likely to be closer to the true value. For this reason, the smallest detector available
should be used when performing small field dosimetry (Alfonso et all 2008 and Sauer et al
2007). For central axis measurements, such as depth dose, tissue maximum ratios and scat-
ter/output factors, the detector dimensions should be significantly smaller than the field size.
Special care is required when selecting and handling the required dosimetry equipment. For
small field sizes, it is particularly important to correctly align the water phantom and the de-
tector movement direction in relation to the beam axis and the beam center. Even if the de-
tector size is suitable for the small fields to be measured, accurate sensitivity corrections
(e.g. energy dependency of the detector signal) must be applied in accordance with the spec-
ifications provided by the detector manufacturer.

Ensuring Accuracy

You must observe the specifications and recommendations provided by the

manufacturer of your dosimetry equipment. Dose detectors in particular have
a clearly specified range of field sizes for which they may be used. Using a dose
detector for an application for which it was not intended, or in the wrong orien-
tation, may lead to incorrect dose calculations.

When treating small field sizes, the dose profile will either show only a narrow
plateau region or no plateau at all. If the sensitive volume of the detector is too
large, the measured dose will be lower than the real dose, resulting in radiation
overdose. The use of incorrectly sized sensitive volumes is a major contributing
factor in inaccurate dose measurement.

24 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Pencil Beam: Algorithm

General Information

Contents

Topics Covered
Section See
Pencil Beam Dose Algorithm Page 26
Limitations of the Pencil Beam Algorithm Page 36

Technical Reference Guide Rev. 1.2 Brainlab Physics 25

Pencil Beam Dose Algorithm

Pencil Beam Dose Algorithm

Understanding the Pencil Beam Algorithm

Background Pencil beam algorithms are well established and accepted methods to calculate dose distri-
butions in radiotherapy.
In the Brainlab pencil beam dose algorithm the incident beams are divided into many thin
beamlets. For each beamlet an individual radiological path length correction is performed
to correct for tissue density inhomogeneities, taking into account even very small-structured
inhomogeneities. The Fast Fourier Transformation (FFT) is used for the beam-kernel con-
volution with the fluency distribution of the beam. The algorithm uses fast ray tracing and
adaptive grid calculations that reduce the number of necessary dose computations. Due to
these optimizations 2D and 3D dose distributions can be calculated within milliseconds.
The Brainlab pencil beam dose algorithm is based on publications by Mohan et al (1985,
1986, and 1987). It is implemented to work for conformal beam, conformal arc, and IMRT
treatments. This chapter describes the dose algorithm as it is applied in Brainlab planning
software for the different treatment modules.

Monoenergetic In the following, the definition monoenergetic pencil beam is used for a parallel monoener-
Pencil Beam (MPB) getic photon beam with energy E and an infinitesimal cross section. A pencil beam incident
on a homogeneous water phantom perpendicular to the surface gives rise to a dose distribu-
tion. Assuming a linear attenuation of the photon fluence in water, the number of first col-
lisions in a unit volume taking place at a depth d below the water surface is given by
– μ water ( E ) ⋅ d
NOF (E) ⋅ e ⋅ μ water ( E )
where
= Number of photons with energy E, averaged over open field. The radial
NOF (E) variation of the beam intensity is incorporated at a later point.

μ water(E) = Linear attenuation coefficient of photons in water.

d = Depth of observation point in water.

26 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Differential Pencil A differential pencil beam (DPB) describes the dose distribution relative to the first collision
Beam (DPB) of a monoenergetic pencil beam of photons in an infinitely large homogeneous medium. The
dose distribution kPB, diff (E, lPQ, θPQ) is a function of the photon energy E, the distance lPQ
between the point of first collision P and the observation point Q and the polar angle θ be-
tween the incident pencil beam and the scattering direction (see Figure 1 on page 27). The
calculation of DPB dose distributions is performed by a Monte Carlo code for various pho-
ton energies between 100 keV and 50 MeV.
It takes into account scattering of secondary photons and electrons up to a certain cutoff en-
ergy.

Pencil Beam

(0, 0, 0)

dp
P
Point of first collision
lPQ
θ

Q
kPB,diff(lPQ, θPQ, E)

Figure 1Definition of Differential Pencil Beam

Technical Reference Guide Rev. 1.2 Brainlab Physics 27

Pencil Beam Dose Algorithm

Pencil Beam Kernel Given the DPBs and the number of photons at depth d, the dose of a monoenergetic pencil
beam at point Q is given by the line integral in the semi-infinite water phantom. Given the
accelerator dependent energy distribution NOF (E) of the photon beam, the integration
over all energies can be performed, giving the polyenergetic pencil beam kernel.

l PQ = Q – P

θ PQ = ∠( PQ, P )

P = ( O, O, d p )

Q = ( x, y, d )

– μ water ( E ) ⋅ d p
P ( x, y, d) =
∫∫ NOF ( E ) ⋅ e ⋅ μ water ( E ) ⋅

k PB, diff ( E, l PQ, θ PQ ) dE ⋅ dd p

Source Function An optional source function correction can be applied, which describes the influence of the
Correction finite size of the source, collimator and flattening filter scatter, curvature of leaf ends and
other effects broadening the penumbra.
The source function correction is specified to have a Gaussian distribution with the width
sigma and the amplitude at a certain depth. The width sigma and the amplitude can be spec-
ified for two depths in the Beam Profile Editor/Physics Administration.
For all other depths, the values sigma and amplitude are linearly interpolated.
The source function correction is incorporated in the dose calculation by convolution of the
pencil beam kernels kPB, poly (x, y, d) with the Gaussian distribution gSFC (x, y, d) where the
amplitude A(d) gives the fraction of the Gaussian distribution convoluted with the kernel.
Additional measurements are necessary in order to adjust source function correction and ra-
diologic field correction.

Radiologic Field Radiologic field correction allows small deviations of the radiologic field resulting from
Correction gap settings and the MLC design (round leaf-end and tongue-and-groove) to be corrected
with respect to the nominal field size defined by the MLC.
• In the leaf direction, an offset can be defined in the Beam Profile Editor/Physics Ad-
ministration using the value Leaf Shift Static in the section Radiologic Field.
• Perpendicular to the leaf direction, the required offset can be defined in the Beam Pro-
file Editor/Physics Administration using the value Tongue and Groove Size in the
section Radiologic Field.

28 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Idealized Dose The idealized dose distribution (IDD) for a collimator with an arbitrary shape is the two di-
Distribution (IDD) mensional convolution of the polyenergetic pencil beam kernel with the photon fluence. It
describes the dose distribution in photon beams in a homogeneous water phantom and is
given by

IDD(x, y, d) = ∫ ∫ φ(x', y', d) ⋅ p(x' – x, y' – y, d) ⋅ dx′ ⋅ dy′

The photon fluence in an isocenter plane perpendicular to the central beam at a depth d is
given by
φ(x, y, d) = φ 0(x, y) ⋅ RFS(r, d)

where φ 0(x, y) is the fluence matrix in the isocenter plane due to the collimator shape hav-
ing a value of 1 for open and 0 for closed fields. Fractional values are used if a matrix voxel
is partly covered by some leaves (Figure 2). RFS(r, d) is the radial factor giving the pho-
ton fluence at a distance from the central beam at a depth d in the phan-
tom.
r = x2 + y2

Figure 2Fluence Matrix

The fluence matrix (above) shows a contour of the target volume from the beam eye view.
Fractional values are used if matrix voxels are partly covered by leaves.

Technical Reference Guide Rev. 1.2 Brainlab Physics 29

Pencil Beam Dose Algorithm

Total Dose For calculation of the total dose of a shaped beam at a point in the tissue, the following for-
mula applies

D(x, y, d) = MU ⋅ NLOut ⋅ S t(c mlc, c jaw) ⋅

⎛ SSD cal + d cal⎞ 2

TMR(l rad, c d ,equ) ⋅ ⎝ --------------------------------⎠ ⋅
SSD + d
IDD(x SID, y SID, l rad)

where:
MU = Monitor units applied by the linac.
Nominal linac output, giving the ratio between absolute dose,
measured in a water phantom for an open field (calibration
NLOut =
field size) at a calibration depth dcal, divided by the amount of
monitor units (MU) applied.
cjaw = Size of the equivalent squared jaw field.
cmlc = Size of the equivalent squared MLC field.
Radiological path length of the beam from the tissue surface to
lrad = the observation point, corrected for tissue density inhomogene-
ities.
SSD = Source-surface distance of central beam.
SID = Source-isocenter distance.
d = Depth of observation point in tissue.
Depth of point where NLOut and scatter factors were mea-
dcal =
sured.
Total scatter factor, describing the relative output factor for a
St(cmlc,cjaw) =
squared MLC and jaw field.
Tissue maximum ratio for the square field equivalent to the
MLC and jaw settings in depth lrad.
TMR (cd, coll, lrad) = Strictly speaking, the data is better named as TPR (Tissue
Phantom Ratio), because the normalization depth may not be
the depth of the peak dose, but dcal
SSD + d
cd = c ⋅ --------------------
SSD

IDD(xSID, ySID, Idealized dose distribution in depth Irad with

=
Irad)
SID
= x ⋅ -------------------
-
SSD + d and y analogue.
xSID

30 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Definition of
Coordinates and Source
Parameters

SID

SSD
XSID, YSID

Air

d
lrad
dcal
(x, y, d)
Pcal
Tissue

Figure 3Definition of Coordinates and Parameters

The convolution between pencil beam kernels and photon fluence map assumes that the
pencil beam kernels are translation invariant in the x and y direction, which means that a
homogeneous medium is assumed. For doses that are calculated next to inhomogeneities,
this assumption may not hold, and the calculation can be incorrect.
For inhomogeneous regions traversed by the beam, the correct path length is calculated and
the algorithm computes correct values if the distance to the heterogeneity is large enough
that equilibrium is reestablished.

Radial Factors Radial factors are relative dose distributions along the radial direction of the central beam
(RFS) axis
D(r, d, SSD)
RFS(r, d, SSD) = -------------------------------
D(0, d, SSD)
and the radial symmetric dose
D ( r, d, SSD ) = D ( x, y, d, SSD )

where r = x 2 + y 2 is the radial distance to the central beam. The other parameters
have been described above.

Technical Reference Guide Rev. 1.2 Brainlab Physics 31

Pencil Beam Dose Algorithm

Monitor Unit Monitor units (MU) are the unit of measurement used to quantify the dose delivered by a
Calibration linear accelerator. These units are calibrated to absorbed dose to water in Gray. This is usu-
ally performed using a water phantom under reference conditions at a standard depth, dcal,
a source-surface distance, SSDcal and a standard field size (usually 100 x 100 mm²), giving
the nominal linac output:

NLout = D(c cal, c cal, d cal, SSD cal) ⁄ MU

Total Scatter Total scatter factors (St) describe the relative dose output of a linac at the calibration point
Factor (St) in water for different jaw and MLC sizes. St account for head and phantom scatter. It is im-
portant that the total scatter factors St are measured with the calibration setup defined above
(SSDcal, dcal).
The measurement of total scatter factors is made on the central axis of the beam at the depth
dcal in the phantom for various combinations of different square field jaw and MLC sizes.
Recommended sizes depend on the type of MLC for which the measurements are made. For
the scatter factors doses must be measured at the same depth dcal and the same SSDcal where
the nominal linac output is measured. Normalization of the scatter factor St is performed
with respect to the dose measured for a certain normalization field size (in general a jaw and
MLC field size of 100 x 100 mm² is used).
D(c mlc, c jaw, d cal, SSD cal)
S t(c mlc, c jaw) = ---------------------------------------------------------------
D ( c cal, c cal, d cal, SSD cal )
where:
cmlc = Size of square field MLC opening.
cjaw = Size of square field jaw opening.
ccal = Calibration field size.
dcal = Depth in the phantom where calibration measurements of scatter factors and nominal
linac output are performed.
SSDcal = Source-surface distance for calibration.

32 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Tissue Maximum The TMR builds another approach to characterize the depth characteristic of radiation inter-
Ratio (TMR) actions. Compared with the percentage depth dose (PDD) TMR reflects the more practical
situation that the SSD is changing while the SAD (usually equal to the SDD) is constant. It
has been shown [Khan] that the TMR is practically independent of the SSD, since it can be
assumed that the fractional scatter contribution to the depth dose at a measuring point is only
a function of the field size at the measuring point and the depth of the measuring point in
tissue.
For calibration of the pencil beam algorithm TMRs are measured by varying the SSD using
a water phantom for different (if applicable square) field sizes and a fixed SDD.
A TMR can also be calculated from a percentage depth dose (PDD) distribution that is mea-
sured with a constant SSD and the detector moving along the central beam axis. The neces-
sary transformation is based on the following equation [Khan].

PDD ( d, c, SSD cal ) ( SSD cal + d )

2
S p ( c d cal )
TMR(d, c d) = ----------------------------------------------
- ⋅ - ⋅ -------------------
--------------------------------------- -
100 ( SSD + d )
2 S p d( c )
cal cal

using the collimator field size c at the SSD, the collimator field size cd at the depth d
( SSD cal + d )
c d = c ⋅ -------------------------------
SSD cal
and the collimator field size cdcal at the calibration depth dcal

( SSD cal + d cal )

cd = c ⋅ -------------------------------------
cal SSD cal

Assuming that
Sp ( cd ) ≈
= Sp ( cd )
cal

the transformation reduces to

2
PDD ( d, c, SSD cal ) ( SSD cal + d )
TMR(d, c d) = ----------------------------------------------- ⋅ ---------------------------------------2-
100 ( SSD + d ) cal cal

The error produced through this assumption will increase with increasing depth and decreas-
ing field size.

Technical Reference Guide Rev. 1.2 Brainlab Physics 33

Pencil Beam Dose Algorithm

Radiological Path By default the path length correction is activated for the pencil beam algorithm. The algo-
Length (RPL) rithm uses ray tracing along a ray ranging from the source to the observation point to calcu-
Correction late the radiological path length. It corrects for tissue inhomogeneities and is based upon CT
Hounsfield Units. It therefore relies on a correct calibration of the CT scanner used for the
patient imaging.
NOTE: All regions outside the outer contour are assumed to be air and no depth calcula-
tion is performed, even if tissue heterogeneity correction is switched off.
The conversion of CT numbers (HU) to electron density is assumed to be linear in the range
from –1000 (electron density = 0.0) up to 47 (electron density = 1.0). Above this value it is
again assumed to be linear but with a different slope. With reference to Schneider 1996 the
following default relationship is used:

ρe = (HU + 1000)/1000 -1000 < HU < 47

ρe = (HU / 1827.15) + 1.0213 HU > 47

If required, this default can be edited as appropriate if you are using the iPlan RT Dose ra-
diotherapy treatment planning software. For RPL calculations the path of a straight ray from
the source to a given point inside the patient scan is traced. The distance through every voxel
on the ray’s path is scaled by the electron density of that voxel. The summation of all cor-
rected distances through the voxels gives the radiological path length to the point for which
the dose is calculated.

Adaptive Grid Dose For calculation of dose distributions in two-dimensional images (i.e. slice views) or in three-
Calculation dimensional volumes (i.e. DVH) an adaptive grid algorithm is used. The algorithm can ac-
celerate dose calculation tremendously by using the fact that the pixel or voxel resolution is
finer than the resolution of the local changes of the dose distribution. The grid size is locally
adapted in a way to achieve a predefined accuracy of the dose distribution.
The adaptive grid algorithm first calculates the dose values on a coarse grid, using the pencil
beam dose algorithm. Where the dose values in the surrounding of an adaptive grid point
can be approximately described by interpolation, the intermediate dose values between the
adaptive grid points are interpolated. In the other case, the step size of the adaptive grid
points is locally reduced. The dose values are calculated directly on the new grid points us-
ing the dose algorithm. This procedure is repeated recursively until the required accuracy is
achieved.
As a result, the adaptive grid is typically coarse in regions with smooth dose distributions
and fine in regions where dose distributions are inhomogeneous (i.e. close to the penumbra
region of a beam or close to tissue inhomogeneities.

34 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Pencil Beam for Dynamic Conformal Arc

Dose Calculation For the calculation of the dose that will be delivered to a point the continuous arc is split into
N discrete fixed beams positioned at a certain interval (typically 10° or less) along the arc
plane. As it is assumed that the dose rate of the linac is constant during the arc each assumed
fixed calculation beam contributes with the same fraction of monitor units.
The dose delivered by an arc to an arbitrary point is given by the sum of the Nfb assumed
beams, where each beam is calculated according to the conformal beam algorithm:

N fb
D ( x, y, z ) = NLout ⋅ ∑ MU n ⋅ TMR(c d, equ, n, l rad, n)
n=1

SSD cal + d cal 2

⋅ ⎛ --------------------------------⎞ ⋅ S t ( c mlc ,n, c jaw ,n ) ⋅ IDD(u, v, l rad, n)
⎝ SSD n + d n ⎠

MUn is the number of monitor units for beam n. To obtain a uniform monitor unit value per
degree of distribution, the first beam (n=1) and the last beam (n=N) use half the monitor
units of the other beams. If the total amount of monitor units is MUtot, the formula for cal-
culating MUn for N>1 is:

⎧ MU
⎪ --------------------
tot
- for n = 1∨n = N
⎪ 2(N – 1)
MU n = ⎨
⎪ MU tot
⎪ --------------- otherwise
⎩ N–1

Technical Reference Guide Rev. 1.2 Brainlab Physics 35

Limitations of the Pencil Beam Algorithm

Limitations of the Pencil Beam Algorithm

Primary Jaw Positioning

Background The use of treatment fields where the primary jaws block the MLC aperture may result in
inaccurate dose calculation. This is because the pencil beam dose algorithm does not take
the intersection of the MLC and jaw aperture correctly into account. This may result in the
selection of an incorrect depth dose curve from the PDD/TMR tables in the beam data.

Primary Jaw
Overlap

Figure 4Left: Primary Jaw Overlap of 4 mm, Right: Primary Jaw Overlap of 44 mm

Safety Notes

Treatments that use the primary jaws for collimation while the MLC leaves are
retracted are not recommended. To perform treatments with rectangular fields,
use the MLC leaves instead of the primary jaws, or use the MLC leaves in ad-
dition to the primary jaws to collimate the radiation field.

36 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Algorithm

Extrapolation Outside the Range of Measured Values

Background The pencil beam dose algorithm uses tabulated measured values for the dose calculation. Al-
though the usage of these algorithms outside the range of measured values is not recom-
mended, the algorithm uses extrapolations described in the following table. You have to be
aware that extrapolated values do not represent reality with the same accuracy as the dose
algorithm generally does.

If the dose algorithm is used with parameters outside the measured and tabu-
lated values, the accuracy of the calculated dose cannot be guaranteed. You
must ensure that all necessary parameters, in particular the field size, depth
and off-axis distance for the patient treatment are included in the measured
beam data.

Measured Values
PDD/TMR
Depth < Minimum Depth Constant extrapolation of PDD/TMR (min. depth)
Exponential extrapolation points to determine ex-
ponential function: maximum depth, intermediate
Depth > Maximum Depth
depth (depth approximately in the middle between
depth of maximum dose and maximum depth)
Field Size < Minimum Field Constant extrapolation of PDD/TMR (min. field
Size size)
Field Size > Maximum Field Constant extrapolation of PDD/TMR (max. field
Size size)
Scatter
MLC Size < Minimum MLC
Constant extrapolation of scatter (min. MLC size)
Size
MLC Size < Maximum MLC
Constant extrapolation of scatter (max. MLC size)
Size
Jaw Size < Minimum Jaw Size Constant extrapolation of scatter (min. jaw size)
Jaw Size < Maximum Jaw Size Constant extrapolation of scatter (max. jaw size)
RFS
Depth < Minimum Depth Constant extrapolation of RFS (min. depth)
Depth > Maximum Depth Constant extrapolation of RFS (max. depth)
Radius < Minimum Radius Constant extrapolation of RFS (min. radius)
Radius > Maximum Radius Constant extrapolation of RFS (max. radius)

Technical Reference Guide Rev. 1.2 Brainlab Physics 37

Limitations of the Pencil Beam Algorithm

Other Limitations

Pencil Beam
Limitations

When using the pencil beam algorithm in dose calculations near inhomoge-
neous areas such as lung or bone tissue or close to the tissue border (both within
a range of a few centimeters), the calculated dose can deviate from the real dose
delivered by more than 10%.

Depending on the MLC type, the pencil beam algorithm uses kernels of a fixed
resolution that define the overall resolution of the dose calculation perpendicu-
lar to the beam axis. In the case of small structures in combination with a insuf-
ficient kernel grid size, the pencil beam dose calculation may be too coarse to
identify every detail of the delivered dose distribution.

The field width of the maximum open MLC-field is limited by the linac design
(e.g. primary collimator, flattening filter). The Radial Factors of the Pencil
Beam algorithm may not accurately model this. Thus, the accuracy of the cal-
culated dose for larger distances from the central axis might be limited.

38 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Pencil Beam: General Beam Data

Measurement

General Information

Contents

Topics Covered
Section See
Introduction Page 40
Absolute Linac Calibration Page 46
Background Leakage Page 49
Depth Dose Profile Page 51
Scatter Factors (Output Factors) Page 54
Diagonal Radial Profiles Page 56
Transversal Profiles Page 59
Dynamic Leaf Shift Measurements Page 64
Verification of Radiologic Field Corrections Page 66

Technical Reference Guide Rev. 1.2 Brainlab Physics 39

Introduction

Introduction

Getting Started

Purpose of This This chapter describes the measurement techniques recommended for acquiring the beam
Chapter data required for dose calculation using Brainlab’s pencil beam algorithm.
As well as providing general instructions, this chapter also includes specific information
such as MLC and jaw field sizes to be used for the measurements.

Commissioning a Before starting the commissioning of your linear accelerator you should be familiar with na-
Linear Accelerator tional or international recommendations on commissioning a linear accelerator, e.g. the
AAPM TG-106 Report:
This report provides guidelines and recommendations on the proper selection of phantoms
and detectors, setting up a phantom for data acquisition of both scanning and no-scanning
data, procedures for acquiring specific photon and electron beam parameters and methods
to reduce measurement errors (<1%), beam data processing and detector size convolution
for accurate profiles. The TG-106 also provides a brief discussion on the emerging trend in
Monte Carlo simulation techniques in photon and electron beam commissioning. The pro-
cedures described in this report should assist a qualified medical physicist in either measur-
ing a complete set of beam data, or in verifying a subset of data before initial use or for
periodic quality assurance measurements (Das et al 2008).

Definitions and
Abbreviations Term Explanation
MLC Multileaf Collimator
NLOut Nominal Linac Output
PDD Percentage Depth Dose
RFS Radial Factors
SFC Source Function Correction
SID Source-Isocenter Distance (1000 mm)
SSD Source-surface Distance
Tissue Maximum Ratio
Since depth dose data need not bee entered normalized
TMR in Beam Profile Editor/Physics Administration, the
depth dose data may actually be TPR (Tissue Phantom
Ratio) and not TMR.

40 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Measurement The measurements specified within this user guide are sufficient to achieve the specified ac-
Accuracy curacy for Brainlab dose algorithms. If you wish to improve the accuracy of the dose calcu-
lation, perform the measurements with extreme care, repeat them, select the best results (e.g.
lowest noise) and average them. A finer than recommended increment for field size, depth
or radial direction, although not prohibited, will not significantly improve dose accuracy.

The accuracy of all Brainlab dose algorithms is directly dependent on the accu-
racy and the range of the beam data measurements. It must be ensured that the
beam data measurement covers the range of field sizes and depths that will be
used in subsequent treatment planning. This is especially the case for the mea-
surements of the scatter factors, the radial profiles and the depth dose.

For accurate results you must set up the linac and the motorized water tank
with extreme care. The central beam axis must be exactly vertical, i.e. orthogo-
nal to the water surface. The detector movement direction must be exactly
aligned with the water surface and with the central beam axis in each case.

Data Correction A limited level of data correction is allowed in order to eliminate small errors during mea-
surement data acquisition. However, such corrections must be approached with caution. It
is always better to avoid corrections by measuring data that does not need to be modified.

Beam Profile It is the responsibility of the hospital physicist to perform proper verification of every new-
Verification ly-created or modified beam profile (machine profile). This must include end-to-end testing
for every treatment modality and treatment condition to be used clinically. You always
should consult relevant national or international recommendations on QA (e.g. IAEA TRS-
430).

Technical Reference Guide Rev. 1.2 Brainlab Physics 41

Introduction

Responsibility

When measured data is sent to Brainlab, Brainlab has no possibility to verify

the correctness of
- any data received from a user
- any data returned to a user.
Any feedback or recommendations provided by Brainlab based on the data re-
ceived depend on the correctness of the data itself. If received data has been pro-
cessed by Brainlab and returned to the user, this in no way ensures that the
returned data is correct. The user is fully responsible for verifying the correct-
ness of the data returned by Brainlab and is also fully responsible for verifying
the correctness of any feedback or recommendations provided by Brainlab. The
user must validate the safety and effectiveness of the data returned by Brainlab
before performing any patient treatment. The fact that Brainlab may have pro-
cessed certain data does not affect the overall responsibility of the user for the
correctness of the final beam profile.

42 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Recommended Equipment

Background The following equipment is necessary in order to perform the recommended measurements.
Some items are optional and depend on the type of dose algorithm, linac, collimator and
treatment modality.

Equipment
Component Explanation
The tank should extend at least 50 mm beyond all four sides of the
measured field size at the depth of measurement. It should also ex-
Motorized tend to at least 50 mm beyond the maximum depth of measurement.
water tank For a standard field size of 400 x 400 mm², a depth of up to 350 mm,
a phantom with a base area of more than 500 x 500 mm², and a water
depth of at least 400 mm is necessary.
A calibrated cylindrical ionization chamber with a cavity volume of
at least 0.125 cm3 but not more than 0.6 cm3 is required. The effec-
Calibrated
tive point of measurement shall be determined based on valid inter-
chamber
national dosimetry standards (e.g. IAEA TRS-398) and the
corresponding recommendation of the detector provider.
A cylindrical ionization chamber with a cavity volume of 0.125 cm3
or smaller. The effective point of measurement shall be determined
Ionization
based on valid international dosimetry standards (e.g. IAEA TRS-
chamber
398) and the corresponding recommendation of the detector provid-
er.
A small cylindrical ionization chamber with a cavity volume of not
more than 0.03 cm3 (e.g. pinpoint chamber) is required. The effec-
Small
tive point of measurement shall be determined based on valid inter-
chamber
national dosimetry standards (e.g. IAEA TRS-398) and the
corresponding recommendation of the detector provider.
High- A very small detector for high-resolution profile measurements and
resolution dosimetry of small fields is required. Brainlab recommends the use
detector of a stereotactic diode.
This should be comprised of a number of plastic plates with an elec-
Plastic
tron density equivalent to the electron density of water. Plastic phan-
phantom
toms should not be used for reference dosimetry.
Radiographic This includes Kodak XV-2 or Kodak EDR-2, and film processing
film equipment.
Calibrated A calibrated film scanner for film dosimetry and QA (e.g. VIDAR’s
film scanner DosimetryPRO) is required.

Bear in mind that the sensitivity of the detector may depend on its orientation.
Observe the specifications and recommendations provided by the manufactur-
er of your dosimetry equipment.

Technical Reference Guide Rev. 1.2 Brainlab Physics 43

Introduction

Alternatives If film equipment is not available, high-resolution profile measurements can be performed
using the high-resolution detector.

44 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

General Measurement Requirements

Background General measurement requirements for all MLCs and linac energies are described below.
Specific information for particular MLCs is provided under “Pencil Beam: Beam Data
Checklists” on page 71.

Minimum • Nominal linac output (NLOut) for a field of 100 x 100 mm²
Measurement • Leakage for open and closed jaws
Requirements
• Depth dose profiles (TMR/PDD) for different field sizes
• Scatter factors (output factors) for different combinations of jaw and MLC sizes
• Radial profiles in the diagonal direction for open fields at several depths
• Transversal profile measurements for one setup field for adjustment of source function
correction and of radiological field correction. These must be processed at Brainlab
headquarters.
NOTE: Depending on the MLC type, conversion to radial factors at Brainlab headquarters
may be required.

Additional For installations with dynamic IMRT functionality, additional dynamic leaf shift measure-
Measurements ments are required.

Data Input It is the responsibility of the hospital’s physicist to enter the following data into the Beam
Profile Editor/Physics Administration (Machine Profile mode):

• Nominal linac output in Gy/100 MU (see “Nominal Linac Output Measurement” on

page 46)
• Source-surface distance (SSD), normalization depth and normalization field size
• Leakage values in percent
• Parameters for source function correction and radiological field correction (as provided
by Brainlab following processing of customer data)
• Depth dose profile table
• Scatter factors table
• Radial factors table (as provided by Brainlab following processing of customer data)
Further information on using the Beam Profile Editor/Physics Administration is provided
in the corresponding Brainlab planning software user guide.
All data should also be entered into the corresponding Excel template available from Brain-
lab. The completed template should be sent to [email protected].

Technical Reference Guide Rev. 1.2 Brainlab Physics 45

Absolute Linac Calibration

Absolute Linac Calibration

Nominal Linac Output Measurement

Background The dose algorithms require as input the relation between monitor units and the absorbed
dose to water under reference conditions for a certain beam quality (see “Linac Energy” on
page 269).
This relation is defined as the nominal linac output
Nlout = D(ccal, dcal, SSDcal) / MU
and is given in Gy/100 MU with:
• the calibration field size ccal
• the calibration depth dcal
• the source-surface distance used for calibration SSDcal

Setup

Figure 5Water Phantom and Chamber Setup

• To measure the nominal linac output you must use the relevant calibrated chamber
(see page 43).
• The water surface is adjusted at isocenter depth (SSD = SID), with the reference point
of the active chamber volume set at the isocenter (setup position, depth = 0 mm).
• For measurement purposes, the chamber is moved vertically downwards to a depth of
100 mm.

46 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Workflow Brainlab recommends following a recognized code of practice (e.g. IAEA TRS-398 or
AAPM TG-51). Alternatively, the procedure described below may also be used.

Steps
1. Set up the motorized water tank with the isocenter at water surface level
(SSD = SID = 1000 mm).
2. Adjust the center of the active chamber volume to coincide with the isocenter
(level of water surface) and mark this as depth zero (see Figure 5).
3. Move the chamber to the calibration depth of dcal= 100 mm.
4. Set the MLC square field size and the jaw aperture to 100 x 100 mm².
Note: If your MLC does not facilitate a 100 x 100 mm² field, refer to the instruc-
tions specific to your MLC (see “Pencil Beam: Beam Data Checklists” on
page 71).
5. • Deliver 100 MU and obtain the dosimeter reading in Gy (apply all necessary
conversions and corrections; e.g. chamber type, beam quality, temperature,
pressure, etc.).
• The result must be in Gy/100 MU.
6. We recommend repeating the measurement three times and using the average
value to increase the accuracy.

NOTE: SSD and normalization depth values other than those specified above may be used.
However:
• All the measurements for NLOut, leakage, PDD, radial factors (PDD approach) and
scatter factors must be performed with the same SSD.
• All the measurements for NLOut, leakage and scatter factors must be performed at the
same depth.

Technical Reference Guide Rev. 1.2 Brainlab Physics 47

Absolute Linac Calibration

Entering
Measurement Required Entries in
Results Software
Beam Profile Editor/Physics Administration

Under Pencil Beam in the General Settings page, enter:

• The measured nominal linac output in the Nominal LINAC
BrainSCAN with
Output field
Beam Profile
Editor up to • The normalization depth (in millimeters) in the Normaliza-
version 5.x tion Depth field
• The source-surface distance (in centimeters) in the Source
Surface Distance field

Under Pencil Beam in the Pencil Beam Settings page, enter:

• The measured nominal linac output in the Nominal LINAC
iPlan RT Dose Output field
with Beam Profile • The normalization depth (in millimeters) in the Normaliza-
Editor 6.0 or higher tion Depth field
• The source-surface distance (also in millimeters) in the
Source Surface Distance field

Enter the following data in the Pencil Beam tab of the Proper-
ties dialog:

• Under Pencil Beam Setup, enter the source-surface distance

(SSD, in millimeters) in the Source Surface Distance field.
iPlan RT Dose 4.5 Important: This value needs to be identical to the SSD of the
( o r h i g h e r) w i t h scatter data!
Physics • Under Pencil Beam Setup, enter the normalization depth (in
Administration millimeters) in the Measurement Depth field.
Important: This value needs to be identical to the measure-
ment depth of the scatter data!
• Under Nominal Linac Output, enter the measured nominal
linac output and the corresponding field size (100 x 100 mm²).

Ensuring Accuracy

To obtain an accurate absorbed dose to water measurement, you must apply a

number of corrections to the dosimeter reading, e.g. beam quality (linac ener-
gy), pressure, temperature and polarity. You must consult the documentation
provided with your dosimetric equipment and the national standards applica-
ble in your country.

48 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Background Leakage

Open and Closed Jaw Measurement

Background The background leakage values define the average percentage of leakage radiation through
the leaves and through the combination of leaves and jaws.

Setup • The setup for measuring background leakage is identical to the setup for measuring
nominal linac output.
• The same calibrated chamber should be used for measuring nominal linac output and
background leakage. In this case, the nominal linac output can be used as a reference
value for determining the leakage value.
• Otherwise, the nominal linac output measurement must be repeated with the new cali-
bration chamber to obtain this reference value.

Workflow
Step
1. Leave the primary jaws open at 100 x 100 mm².
2. • Close the MLC leaves asymmetrically.
• The leaf gap should be 50 mm from the isocenter.
3. Deliver 100 MU and obtain the dosimeter reading.
4. Close the primary jaws asymmetrically.
5. Repeat step 3.
NOTE: If the linac does not support asymmetric closed jaw settings, the chamber can be
moved horizontally in the x and y directions by at least 20 mm. In this case, the reference
value must be measured at the new location using a square field jaw and MLC aperture of
100 x 100 mm². If the linac does not support jaw usage, the jaw leakage should be set to ze-
ro.

Technical Reference Guide Rev. 1.2 Brainlab Physics 49

Background Leakage

Entering
Measurement Required Entries in
Results Software
Beam Profile Editor/Physics Administration

Under Multileaf Background Leakage in the Pencil Beam Re-

BrainSCAN with lated Properties page, enter:
Beam Profile
Editor up to • The measured dose fractions (relative to the nominal linac
version 5.x output) in the fields Leakage for Open Jaws and Leakage
for Closed Jaws
Under Multileaf Background Leakage in the Pencil Beam Set-
iPlan RT Dose tings page, enter:
with Beam Profile • The measured dose fractions (relative to the nominal linac
Editor 6.0 or higher output) in the fields Leakage for Open Jaws and Leakage
for Closed Jaws

Enter the following data in the Pencil Beam tab of the Proper-
iPlan RT Dose 4.5 ties dialog under Multileaf Background Leakage:
( o r h i g h e r) w i t h
Physics • The measured dose fractions (relative to the nominal linac
Administration output) in the fields Leakage for Open Jaws and Leakage
for Closed Jaws.

50 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Depth Dose Profile

PDD and TMR Measurement

Background To determine the depth dose profile, use one of the two options below:

Option Explanation
PDD Use this option if the water phantom and SSD are fixed. PDD
(percentage depth values are measured by adjusting the chamber vertically along
dose) the beam axis.
TMR
Use this option if the chamber is fixed at isocenter. TMR val-
(tissue maximum ra-
ues are measured by varying the water level (water surface).
tio)

In the Beam Profile Editor/Physics Administration, you must specify under Values are ...
whether your data is based on TMR or PDD. Further information is provided in the corre-
sponding Brainlab planning software user guide.

Technical Reference Guide Rev. 1.2 Brainlab Physics 51

Depth Dose Profile

Setup

Figure 6Left: PDD Measurement, Right: TMR Measurement

• Large field PDDs shall be measured using an ionization chamber of medium or large
volume (0.1 cm3 – 0.6 cm3) to avoid the effect of energy response variations (see sec-
tion III.D.5 and Fig. 1 of the AAPM TG-106 Report (Das et al 2008).
• For smaller field sizes that are not included in range of field sizes of the ionization
chamber, use the relevant high-resolution detector (see page 43). In this case, at least
one measurement must be performed with both measurement devices, in order to com-
pare the measurement results achieved using the ionization chamber with those of the
high-resolution detector.
NOTE: Do not forget to recalibrate the x/y/z coordinates of the water phantom when
changing the chamber.

52 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

PDD Workflow
Steps
Set up the water phantom in the same way as for the measurement of nominal
linac output (see page 46):
1. • SSD = SID = 1000 mm
• The isocenter is at water surface level (depth = 0 mm)
• The effective point of measurement is at isocenter
• Move the jaws and the MLC leaves to form different square fields for each
measurement.
2.
• The required MLC and jaw field sizes are specified under “Pencil Beam:
Beam Data Checklists” on page 71.
• Use the water phantom software to measure depths from 0 to the desired
depth.
3.
• Use a step size of 1 mm for 0 - 50 mm depth and a step size of 5 mm for great-
er depths.

TMR Workflow As Brainlab does not suggest a specific workflow for measuring TMR, you are free to use
a workflow appropriate to your clinical needs.

Entering In all cases, the complete matrix of depth dose values must be entered in the Beam Profile
Measurement Editor/Physics Administration. You must also specify under Values are ... whether your
Results data is based on the TMR or the PDD approach.

Ensuring Accuracy To prevent errors due to bending of the water surface (capillary effects), move the chamber
from the bottom upwards.
Take care to measure up to a depth that is equivalent to or greater than the maximum
depth required inside the patient’s body:
• For cranial treatments, 250 mm may be sufficient.
• For extracranial cases a range of up to 400 mm or more must be covered.
Depending on the clearance of your linac, it may not be possible to measure the TMR up
to a depth of 300 mm or 350 mm. If such depths are necessary, you must measure the
PDD.
NOTE: All depth profiles must use the same depth axis values. If necessary, use an appro-
priate software to perform interpolation. TMR/PDD values can be normalized arbitrarily
as this is controlled by the dose algorithm.

Technical Reference Guide Rev. 1.2 Brainlab Physics 53

Scatter Factors (Output Factors)

Scatter Factors (Output Factors)

Scatter Factor Measurement

Background Scatter factors provide information relative to the nominal linac output. They can be entered
into the Beam Profile Editor/Physics Administration, normalized arbitrarily, as this is con-
trolled by the dose algorithm.

Setup • Use the relevant small chamber (see page 43) for all field sizes included in the range of
field sizes specified by the chamber manufacturer.
• For smaller field sizes that are not included in this range, use the relevant high-resolu-
tion detector (see page 43). In this case, at least one measurement must be performed
with both measurement devices in order to link the relative measurement of the small
chamber with the additional measurements of the high-resolution detector. These
repeated measurements should not exceed the field size specifications defined by the
device manufacturer in each case.

Workflow
Steps
1. Set up the motorized water tank with the isocenter at water surface level
(SSD = SID = 1000 mm).
2. Adjust the center of the active chamber volume to coincide with the isocenter
(level of water surface) and mark this as depth zero (see Figure 5).
3. Move the chamber to the calibration depth of dcal = 100 mm.
4. Measure the scatter factors for a matrix of combinations of square MLC fields
and square jaw fields (see “Sample Matrix” on page 98).
The required MLC and jaw field sizes are specified under “Pencil Beam: Beam Data Check-
lists” on page 71.

Using the Sample • The gray fields in the sample matrix tables provided from page 71 must be measured in
Matrix all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• It is therefore not necessary to measure these larger MLC fields. Instead, it is sufficient
to enter the last mandatory value measured, e.g. in the case of a jaw setting of
60 x 60 mm² you can use the value measured for the 60 x 60 mm² MLC field (0.8710 in
Table 7 on page 98).

54 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Entering In all cases, the complete matrix of scatter factors must be entered in the Beam Profile Ed-
Measurement itor/Physics Administration. No zero values should remain.
Results

Ensuring Accuracy • To ensure accuracy, refer to “Measurement for Small Radiation Fields” on page 24.
• Measure the fields exactly as indicated.
• For each jaw field size, the measured MLC field size range must be larger than or equal
to the jaw field size.
• For each jaw field size, the scatter factors for MLC field sizes larger than the jaw field
size may be set to the value measured for the smallest MLC size that is larger than (or
equal to) the jaw field size. For further information, see the white fields in the sample
matrix tables provided from page 71.

Technical Reference Guide Rev. 1.2 Brainlab Physics 55

Diagonal Radial Profiles

Diagonal Radial Profiles

Radial Factor and Radial Profile Measurement

Background Radial factors are dose functions that run horizontally through the beam axis at various
depths. Their purpose is to correct off-axis variations of the open beam.
If it is not possible to detach the MLC from the gantry head, radial factors cannot be mea-
sured directly. In this case, radial profiles must be measured diagonally to the jaw field in
order to include the dose fall-off due to the restricted field size.

Figure 7

Radial profiles measured diagonally (to reduce boundary effects) contain the
required information, however they must be converted to radial factors at
Brainlab headquarters. Radial profile measurements cannot be entered direct-
ly into the Beam Profile Editor/Physics Administration (Machine Profile mode).

56 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Setup Radial factors/profiles can be measured using an approach similar to that used for TMR
and PDD measurements.

Figure 8Beam’s Eye View of Measurement Direction for Radial Profiles

• The same water phantom setup as used for TMR/PDD measurements can be used here
(see Figure 6 on page 52).
• Use the small chamber to measure the radial profiles. The chamber should be mounted
so as to allow maximum spatial resolution along the measuring direction.
NOTE: The pencil beam algorithm assumes rotational symmetry of the radial factors.
Therefore it is possible to measure half profiles, but only if the water phantom is not suffi-
ciently large to allow for a complete diagonal profile. To improve accuracy, it is recom-
mended to average several half profiles measured in different directions.

Technical Reference Guide Rev. 1.2 Brainlab Physics 57

Diagonal Radial Profiles

Workflow
Steps
1. Detach the MLC from the linac.
NOTE: If the MLC cannot be detached, retract the MLC leaves until the maxi-
mum permitted field size is reached.
2. Retract the jaws until the maximum permitted field size is reached.
3. • Measure the radial profiles for the following depths: 5, 14, 25, 50, 100, 200,
and 350 [mm].
• Use a radial resolution of at least 5 mm.
4. Measure the entire profile range from one corner of the field to the other.

Entering If the MLC has been detached from the linac as described above, enter the radial factors
Measurement into the Beam Profile Editor/Physics Administration (Machine Profile mode).
Results
In all other cases, transfer your measurement results to the Excel template provided by
Brainlab and forward the completed template to [email protected].
Once you have received the radial factors from Brainlab, you must also specify under Val-
ues are ... in the Beam Profile Editor/Physics Administration whether your data is based
on the TMR or the PDD approach.

Ensuring Accuracy • The radius should correspond with the actual distance between the beam axis and the
chamber. Radius conversion to the isocenter plane is not necessary.
• If radial factors have been measured using an approach similar to that used for PDD,
the same SSD must be used for radial factors as used in the PDD measurement.
• To obtain results with low noise, move the chamber slowly to avoid waves, especially
for lower depth values.
• The type of data measured must be communicated to Brainlab headquarters together
with the corresponding data files.
• Radial profiles can be can be normalized arbitrarily as this is controlled by the dose
algorithm.
• The calculated radial factors are based on the radial profile data ranging from the beam
center to its 50% isodose width. This beam data range must be measured as exactly as
possible.
NOTE: All profiles must use the same radius values (either isocentric or real). If neces-
sary, use the water phantom software to perform interpolation.

58 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Transversal Profiles

Transversal Profile Measurement

Background Additional measurements are necessary in order to adjust the source function correction and
the radiologic field correction. The source function correction is an empirical way of simu-
lating an extended beam source and other effects that smear out the beam edge.

Figure 9Water Phantom Measurements

Two measurement options are provided:

• “Film Dosimetry Measurement” on page 61 (preferred option)
• “Measurement Using a Water Phantom and High-Resolution Detector” on page 63

Technical Reference Guide Rev. 1.2 Brainlab Physics 59

Transversal Profiles

Setup

Figure 10Beam’s Eye View of Measurement Direction for Transversal Profiles

The transversal profiles are measured along and perpendicular to the leaf direction. You
must ensure that the profiles are taken directly under the leaves in such a way that they are
not influenced by the interleaf or intraleaf gap.

60 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Film Dosimetry Measurement

Background For accurate film dosimetry, measurements should be performed using film and a plastic
phantom comprising variable build-up layers and sufficient back scatter material that is
100 mm thick.

Setup The measurements should be performed at the following depths: dmax, 100 mm, and
200 mm.
• Place the back scatter material on the patient couch and align it to the isocenter position
using the positioning lasers.
• Make sure that the upper surface of the back scatter material is horizontally aligned at
isocenter level.
• Place a film on the lower slab in the isocenter plane, and add the appropriate build-up
layer.
• Use the MLC and the jaws to form the shape specified for your MLC (see “Pencil
Beam: Beam Data Checklists” on page 71).

Workflow • Profiles (x and y) must be extracted for each film.

• To provide sufficient information about the penumbra region and the area blocked by
the MLC, the profiles should cover the entire field size with a resolution of 0.5 mm.
• All the x/y profiles must use the same x/y axis values. If necessary use an appropriate
software to perform interpolation.
Steps
1. Expose three films using the build-up layers at dmax (depending on the linac en-
ergy, e.g. 15 mm for 6 MV), 100 mm and 200 mm.
• In order to remain within the linear range of the sensitometric curve, irradiate
using an appropriate level of MUs.
• For example, for Kodak X-Omat film, the dose should not exceed 0.8 Gy. For
Kodak EDR2 film it should not exceed 2.0 Gy.
2. Develop and scan the films.
3. • Extract the x-profile parallel to the leaf direction.
• To avoid an interleaf gap, take the profile from the middle of one of the central
leaves.
4. • Extract the y-profile through the beam center perpendicular to the leaf direc-
tion.
• Make sure that the distance of the leaf gaps to the scan axis is more than
20 mm; adjust the axis if necessary.

Technical Reference Guide Rev. 1.2 Brainlab Physics 61

Transversal Profiles

Entering Import the extracted profiles to the Excel template provided by Brainlab and forward the
Measurement completed template to [email protected]. Enter the source function correction
Results and the radiologic leaf shift in the Beam Profile Editor/Physics Administration once you
have received the processing results from Brainlab.

Ensuring Accuracy Check your measured profiles against the example shown in Figure 9 on page 59, and make
sure that:
• The penumbra width is small (approximately 4±1 mm for micro MLCs)
• The outside MLC leakage for a depth less than 50 mm is close to 3%

During film dosimetry measurement, the accuracy of the sensitometric curve is

essential for accurate adjustment of the source function correction.

62 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Measurement Using a Water Phantom and High-Resolution Detector

Background If film dosimetry is not an option, water phantom measurements can be performed instead.
The high-resolution detector as specified under “Recommended Equipment” on page 43
must be used in this case.

Setup Set up the water phantom in the same way as previously (SSD = SID = 1000 mm).
• The measurements should be performed at the following depths: dmax, 100 mm, and
200 mm.
• Recalibrate the x/y/z coordinates of the water phantom if the detector has been changed
or rotated.
• Use the MLC and the jaws to form the shape specified for your MLC (see “Pencil
Beam: Beam Data Checklists” on page 71).

Workflow • To provide sufficient information about the penumbra region and the area blocked by
the MLC, the profiles should cover the entire field size with a resolution of 0.5 mm.
• All the x/y profiles must use the same x/y axis values. If necessary use an appropriate
software to perform interpolation.
Steps
1. Position the detector so that an interleaf gap is avoided, for example for a MLC
design using 2 central leaves, take the x-profile from the middle of one of the
two central leaves.
2. Orient the detector so as to allow maximum resolution for the profile measure-
ment (remember to rotate the detector between the parallel and perpendicular di-
rection).
3. Position the detector at the beam center and make sure that the distance of the in-
traleaf gaps to the scan axis is more than 20 mm; adjust the axis if necessary.
4. Repeat step 2.

Entering Import the measured profiles to the Excel template provided by Brainlab and forward the
Measurement completed template to [email protected]. Enter the source function correction
Results and the radiologic leaf shift in the Beam Profile Editor/Physics Administration once you
have received the processing results from Brainlab.

Ensuring Accuracy Check your measured profiles against the example shown in Figure 9 on page 59, and make
sure that:
• The penumbra width is small (approximately 4±1 mm for micro MLCs)
• The outside MLC leakage for a depth less than 50 mm is close to 3%

Technical Reference Guide Rev. 1.2 Brainlab Physics 63

Dynamic Leaf Shift Measurements

Dynamic Leaf Shift Measurements

Dynamic Leaf Shift

Background The dynamic leaf shift describes an effective leaf shift due to the round leaf end design of
most MLCs.
This value is determined by using prepared MLC files to measure the isocenter doses for
sliding gaps with different widths.
The measured dose D can approximately be described by the linear function

D − Dleak = b( gap + 2δ ) = b ⋅ gap + a

where:
• gap is the nominal gap width (1, 5, …, 100 mm)
• Dleak is the measured MLC leakage

• δ is the effective dynamic leaf shift per leaf

After determination of a and b by linear regression, δ is calculated by:
δ = a 2b

NOTE: For further information, see the Excel sheet “Dynamic Shift” in the Excel template
provided by Brainlab.

Setup • Position the relevant calibrated chamber or the ionization chamber (see page 43) in the
water phantom, so that the chamber axis is perpendicular to the leaf direction.
• Adjust the water surface level so that the detector is below the build-up region (dmax or
deeper) where [SSD = 1000 mm - measurement depth]. For 6 MV, the recommended
depth is 20 mm.
• Set the jaws to form a square field of 100 x 100 mm².

Workflow
Steps
1. Successively irradiate the dynamic MLC fields specified for your MLC under
“Pencil Beam: Beam Data Checklists” on page 71.
2. • Close the MLC and measure the leakage dose using the same setting as above.
• With an asymmetric gap setting, the leaf gap should be 50 mm off the iso-
center.
3. Set the MLC to a square field of 100 x 100 mm² and measure the open field dose
using the same settings as above.

64 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Entering All data should also be entered into the corresponding Excel template available from Brain-
Measurement lab. The result is calculated and displayed in the Excel template. In the Beam Profile Editor/
Results Physics Administration, enter the result from the Excel template in the Leaf Shift Dynamic
field under Radiologic Field.

Technical Reference Guide Rev. 1.2 Brainlab Physics 65

Verification of Radiologic Field Corrections

Verification of Radiologic Field Corrections

Overview

Background This section describes how to verify and update the radiologic field corrections (static and
dynamic radiologic leaf shift).
The reviewed parameters are employed in the customer specific machine profile, which is
used in conjunction with the Brainlab treatment planning software iPlan RT Dose or Brain-
SCAN.

When to Verify Brainlab recommends verifying the radiologic field corrections routinely, and especially af-
ter modifications to the MLC, such as:
• Mechanical changes to the infrared light barrier, which calibrates the leaf positions dur-
ing the MLC initialization
• Exchanging the m3 power supply
• Changes to the MLC leaf position calibrations, for example modifying the mlcx.cal file
at the MLC controller workstation
Depending on the modifications, further measurements may be necessary to ensure that the
delivery system works as intended.

66 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Difference Between Figure 11 illustrates the difference between the radiologic field and the nominal MLC leaf
Radiologic Field positions. The radiologic field differs from the nominal MLC field in both the x- and y-di-
and MLC rection. The field difference in the y-direction (tongue-and-groove size) depends mainly on
the geometric design of the leaf and thus is independent of MLC modifications. In x-direc-
tion modifications to the MLC might lead to slightly different radiologic field corrections.

Figure 11Illustration of the difference between the radiologic and the geometric MLC field.

About Verification The radiologic field corrections are defined as correction distances at the isocenter plane.
This is why the described film measurement is performed isocentrically. For accurate film
dosimetry Brainlab recommends using a plastic phantom which is composed of a build-up
layer of 25mm and sufficient back scatter material that is at least 100 mm thick.

Technical Reference Guide Rev. 1.2 Brainlab Physics 67

Verification of Radiologic Field Corrections

Preparation
Steps
1. Place the back scatter material on the patient couch and align its upper edge to
the isocenter position using the positioning lasers.
2. Make sure that the upper surface of the back scatter material is horizontally
aligned at isocenter level.
3. Place a film on the lower slab in the isocenter plane, and add the appropriate
build-up layer.
4. Use the MLC to form a quadratic (or nearly quadratic) field:
60mm x 60mm MLC field.
5. Make sure that the jaw field boarder extends the MLC field by at least 10mm on
each side:
80x80mm jaw field.

Workflow To provide sufficient information about the penumbra region and the area blocked by the
MLC, the profile should cover the entire field size with a resolution of at least 0.5 mm.

Steps
1. Expose the film using the build-up layer of 25 mm.
• In order to remain within the linear range of the sensitometric curve, irradiate
using an appropriate level of MUs.
• For example, for a Kodak X-Omat film, the dose should not exceed 0.8 Gy.
For a Kodak EDR2 film it should not exceed 2.0 Gy. If the film is not suffi-
ciently linear in the considered dose range, use calibration films to transform
the grey patterns to dose values.
2. Develop and scan the film.
3. Extract the x-profile (direction parallel to the leaf movement).
To avoid an interleaf gap, take the profile from the middle of one of the central
leaves.
4. Measure the 50% isodose width of the profile and determine the static leaf shift
( Δs ) between the nominal field size in x-direction ( s nominal ) and the mea-
sured 50% isodose width ( s 50% ):
Δs = 0.5∗ ( s 50% – s nominal ) , ( Δs > 0 )

68 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: General Beam Data Measurement

Comparing the Compare the new radiologic leaf shift value with the currently used static leaf shift value in
Results the Beam Profile Editor/Physics Administration (see chapter 13 of the iPlan RT Dose 4.x
Clinical User Guide). If the difference between both values is not negligible, enter the new
value into the appropriate field of the Beam Profile Editor/Physics Administration.
If the static leaf shift parameter is outdated, the dynamic leaf shift parameter could be inac-
curate. In this case, Brainlab recommends repeating the dynamic leaf shift measurements,
described in “Dynamic Leaf Shift Measurements” on page 64.
If there is a significant difference between the old and the new dynamic leaf shift value, en-
ter the new value into the appropriate field of the Beam Profile Editor/Physics Adminis-
tration. Then save and approve the updated machine profile.

Technical Reference Guide Rev. 1.2 Brainlab Physics 69

Verification of Radiologic Field Corrections

70 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Pencil Beam: Beam Data Checklists

General Information

Contents

Topics Covered
Section See
Beam Data for Brainlab m3 Page 72
Beam Data for Elekta Beam Modulator Page 76
Beam Data for Elekta MLCi Page 80
Beam Data for MHI MLC 60 Page 84
Beam Data for Novalis Page 88
Beam Data for Novalis Tx (SRS) Page 92
Beam Data for Novalis Tx (Standard Irradiation Mode) Page 96
Beam Data for Siemens 3-D (58 and 82 Leaves) Page 100
Beam Data for Siemens 160 Page 104
Beam Data for Siemens ModuLeaf Page 108
Beam Data for Varian 52 Page 112
Beam Data for Varian 80 Page 116
Beam Data for Varian 120 (SRS) Page 120
Beam Data for Varian 120 (Standard Irradiation Mode) Page 124

Technical Reference Guide Rev. 1.2 Brainlab Physics 71

Beam Data for Brainlab m3

Beam Data for Brainlab m3

Checklist (Excel template Brainlab FORM 09-620)

Measurement See also Done

Linac calibration (NLOut) using the calibrated chamber: “Nominal Linac

Output Mea-
• Jaw: 98 x 98 mm² surement” on
• MLC: 100 x 100 mm² page 46
Background leakage for open and closed jaws using the calibrated chamber:
• Enter NLOut into the Excel template
• Enter leakage values into the Excel template “Background
• Enter SSD and the normalization depth into the Excel template Leakage” on
Open field: page 49

• Jaw: 98 x 98 mm²
• MLC: 100 x 100 mm²
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields “Depth Dose
6 x 6 (8 x 8), 12 x 12 (14 x 14), 18 x 18 (20 x 20), 30 x 30 (32 x 32), 42 x 42 Profile” on
(44 x 44), 60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (98 x 98) [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
8 x 8, 14 x 14, 20 x 20, 44 x 44, 60 x 60, 80 x 80, 98 x 98 [mm²] “Scatter Fac-
• MLC fields tors (Output
Factors)” on
6 x 6, 12 x 12, 18 x 18, 24 x 24, 30 x 30, 36 x 36, 42 x 42, 60 x 60, 80 x 80, page 54
100 x 100 [mm²]
A sample matrix is provided on page 74. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• m3 MLC detached “Diagonal Radi-
• Jaws retracted al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

72 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 98 x 98 mm² “Transversal
• MLC fields (see page 75) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “M3_1.d01”, “Dynamic Leaf
“M3_5.d01”, … , “M3_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 73

Beam Data for Brainlab m3

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field
8x8 14 x 14 20 x 20 44 x 44 60 x 60 80 x 80 98 x 98
Sizes
[mm²]
6x6 0.601 0.605 0.606 0.607 0.608 0.608 0.609
12 x 1
0.605 0.746 0.759 0.765 0.766 0.766 0.768
2
18 x 1
0.605 0.756 0.796 0.814 0.815 0.815 0.817
8
24 x 2
0.605 0.756 0.810 0.838 0.840 0.841 0.842
4
30 x 3
0.605 0.756 0.810 0.858 0.860 0.860 0.862
0
36 x 3
0.605 0.756 0.810 0.876 0.878 0.880 0.880
6
42 x 4
0.605 0.756 0.810 0.880 0.894 0.896 0.897
2
60 x 6
0.605 0.756 0.810 0.888 0.931 0.936 0.937
0
80 x 8
0.605 0.756 0.810 0.888 0.931 0.969 0.972
0
100 x
0.605 0.756 0.810 0.888 0.931 0.969 1.000
100
Table 1: Brainlab m3: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

74 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 12Brainlab m3: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 2-4, 7-20, 24-25
IEC 1217 leaf position -40 mm and +40 mm -50 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 75

Beam Data for Elekta Beam Modulator

Beam Data for Elekta Beam Modulator

Checklist (Excel template Brainlab FORM 09-621)

Measurement See also Done

Linac calibration (NLOut) using the calibrated chamber: “Nominal Linac

Output Mea-
• MLC field: 104 x 96 mm² (crossplane x in-plane), which has the equivalent surement” on
square field size of 100 mm page 46
Background leakage for closed MLC field using the calibrated chamber:
• Enter NLOut into the Excel template “Background
• Enter leakage values into the Excel template Leakage” on
• Enter SSD and the normalization depth into the Excel template page 49

Open MLC field (crossplane x in-plane): 104 x 96 mm²

Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC fields (crossplane x in-plane)
“Depth Dose
8 x 8, 16 x 16, 24 x 24, 32 x 32, 48 x 48, 80 x 80, 104 x 96, 120 x 120, Profile” on
160 x 160, 210 x 160 [mm²] page 51
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab. Always use equivalent square field sizes
(i.e. 104 x 96 mm² Q 100 mm and 210 x 160 mm² Q 182 mm).
Scatter factors using the small chamber and high-resolution detector:
• MLC fields (crossplane x in-plane) “Scatter Fac-
8 x 8, 16 x 16, 24 x 24, 32 x 32, 48 x 48, 80 x 80, 104 x 96, 120 x 120, tors (Output
160 x 160, 210 x 160 [mm²] Factors)” on
page 54
A sample matrix is provided on page 78. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
“Diagonal Radi-
• MLC leaves retracted
al Profiles” on
Following measurement completion, import the diagonal radial profiles into page 56
the Excel template provided by Brainlab.
Transversal profiles using the high-resolution detector:
“Transversal
• MLC fields (see page 79)
Profiles” on
Following measurement completion, import the transversal profiles into the page 59
Excel template provided by Brainlab.

76 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 77

Beam Data for Elekta Beam Modulator

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings for

Beam Profile Editor/
Physics Administration
[mm]

MLC Field Sizes Equivalent MLC Field Size

182
[mm²] [mm]
8x8 8 0.587
16 x 16 16 0.817
24 x 24 24 0.870
32 x 32 32 0.902
48 x 48 48 0.939
80 x 80 80 0.986
104 x 96 100 1.000
120 x 120 120 1.021
160 x 160 160 1.041
210 x 160 182 1.048
Table 2: Elekta Beam Modulator: Possible Measured Scatter Factors (Examples Only)
• To enter the data into the Beam Profile Editor/Physics Administration, use the jaw
field size setting 182 mm.
• For iPlan RT Dose 3.x, it is important that at least two jaw columns are present. You
must therefore enter the MLC data twice: once with a jaw field size of 181 mm and a
second time with a jaw field size of 182 mm.

78 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 13Elekta Beam Modulator: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 14, 18-22, 25-28
IEC 1217 leaf position -75 mm and +25 mm -105 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 79

Beam Data for Elekta MLCi

Beam Data for Elekta MLCi

Checklist (Excel template Brainlab FORM 09-622)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC and jaw fields “Depth Dose
20 x 20, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, Profile” on
300 x 300, 400 x 400 [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
20 x 20, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200,
300 x 300, 400 x 400 [mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
20 x 20, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, page 54
300 x 300, 400 x 400 [mm²]
A sample matrix is provided on page 82. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
“Diagonal Radi-
• MLC and jaw field: 400 x 400 [mm²]
al Profiles” on
Following measurement completion, import the diagonal radial profiles into page 56
the Excel template provided by Brainlab.

80 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 mm² “Transversal
• MLC fields (see page 83) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 81

Beam Data for Elekta MLCi

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field 100 x 1 140 x 1 200 x 2 300 x 3 400 x 4
20 x 20 40 x 40 60 x 60 80 x 80
Sizes 00 40 00 00 00
[mm²]
20 x 2
0.8337 0.8507 0.8546 0.8572 0.8579 0.8612 0.8677 0.869 0.869
0
40 x 4
0.8337 0.8939 0.9122 0.9234 0.9273 0.9306 0.9371 0.9384 0.9384
0
60 x 6
0.8337 0.8939 0.9371 0.9542 0.964 0.9725 0.9797 0.9823 0.9823
0
80 x 8
0.8337 0.8939 0.9371 0.9718 0.9856 0.9987 1.0079 1.0105 1.0105
0
100x1
0.8337 0.8939 0.9371 0.9718 1 1.019 1.0295 1.0314 1.0314
00
140x1
0.8337 0.8939 0.9371 0.9718 1 1.0452 1.0655 1.0655 1.0655
40
200x2
0.8337 0.8939 0.9371 0.9718 1 1.0452 1.1054 1.1133 1.1133
00
300x3
0.8337 0.8939 0.9371 0.9718 1 1.0452 1.1054 1.1244 1.1244
00
400x4
0.8337 0.8939 0.9371 0.9718 1 1.0452 1.1054 1.1244 1.13
00
Table 3: Elekta MLCi: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54). This
is why it is important to copy your measured scatter values into the correct column and
row (see example above).

82 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 14Elekta MLCi: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 12-14, 17-24, 28-29
IEC 1217 leaf position +75 mm -75 mm and -70 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 83

Beam Data for MHI MLC 60

Beam Data for MHI MLC 60

Checklist (Excel template Brainlab FORM 09-623)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for closed MLC field using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC fields “Depth Dose
10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 120 x 120, Profile” on
150 x 150 [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• MLC fields “Scatter Fac-
10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 120 x 120, tors (Output
150 x 150 [mm²] Factors)” on
page 54
A sample matrix is provided on page 86. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
“Diagonal Radi-
• MLC leaves retracted
al Profiles” on
Following measurement completion, import the diagonal radial profiles into page 56
the Excel template provided by Brainlab.
Transversal profiles using the high-resolution detector:
“Transversal
• MLC fields (see page 87)
Profiles” on
Following measurement completion, import the transversal profiles into the page 59
Excel template provided by Brainlab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.

84 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 85

Beam Data for MHI MLC 60

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings for

Beam Profile Editor/Physics
Administration [mm]

MLC Field Sizes [mm²] 150

10 x 10 0.828
20 x 20 0.934
30 x 30 0.953
40 x 40 0.964
60 x 60 0.977
80 x 80 0.988
100 x 100 1.000
120 x 120 1.010
150 x 150 1.022
Table 4: MHI MLC 60: Possible Measured Scatter Factors (Examples Only)
• To enter the data into the Beam Profile Editor/Physics Administration, use the jaw
field size setting 150 mm.
• For iPlan RT Dose 3.x, it is important that at least two jaw columns are present. You
must therefore enter the MLC data twice: once with a jaw field size of 150 mm and a
second time with a jaw field size of 152 mm.

86 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 15MHI MLC 60: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 6-8, 12-19, 22-25
No manual position-
IEC 1217 leaf position -50 mm and +50 mm
ing necessary

Technical Reference Guide Rev. 1.2 Brainlab Physics 87

Beam Data for Novalis

Beam Data for Novalis

Checklist (Excel template Brainlab FORM 09-624)

Measurement See also Done

Linac calibration (NLOut) using the calibrated chamber: “Nominal Linac

Output Mea-
• Jaw: 98 x 98 mm² surement” on
• MLC: 100 x 100 mm² page 46
Background leakage for open and closed jaws using the calibrated chamber:
• Enter NLOut into the Excel template
• Enter leakage values into the Excel template “Background
• Enter SSD and the normalization depth into the Excel template Leakage” on
Open field: page 49

• Jaw: 98 x 98 mm²
• MLC: 100 x 100 mm²
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields “Depth Dose
6 x 6 (8 x 8), 12 x 12 (14 x 14), 18 x 18 (20 x 20), 30 x 30 (32 x 32), 42 x 42 Profile” on
(44 x 44), 60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (98 x 98) [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
8 x 8, 14 x 14, 20 x 20, 44 x 44, 60 x 60, 80 x 80, 98 x 98 [mm²] “Scatter Fac-
• MLC fields tors (Output
Factors)” on
6 x 6, 12 x 12, 18 x 18, 24 x 24, 30 x 30, 36 x 36, 42 x 42, 60 x 60, 80 x 80, page 54
100 x 100 [mm²]
A sample matrix is provided on page 90. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• MLC field: 100 x 100 mm² “Diagonal Radi-
• Jaw field: 98 x 98 mm² al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

88 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 98 x 98 [mm²] “Transversal
• MLC fields (see page 91) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “M3_1.d01”, “Dynamic Leaf
“M3_5.d01”, … , “M3_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 89

Beam Data for Novalis

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field
8x8 14 x14 20 x 20 44 x44 60 x 60 80 x 80 98 x 98
Sizes
[mm²]
6x6 0.601 0.605 0.606 0.607 0.608 0.608 0.609
12 x 12 0.605 0.746 0.759 0.765 0.766 0.766 0.768
18 x 18 0.605 0.756 0.796 0.814 0.815 0.815 0.817
24 x 24 0.605 0.756 0.810 0.838 0.840 0.841 0.842
30 x 30 0.605 0.756 0.810 0.858 0.860 0.860 0.862
36 x 36 0.605 0.756 0.810 0.876 0.878 0.880 0.880
42 x 42 0.605 0.756 0.810 0.880 0.894 0.896 0.897
60 x 60 0.605 0.756 0.810 0.888 0.931 0.936 0.937
80 x 80 0.605 0.756 0.810 0.888 0.931 0.969 0.972
100 x 1
0.605 0.756 0.810 0.888 0.931 0.969 1.000
00
Table 5: Novalis: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

90 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 16Novalis: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 2-4, 7-20, 24-25
IEC 1217 leaf position -40 mm and +40 mm -50 mm

References For further examples of the dosimetric characteristics of Novalis, refer to Yin et al, 2002
(see the general references provided on page 271).

Technical Reference Guide Rev. 1.2 Brainlab Physics 91

Beam Data for Novalis Tx (SRS)

Beam Data for Novalis Tx (SRS)

Checklist (Excel template Brainlab FORM 09-625)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
5 x 5 (8 x 8), 10 x 10 (12 x 12), 20 x 20 (22 x 22), 30 x 30 (32 x 32), 40 x 40 Profile” on
(42 x 42), 60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (100 x 100), page 51
120 x 120 (120 x 120), 150 x 150 (150 x 150) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
8 x 8, 12 x 12, 22 x 22, 32 x 32, 42 x 42, 60 x 60, 80 x 80, 100 x 100,
120 x 120, 150 x 150 [mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
5 x 5, 10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, page 54
120 x 120, 150 x 150 [mm²]
A sample matrix is provided on page 94. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaw field: 150 x 150 [mm²] “Diagonal Radi-
• MLC leaves parked, field size 150x150 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

92 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 95) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“NTx_1.d01”, “NTx_5.d01”, … , “NTx_100.d01”. Shift Measure-
• In each case: deliver 1000 MU at a dose rate of 1000 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 93

Beam Data for Novalis Tx (SRS)

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field 12 x1 22 x 2 32 x3 42 x 4 60 x 6 80 x 8 100 x 120 x 150 x
8x8
Sizes 2 2 2 2 0 0 100 120 150
[mm²]
5x5 0.638 0.682 0.685 0.686 0.687 0.688 0.689 0.692 0.692 0.694
10 x 10 0.647 0.807 0.818 0.819 0.819 0.820 0.826 0.824 0.826 0.828
20 x 20 0.647 0.815 0.876 0.881 0.891 0.892 0.894 0.894 0.895 0.899
30 x 30 0.647 0.815 0.883 0.892 0.913 0.923 0.924 0.927 0.926 0.929
40 x 40 0.647 0.815 0.883 0.907 0.927 0.939 0.946 0.949 0.949 0.954
60 x 60 0.647 0.815 0.883 0.907 0.935 0.959 0.972 0.974 0.977 0.979
80 x 80 0.647 0.815 0.883 0.907 0.935 0.959 0.982 0.989 0.992 0.996
100 x 1
0.647 0.815 0.883 0.907 0.935 0.959 0.982 1.000 1.007 1.009
00
120 x 1
0.647 0.815 0.883 0.907 0.935 0.959 0.982 1.000 1.018 1.027
20
150 x 1
0.647 0.815 0.883 0.907 0.935 0.959 0.982 1.000 1.018 1.045
50
Table 6: Novalis Tx (SRS): Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

94 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 17Novalis Tx (SRS): MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 13-14, 23-38, 43-52
IEC 1217 leaf position -35 mm and +65 mm -75 mm

References For further examples of the dosimetric characteristics of Novalis Tx, refer to Chang et al,
2008 (see the general references provided on page 271).

Technical Reference Guide Rev. 1.2 Brainlab Physics 95

Beam Data for Novalis Tx (Standard Irradiation Mode)

Beam Data for Novalis Tx (Standard Irradiation Mode)

Checklist (Excel template Brainlab FORM 09-626)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
5 x 5 (8 x 8), 10 x 10 (12 x 12), 20 x 20 (22 x 22), 30 x 30 (32 x 32), 40 x 40 Profile” on
(42 x 42), 60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (100 x 100), page 51
140 x 140 (140 x 140), 220 x 220 (220 x 220), 300 x 220 (300 x 220) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
8 x 8, 12 x 12, 22 x 22, 32 x 32, 42 x 42, 60 x 60, 80 x 80, 100 x 100,
140 x 140, 220 x 220, 300 x 220 [mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
5 x 5, 10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, page 54
140 x 140, 220 x 220, 300 x 220 [mm²]
A sample matrix is provided on page 98. Following measurement completion,
import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaw field: 400 x 400 [mm²] “Diagonal Radi-
• MLC leaves parked, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

96 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 99) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“NTx_1.d01”, “NTx_5.d01”, … , “NTx_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 97

Beam Data for Novalis Tx (Standard Irradiation Mode)

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC 300 x
Field 12 x 22 x 32 x 42 x 60 x 80 x 100 x 140 x 220 x 220
8x8
Sizes 12 22 32 42 60 80 100 140 220 (254 x 254
[mm²] )

0.63 0.66 0.67 0.67 0.67 0.67 0.67 0 .679 0 .6 80 0 .6 87 0 .6 86

5x5
56 73 26 29 39 58 68 1 4 0 0
0.66 0.76 0.77 0.77 0.77 0.78 0.78 0 .783 0 .7 85 0 .7 92 0 .7 93
10 x 10
08 49 54 70 87 00 19 2 2 4 1
0.66 0.77 0.83 0.84 0.85 0.85 0.85 0 .857 0 .8 61 0 .8 67 0 .8 69
20 x 20
08 47 37 12 07 46 72 9 2 7 0
0.66 0.77 0.83 0.85 0.87 0.89 0.89 0 .897 0 .9 01 0 .9 07 0 .9 09
30 x 30
08 47 89 83 82 19 59 8 1 7 0
0.66 0.77 0.83 0.86 0.89 0.91 0.92 0 .927 0 .9 30 0 .9 37 0 .9 38
40 x 40
08 47 89 89 39 22 34 3 6 1 4
0.66 0.77 0.83 0.86 0.89 0.93 0.95 0 .964 0 .9 72 0 .9 79 0 .9 82
60 x 60
08 47 89 89 59 71 42 0 5 7 3
0.66 0.77 0.83 0.86 0.89 0.93 0.97 0 .985 0 .9 98 1 .0 07 1 .0 10
80 x 80
08 47 89 89 59 71 18 6 7 9 5
100 x 1 0.66 0.77 0.83 0.86 0.89 0.93 0.97 1 .000 1 .0 19 1 .0 29 1 .0 31
00 08 47 89 89 59 71 18 0 0 5 4
140 x 1 0.66 0.77 0.83 0.86 0.89 0.93 0.97 1 .000 1 .0 45 1 .0 65 1 .0 65
40 08 47 89 89 59 71 18 0 2 5 5
220 x 2 0.66 0.77 0.83 0.86 0.89 0.93 0.97 1 .000 1 .0 45 1 .1 05 1 .1 13
20 08 47 89 89 59 71 18 0 2 4 3
300 x 2
20 0.66 0.77 0.83 0.86 0.89 0.93 0.97 1 .000 1 .0 45 1 .1 05 1 .1 24
(254 x 08 47 89 89 59 71 18 0 2 4 4
254)
Table 7: Novalis Tx (Standard Irradiation Mode): Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

98 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

• For the scatter factors measured for a rectangular field size of 300 x 220 mm², the
equivalent square field size of 254 mm must be used in the Beam Profile Editor/Phys-
ics Administration.

Transversal Profile
Shape

Figure 18Novalis Tx (Standard Irradiation Mode):

MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 13-14, 23-38, 43-52
IEC 1217 leaf position -35 mm and +65 mm -75 mm

References For further examples of the dosimetric characteristics of Novalis Tx, refer to Chang et al,
2008 (see the general references provided on page 271).

Technical Reference Guide Rev. 1.2 Brainlab Physics 99

Beam Data for Siemens 3-D (58 and 82 Leaves)

Beam Data for Siemens 3-D (58 and 82 Leaves)

Checklist (Excel template Brainlab FORM 09-628)

Measurement See also Done

Linac calibration (NLOut) using the calibrated chamber: “Nominal Linac

Output Mea-
• Y jaw opening: 100 mm surement” on
• MLC field: 100 x 110 mm² page 46
Background leakage for open and closed jaws using the calibrated chamber:
• Enter NLOut into the Excel template
• Enter leakage values into the Excel template “Background
• Enter SSD and the normalization depth into the Excel template Leakage” on
Open field: page 49

• Y jaw opening: 100 mm

• MLC field (crossplane x in-plane): 100 x 110 mm²
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (Y jaw) fields “Depth Dose
10 x 10 (12), 30 x 30 (32), 50 x 50 (50), 70 x 70 (70), 90 x 90 (90), 130 x 130 Profile” on
(130), 190 x 190 (190), 270 x 270 (270), 400 x 400 (400) [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Y jaw openings
12, 32, 50, 70, 90, 130, 190, 270, 400 [mm] “Scatter Fac-
• MLC fields tors (Output
Factors)” on
10 x 10, 30 x 30, 50 x 50, 70 x 70, 90 x 90, 130 x 130, 190 x 190, 270 x 270, page 54
400 x 400 [mm²]
A sample matrix is provided on page 102. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaws retracted, Y opening 400 mm “Diagonal Radi-
• MLC leaves retracted, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

100 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Y jaw openings
“Transversal
Y1 jaw at -57 mm, Y2 jaw at 77 mm (2 mm margin to open MLC field)
Profiles” on
• MLC fields (see page 103) page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 101

Beam Data for Siemens 3-D (58 and 82 Leaves)

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Y Jaw Field Size Settings [mm]

MLC
Field
12 32 50 70 90 130 190 270 400
Sizes
[mm²]
10x10 0.6760 0.6790 0.6810 0.6800 0.6810 0.6840 0.6860 0.6920 0.6920
30x30 0.6905 0.7800 0.7870 0.7870 0.7880 0.7920 0.7930 0.8010 0.8010
50x50 0.6905 0.7830 0.8230 0.8260 0.8270 0.8310 0.8330 0.8420 0.8420
70x70 0.6905 0.7830 0.8230 0.8490 0.8530 0.8560 0.8580 0.8660 0.8660
90x90 0.6905 0.7830 0.8230 0.8490 0.8800 0.8880 0.8930 0.8980 0.8980
130x13
0.6905 0.7830 0.8230 0.8490 0.8800 0.9200 0.9250 0.9320 0.9320
0
190x19
0.6905 0.7830 0.8230 0.8490 0.8800 0.9200 0.9410 0.9520 0.9600
0
270x27
0.6905 0.7830 0.8230 0.8490 0.8800 0.9200 0.9410 0.9770 0.9820
0
400x40
0.6905 0.7830 0.8230 0.8490 0.8800 0.9200 0.9410 0.9770 1.0050
0
Table 8: Siemens 3-D (58 and 82 Leaves): Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

102 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 19Siemens 3-D (58 and 82 Leaves): MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves for 3-D MLC 58:

Leaf #: 10, 13-17, 19-22
Closed Leaves:
Open Leaves for 3-D MLC 82:
Leaf #: 16, 19-23, 25-28
IEC 1217 leaf position -25 mm and +95 mm -25 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 103

Beam Data for Siemens 160

Beam Data for Siemens 160

Checklist (Excel template Brainlab FORM 09-627)

Measurement See also Done

Linac calibration (NLOut) using the calibrated chamber. “Nominal Linac

Output Mea-
• Y jaw opening: 100 mm surement” on
• MLC field: 100 x 100 mm² page 46
Background leakage for open and closed Y jaw using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (Y jaw) fields
“Depth Dose
10 x 10 (12), 20 x 20 (22), 30 x 30 (32), 40 x 40 (42), 60 x 60 (60), 80 x 80 Profile” on
(80), 100 x 100 (100), 140 x 140 (140), 200 x 200 (200), 300 x 300 (300), page 51
400 x 400 (400) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Y jaw openings
12, 22, 32, 42, 60, 80, 100, 140, 200, 300, 400 [mm] “Scatter Fac-
• MLC fields tors (Output
Factors)” on
10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, page 54
200 x 200, 300 x 300, 400 x 400 [mm²]
A sample matrix is provided on page 106. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Y jaw opening: 400 [mm] “Diagonal Radi-
• MLC leaves retracted, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

104 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Y jaw openings
“Transversal
Y1 jaw at -72 mm, Y2 jaw at 52 mm (2 mm margin to open MLC field)
Profiles” on
• MLC fields (see page 107) page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 105

Beam Data for Siemens 160

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Y Jaw Field Size Settings [mm]

MLC
Field
12 22 32 42 60 80 100 140 200 300 400
Sizes
[mm²]
10 x 1 0.764 0.775 0.777 0.778 0.780 0.781 0.783 0.785 0.792 0.793 0.793
0 9 4 0 7 0 9 2 2 4 1 1
20 x 2 0.774 0.833 0.841 0.850 0.854 0.857 0.857 0.861 0.867 0.869 0.869
0 7 7 2 7 6 2 9 2 7 0 0
30 x 3 0.774 0.838 0.858 0.878 0.891 0.895 0.897 0.901 0.907 0.909 0.909
0 7 9 3 2 9 9 8 1 7 0 0
40 x 4 0.774 0.838 0.868 0.893 0.912 0.923 0.927 0.930 0.937 0.938 0.938
0 7 9 9 9 2 4 3 6 1 4 4
60 x 6 0.774 0.838 0.868 0.895 0.937 0.954 0.964 0.972 0.979 0.982 0.982
0 7 9 9 9 1 2 0 5 7 3 3
80 x 8 0.774 0.838 0.868 0.895 0.937 0.971 0.985 0.998 1.007 1.010 1.010
0 7 9 9 9 1 8 6 7 9 5 5
100 x 0.774 0.838 0.868 0.895 0.937 0.971 1.000 1.019 1.029 1.031 1.031
100 7 9 9 9 1 8 0 0 5 4 4
140 x 0.774 0.838 0.868 0.895 0.937 0.971 1.000 1.045 1.065 1.065 1.065
140 7 9 9 9 1 8 0 2 5 5 5
200 x 0.774 0.838 0.868 0.895 0.937 0.971 1.000 1.045 1.105 1.113 1.113
200 7 9 9 9 1 8 0 2 4 3 3
300 x 0.774 0.838 0.868 0.895 0.937 0.971 1.000 1.045 1.105 1.124 1.124
300 7 9 9 9 1 8 0 2 4 4 4
400 x 0.774 0.838 0.868 0.895 0.937 0.971 1.000 1.045 1.105 1.124 1.124
400 7 9 9 9 1 8 0 2 4 4 4
Table 9: Siemens 160 MLC: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

106 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 20Siemens 160 MLC: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 27-34, 37-44, 49-50
IEC 1217 leaf position -75 mm and +25 mm -175 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 107

Beam Data for Siemens ModuLeaf

Beam Data for Siemens ModuLeaf

Checklist (Excel template Brainlab FORM 09-629)

The jaw and MLC field size specifications in the table below are based on an iso-
centric leaf width of 2.5 mm. This is an approximation for the ModuLeaf
mounted at a Siemens Linac with a SCD of 678.6 mm or an Elekta Linac with a
SCD of 673.6 mm. For installations with a SCD outside this range the field sizes
need to be adapted accordingly.

Measurement See also Done

Obtain the source collimator distance (SCD) from the MLC system and enter
the value into the Excel template.
“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields (crossplane x in-plane)
5 x 5 (8 x 8), 10 x 10 (12 x 12), 15 x 15 (18 x 18), 20 x 20 (22 x 22), “Depth Dose
30 x 30 (32 x 32), 40 x 40 (42 x 42), 60 x 60, 80 x 80, 100 x 100, Profile” on
120 x 100 [mm²] page 51

Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab. Always use equivalent square field sizes
(i.e. 120 x 100 mm² Q 109 mm).

108 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Scatter factors using the small chamber and high-resolution detector:
• Jaw fields (crossplane x in-plane)
8 x 8, 12 x 12, 22 x 22, 42 x 42, 60 x 60, 80 x 80, 100 x 100, 120 x 100 [mm²]
“Scatter Fac-
• MLC fields (crossplane x in-plane) tors (Output
5 x 5, 10 x 10, 15 x 15, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, Factors)” on
120 x 100 [mm²] page 54

A sample matrix is provided on page 110. Following measurement comple-

tion, import the scatter factors into the Excel template provided by Brainlab.
Always use equivalent square field sizes (i.e. 120 x 100 mm² Q 109 mm).
Diagonal radial profiles using the small chamber:
• MLC detached “Diagonal Radi-
• Jaws retracted al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.
Transversal profiles using the high-resolution detector:
• Jaw field (crossplane x in-plane): 100 x 100 mm² “Transversal
• MLC fields (see page 111) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 109

Beam Data for Siemens ModuLeaf

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
120 x
Field 100x1
8x8 12x12 22x22 42x42 60x60 80x80 100
Sizes 00
(109²)
[mm²]
5x5 0.423 0.468 0.470 0.471 0.472 0.474 0.474 0.475
10 x 1
0.451 0.723 0.737 0.738 0.737 0.744 0.745 0.744
0
15 x 1
0.451 0.743 0.815 0.828 0.830 0.831 0.832 0.832
5
20 x 2
0.451 0.743 0.848 0.867 0.874 0.875 0.876 0.876
0
30 x 3
0.451 0.743 0.868 0.897 0.910 0.917 0.920 0.920
0
40 x 4
0.451 0.743 0.868 0.912 0.927 0.937 0.943 0.945
0
60 x 6
0.451 0.743 0.868 0.919 0.950 0.963 0.971 0.973
0
80 x 8
0.451 0.743 0.868 0.919 0.950 0.979 0.990 0.993
0
100 x
0.451 0.743 0.868 0.919 0.950 0.979 1.000 1.007
100
120 x
100 0.451 0.743 0.868 0.919 0.950 0.979 1.000 1.009
(109²)
Table 10: Siemens ModuLeaf: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

110 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 21Siemens ModuLeaf: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves: Closed Leaves:

Leaf #: 7-12, 15-26, 33-34 (5 mm Leaf Gap)

IEC 1217 leaf position -40 mm and +40 mm -60 mm and -55 mm

Important Notes • All field sizes specified in this document refer to the standard mounting distance of the
ModuLeaf MLC for all Siemens linacs, which is SCD = 678.6 mm (measured between
the source and the lower end of the collimator). Please check whether your installed
MLC uses this SCD. If the SCD used deviates more than 1% from 678.6 mm, please
contact Brainlab for further advice, as the setup field sizes need to be adapted accord-
ingly.
• Make sure that the jaw aperture never exceeds 120 x 100 mm² while the MLC is
mounted.

Technical Reference Guide Rev. 1.2 Brainlab Physics 111

Beam Data for Varian 52

Beam Data for Varian 52

Checklist (Excel template Brainlab FORM 09-630)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
20 x 20 (22 x 22), 40 x 40 (42 x 42), 60 x 60 (60 x 60), 80 x 80 (80 x 80), Profile” on
100 x 100 (100 x 100), 140 x 140 (140 x 140), 200 x 200 (200 x 200), page 51
290 x 256 (290 x 256) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
22 x 22, 42 x 42, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, 290 x 256
[mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
20 x 20, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, 290 x 256 page 54
[mm²]
A sample matrix is provided on page 114. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaw field: 400 x 400 [mm²] “Diagonal Radi-
• MLC leaves retracted, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

112 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 115) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“V52_1.d01”, “V52_5.d01”, … , “V52_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 113

Beam Data for Varian 52

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC 290 x 25
Field 100 x 10 140 x 14 200 x 20 6
22 x 22 42 x 42 60 x 60 80 x 80
Sizes 0 0 0 (272 x 2
[mm²] 72)
20 x 20 0.7825 0.7865 0.7870 0.7880 0.7920 0.7930 0.8010 0.8010
40 x 40 0.7830 0.8310 0.8490 0.8530 0.8560 0.8580 0.8660 0.8660
60 x 60 0.7830 0.8400 0.8710 0.8800 0.8880 0.8930 0.8980 0.8980
80 x 80 0.7830 0.8400 0.8710 0.8940 0.9080 0.9130 0.9190 0.9190
100 x 1
0.7830 0.8400 0.8710 0.8940 0.9200 0.9250 0.9320 0.9320
00
140 x1
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9520 0.9600
40
200 x 2
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 0.9820
00
290 x 2
56
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 1.0050
(272 x
272)
Table 11: Varian 52: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).
• For the scatter factors measured for a rectangular field size of 290 x 256 mm², the
equivalent square field size of 272 mm must be used in the Beam Profile Editor/Phys-
ics Administration.

114 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 22Varian 52: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 9, 12-15, 17-20
IEC 1217 leaf position -35 mm and +65 mm -50 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 115

Beam Data for Varian 80

Beam Data for Varian 80

Checklist (Excel template Brainlab FORM 09-631)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
20 x 20 (22 x 22), 40 x 40 (42 x 42), 60 x 60 (60 x 60), 80 x 80 (80 x 80), Profile” on
100 x 100 (100 x 100), 140 x 140 (140 x 140), 200 x 200 (200 x 200), page 51
290 x 300 (290 x 300) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
22 x 22, 42 x 42, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, 290 x 300
[mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
20 x 20, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200, 290 x 300 page 54
[mm²]
A sample matrix is provided on page 118. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaw field: 400 x 400 [mm²] “Diagonal Radi-
• MLC leaves retracted, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

116 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 119) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“V80_1.d01”, “V80_5.d01”, … , “V80_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 117

Beam Data for Varian 80

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC 290 x 30
Field 100 x 10 140 x 14 200 x 20 0
22 x 22 42 x 42 60 x 60 80 x 80
Sizes 0 0 0 (295 x 2
[mm²] 95)
20 x 20 0.7825 0.7865 0.7870 0.7880 0.7920 0.7930 0.8010 0.8010
40 x 40 0.7830 0.8310 0.8490 0.8530 0.8560 0.8580 0.8660 0.8660
60 x 60 0.7830 0.8400 0.8710 0.8800 0.8880 0.8930 0.8980 0.8980
80 x 80 0.7830 0.8400 0.8710 0.8940 0.9080 0.9130 0.9190 0.9190
100 x 1
0.7830 0.8400 0.8710 0.8940 0.9200 0.9250 0.9320 0.9320
00
140 x1
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9520 0.9600
40
200 x 2
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 0.9820
00
290 x 3
00
0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 1.0050
(295 x
295)
Table 12: Varian 80: Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).
• For the scatter factors measured for a rectangular field size of 290 x 300 mm², the
equivalent square field size of 295 mm must be used in the Beam Profile Editor/Phys-
ics Administration.

118 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 23Varian 80: MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 16, 19-22, 24-27
IEC 1217 leaf position -35 mm and +65 mm -50 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 119

Beam Data for Varian 120 (SRS)

Beam Data for Varian 120 (SRS)

Checklist (Excel template Brainlab FORM 09-632)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
10 x 10 (12 x 12), 20 x 20 (22 x 22), 30 x 30 (32 x 32), 40 x 40 (42 x 42), Profile” on
60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (100 x 100), 120 x 120 page 51
(120 x 120), 150 x 150 (150 x 150) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
12 x 12, 22 x 22, 32 x 32, 42 x 42, 60 x 60, 80 x 80, 100 x 100, 120 x 120,
150 x 150 [mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 120 x 120, page 54
150 x 150 [mm²]
A sample matrix is provided on page 122. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• Jaw field: 150 x 150 [mm²] “Diagonal Radi-
• MLC leaves parked, field size 150 x 150 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

120 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 123) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“V120_1.d01”, “V120_5.d01”, … , “V120_100.d01”. Shift Measure-
• In each case: deliver 1000 MU at a dose rate of 1000 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 121

Beam Data for Varian 120 (SRS)

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field 100x10 120x12 150x15
12x12 22x22 32x32 42x42 60x60 80x80
Sizes 0 0 0
[mm²]
10 x 1
0.800 0.818 0.819 0.819 0.820 0.826 0.824 0.826 0.828
0
20 x 2
0.807 0.869 0.881 0.891 0.892 0.894 0.894 0.895 0.899
0
30 x 3
0.807 0.876 0.892 0.913 0.923 0.924 0.927 0.926 0.929
0
40 x 4
0.807 0.876 0.907 0.927 0.939 0.946 0.949 0.949 0.954
0
60 x 6
0.807 0.876 0.907 0.938 0.959 0.972 0.974 0.977 0.979
0
80 x 8
0.807 0.876 0.907 0.938 0.959 0.982 0.989 0.992 0.996
0
100 x
0.807 0.876 0.907 0.938 0.959 0.982 1.000 1.007 1.009
100
120 x
0.807 0.876 0.907 0.938 0.959 0.982 1.000 1.018 1.027
120
150 x
0.807 0.876 0.907 0.938 0.959 0.982 1.000 1.018 1.045
150
Table 13: Varian 120 (SRS): Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

122 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 24Varian 120 (SRS): MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 21-22, 27-34, 37-44
IEC 1217 leaf position -35 mm and +65 mm -50 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 123

Beam Data for Varian 120 (Standard Irradiation Mode)

Beam Data for Varian 120 (Standard Irradiation Mode)

Checklist (Excel template Brainlab FORM 09-633)

Measurement See also Done

“Nominal Linac
Output Mea-
Linac calibration (NLOut) using the calibrated chamber.
surement” on
page 46
Background leakage for open and closed jaws using the calibrated chamber:
“Background
• Enter NLOut into the Excel template
Leakage” on
• Enter leakage values into the Excel template page 49
• Enter SSD and the normalization depth into the Excel template
Depth dose profile (PDD/TMR) using the ionization chamber and high-resolu-
tion detector:
• MLC (jaw) fields
“Depth Dose
10 x 10 (12 x 12), 20 x 20 (22 x 22), 30 x 30 (32 x 32), 40 x 40 (42 x 42), Profile” on
60 x 60 (60 x 60), 80 x 80 (80 x 80), 100 x 100 (100 x 100), 140 x 140 page 51
(140 x 140), 200 x 200 (200 x 200), 300 x 300 (300 x 300) [mm²]
Following measurement completion, import the TMR or PDD values into the
Excel template provided by Brainlab.
Scatter factors using the small chamber and high-resolution detector:
• Jaw fields
12 x 12, 22 x 22, 42 x 42, 60 x 60, 80 x 80, 100 x 100, 140 x 140, 200 x 200,
300 x 300 [mm²] “Scatter Fac-
tors (Output
• MLC fields Factors)” on
10 x 10, 20 x 20, 30 x 30, 40 x 40, 60 x 60, 80 x 80, 100 x 100, 140 x 140, page 54
200 x 200, 300 x 300 [mm²]
A sample matrix is provided on page 126. Following measurement comple-
tion, import the scatter factors into the Excel template provided by Brainlab.
Diagonal radial profiles using the small chamber:
• MLC leaves retracted, field size 400 x 400 mm2 “Diagonal Radi-
• Jaws retracted, field size 400 x 400 mm2 al Profiles” on
page 56
Following measurement completion, import the diagonal radial profiles into
the Excel template provided by Brainlab.

124 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Measurement See also Done

Transversal profiles using the high-resolution detector:
• Jaw field: 150 x 150 [mm²] “Transversal
• MLC fields (see page 127) Profiles” on
page 59
Following measurement completion, import the transversal profiles into the
Excel template provided by Brainlab.
Dynamic leaf shift (dynamic IMRT only) using the calibrated detector:
• For the irradiation of the dynamic leaf gaps, use the MLC files: “Dynamic Leaf
“V120_1.d01”, “V120_5.d01”, … , “V120_100.d01”. Shift Measure-
• In each case: deliver 300 MU at a dose rate of 300 MU/min. ments” on
page 64
Calculate the dynamic leaf shift using the Excel template provided by Brain-
lab.
Forward the completed measurement data (Excel template) either directly to
Brainlab headquarters ([email protected]) or to your local support
engineer.
Prepare the required beam profile using the Beam Profile Editor/Physics Ad-
ministration (Machine Profile mode).

Technical Reference Guide Rev. 1.2 Brainlab Physics 125

Beam Data for Varian 120 (Standard Irradiation Mode)

Additional Information

Sample Matrix

The data measured for your linac may differ. Do not use this example clinically.

Jaw Settings [mm]

MLC
Field 100 x 1 140 x 1 200 x 2 300 x 3
12 x 12 22 x 22 42 x 42 60 x 60 80 x 80
Sizes 00 40 00 00
[mm²]
10 x 1
0.6730 0.6790 0.6810 0.6800 0.6810 0.6840 0.6860 0.6920 0.6920
0
20 x 2
0.6760 0.7820 0.7870 0.7870 0.7880 0.7920 0.7930 0.8010 0.8010
0
30 x 3
0.6760 0.7830 0.8230 0.8260 0.8270 0.8310 0.8330 0.8420 0.8420
0
40 x 4
0.6760 0.7830 0.8350 0.8490 0.8530 0.8560 0.8580 0.8660 0.8660
0
60 x 6
0.6760 0.7830 0.8400 0.8710 0.8800 0.8880 0.8930 0.8980 0.8980
0
80 x 8
0.6760 0.7830 0.8400 0.8710 0.8940 0.9080 0.9130 0.9190 0.9190
0
100 x
0.6760 0.7830 0.8400 0.8710 0.8940 0.9200 0.9250 0.9320 0.9320
100
140 x
0.6760 0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9520 0.9600
140
200 x
0.6760 0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 0.9820
200
300 x
0.6760 0.7830 0.8400 0.8710 0.8940 0.9200 0.9410 0.9770 1.0050
300
Table 14: Varian 120 (Standard Irradiation Mode): Possible Measured Scatter Factors (Examples Only)
• The gray fields must be measured in all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• Blank fields are not permitted (see “Scatter Factors (Output Factors)” on page 54).

126 Technical Reference Guide Rev. 1.2 Brainlab Physics

Pencil Beam: Beam Data Checklists

Transversal Profile
Shape

Figure 25Varian 120 (Standard Irradiation Mode):

MLC Field Setup for Profile Measurements (X and Y Direction)

Open Leaves:
Closed Leaves
Leaf #: 21-22, 27-34, 37-44
IEC 1217 leaf position -35 mm and +65 mm -50 mm

Technical Reference Guide Rev. 1.2 Brainlab Physics 127

Beam Data for Varian 120 (Standard Irradiation Mode)

128 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

Monte Carlo: Algorithm

General Information

Contents

Topics Covered
Section See
Monte Carlo Algorithm Page 130

Technical Reference Guide Rev. 1.2 Brainlab Physics 129

Monte Carlo Algorithm

Monte Carlo Algorithm

Introduction

General Overview The description that follows shall provide an overview of the physical features behind the
iPlan RT Dose Monte Carlo (MC) algorithm. The intention is to allow the user to work with
the software, to understand the behavior of the MC algorithm and to understand the meaning
of the MC user options. For more detailed information about the MC techniques in general
and XVMC in particular, we will refer to the publications listed under “Monte Carlo” on
page 275.
New cancer treatment techniques such as IGRT and IMRT allow more precise dose deposi-
tion in the target volume and an improved control of the normal tissue complications. An
accurate dose calculation is essential to assure the quality of the improved techniques. Con-
ventional dose calculation methods, such as the pencil beam algorithm, are of high quality
in regions with homogeneous tissue, e.g. within the brain. However, for treatments in the
head-and-neck or in the thorax regions, i.e. in regions consisting of bone, soft tissue and air
cavities, an improved accuracy is required. For example, the pencil beam algorithm is
known to overestimate the dose in the target volume for the treatment of small lung tumors.
This is because, the pencil beam algorithm calculates dose by scaling pencil beam dose dis-
tribution kernels in water to take the tissue heterogeneities into account, but this method has
accuracy limitations in these regions. MC dose calculation algorithms, on the other hand,
provide more accurate results, especially in heterogeneous regions.

Usage of Monte In radiotherapy, MC techniques are applied to solve the transport problem of ionizing radi-
Carlo in ation within the human body. Here the radiation is decomposed into single quantum parti-
Radiotherapy cles (photons, electrons, positrons). The motion of these particles through the irradiation
device and the human tissue is simulated by taking into account the material properties of
the different components of the linac head and the tissue properties in each volume element
(voxel). The photons, electrons and positrons interact with the electrons of the atomic shells
and the electromagnetic field of the atomic nuclei. This can cause ionization events. The
corresponding interaction properties are based on the laws of quantum physics. For the linac
head these properties can be calculated using the known atomic composition of the different
components; for the patient they can be calculated based on the CT images and the Houn-
sfield Unit in each voxel. The interaction properties are given as total and differential cross
sections. Total cross sections characterize the interaction probabilities of a particle with a
given energy in a medium with a definite atomic composition. Differential cross sections
characterize the probability distribution functions for the generation of secondary particles
with definite secondary particle parameters, such as energy and scattering angle. The ran-
dom numbers in a MC simulation are required to sample the specific parameters from these
probability distribution functions.
For a more thorough introduction into all issues associated with clinical implementation of
Monte Carlo-based external beam treatment planning, we refer to the review by Reynaert et
al (2007), or the AAPM Task Group Report No 105 (2007).

130 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

Brainlab Monte Carlo Algorithm

Background The iPlan RT Dose Monte Carlo algorithm is based on the X-ray Voxel Monte Carlo algo-
rithm developed by Iwan Kawrakow and Matthias Fippel (Kawrakow et al 1996, Fippel et
al 1997, Fippel 1999, Fippel et al 1999, Kawrakow and Fippel 2000, Fippel et al 2003, Fip-
pel 2004).

Brainlab Monte
Carlo Algorithm

Figure 26The Three Components of the Brainlab MC Algorithm

The Brainlab MC algorithm consists of three main components (see Figure 26). The first
component is used as the particle source. It models the upper part of the linac head (target,
primary collimator, flattening filter) and generates photons as well as contaminant electrons
from the corresponding distribution. The particles are then transferred to the second compo-
nent, the model of the collimating system. Depending on the field configuration, the parti-
cles are absorbed, scattered or passed through the collimator system without interaction. The
surviving particles are transferred to the patient dose computation engine. In this third com-
ponent, the radiation transport through the patient geometry is simulated and the dose dis-
tribution is computed. In the following sections, the three components of the Brainlab MC
algorithm are characterized in further detail.

Technical Reference Guide Rev. 1.2 Brainlab Physics 131

Monte Carlo Algorithm

The Virtual Energy Fluence Model (VEFM)

Background The geometry of the target, the flattening filter and the primary collimator do not change
when the field shape is changed. Therefore, it can be assumed that the phase space of pho-
tons and charged particles above the jaws and the multileaf collimators (MLC) is indepen-
dent of the field configuration. To model this phase space, a Virtual Energy Fluence Model
(VEFM) is employed. With some extensions this model is based on the work by Fippel et
al (2003).

Geometry The VEFM consists of two or three photon sources with two-dimensional Gaussian shapes
Parameters and one charged particle (electron) contamination source. The photon sources model
Bremsstrahlung photons created in the target and Compton photons scattered by the primary
collimator and flattening filter materials. For the photon sources various parameters are re-
quired. For example, the distances of the sources to the nominal beam focus is either esti-
mated or taken from the technical information provided by linac vendor. The Gaussian
widths (standard deviations) as well as the relative weights of the photon sources are fitted
using measured dose distributions in air. Additional horn correction parameters are also fit-
ted from these measurements. They model deviations of the beam profile from an ideal flat
profile.

Energy Parameters The VEFM also requires information about the photon energy spectrum as well as the flu-
ence of charged particle contamination at the patient’s surface.
This information is derived from a measured depth dose curve D meas(z) in water for the ref-
erence field size (field size used for the dose – monitor unit calibration).
The curve D meas(z) is used to minimize the squared difference to a calculated depth dose
curve D calc(z) . Based on the model assumptions, D calc(z) is given by:
E max

D calc(z) = w γ ∫ p(E)D mono(E, z) dE + w e D e(z)

E min

The set of mono-energetic depth dose curves Dmono(E, z) in water can be calculated using
the whole MC system and the geometric beam model parameters derived after fitting the
measured profiles in air.

132 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

Energy Parameter The set must be calculated for a table of energies reaching from the minimum energy of the
Range spectrum E min up to an energy that is a little larger than the maximum energy E max . This
allows us to also use E max as a fitting parameter. In contrast to the original paper (Fippel et
al 2003), we model the energy spectrum p(E) by:

p(E) = N ( 1 – exp ( – lE ) ) exp ( – bE ) E min ≤ E ≤ Emax

This function is comparable to spectra calculated using EGSnrc (Kawrakow 2000) and
BEAM (Rogers et al 1995), especially in the low energy region.
The free parameters l,b and the normalization factor N have to be fitted. For E min and E max
we usually take fixed values, but it is also possible to adjust them, because sometimes the
maximum energy of the spectrum can be different from the nominal photon energy setting
in MV. The parameter w γ is the total weight of all photon sources. It is calculated by
w γ = 1 – w e with w e being the weight of the electron contamination source. The parameter
w e is also fitted using the measured depth dose in water and the formula on D calc(z).

It requires the depth dose MC computation of a pure electron contamination source in water
D e(z) .

Because most of the electrons originate in the flattening filter, the location of the electron
source is assumed to be the foot plane of the filter. The energy spectrum of the electrons is
estimated by an exponential distribution as described by Fippel et al (2003).

Monte Carlo and During the commissioning procedure all parameters (fixed and fitted) are written into a dose
Pencil Beam profile file. This file is then linked to the machine profile of the corresponding linac. It is
also linked to the dose profile for the pencil beam algorithm. This means the MC dose cal-
culation algorithm cannot be used without the pencil beam algorithm. This is a restriction,
but it has been implemented into the iPlan RT Dose treatment planning software because of
three main advantages:
• It allows the user to cross check the results using two almost independent dose calcula-
tions.
• It provides a smooth transition from clinical experience (protocols) based on pencil
beam dose calculations to a more accurate experience based on Monte Carlo dose cal-
culations.
• The faster pencil beam algorithm can be used for the intermediate planning process.
Later the user can switch to Monte Carlo to fine tune the treatment plan.
Therefore commissioning of the MC dose calculation algorithm requires commissioning of
the pencil beam algorithm.
Before using the MC dose profile clinically, it has to be validated against measured dose dis-
tributions and output (scatter) factors in a homogeneous water phantom. We refer to the
Monte Carlo base data measurement instructions for more information on this data.

Technical Reference Guide Rev. 1.2 Brainlab Physics 133

Monte Carlo Algorithm

Modeling of the Collimating System

Jaws The components of the collimating system (jaws and MLC) are modeled in different ways.
The rectangle given by the positions of both jaw pairs are used to define the sampling space
of the initial particles. That means only photons and electrons are generated going through
the jaw opening. In other words, the MC algorithm assumes fully blocking jaws. The error
of this assumption is estimated to be below 0.5% because of the jaw thickness and the atten-
uation of the jaw material. Furthermore, the beam is also blocked by the MLC, leading to
further reduction of the photon fluence outside the beam limits. The advantage of this ap-
proach is that it saves computation time. The simulation of photon histories being absorbed
within the jaw material would just be a waste of computing power and it would not have a
significant effect on the calculation accuracy.

MLC Leaf Designs

Figure 27Different MLC Leaf Designs

From upper left to lower right:

• Ideal MLC (no leakage radiation)
• Tilted leaves (Siemens)
• Step design (Elekta)
• Tongue and groove design (Varian)
• Varian Millennium
• Brainlab m3
Only 4 leaf pairs per MLC are represented.

134 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

MLC Simulation in The MLC can be simulated with two different precision levels selected by the user of iPlan
iPlan RT Dose RT Dose.

In the Monte Carlo options, it is possible to choose between the following MLC models:
• “Accuracy optimized” (default setting)
• “Speed optimized”
Depending on this selection and depending on the type of the MLC, one of the MLC models
represented in Figure 27 is used for the Monte Carlo simulation.
The model of an ideal MLC (upper left MLC in Figure 27) will be used if “Speed optimized”
is selected. This model neglects both the air gaps between neighbor leaves as well as the cor-
responding tongue and groove design. On the other hand, the thickness of the MLC, the
widths of the leaves, the material of the leaves and the rounded leaf tips (if available) are
correctly taken into account with the “Speed optimized” selection. Especially for the Brain-
lab m3, the computation time can be reduced by factors of 2 to 3 using this selection. The
influence of the “Speed optimized” MLC model on the dose accuracy depends on the beam
setup.
It is expected to be small for conformal beams, but it can be larger for IMRT beams. There-
fore it is recommended to use the “Speed optimized” option only for the intermediate plan-
ning process. The final dose calculation should be performed with an “Accuracy optimized”
model. The “Accuracy optimized” model always takes the correct tongue and groove design
depending on the MLC type into account (see Figure 27).

MLC Simulation The algorithm behind these models is based on the work published by Fippel (2004). It is a
Algorithm full MC geometry simulation of the photon transport. It takes into account Compton inter-
actions, pair production events and photoelectric absorptions. Primary and secondary elec-
trons are simulated using the continuous slowing down approximation. In this approach the
geometries are defined by virtually placing planes and cylinder surfaces in the 3D space.
The planes (and surfaces) define the boundaries between regions of different material. For
MLCs, in general the regions consist of a tungsten alloy and air. For these materials photon
cross section tables pre-calculated using the computer code XCOM (Berger and Hubbell
1987) as well as electron stopping power and range tables pre-calculated using the ESTAR
software (Berger 1993) are used. The particle ray-tracing algorithm is based on bit masks
and bit patterns to identify the region indices. In extension to the original paper, further
MLC models have been implemented.

Determination of In iPlan RT Dose the nominal leaf position is defined in the isocenter plane. The real leaf
Leaf Positions position as required by the MC algorithm is calculated from the nominal position assuming
a light field calibration. For an MLC with rounded leaf tip this means, the leaf touches the
straight line between the nominal focus and the nominal leaf position. In this way, the
straight line becomes a tangent of the leaf tip curvature.
In iPlan RT Dose 4.5 and higher versions the leaf positions for closed leaf pairs are deter-
mined differently. In the case of closed leaf pairs, the straight line between the nominal fo-
cus and the nominal leaf position goes directly through the end point of the leaf tip. This
behavior has been implemented to avoid air gaps between opposite leaf tips if the leaf pair
is closed far off axis.

Technical Reference Guide Rev. 1.2 Brainlab Physics 135

Monte Carlo Algorithm

The MC Patient Dose Computation Engine

Background The MC algorithm to simulate the transport of photons and electrons through human tissue
is based on the publications by Kawrakow et al (1996), Fippel (1999), Kawrakow and Fippel
(2000). It is a condensed history algorithm with continuous boundary crossing to simulate
the transport of secondary and contaminant electrons. It takes into account and simulates
delta electrons (free secondary electrons created during electron-electron interactions) as
well as Bremsstrahlung photons. For the MC photon transport simulations, Compton inter-
actions, pair production events and photoelectric absorptions are considered. Several vari-
ance reduction techniques such as electron history repetition, multiple photon transport or
Russian Roulette, speed up the dose computation significantly compared to general-purpose
MC codes, e.g. EGSnrc (Kawrakow 2000). The MC particle histories can run in parallel
threads, therefore the code fully benefits from the use of multi-processor machines, such as
the iPlan Workstation Premium with 8 CPU cores. Gantry rotations (static and dynamic)
are simulated continuously. This feature is a big advantage compared to other algorithms
such as the pencil beam, because they need discrete gantry positions to model the rotation.

Mass Density The photon cross-sections as well as the electron collision and radiation stopping powers are
Calculation calculated using a 3D distribution of mass densities. The mass density in each voxel is de-
rived from the CT Hounsfield unit (HU). This requires a precise calibration of the CT scan-
ner providing a HU to mass density mapping function.
If the mass density ρ is known in a specific voxel, the total cross section for e.g. Compton
interactions μ C(ρ, E) for a photon with energy E can be calculated by:
ρ
- f (ρ) μ C W(E)
μ C(ρ, E) = ------
W C
ρ
W
The function μ C (E) is the tabulated Compton cross-section in water, ρ is the mass den-
W

sity of water and the function f C(ρ) is a fit function based on analyzing ICRU cross section
data for body tissues (ICRU 1992). The factorization into a function depending only on ρ
and a second function depending only on E is an approximation. However the data of ICRU
Report 46 (1992) imply that this approximation is possible for human tissue.

Non-human tissue such as implants may not be considered correctly. This may
lead to inaccurate dose calculation.

136 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

Compton Cross- Figure 28 shows the Compton cross-section ratio f C(ρ) as a function of mass density ρ for
Section Ratio all materials from ICRU Report 46.

Figure 28Compton Cross-Section Ratio

The illustration above shows the compton cross-section ratio versus mass density for all ma-
terials of ICRU report 46 (crosses). The line represents a fit to this data. This function is used
by MC to calculate the Compton cross-section.
The line in Figure 28 represents a fit to this data. It is given by:

w w
⎧ 0.99 + 0.01ρ/ρ , ρ ≤ ρ
f c(ρ) ≈ ⎨
⎩ 0.85 + 0.15ρ ⁄ ρ w , ρ ≥ ρ w

This fit function is used by MC to calculate the Compton cross-section. There are a few ma-
terials with deviations between the real cross section ratio and the fit function of up to 1.5%.
However, these are materials such as gallstone or urinary stones. Furthermore, the correct
elemental composition in a given voxel is unknown. Only a HU number is known and dif-
ferent material compositions can lead to the same HU. Therefore, the HU number itself has
some uncertainty overlaying in this manner the uncertainty of the fit function. The influence
of the HU number uncertainty on Monte Carlo calculated dose distributions has been dis-
cussed in the literature (Vanderstraeten et al 2007). Similar fit functions exist to calculate
the pair production and photoelectric cross-sections as well as the electron collision and ra-
diation stopping powers. Their dependencies on the mass density of course differ from
f C(ρ) .

The function f C(ρ) is also used to convert mass densities ρ into electron densities n e or
vice versa. The relation is given by:
W ρ-
ne = ne ----- f (ρ)
w C
ρ
W
with n e being the electron density of water.

Technical Reference Guide Rev. 1.2 Brainlab Physics 137

Monte Carlo Algorithm

MC Parameters

Background The user of the software has some influence on the MC dose calculation accuracy, the dose
calculation time and the dose result type. This can be done using the Monte Carlo options
provided in iPlan RT Dose. Four parameters can be influenced:
• Spatial resolution (in mm)
• Mean variance (in %)
• Dose result type (“Dose to medium” or “Dose to water”)
• MLC model (“Accuracy optimized” or “Speed optimized”)

Spatial Resolution The spatial resolution defines the size of the internal MC dose computation grid. It does not
mean however that the final MC grid size is exactly equal to the value of the parameter. The
MC voxels are constructed by combining an integer number of pixels from the original CT
cube. Therefore the final sizes of the voxels are only approximately equal to the value of the
spatial resolution parameter. They can also be different for the 3 spatial directions. Further-
more, they cannot be smaller than the initial pixel sizes. The selection of this parameter has
a strong influence on the calculation time. Decreasing this parameter by a factor of 2 can
increase the calculation time by a factor of about 6. The spatial resolution is limited to values
between 2 mm and 10 mm. A large value like 5 mm might be a good choice for the inter-
mediate planning process or for large tumors and large field sizes. Final dose calculations
for small tumors, however, should be performed with a spatial resolution of 2-3 mm.

Mean Variance The mean variance parameter estimates the number of particles histories needed to achieve
this variance per beam in % of the maximum dose of that beam. Because everything here is
normalized per beam, the final variance in the PTV can be smaller. For example, if we have
5 overlapping beams in the PTV and each beam is calculated with 2% variance, then the
variance in the PTV is about 1%.
In the non-overlapping regions it remains 2%. The statistical variance per voxel decreases
with increasing number of histories Nhist as:
1 ⁄ ( N hist )

i.e. the statistical variance can be decreased by a factor of 2 if the number of histories is in-
creased by a factor of 4. Therefore, also the calculation time is increased by a factor of 4.
The default setting is 2%; the final calculation should be 1% or smaller.

138 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Algorithm

Dose Result Type The iPlan RT Dose application allows the calculation of 2 different dose types. The default
setting “Dose to medium” means real energy dose, i.e. the energy absorbed in a small tissue
element divided by the mass of the tissue element. “Dose to water”, on the other hand,
means energy absorbed in a small cavity of water divided by the mass of that cavity, whereas
some tissue, e.g. bone, surrounds the cavity (see Figure 29). There is no visible difference
between “Dose to medium” and “Dose to water” for most of the human soft tissue types.
However, “Dose to water” can be up to 15% larger compared to “Dose to medium” for bony
tissues (AAPM 2007). This is because of the high-density bone causing a higher fluence of
secondary electrons in the water cavity and accordingly causing a higher dose compared to
the case of the cavity filled also with bone. Therefore “Dose to water” should be selected if
the user wants to know the dose in soft tissue cells within a bony structure (see Figure 29).
The relation between “Dose to water” D W and “Dose to medium” D M is calculated by:
S W
D W = D M ⎛ ---⎞
⎝ ρ⎠ M
W
with ( S ⁄ ρ ) M being the unrestricted electron mass collision stopping power ratio for water
to that for the medium averaged over the spectrum of the photon beam. This ratio is approx-
imately 1.0 for soft tissues with a mass density of about 1.0 g/cm3. It increases up to ~1.15
for bony tissues of mass density up to 2.0 g/cm3.

Figure 29Dose to Medium Versus Dose to Water

“Dose to medium” should be calculated if the user is interested in the average dose within
the whole voxel. “Dose to water” should be calculated if the user has more interest in the
dose within small soft tissue cells surrounded by bone material.

Technical Reference Guide Rev. 1.2 Brainlab Physics 139

Monte Carlo Algorithm

MLC Model The MLC model precision can be either “Accuracy optimized” or “Speed optimized”. “Ac-
Precision curacy optimized” means, the MLC is modeled with full tongue-and-groove design. It takes
into account the air gaps between neighbor leaves. The “Speed optimized” option neglects
this effect. It employs a model of an ideal MLC (see “Modeling of the Collimating System”
on page 134 and Figure 27). Therefore this option shortens the calculation time. “Modeling
of the Collimating System” on page 134 contains more detailed information about the MLC
modeling.

Monte Carlo
Limitations

The accuracy of the Monte Carlo dose calculation depends on the defined sta-
tistical variance. The value used for final treatment plan approval must be as
low as possible and not higher than 2%. You must keep in mind that the statis-
tical variance is defined relative to the highest dose in the treatment plan. As a
consequence, the uncertainty of the dose values inside OARs in the low dose re-
gion is higher relative to the maximum dose inside the OAR.

140 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: General Beam Data Measurement

Monte Carlo: General Beam Data

Measurement

General Information

Contents

Topics Covered
Section See
Getting Started Page 142
Recommended Equipment Page 144
Coordinate Systems Page 145
Measurements in Air Page 148
Measurements in Water Page 149
Data Correction Page 147

Technical Reference Guide Rev. 1.2 Brainlab Physics 141

Monte Carlo Algorithm

Getting Started

Purpose of This This chapter provides general instructions on how the beam data for multileaf collimators
Chapter must be acquired. It is suitable for treatment planning using the Monte Carlo dose algorithm
with iPlan RT Dose version 4.0 and higher.
MLC specific information such as MLC and jaw field sizes to be used for the measurements
can be found in the corresponding checklist.

Commissioning a Before starting the commissioning of your linear accelerator you should be familiar with na-
Linear Accelerator tional or international recommendations on commissioning a linear accelerator, e.g. the
AAPM TG-106 Report:
This report provides guidelines and recommendations on the proper selection of phantoms
and detectors, setting up a phantom for data acquisition of both scanning and no-scanning
data, procedures for acquiring specific photon and electron beam parameters and methods
to reduce measurement errors (<1%), beam data processing and detector size convolution
for accurate profiles. The TG-106 also provides a brief discussion on the emerging trend in
Monte Carlo simulation techniques in photon and electron beam commissioning. The pro-
cedures described in this report should assist a qualified medical physicist in either measur-
ing a complete set of beam data, or in verifying a subset of data before initial use or for
periodic quality assurance measurements (Das et al 2008).

Definitions and
Abbreviations Term Explanation
CAX Central Axis
Linac Linear Accelerator
MLC Multileaf Collimator
PDD Percentage Depth Dose
SID Source-Isocenter Distance (1000 mm)
SSD Source-Surface Distance

Prerequisites The Monte Carlo dose calculation algorithm cannot be used without the pencil beam algo-
rithm. Therefore commissioning of the Monte Carlo dose calculation algorithm requires
commissioning of the Pencil Beam algorithm. For further information, see “Pencil Beam:
Beam Data Checklists” on page 71.

142 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: General Beam Data Measurement

Measurement The measurements specified within this user guide are sufficient to achieve the specified ac-
Accuracy curacy for Brainlab dose algorithms. If you wish to improve the accuracy of the dose calcu-
lation, perform the measurements with extreme care, repeat them, select the best results (e.g.
lowest noise) and average them. A finer than recommended increment for field size, depth
or radial direction, although not prohibited, will not significantly improve dose accuracy.

The accuracy of all Brainlab dose algorithms is directly dependent on the accu-
racy and the range of the beam data measurements. It must be ensured that the
beam data measurement covers the range of field sizes and depths that will be
used in subsequent treatment planning. This is especially the case for the mea-
surements of the scatter factors, the radial profiles and the depth dose.

For accurate results you must set up the linac and the motorized water tank
with extreme care. The central beam axis must be exactly vertical, i.e. orthogo-
nal to the water surface. The detector movement direction must be exactly
aligned with the water surface and with the central beam axis in each case.

Beam Profile It is the responsibility of the hospital physicist to perform proper verification of every new-
Verification ly-created or modified beam profile (machine profile). This must include end-to-end testing
for every treatment modality and treatment condition to be used clinically. You always
should consult relevant national or international recommendations on QA (e.g. IAEA TRS-
430).

Responsibility

When measured data is sent to Brainlab, Brainlab has no possibility to verify

the correctness of
- any data received from a user
- any data returned to a user.
Any feedback or recommendations provided by Brainlab based on the data re-
ceived depend on the correctness of the data itself. If received data has been pro-
cessed by Brainlab and returned to the user, this in no way ensures that the
returned data is correct. The user is fully responsible for verifying the correct-
ness of the data returned by Brainlab and is also fully responsible for verifying
the correctness of any feedback or recommendations provided by Brainlab. The
user must validate the safety and effectiveness of the data returned by Brainlab
before performing any patient treatment. The fact that Brainlab may have pro-
cessed certain data does not affect the overall responsibility of the user for the
correctness of the final beam profile.

Technical Reference Guide Rev. 1.2 Brainlab Physics 143

Monte Carlo Algorithm

Recommended Equipment

Equipment
Component Explanation
Use a motorized water tank of sufficient size: the tank should ex-
tend at least 50 mm beyond all four sides of the measured field size
at the depth of measurement. It should also extend to at least
Motorized
50 mm beyond the maximum depth of measurement. For a stan-
water tank
dard field size of 400 x 400 mm2 up to a depth of 350 mm, a phan-
tom of more than 500 x 500 mm2 base area and a water depth of at
least 400 mm is necessary.
Use a calibrated chamber: a calibrated cylindrical ionization cham-
ber with a cavity volume of at least 0.125 cm3 but not more than
Calibrated 0.6 cm3. The effective point of measurement shall be determined
chamber based on valid international dosimetry standards (e.g. IAEA TRS-
398) and the corresponding recommendation of the detector pro-
vider.
Use a ionization chamber: a cylindrical ionization chamber with a
cavity volume of 0.125 cm3 or smaller. The effective point of mea-
Ionization
surement shall be determined based on valid international dosime-
chamber
try standards (e.g. IAEA TRS-398) and the corresponding
recommendation of the detector provider.
Use a small cylindrical ionization chamber with a cavity volume of
not more than 0.03 cm3 (e.g. pinpoint chamber). The effective point
Small chamber of measurement shall be determined based on valid international
dosimetry standards (e.g. IAEA TRS-398) and the corresponding
recommendation of the detector provider.
Use a very small detector for high-resolution profile measurements
High-resolution
and dosimetry of small fields. Brainlab recommends the use of a
detector
stereotactic diode.
Use a small build-up cap made of brass or material of similar mass
density for measurements in air. The thickness of build-up cap:

Small build-up 10E 3

cap d cap ≈ -------------- , ( d cap in mm, E in MV, ρ cap in g/cm ),
3ρ cap

for brass: d brass ( 6 MV ) ≈ 2.4 mm, d brass ( 15 MV ) ≈ 5.9 mm.

Bear in mind that the sensitivity of the detector may depend on its orientation.
Observe the specifications and recommendations provided by the manufactur-
er of your dosimetry equipment.

144 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: General Beam Data Measurement

Coordinate Systems

Background The measurements described in this document are based on the coordinate system illustrated
below.
• All length units are given in mm.
• For all measurements, the collimator angle and the gantry angle must be both set to 0°.
• Please consult the specific checklist for your MLC (See “Monte Carlo: Beam Data
Checklists” on page 151.).

Coordinate System

Figure 30Coordinate System (Left: Measurements in Air; Right: Measurements in Water)

Technical Reference Guide Rev. 1.2 Brainlab Physics 145

Monte Carlo Algorithm

Understanding the The coordinate system corresponds to the fixed system of IEC 1217, but rotated by 180
Coordinate System around the X-axis, i.e. the Y and Z point into the opposite directions.

Measurement Explanation
For all measurements in air, the origin of the coordinate system is
not located in the isocenter, but in the nominal photon source point
in the target, i.e., at a distance of SID away from the isocenter as in-
Air
dicated above. This means that Z coordinates for all measurements
in air (especially the Z profiles) must be specified as a distance to
the source (focus) point in millimeters.
For measurements in water, the coordinate system is slightly differ-
ent. Here the origin is located at the surface of the water phantom,
i.e. depth dose curves are measured as dose per depth in water in
Water millimeters. The X, Y and Z directions remain the same. These di-
rections are independent of the mounting direction of the MLC. In
other words, MLCs with leaves moving in X direction and MLCs
with leaves moving in Y direction are possible.

146 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: General Beam Data Measurement

Data Correction

Background A limited level of data correction is allowed in order to eliminate small errors during mea-
surement data acquisition. However, such corrections must be approached with caution. It
is always better to avoid corrections by measuring data that does not need to be modified.
For example, to take central axis deviations caused by measurement errors into account, it
is useful to shift the profiles by the corresponding off-axis distance.
It might also be useful to symmetrize the measured profiles because the fitting algorithm as-
sumes symmetric profiles. It is always better if the accelerator can produce symmetric (or
almost symmetric) and flat profiles.
Symmetrization should not be performed before centering the profiles (accounting for cen-
tral axis deviations).

Data Format All measured data (in water and air) must be entered into the Beam Profile Editor using the
Raw Data Input or Monte Carlo raw data mode of Physics Administration provided by
Brainlab. The resulting files (with the file extension *.xmcdat) containing the complete set
of measurements per photon energy must be sent to [email protected].

Technical Reference Guide Rev. 1.2 Brainlab Physics 147

Beam Data Measurement

Beam Data Measurement

Measurements in Air

Ionization Use an ionization chamber with a brass build up cap (or similar material) to measure the X,
Chambers Y and Z profiles in air for all photon energies and different field sizes. The field sizes for
your MLC are documented in the corresponding checklist (“Monte Carlo: Beam Data
Checklists” on page 151). If possible, only the jaws should collimate the fields, i.e. the MLC
leaves should be fully retracted. If this is not possible (e.g. for Siemens and Elekta MLCs),
use the MLC like a pair of jaws. For a linac with a MLC only (no jaws), e.g. MHI, use the
MLC for field collimation.

MLC and Jaw Field Always provide the correct MLC and jaw field shapes for each of the field sizes. The fol-
Shapes lowing data must be measured:
• Z profile (depth dose) at the central axis (X = Y = 0) from about Z = 850 to Z = 1150
(Z = 0: corresponds to the nominal focus of the photon source)
• 3 X profiles for Y = 0 and Z = 850, Z = 1000, Z = 1150
• 3 Y profiles for X = 0 and Z = 850, Z = 1000, Z = 1150
• In-air output factors at Z = 1000 for all field sizes normalized by one of the fields, usu-
ally the largest field (e.g. 400 x 400 mm²) or the 100 x 100 mm² field

148 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: General Beam Data Measurement

Measurements in Water

Absolute Dose You must measure the absolute dose in Gray per monitor unit for the 100 x 100 mm2 field
size for both SSD = 900 mm and SSD = 1000 mm at the reference water depth, e.g., at
100 mm depth or at the depth of maximum dose. Here, an ionization chamber calibrated for
absolute dose measurements must be used. Both the jaws and the MLC must collimate the
field.

Measurements in X, Y and Z (depth dose) profiles in water are required for all photon energies and for the
Water (SSD=1000 field size 100 x 100 mm2 (source-surface distance of the water phantom: SSD = 1000 mm).
mm) Both the jaws and the MLC must collimate the fields:
• Z profile (depth dose) at the central axis (X = Y = 0), Z = 0: corresponds to the surface
of the water phantom
• 3 X profiles for Y = 0 and depth of maximum dose, Z = 100, Z = 200
• 3 Y profiles for X = 0 and depth of maximum dose, Z = 100, Z = 200
The X and Y profiles must be measured using detectors small enough for the corresponding
field size and to reproduce the penumbra correctly. The central axis depth dose curve shall
be measured with an ionization chamber or a diode detector. It is used to determine the pho-
ton energy distribution and the amount of electron contamination.

Measurements in X, Y and Z (depth dose) profiles in water are required for all photon energies and different
Water (SSD=900 field sizes (source-surface distance of the water phantom: SSD = 900 mm). The field sizes
mm) for your MLC are documented in the corresponding checklist (“Monte Carlo: Beam Data
Checklists” on page 151). Both the jaws and the MLC must collimate the fields:
• Z profile (depth dose) at the central axis (X = Y = 0), Z = 0: corresponds to the surface
of the water phantom
• 3 X profiles for Y = 0 and depth of maximum dose, Z = 100, Z = 200
• 3 Y profiles for X = 0 and depth of maximum dose, Z = 100, Z = 200
• Output factors at Z = 100 for all field sizes normalized by the 100 x 100 field at
SSD = 900 mm
All PDDs, X profiles, Y profiles and the output factors shall be measured using detectors
small enough for the corresponding field size and to reproduce the penumbra correctly.
Large field PDDs and output factors shall be measured using an ionization chamber of me-
dium or large volume (0.1 cm3 – 0.6 cm3) to avoid the effect of energy response variations
(see section III.D.5 and Fig. 1 of the AAPM TG-106 Report (Das et al 2008).

Technical Reference Guide Rev. 1.2 Brainlab Physics 149

Beam Data Measurement

Ensuring Accuracy

To obtain an accurate absorbed dose to water measurement, you must apply a

number of corrections to the dosimeter reading, e.g. beam quality (linac ener-
gy), pressure, temperature and polarity. You must consult the documentation
provided with your dosimetric equipment and the national standards applica-
ble in your country.

150 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Monte Carlo: Beam Data Checklists

General Information

Contents

Topics Covered
Section See
Beam Data for Elekta Beam Modulator Page 152
Beam Data for Elekta MLCi Page 155
Beam Data for MHI MLC 60 Page 158
Beam Data for Novalis/Brainlab m3 Page 161
Beam Data for Novalis Tx (SRS) Page 164
Beam Data for Novalis Tx (Standard Irradiation Mode) Page 167
Beam Data for Siemens 3-D (58 Leaves) Page 170
Beam Data for Siemens 3-D (82 Leaves) Page 173
Beam Data for Siemens 160 Page 176
Beam Data for Siemens ModuLeaf Page 179
Beam Data for Varian 52 Page 182
Beam Data for Varian 80 Page 185
Beam Data for Varian 120 (SRS) Page 188
Beam Data for Varian 120 (Standard Irradiation Mode) Page 191

Technical Reference Guide Rev. 1.2 Brainlab Physics 151

Beam Data for Elekta Beam Modulator

Beam Data for Elekta Beam Modulator

Checklist

No. of See
Task Equipment Done
Measurements Also

“Mea-
CAX profiles in air sure-
Ionization
MLC field sizes: 16 x 16, 32 x 32, 48 x 48, ments in
10 chamber with
80 x 80, 104 x 96, 160 x 160, 50 x 160, Air” on
build-up cap
100 x 160, 210 x 48, 210 x 96 page 14
8

X profiles in air
MLC field sizes: 16 x 16, 32 x 32, 48 x 48, Ionization
80 x 80, 104 x 96, 160 x 160, 50 x 160, 30 chamber with
100 x 160, 210 x 48, 210 x 96; build-up cap
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: 16 x 16, 32 x 32, 48 x 48, Ionization
80 x 80, 104 x 96, 160 x 160, 50 x 160, 30 chamber with
100 x 160, 210 x 48, 210 x 96; build-up cap
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: 16 x 16, 32 x 32, 48 x 48, Ionization
80 x 80, 104 x 96, 160 x 160, 50 x 160, 10 chamber with
100 x 160, 210 x 48, 210 x 96; build-up cap
X = 0; Y = 0; Z=1000

“Abso-
Absolute Dose in Gy per MU lute
Calibrated Dose”
MLC field size: 104 x 96; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Absolute Dose in Gy per MU

Calibrated
MLC field size: 104 x 96; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

152 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC field size: 104 x 96; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC field size: 104 x 96; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC field size: 104 x 96; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water ments in
Ionization Water
MLC field sizes: 8 x 8, 16 x 16, 32 x 32,
chamber and (SSD=9
48 x 48, 80 x 80, 104 x 96, 160 x 160, 11
high-resolu- 00
50 x 160, 100 x 160, 210 x 48, 210 x 96;
tion detector mm)”
SSD = 900 on
page 14
9

X profiles in water
Small ioniza-
MLC field sizes: 8 x 8, 16 x 16, 32 x 32, tion chamber
48 x 48, 80 x 80, 104 x 96, 160 x 160, 33 or high-reso-
50 x 160, 100 x 160, 210 x 48, 210 x 96; lution detec-
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
Small ioniza-
MLC field sizes: 8 x 8, 16 x 16, 32 x 32, tion chamber
48 x 48, 80 x 80, 104 x 96, 160 x 160, 33 or high-reso-
50 x 160, 100 x 160, 210 x 48, 210 x 96; lution detec-
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Technical Reference Guide Rev. 1.2 Brainlab Physics 153

Beam Data for Elekta Beam Modulator

No. of See
Task Equipment Done
Measurements Also

Output factors in water

Ionization
MLC field sizes: 8 x 8, 16 x 16, 32 x 32,
chamber and
48 x 48, 80 x 80, 104 x 96, 160 x 160, 11
high-resolu-
50 x 160, 100 x 160, 210 x 48, 210 x 96;
tion detector
SSD = 900; X = 0; Y = 0, Z = 100

154 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Elekta MLCi

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air

“Mea-
MLC field sizes: use MLC as pair of X sure-
Ionization
jaws; ments in
11 chamber with
Air” on
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, build-up cap
page 14
80 x 80, 100 x 100, 200 x 200, 400 x 400,
8
40 x 400, 100 x 400, 400 x 40, 400 x 100

X profiles in air
MLC field sizes: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 33 chamber with
80 x 80, 100 x 100, 200 x 200, 400 x 400, build-up cap
40 x 400, 100 x 400, 400 x 40, 400 x 100;
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 33 chamber with
80 x 80, 100 x 100, 200 x 200, 400 x 400, build-up cap
40 x 400, 100 x 400, 400 x 40, 400 x 100;
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 11 chamber with
80 x 80, 100 x 100, 200 x 200, 400 x 400, build-up cap
40 x 400, 100 x 400, 400 x 40, 400 x 100;
X = 0; Y = 0; Z = 1000

Technical Reference Guide Rev. 1.2 Brainlab Physics 155

Beam Data for Elekta MLCi

No. of See
Task Equipment Done
Measurements Also

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water
ments in
MLC and jaw field sizes: 20 x 20, 40 x 40, Ionization Water
60 x 60, 80 x 80, 100 x 100, 200 x 200, chamber and (SSD=9
11
400 x 400, 40 x 400, 100 x 400, 400 x 40, high-resolu- 00
400 x 100; tion detector mm)”
on
SSD = 900
page 14
9

156 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

X profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40,
tion chamber
60 x 60, 80 x 80, 100 x 100, 200 x 200,
33 or high-reso-
400 x 400, 40 x 400, 100 x 400, 400 x 40,
lution detec-
400 x 100;
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40,
tion chamber
60 x 60, 80 x 80, 100 x 100, 200 x 200,
33 or high-reso-
400 x 400, 40 x 400, 100 x 400, 400 x 40,
lution detec-
400 x 100;
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC and jaw field sizes: 20 x 20, 40 x 40, Ionization
60 x 60, 80 x 80, 100 x 100, 200 x 200, chamber and
11
400 x 400, 40 x 400, 100 x 400, 400 x 40, high-resolu-
400 x 100; tion detector
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 157

Beam Data for MHI MLC 60

Beam Data for MHI MLC 60

Checklist

No. of See
Task Equipment Done
Measurements Also

“Mea-
CAX profiles in air sure-
Ionization
MLC field sizes: 20 x 20, 30 x 30, 50 x 50, ments in
10 chamber with
70 x 70, 100 x 100, 150 x 150, 50 x 150, Air” on
build-up cap
100 x 150, 150 x 50, 150 x 100 page 14
8

X profiles in air
MLC field sizes: 20 x 20, 30 x 30, 50 x 50, Ionization
70 x 70, 100 x 100, 150 x 150, 50 x 150, 30 chamber with
100 x 150, 150 x 50, 150 x 100 build-up cap
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: 20 x 20, 30 x 30, 50 x 50, Ionization
70 x 70, 100 x 100, 150 x 150, 50 x 150, 30 chamber with
100 x 150, 150 x 50, 150 x 100 build-up cap
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: 20 x 20, 30 x 30, 50 x 50, Ionization
70 x 70, 100 x 100, 150 x 150, 50 x 150, 10 chamber with
100 x 150, 150 x 50, 150 x 100 build-up cap
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Absolute dose in Gy per MU

Calibrated
MLC field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

158 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water ments in
Ionization Water
MLC field sizes: 10 x 10, 30 x 30, 50 x 50,
chamber and (SSD=9
70 x 70, 100 x 100, 150 x 150, 50 x 150, 10
high-resolu- 00
100 x 150, 150 x 50, 150 x 100;
tion detector mm)”
SSD = 900 on
page 14
9

X profiles in water
Small ioniza-
MLC field sizes: 10 x 10, 30 x 30, 50 x 50, tion chamber
70 x 70, 100 x 100, 150 x 150, 50 x 150, 30 or high-reso-
100 x 150, 150 x 50, 150 x 100; lution detec-
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
Small ioniza-
MLC field sizes: 10 x 10, 30 x 30, 50 x 50, tion chamber
70 x 70, 100 x 100, 150 x 150, 50 x 150, 30 or high-reso-
100 x 150, 150 x 50, 150 x 100; lution detec-
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Technical Reference Guide Rev. 1.2 Brainlab Physics 159

Beam Data for MHI MLC 60

No. of See
Task Equipment Done
Measurements Also

Output factors in water

Ionization
MLC field sizes: 10 x 10, 30 x 30, 50 x 50,
chamber and
70 x 70, 100 x 100, 150 x 150, 50 x 150, 10
high-resolu-
100 x 150, 150 x 50, 150 x 100;
tion detector
SSD = 900; X = 0; Y = 0, Z = 100

160 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Novalis/Brainlab m3

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

Ionization sure-
MLC field sizes: 100 x 100
chamber ments in
10
Jaw field sizes: 18 x 18, 24 x 24, 42 x 42, with build-up Air” on
60 x 60, 80 x 80, 98 x 98, 24 x 98, cap page 14
42 x 98, 100 x 24, 98 x 42 8

X profiles in air
MLC field sizes: 100 x 100 Ionization
Jaw field sizes: 18 x 18, 24 x 24, 42 x 42, chamber
30
60 x 60, 80 x 80, 98 x 98, 24 x 98, with build-up
42 x 98, 98 x 24, 98 x 42 cap

Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: 100 x 100 Ionization
Jaw field sizes: 18 x 18, 24 x 24, 42 x 42, chamber
30
60 x 60, 80 x 80, 98 x 98, 24 x 98, with build-up
42 x 98, 98 x 24, 98 x 42 cap

X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: 100 x 100 Ionization
Jaw field sizes: 18 x 18, 24 x 24, 42 x 42, chamber
10
60 x 60, 80 x 80, 98 x 98, 24 x 98, with build-up
42 x 98, 98 x 24, 98 x 42 cap

X = 0; Y = 0; Z = 1000

Absolute dose in Gy per MU “Abso-

lute
MLC field size: 100 x 100; Calibrated Dose”
1
Jaw field size: 98 x 98 chamber on
page 14
SSD = 1000; X = 0; Y = 0; Z = 100 9

Technical Reference Guide Rev. 1.2 Brainlab Physics 161

Beam Data for Novalis/Brainlab m3

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

MLC field size: 100 x 100; Calibrated
1
Jaw field size: 98 x 98 chamber

SSD = 900; X = 0; Y = 0; Z = 100

“Mea-
sure-
CAX PDD in water ments in
Water
MLC field size: 100 x 100; Ionization (SSD=1
1
Jaw field size: 98 x 98 chamber 000
mm)”
SSD = 1000 on
page 14
9

X profiles in water Small ioniza-

MLC field size: 100 x 100; tion cham-
3 ber or high-
Jaw field size: 98 x 98 resolution
SSD = 1000; Y = 0; Z = Zmax, 100, 200 detector

Y profiles in water Small ioniza-

MLC field size: 100 x 100; tion cham-
3 ber or high-
Jaw field size: 98 x 98 resolution
SSD = 1000; X = 0; Z = Zmax, 100, 200 detector

“Mea-
CAX PDDs in water
sure-
MLC and jaw field sizes: 12 x 12, 18 x 18, ments in
Small ioniza-
24 x 24, 42 x 42, 60 x 60, 80 x 80, Water
tion cham-
100 x 100 (jaws: 98 x 98), 24 x 100 (jaws: (SSD=9
11 ber and high-
24 x 98), 42 x 100 (jaws: 42 x 98), 00
resolution
100 x 24 (jaws: 98 x 24), 100 x 42 (jaws: mm)”
detector
98 x 42); on
page 14
SSD = 900
9

162 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

X profiles in water
MLC and jaw field sizes: 12 x 12, 18 x 18,
Small ioniza-
24 x 24, 42 x 42, 60 x 60, 80 x 80,
tion cham-
100 x 100 (jaws: 98 x 98), 24 x 100 (jaws:
33 ber or high-
24 x 98), 42 x 100 (jaws: 42 x 98),
resolution
100 x 24 (jaws: 98 x 24), 100 x 42 (jaws:
detector
98 x 42);
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
MLC and jaw field sizes: 12 x 12, 18 x 18,
Small ioniza-
24 x 24, 42 x 42, 60 x 60, 80 x 80,
tion cham-
100 x 100 (jaws: 98 x 98), 24 x 100 (jaws:
33 ber or high-
24 x 98), 42 x 100 (jaws: 42 x 98),
resolution
100 x 24 (jaws: 98 x 24), 100 x 42 (jaws:
detector
98 x 42);
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC and jaw field sizes: 12 x 12, 18 x 18,
24 x 24, 42 x 42, 60 x 60, 80 x 80, Ionization
100 x 100 (jaws: 98 x 98), 24 x 100 (jaws: chamber and
11
24 x 98), 42 x 100 (jaws: 42 x 98), high-resolu-
100 x 24 (jaws: 98 x 24), 100 x 42 (jaws: tion detector
98 x 42);
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 163

Beam Data for Novalis Tx (SRS)

Beam Data for Novalis Tx (SRS)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field sizes: fully retracted Ionization
ments in
10 chamber with
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, Air” on
build-up cap
80 x 80, 100 x 100, 150 x 150, 50 x 150, page 14
100 x 150, 150 x 50, 150 x 100 8

X profiles in air
MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 30 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 30 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 10 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

164 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water
ments in
MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization Water
40 x 40, 60 x 60, 80 x 80, 100 x 100, chamber and (SSD=9
11
150 x 150, 50 x 150, 100 x 150, 150 x 50, high-resolu- 00
150 x 100; tion detector mm)”
on
SSD = 900
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
150 x 150, 50 x 150, 100 x 150, 150 x 50,
lution detec-
150 x 100;
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Technical Reference Guide Rev. 1.2 Brainlab Physics 165

Beam Data for Novalis Tx (SRS)

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
150 x 150, 50 x 150, 100 x 150, 150 x 50,
lution detec-
150 x 100;
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization
40 x 40, 60 x 60, 80 x 80, 100 x 100, chamber and
11
150 x 150, 50 x 150, 100 x 150, 150 x 50, high-resolu-
150 x 100; tion detector
SSD = 900; X = 0; Y = 0, Z = 100

166 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Novalis Tx (Standard Irradiation Mode)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field sizes: fully retracted Ionization
ments in
11 chamber with
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, Air” on
build-up cap
80 x 80, 100 x 100, 150 x 150, 220 x 220, page 14
50 x 220, 100 x 220, 250 x 50, 250 x 100 8

X profiles in air
MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 33 chamber with
80 x 80, 100 x 100, 150 x 150, 220 x 220, build-up cap
50 x 220, 100 x 220, 250 x 50, 250 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 33 chamber with
80 x 80, 100 x 100, 150 x 150, 220 x 220, build-up cap
50 x 220, 100 x 220, 250 x 50, 250 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field sizes: fully retracted
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 11 chamber with
80 x 80, 100 x 100, 150 x 150, 220 x 220, build-up cap
50 x 220, 100 x 220, 250 x 50, 250 x 100
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Technical Reference Guide Rev. 1.2 Brainlab Physics 167

Beam Data for Novalis Tx (Standard Irradiation Mode)

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water
ments in
MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization Water
40 x 40, 60 x 60, 80 x 80, 100 x 100, chamber and (SSD=9
11
220 x 220, 50 x 220, 100 x 220, 250 x 50, high-resolu- 00
250 x 100; tion detector mm)”
on
SSD = 900
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
220 x 220, 50 x 220, 100 x 220, 250 x 50,
lution detec-
250 x 100;
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

168 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
220 x 220, 50 x 220, 100 x 220, 250 x 50,
lution detec-
250 x 100;
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization
40 x 40, 60 x 60, 80 x 80, 100 x 100, chamber and
11
220 x 220, 50 x 220, 100 x 220, 250 x 50, high-resolu-
250 x 100; tion detector
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 169

Beam Data for Siemens 3-D (58 Leaves)

Beam Data for Siemens 3-D (58 Leaves)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air

“Mea-
MLC field size: use MLC as pair of X sure-
Ionization
jaws; ments in
11 chamber with
Air” on
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, build-up cap
page 14
70 x 70, 100 x 100, 200 x 200, 400 x 400,
8
50 x 400, 100 x 400, 400 x 50, 400 x 100;

X profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100;
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100;
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 11 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100;
X = 0; Y = 0; Z = 1000

170 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU “Abso-

lute
MLC field size: 100 x 110; Calibrated Dose”
1
Y jaws opening: 100; chamber on
page 14
SSD = 900; X = 0; Y = 0; Z = 100 9

Absolute dose in Gy per MU

MLC field size: 100 x 110; Calibrated
1
Y jaws opening: 100; chamber

SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
CAX PDD in water ments in
Water
MLC field size: 100 x 110; Ionization (SSD=1
1
Y jaws opening: 100; chamber 000
mm)”
SSD = 1000 on
page 14
9

X profiles in water Small ioniza-

MLC field size: 100 x 110; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200 tor

Y profiles in water Small ioniza-

MLC field size: 100 x 110; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200 tor

“Mea-
CAX PDDs in water
sure-
MLC field sizes (Y jaws): 10 x 10 (10), ments in
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization Water
100 x 110 (100), 250 x 250 (250), chamber and (SSD=9
11
400 x 400 (400), 50 x 400 (400), high-resolu- 00
100 x 400 (400), 400 x 50 (50), 400 x 110 tion detector mm)”
(100); on
page 14
SSD = 900
9

Technical Reference Guide Rev. 1.2 Brainlab Physics 171

Beam Data for Siemens 3-D (58 Leaves)

No. of See
Task Equipment Done
Measurements Also

X profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 110 (100), 250 x 250 (250),
33 or high-reso-
400 x 400 (400), 50 x 400 (400),
lution detec-
100 x 400 (400), 400 x 50 (50), 400 x 110
tor
(100);
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 110 (100), 250 x 250 (250),
33 or high-reso-
400 x 400 (400), 50 x 400 (400),
lution detec-
100 x 400 (400), 400 x 50 (50), 400 x 110
tor
(100);
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC field sizes (Y jaws): 10 x 10 (10),
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization
100 x 110 (100), 250 x 250 (250), chamber and
11
400 x 400 (400), 50 x 400 (400), high-resolu-
100 x 400 (400), 400 x 50 (50), 400 x 110 tion detector
(100);
SSD = 900; X = 0; Y = 0, Z = 100

172 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Siemens 3-D (82 Leaves)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air

“Mea-
MLC field size: use MLC as pair of X sure-
Ionization
jaws; ments in
11 chamber with
Air” on
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, build-up cap
page 14
70 x 70, 100 x 100, 200 x 200, 400 x 400,
8
50 x 400, 100 x 400, 400 x 50, 400 x 100

X profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 11 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Y = 0; Z = 1000

Technical Reference Guide Rev. 1.2 Brainlab Physics 173

Beam Data for Siemens 3-D (82 Leaves)

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU “Abso-

lute
MLC field size: 100 x 110; Calibrated Dose”
1
Y jaws opening: 100; chamber on
page 14
SSD = 900; X = 0; Y = 0; Z = 100 9

Absolute dose in Gy per MU

MLC field size: 100 x 110; Calibrated
1
Y jaws opening: 100; chamber

SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
CAX PDD in water ments in
Water
MLC field size: 100 x 110; Ionization (SSD=1
1
Y jaws opening: 100; chamber 000
mm)”
SSD = 1000 on
page 14
9

X profiles in water Small ioniza-

MLC field size: 100 x 110; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200 tor

Y profiles in water Small ioniza-

MLC field size: 100 x 110; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200 tor

“Mea-
CAX PDDs in water
sure-
MLC field sizes (Y jaws): 10 x 10 (10), ments in
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization Water
100 x 110 (100), 250 x 250 (250), chamber and (SSD=9
11
400 x 410 (400), 50 x 410 (400), high-resolu- 00
100 x 410 (400), 400 x 50 (50), 400 x 110 tion detector mm)”
(100); on
page 14
SSD = 900
9

174 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

X profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 110 (100), 250 x 250 (250),
33 or high-reso-
400 x 410 (400), 50 x 410 (400),
lution detec-
100 x 410 (400), 400 x 50 (50), 400 x 110
tor
(100);
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 110 (100), 250 x 250 (250),
33 or high-reso-
400 x 410 (400), 50 x 410 (400),
lution detec-
100 x 410 (400), 400 x 50 (50), 400 x 110
tor
(100);
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC field sizes (Y jaws): 10 x 10 (10),
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization
100 x 110 (100), 250 x 250 (250), chamber and
11
400 x 410 (400), 50 x 410 (400), high-resolu-
100 x 410 (400), 400 x 50 (50), 400 x 110 tion detector
(100);
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 175

Beam Data for Siemens 160

Beam Data for Siemens 160

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air

“Mea-
MLC field size: use MLC as pair of X sure-
Ionization
jaws; ments in
11 chamber with
Air” on
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, build-up cap
page 14
70 x 70, 100 x 100, 200 x 200, 400 x 400,
8
50 x 400, 100 x 400, 400 x 50, 400 x 100

X profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: use MLC as pair of X
jaws; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 11 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Y = 0; Z = 1000

176 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU “Abso-

lute
MLC field size: 100 x 100; Calibrated Dose”
1
Y jaws opening: 100; chamber on
page 14
SSD = 900; X = 0; Y = 0; Z = 100 9

Absolute dose in Gy per MU

MLC field size: 100 x 100; Calibrated
1
Y jaws opening: 100; chamber

SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
CAX PDD in water ments in
Water
MLC field size: 100 x 100; Ionization (SSD=1
1
Y jaws opening: 100; chamber 000
mm)”
SSD = 1000 on
page 14
9

X profiles in water Small ioniza-

MLC field size: 100 x 100; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200 tor

Y profiles in water Small ioniza-

MLC field size: 100 x 100; tion chamber
3 or high-reso-
Y jaws opening: 100; lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200 tor

“Mea-
CAX PDDs in water
sure-
MLC field sizes (Y jaws): 10 x 10 (10), ments in
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization Water
100 x 100 (100), 200 x 200 (200), chamber and (SSD=9
11
400 x 400 (400), 50 x 400 (400), high-resolu- 00
100 x 400 (400), 400 x 50 (50), 400 x 100 tion detector mm)”
(100); on
page 14
SSD = 900
9

Technical Reference Guide Rev. 1.2 Brainlab Physics 177

Beam Data for Siemens 160

No. of See
Task Equipment Done
Measurements Also

X profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 100 (100), 200 x 200 (200),
33 or high-reso-
400 x 400 (400), 50 x 400 (400),
lution detec-
100 x 400 (400), 400 x 50 (50), 400 x 100
tor
(100);
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
MLC field sizes (Y jaws): 10 x 10 (10),
Small ioniza-
30 x 30 (30), 50 x 50 (50), 70 x 70 (70),
tion chamber
100 x 100 (100), 200 x 200 (200),
33 or high-reso-
400 x 400 (400), 50 x 400 (400),
lution detec-
100 x 400 (400), 400 x 50 (50), 400 x 100
tor
(100);
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC field sizes (Y jaws): 10 x 10 (10),
30 x 30 (30), 50 x 50 (50), 70 x 70 (70), Ionization
100 x 100 (100), 200 x 200 (200), chamber and
11
400 x 400 (400), 50 x 400 (400), high-resolu-
100 x 400 (400), 400 x 50 (50), 400 x 100 tion detector
(100);
SSD = 900; X = 0; Y = 0, Z = 100

178 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Siemens ModuLeaf

The jaw and MLC field size specifications in the table below are based on an iso-
centric leaf width of 2.5 mm. This is an approximation for the ModuLeaf
mounted at a Siemens Linac with a SCD of 678.6 mm or an Elekta Linac with a
SCD of 673.6 mm. For installations with a SCD outside this range the field sizes
need to be adapted accordingly.

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field size: 120 x 100; Ionization
ments in
9 chamber with
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, Air” on
build-up cap
80 x 80, 100 x 100, 40 x 100, 80 x 100, page 14
120 x 40, 120 x 100 8

X profiles in air
MLC field size: 120 x 100;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 27 chamber with
80 x 80, 100 x 100, 40 x 100, 80 x 100, build-up cap
120 x 40, 120 x 100;
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: 120 x 100;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 27 chamber with
80 x 80, 100 x 100, 40 x 100, 80 x 100, build-up cap
120 x 40, 120 x 100;
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: 120x100;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 9 chamber with
80 x 80, 100 x 100, 40 x 100, 80 x 100, build-up cap
120 x 40, 120 x 100;
X = 0; Y = 0; Z = 1000

Technical Reference Guide Rev. 1.2 Brainlab Physics 179

Beam Data for Siemens ModuLeaf

No. of See
Task Equipment Done
Measurements Also

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 1000; X = 0; Y = 0; Z = 100 page 14
9

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 900; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water ments in
Ionization Water
MLC and jaw field sizes: 10 x 10, 20 x 20,
chamber and (SSD=9
40 x 40, 60 x 60, 80 x 80, 100 x 100, 10
high-resolu- 00
40 x 100, 80 x 100, 120 x 40, 120 x 100;
tion detector mm)”
SSD=900 on
page 14
9

180 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

X profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20, tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100, 30 or high-reso-
40 x 100, 80 x 100, 120 x 40, 120 x 100; lution detec-
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20, tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100, 30 or high-reso-
40 x 100, 80 x 100, 120 x 40, 120 x 100; lution detec-
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

Ionization
MLC and jaw field sizes: 10 x 10, 20 x 20,
chamber and
40 x 40, 60 x 60, 80 x 80, 100 x 100, 10
high-resolu-
40 x 100, 80 x 100, 120 x 40, 120 x 100;
tion detector
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 181

Beam Data for Varian 52

Beam Data for Varian 52

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field size: 400 x 260; Ionization
ments in
11 chamber with
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, Air” on
build-up cap
70 x 70, 100 x 100, 200 x 200, 400 x 400, page 14
50 x 400, 100 x 400, 400 x 50, 400 x 100 8

X profiles in air
MLC field size: 400 x 260;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: 400 x 260;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: 400 x 260;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 11 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

182 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water ments in
Ionization Water
MLC and jaw field sizes: 20 x 20, 40 x 40,
chamber and (SSD=9
60 x 60, 80 x 80, 100 x 100, 290 x 260, 10
high-resolu- 00
40 x 260, 100 x 260, 290 x 40, 290 x 100;
tion detector mm)”
SSD = 900 on
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40, tion chamber
60 x 60, 80 x 80, 100 x 100, 290 x 260, 30 or high-reso-
40 x 260, 100 x 260, 290 x 40, 290 x 100; lution detec-
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Technical Reference Guide Rev. 1.2 Brainlab Physics 183

Beam Data for Varian 52

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40, tion chamber
60 x 60, 80 x 80, 100 x 100, 290 x 260, 30 or high-reso-
40 x 260, 100 x 260, 290 x 40, 290 x 100; lution detec-
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

Ionization
MLC and jaw field sizes: 20 x 20, 40 x 40,
chamber and
60 x 60, 80 x 80, 100 x 100, 290 x 260, 10
high-resolu-
40 x 260, 100 x 260, 290 x 40, 290 x 100;
tion detector
SSD = 900; X = 0; Y = 0, Z = 100

184 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Varian 80

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

Ionization sure-
MLC field size: 400 x 400;
chamber ments in
11
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, with build-up Air” on
70 x 70, 100 x 100, 200 x 200, 400 x 400, cap page 14
50 x 400, 100 x 400, 400 x 50, 400 x 100 8

X profiles in air
MLC field size: 400 x 400; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, chamber
33
70 x 70, 100 x 100, 200 x 200, 400 x 400, with build-up
50 x 400, 100 x 400, 400 x 50, 400 x 100 cap

Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: 400 x 400; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, chamber
33
70 x 70, 100 x 100, 200 x 200, 400 x 400, with build-up
50 x 400, 100 x 400, 400 x 50, 400 x 100 cap

X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: 400 x 400; Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, chamber
11
70 x 70, 100 x 100, 200 x 200, 400 x 400, with build-up
50 x 400, 100 x 400, 400 x 50, 400 x 100 cap

X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Technical Reference Guide Rev. 1.2 Brainlab Physics 185

Beam Data for Varian 80

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion cham-
MLC and jaw field size: 100 x 100; 3 ber or high-
resolution
SSD = 1000; Y = 0; Z = Zmax, 100, 200
detector

Small ioniza-
Y profiles in water
tion cham-
MLC and jaw field size: 100 x 100; 3 ber or high-
resolution
SSD = 1000; X = 0; Z = Zmax, 100, 200
detector

“Mea-
sure-
CAX PDDs in water ments in
Ionization Water
MLC and jaw field sizes: 20 x 20, 40 x 40,
chamber and (SSD=9
60 x 60, 80 x 80, 100 x 100, 290 x 300, 10
high-resolu- 00
40 x 300, 100 x 300, 290 x 40, 290 x 100;
tion detector mm)”
SSD = 900 on
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40, tion cham-
60 x 60, 80 x 80, 100 x 100, 290 x 300, 30 ber or high-
40 x 300, 100 x 300, 290 x 40, 290 x 100; resolution
detector
SSD = 900; Y = 0; Z = Zmax, 100, 200

186 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 20 x 20, 40 x 40, tion cham-
60 x 60, 80 x 80, 100 x 100, 290 x 300, 30 ber or high-
40 x 300, 100 x 300, 290 x 40, 290 x 100; resolution
detector
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

Ionization
MLC and jaw field sizes: 20 x 20, 40 x 40,
chamber and
60 x 60, 80 x 80, 100 x 100, 290 x 300, 10
high-resolu-
40 x 300, 100 x 300, 290 x 40, 290 x 100;
tion detector
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 187

Beam Data for Varian 120 (SRS)

Beam Data for Varian 120 (SRS)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field size: 400 x 400; Ionization
ments in
10 chamber with
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, Air” on
build-up cap
80 x 80, 100 x 100, 150 x 150, 50 x 150, page 14
100 x 150, 150 x 50, 150 x 100 8

X profiles in air
MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 30 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 30 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 40 x 40, 60 x 60, 10 chamber with
80 x 80, 100 x 100, 150 x 150, 50 x 150, build-up cap
100 x 150, 150 x 50, 150 x 100
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

188 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water
ments in
MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization Water
40 x 40, 60 x 60, 80 x 80, 100 x 100, chamber and (SSD=9
11
150 x 150, 50 x 150, 100 x 150, 150 x 50, high-resolu- 00
150 x 100; tion detector mm)”
on
SSD = 900
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
150 x 150, 50 x 150, 100 x 150, 150 x 50,
lution detec-
150 x 100;
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

Technical Reference Guide Rev. 1.2 Brainlab Physics 189

Beam Data for Varian 120 (SRS)

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
40 x 40, 60 x 60, 80 x 80, 100 x 100,
33 or high-reso-
150 x 150, 50 x 150, 100 x 150, 150 x 50,
lution detec-
150 x 100;
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC(Jaw) field sizes; MLC and jaw field Ionization
sizes: 10 x 10, 20 x 20, 40 x 40, 60 x 60, chamber and
11
80 x 80, 100 x 100, 150 x 150, 50 x 150, high-resolu-
100 x 150, 150 x 50, 150 x 100; tion detector
SSD = 900; X = 0; Y = 0, Z = 100

190 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

Beam Data for Varian 120 (Standard Irradiation Mode)

Checklist

No. of See
Task Equipment Done
Measurements Also

CAX profiles in air “Mea-

sure-
MLC field size: 400 x 400; Ionization
ments in
11 chamber with
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, Air” on
build-up cap
70 x 70, 100 x 100, 200 x 200, 400 x 400, page 14
50 x 400, 100 x 400, 400 x 50, 400 x 100 8

X profiles in air
MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
Y = 0; Z = 850, 1000, 1150

Y profiles in air
MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 33 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Z = 850, 1000, 1150

Output factors in air

MLC field size: 400 x 400;
Ionization
Jaw field sizes: 20 x 20, 30 x 30, 50 x 50, 11 chamber with
70 x 70, 100 x 100, 200 x 200, 400 x 400, build-up cap
50 x 400, 100 x 400, 400 x 50, 400 x 100
X = 0; Y = 0; Z = 1000

“Abso-
Absolute dose in Gy per MU lute
Calibrated Dose”
MLC and jaw field size: 100 x 100; 1
chamber on
SSD = 900; X = 0; Y = 0; Z = 100 page 14
9

Technical Reference Guide Rev. 1.2 Brainlab Physics 191

Beam Data for Varian 120 (Standard Irradiation Mode)

No. of See
Task Equipment Done
Measurements Also

Absolute dose in Gy per MU

Calibrated
MLC and jaw field size: 100 x 100; 1
chamber
SSD = 1000; X = 0; Y = 0; Z = 100

“Mea-
sure-
ments in
CAX PDD in water Water
Ionization (SSD=1
MLC and jaw field size: 100 x 100; 1
chamber 000
SSD = 1000 mm)”
on
page 14
9

Small ioniza-
X profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; Y = 0; Z = Zmax, 100, 200
tor

Small ioniza-
Y profiles in water
tion chamber
MLC and jaw field size: 100 x 100; 3 or high-reso-
lution detec-
SSD = 1000; X = 0; Z = Zmax, 100, 200
tor

“Mea-
sure-
CAX PDDs in water
ments in
MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization Water
30 x 30, 50 x 50, 70 x 70, 100 x 100, chamber and (SSD=9
11
300 x 300, 50 x 300, 100 x 300, 300 x 50, high-resolu- 00
300 x 100; tion detector mm)”
on
SSD = 900
page 14
9

X profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
30 x 30, 50 x 50, 70 x 70, 100 x 100,
33 or high-reso-
300 x 300, 50 x 300, 100 x 300, 300 x 50,
lution detec-
300 x 100;
tor
SSD = 900; Y = 0; Z = Zmax, 100, 200

192 Technical Reference Guide Rev. 1.2 Brainlab Physics

Monte Carlo: Beam Data Checklists

No. of See
Task Equipment Done
Measurements Also

Y profiles in water
Small ioniza-
MLC and jaw field sizes: 10 x 10, 20 x 20,
tion chamber
30 x 30, 50 x 50, 70 x 70, 100 x 100,
33 or high-reso-
300 x 300, 50 x 300, 100 x 300, 300 x 50,
lution detec-
300 x 100;
tor
SSD = 900; X = 0; Z = Zmax, 100, 200

Output factors in water

MLC and jaw field sizes: 10 x 10, 20 x 20, Ionization
30 x 30, 50 x 50, 70 x 70, 100 x 100, chamber and
11
300 x 300, 50 x 300, 100 x 300, 300 x 50, high-resolu-
300 x 100; tion detector
SSD = 900; X = 0; Y = 0, Z = 100

Technical Reference Guide Rev. 1.2 Brainlab Physics 193

Beam Data for Varian 120 (Standard Irradiation Mode)

194 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Algorithm

Circular Cone: Algorithm

General Information

Contents

Topics Covered
Section See
Circular Cone Dose Algorithm Page 196
Limitations of the Circular Cone Algorithm Page 203

Technical Reference Guide Rev. 1.2 Brainlab Physics 195

Circular Cone Dose Algorithm

Circular Cone Dose Algorithm

Introduction

Background In general, the main assumption of stereotactic dose calculation models is that secondary
scatter can be assumed to be of limited significance. Several authors have proposed and in-
vestigated this hypothesis (Rice et al 1987, Luxton et al 1991, Hartmann et al 1995) and dose
calculations have tended to be a function of only three basic beam parameters: tissue maxi-
mum ratios, relative output factors and single beam profiles. Scatter (in particular phantom
scatter) is considered to be implicit to these measurements and does not vary significantly
with depth in a medium.
Here the dose algorithm and calculation are described as they are applied and implemented
within the circular arc treatment modality.

Beam Data Although dose calculation can be carried out using only a limited amount of beam data mea-
Measurement surements, the way in which this beam data is collected presents challenges to the physicist.
In particular, narrow radiosurgery beams with sharp dose gradients require detectors and
chambers with a high spatial resolution. The specific problems involved and the methods
for making accurate beam data measurement, absorbed dose calibration and treatment plan
verification are thoroughly described in the literature (Rice et al 1987, Podgorsak et al 1988,
Bjarngard et al 1990, Serago et al 1992, Hartmann et al 1995, AAPM report 54 1995, Hey-
drian et al 1996).

196 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Algorithm

Circular Cone

Definition of dmax The depth dmax is the depth where the tissue maximum ratio (TMR) or the percentage depth
dose (PDD) reaches the maximum. This depth may, however, vary with the field size in gen-
eral and the circular field size particularly. Thus an average value of dmax should be calcu-
lated for the field sizes that are intended to be used in Brainlab planning software. This
average value is referred to as dmax.
As the total scatter factor St should be performed at that depth dmax the value should be
somehow adjustable and accessible for measurements. The value of dmax must be entered
into the Beam Profile Editor/ Physics Administration (see the corresponding chapter in
your Brainlab planning software user guide).

Dose Values The dose function D depends on the diameter of the conical collimator c, the distance per-
pendicular to the central axis of the beam r, the depth in tissue d, and the source-surface dis-
tance (SSD).
D = D ( c, r, d, SSD )

Tissue Maximum The tissue maximum ratio is usually measured by keeping the source-detector-distance
Ratio (SDD) constant while varying the source-surface distance.
The TMR depends on the diameter of the conical collimator c, the depth in tissue d, the dis-
tance from the central axis r and the source-surface distance SSD. Usually the TMR is mea-
sured at the central axis of the beam (r=0). When neglecting boundary effects for very
narrow fields the TMR is independent from the SSD:
TMR ( c, d ) = TMR ( c, d , SSD , r )

TMR ( c, d ) = D ( c , 0 , d , SSD d ) ⁄ D ( c, 0, d max, SSD dmax )

The ratio of dose at a depth d in the phantom relative to dose at the reference depth dmax for
a collimator diameter c. dmax indicates that the reference depth is selected to be the depth of
dose maximum, approximately 15 mm for a 6 MV X-ray beam. Measurements are made
with the measuring device fixed at the beam isocenter on the beam central axis (r=0). The
source-to-surface distance (SSD) must vary for the two dose measurements.

Technical Reference Guide Rev. 1.2 Brainlab Physics 197

Circular Cone Dose Algorithm

Calculating TMR It is possible to calculate a TMR from a standard percentage depth dose (PDD) measure-
from PDD ment, that is, measurement with a constant source-surface distance SSD and the measure-
ment device moved along the central beam axis. The standard conversion formula is:

d ) = --------- ⋅ ⎛ ----------------------------⎞ ⋅ PDD ( c, d, SSD )

1 SSD + d 2
TMR ( c,
100 ⎝ SSD + d max⎠
where:
SSD = Source-surface distance
(SID – dmax in Figure 31)
and where: SID is the source-isocenter distance
PDD = Percentage depth dose (maximum dose = 100 %)
Note: This formula is an approximation since it assumes that the phantom scatter does not
depend on the SSD.

Off-Axis Ratio The off-axis ratio function is determined by measuring the cross profile intersecting the cen-
(OAR) tral axis of a beam in a direction perpendicular to the central axis beam. The off-axis ratio
values depend on the diameter of the conical collimator c, the distance from the central axis
r, the depth in tissue d, and the source-surface distance SSD.
The off-axis ratio function OAR is defined as:
OAR ( c, r, d, SSD ) = D ( c, r, d, SSD ) ⁄ D ( c, 0, d, SSD )
It is the ratio of dose measured at a radial distance r relative to dose at the central axis for a
collimator diameter c. Measurements are made at isocenter level, at a constant depth d in the
phantom. This depth is usually selected to be larger than dmax. (d is recommended to be
75 mm, that is, SSD = 925 mm.) Thus the formula of OAR might be simplified to:
OAR ( c, r, d ) = D ( c, r, d, SSD d ) ⁄ D ( c, 0, d, SSD d )
where SSDd is the SSD that is necessary to place the detector at isocenter distance in the
depth d in tissue.

Total Scatter The total scatter factor St is sometimes referred to as the relative output factor. It is defined
Factor St as the ratio of the dose measured for a treatment planning program specific setup and a linac
calibration specific setup (see section Monitor Unit Calibration below).
The Total Scatter factor St is defined as:
2
St ( c ) = D ( c, 0, d max, SSD d max ) ⁄ D ( 100 × 100mm ,0, d cal, SSD cal )
It is the ratio of dose at isocenter in depth dmax on the central axis for a collimator diameter
c relative to the dose measured at reference conditions (see “Monitor Unit Calibration” on
page 199) in a standard 100x100 mm2 square calibration field. However the arguments of
the second dose function may vary if the local calibration conditions differ from the de-
scribed settings.

198 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Algorithm

Monitor Unit Monitor units (MU) are the unit of measurement used to quantify the dose delivered by a
Calibration linear accelerator. These units are calibrated to absorbed dose to water in Gray. This is usu-
ally performed using a water phantom under reference conditions at a standard depth, dcal,
a source-surface distance, SSDcal and a standard field size (usually 100 x 100 mm²), giving
the nominal linac output:
2
M ( Gy ⁄ MU ) = D (100 × 100mm , 0 , d cal , SSD cal) ⁄ MU

The corresponding data must be entered into the Beam Profile Editor/Physics Administra-
tion (see the corresponding chapter in your Brainlab planning software user guide).

Different treatment centers may use a different point to calibrate the output of a linac, for
example:
M = 1 Gy ⁄ 100 at d cal = 50mm, SSD cal = 1000 mm

Regardless of the setup used to define the nominal linac output, it is important that the mea-
surement of Total Scatter factors St is also made relative to this calibration position:
D ( c, 0, d max, SSD BL )
St ( c ) = -----------------------------------------------------------------------------------
2
D ( 100 × 100mm , 0, d cal, SSD cal )

where dcal is the calibration depth in the phantom where the calibration is made with the cal-
ibration source-to-surface distance SSDcal, and SSDBL is the SSD where the St measure-
ments for the Brainlab planning software are made.
D(c, 0, dmax, SSDBL) for each collimator is always measured at isocenter:
dmax and SSDBL = SID - dmax.

Figure 31Geometry for a Circular Cone Dose Calculation

Technical Reference Guide Rev. 1.2 Brainlab Physics 199

Circular Cone Dose Algorithm

Dose Calculation The dose D at an arbitrary point P in a plane through the isocenter of a fixed X-ray beam is
for Circular Fields calculated using the following equation:
2
= MU ⋅ M ⋅ TMR ( c ,d ) ⋅ OAR ( c, r' ) ⋅ S t ( c ) ⋅ ⎛ ----------⎞
SID
D ( c ,d ,r ,R )
⎝ R ⎠

where:
Collimator diameter at isocenter, measured perpendicularly to the
c =
beam central axis (mm).
d = Depth of point in tissue (mm).
r = Radial distance from the central axis of the point of interest (mm).
R = Distance of point from source (mm).
MU = Monitor units of the fixed beam
M = Calibrated output of the linac (Gy/MU).
SID = Source-isocenter distance (usually 1000 mm)
TMR(c,d) = Tissue maximum ratio for collimator diameter c at a tissue depth d.
Off-axis ratio for collimator diameter c at a radial distance r´ from the
OAR(c,r´) = central axis at isocenter level, where:
r' = r ⋅ SID ⁄ R
Total scatter factor (often referred to as relative output factor) for a col-
St(c) =
limator of diameter c.
The main components of this algorithm are explained in further detail in the previous sec-
tions.

Arc Simulation Stereotactic radiosurgery is delivered with arcing (moving) circularly collimated beams. To
calculate the dose delivered by such an arc it is simulated by a finite number of fixed beams.
These are positioned at 2, 5 or 10 degrees, depending on the user's choice and the software
version.
Therefore, the dose at a particular point P is the sum of the contribution of each fixed field
simulating the arc. For an arc divided into N fixed beams, the dose to a point is calculated as:
N

DP ( c ) = ∑ DP,i ( c, di, ri, Ri )

i=1

where:
MU 2
D P, i(c, di, r i, R i) = -----------i ⋅ M ⋅ TMR(c, d i) ⋅ OAR(c, ri) ⋅ S t(c) ⋅ ⎛⎝ ----------⎞⎠
SID
N Ri

The values of di, ri, Ri are calculated in a plane defined by the central beam axis, the point
P, the isocenter and the X-ray source when delivering the ith fixed beam in the arc.

200 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Algorithm

Uniform Monitor MUi is the number of monitor units for beam i. To obtain a uniform monitor unit value per
Unit Distribution degree of distribution, the first beam (i=1) and the last beam (i=N) use half the monitor units
of the other beams. If the total amount of monitor units is MUtot, the formula for calculating
MUi for N>1 is:

⎧ MU
⎪ --------------------
tot
- for i = 1∨i = N
⎪ 2(N – 1)
MU i = ⎨
⎪ MU tot
⎪ --------------- otherwise
⎩ N–1

The value of di can be either the actual depth of the isocenter, that is, assuming the tissue
has a density equivalent to water, or it can be an equivalent depth, taking into account any
tissue density inhomogeneities.
The points on a patient’s skin surface where dose calculation is started for each arc segment
can be seen whenever an arc plane reconstruction is selected.

Arc Simulation in The white colored points in the arc plane reconstruction shown below indicate the entrance
the Software points for each arc segment.

Figure 32Arc Plane Image Reconstruction

In situations where an arc plane intersects some external structure other than the patient tis-
sue (in this case the mask fixation holder) the dose is calculated from the intersection point
with this structure.
Without the path length correction selected, all underlying tissue, bone and air would be as-
sumed to be water equivalent. It is obvious that an equivalent path length correction calcu-
lation is more accurate in these situations as a correction is made for the density of the
underlying air as well as the higher density bony structures.

Technical Reference Guide Rev. 1.2 Brainlab Physics 201

Circular Cone Dose Algorithm

Skin Curvature When a radiosurgery dose is calculated, the change in the curvature of the skin surface
across the field of each fixed beam segment of an arc is not considered. Any errors intro-
duced with this problem are very small, as the size of the field area used for radiosurgery
applications is also small (< 50 mm diameter at isocenter). Over the entire arc, the points of
incidence of each fixed-beam segment with the skin surface are accurately calculated.

202 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Algorithm

Limitations of the Circular Cone Algorithm

Extrapolation Outside the Range of Measured Values

Background The circular cone dose algorithm uses tabulated measured values for the dose calculation.
Although the usage of these algorithms outside the range of measured values is not recom-
mended, the algorithm uses extrapolations described in the following table. You have to be
aware that extrapolated values do not represent reality with the same accuracy as the dose
algorithm generally does.

If the dose algorithm is used with parameters outside the measured and tabu-
lated values, the accuracy of the calculated dose cannot be guaranteed. You
must ensure that all necessary parameters, in particular the field size, depth
and off-axis distance for the patient treatment are included in the measured
beam data.

Measured Values
PDD/TMR
Depth < Minimum Depth Constant extrapolation of PDD/TMR (min. depth)
Exponential extrapolation points to determine exponen-
tial function: maximum depth, intermediate depth
Depth > Maximum Depth
(depth approximately in the middle between depth of
maximum dose and maximum depth)
OAR
Radius < Minimum Radius Constant extrapolation of OAR (min. radius)
Radius > Maximum Radius Constant extrapolation of OAR (max. radius)

Technical Reference Guide Rev. 1.2 Brainlab Physics 203

Limitations of the Circular Cone Algorithm

Other Limitations

Circular Cone
Limitations

When using the Circular Cone algorithm in dose calculations near inhomoge-
neous areas such as lung or bone tissue or close to the tissue border (both within
a range of a few centimeters), the calculated dose can deviate from the real dose
delivered by more than 10%.

When using the Circular Cone algorithm in dose calculations for depths differ-
ent from the depth at which the off-axis ratios have been measured, the results
may be inaccurate. The calculated penumbra width may be different from the
penumbra in the real dose delivered.

204 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Circular Cone: General Beam Data

Measurement

General Information

Contents

Topics Covered
Section See
Absolute Linac Calibration Page 214
Scatter Factors (Output Factors) Page 218
Depth Dose Profile Page 221
Off-Axis Ratio Measurement Page 227

Technical Reference Guide Rev. 1.2 Brainlab Physics 205

Limitations of the Circular Cone Algorithm

Getting Started

Purpose of This This chapter describes the measurement techniques recommended for acquiring the beam
Chapter data required for dose calculation using the circular cone dose algorithm.

Commissioning a Before starting the commissioning of your linear accelerator you should be familiar with na-
Linear Accelerator tional or international recommendations on commissioning a linear accelerator, e.g. the
AAPM TG-106 Report:
This report provides guidelines and recommendations on the proper selection of phantoms
and detectors, setting up a phantom for data acquisition of both scanning and no-scanning
data, procedures for acquiring specific photon and electron beam parameters and methods
to reduce measurement errors (<1%), beam data processing and detector size convolution
for accurate profiles. The TG-106 also provides a brief discussion on the emerging trend in
Monte Carlo simulation techniques in photon and electron beam commissioning. The pro-
cedures described in this report should assist a qualified medical physicist in either measur-
ing a complete set of beam data, or in verifying a subset of data before initial use or for
periodic quality assurance measurements (Das et al 2008).

206 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Definitions and
Abbreviations Term Explanation
Off-axis ratio:
OAR
OAR ( c, r, d ) = D ( c, r, d ) ⁄ D ( c, 0, d )

Tissue maximum ratio:

TMR ( c, d ) = D ( c, 0, d ) ⁄ D ( c, 0, d norm )
(SSD changes with d).
The following conversion formula may be used to calculate TMR
TMR from PDD:

PDD ( c, d, SSD )
TMR ( c, d ) = --------------------------------------- ⋅ ⎛ ------------------------------⎞
SSD + d 2
100 ⎝ SSD + d norm⎠

Note: This formula is an approximation. It assumes that the phan-

tom scatter does not depend on the SSD.
Percentage depth dose:
PDD PDD ( c, d, SSD ) = D ( c, 0, d ) ⁄ D ( c, 0, d norm ) ⋅ 100
(in comparison to TMR, SSD is fixed).
Total scatter factor, also referred to as relative output factor:
St 2
S t ( c ) = D ( c, 0, d norm ) ⁄ D ( 100 × 100mm , 0, d cal )

Dose measured for collimator c at depth d and at an off-axis dis-

D(c,r,d) tance of r (SSD varies, see descriptions of OAR, PDD/TMR and
scatter measurements for details).
Dose measured for a 100 x 100 mm² square field at depth dcal
D(100x100 mm
(SSD = SID = 1000 mm), also referred to as nominal linac output
², 0, dcal)
(NLOut)
SSD Source-surface distance
c Diameter of conical collimator attached to linac
r Off-axis distance perpendicular to central beam axis
d Depth in water or water-equivalent material
Normalization depth, usually the average depth of peak (maxi-
dnorm
mum) dose
Calibration depth, used to measure the nominal linac output; it is
dcal
possible to use the same value as dnorm

Technical Reference Guide Rev. 1.2 Brainlab Physics 207

Limitations of the Circular Cone Algorithm

Measurement The measurements specified within this user guide are sufficient to achieve the specified ac-
Accuracy curacy for Brainlab dose algorithms. If you wish to improve the accuracy of the dose calcu-
lation, perform the measurements with extreme care, repeat them, select the best results (e.g.
lowest noise) and average them. A finer than recommended increment for field size, depth
or radial direction, although not prohibited, will not significantly improve dose accuracy.

The accuracy of all Brainlab dose algorithms is directly dependent on the accu-
racy and the range of the beam data measurements. It must be ensured that the
beam data measurement covers the range of field sizes and depths that will be
used in subsequent treatment planning. This is especially the case for the mea-
surements of the scatter factors, the radial profiles and the depth dose.

For accurate results you must set up the linac and the motorized water tank
with extreme care. The central beam axis must be exactly vertical, i.e. orthogo-
nal to the water surface. The detector movement direction must be exactly
aligned with the water surface and with the central beam axis in each case.

Data Correction A limited level of data correction is allowed in order to eliminate small errors during mea-
surement data acquisition. However, such corrections must be approached with caution. It
is always better to measure data in such a way that no further data correction has to be per-
formed.

Beam Profile It is the responsibility of the hospital physicist to perform proper verification of every new-
Verification ly-created or modified beam profile (machine profile). This must include end-to-end testing
for every treatment modality and treatment condition to be used clinically. You always
should consult relevant national or international recommendations on QA (e.g. IAEA TRS-
430).

208 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Responsibility

When measured data is sent to Brainlab, Brainlab has no possibility to verify

the correctness of
- any data received from a user
- any data returned to a user.
Any feedback or recommendations provided by Brainlab based on the data re-
ceived depend on the correctness of the data itself. If received data has been pro-
cessed by Brainlab and returned to the user, this in no way ensures that the
returned data is correct. The user is fully responsible for verifying the correct-
ness of the data returned by Brainlab and is also fully responsible for verifying
the correctness of any feedback or recommendations provided by Brainlab. The
user must validate the safety and effectiveness of the data returned by Brainlab
before performing any patient treatment. The fact that Brainlab may have pro-
cessed certain data does not affect the overall responsibility of the user for the
correctness of the final beam profile.

Technical Reference Guide Rev. 1.2 Brainlab Physics 209

Limitations of the Circular Cone Algorithm

Recommended Equipment

Background The following equipment is necessary in order to perform the recommended measurements.

Equipment
Component Explanation
The tank should extend at least 50 mm beyond all four sides of the
measured field size at the depth of measurement. It should also ex-
Motorized tend to at least 50 mm beyond the maximum depth of measurement.
water tank For the calibration field size of 100 x 100 mm², a depth of up to
250 mm, a phantom with a base area of more than 250 x 250 mm²,
and a water depth of at least 300 mm is necessary.
A calibrated cylindrical ionization chamber with a cavity volume of
at least 0.125 cm3 but not more than 0.6 cm3 is required. The effec-
Calibrated
tive point of measurement shall be determined based on valid inter-
chamber
national dosimetry standards (e.g. IAEA TRS-398) and the
corresponding recommendation of the detector provider.
A very small detector for high-resolution profile measurements and
High-resolution
dosimetry of small fields is required. Brainlab recommends the use
detector
of a stereotactic diode.

Bear in mind that the sensitivity of the detector may depend on its orientation.
Observe the specifications and recommendations provided by the manufactur-
er of your dosimetry equipment.

210 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

General Measurement Requirements

Background The following section describes the measurements needed as input for the circular cone dose
algorithm for radiosurgery with round stereotactic collimators.

Minimum • Nominal linac output (NLOut) for a field of 100 x 100 mm2
Measurement • For each circular collimator:
Requirements
- Off-axis ratio (OAR) table
- Tissue maximum ratio (TMR) table
- Scatter St

Measurements of OAR, TMR and Scatter St for all circular stereotactic colli-
mators MUST be made with identical primary jaw field size setting (for details
see “Primary Jaw Settings for the Use with Circular Cones” on page 212).

Data Input It is the responsibility of the hospital’s physicist to enter this data into the Beam Profile Ed-
itor/Physics Administration.

Further information on using the Beam Profile Editor/Physics Administration is provided

in the corresponding Brainlab planning software user guide.

Technical Reference Guide Rev. 1.2 Brainlab Physics 211

Limitations of the Circular Cone Algorithm

Primary Jaw Settings for the Use with Circular Cones

Background It is important to verify by inspection that the area outside the shielded central part of the
conical collimator is completely covered by the jaws. The models and range of conical col-
limator apertures differ significantly at each customer site.
For Brainlab conical collimators, to avoid radiation outside the conical collimator or leakage
at the edge of the field resulting from potential set-up inaccuracies (mechanical collimator
alignment, jaw positioning, and other tolerances), Brainlab recommends using the jaw set-
tings listed in the tables under “Collimator Diameters and Jaw Sizes” on page 213. If prop-
erly implemented, these settings will aid in keeping the jaw shaped field size tight around
the largest conical collimator.

Verifying the Regardless of the jaw-shaped field size in use, Brainlab recommends using a suitable film
Shielding test to verify and document the complete shielding outside the intended center beam through
the conical collimator.
Please keep in mind that the jaw-shaped field must be centered to the central beam axis and
the identical jaw position must be used for all conical collimators. If you intend to modify
the jaw positions after the initial beam data acquisition you should determine to which de-
gree the adjustment of jaw positions requires re-measurement of certain beam profiles.

To avoid unintended leakage radiation using Brainlab conical collimators, the

jaw size must be smaller than or equal to 40x40 mm2 for Novalis (non-Novalis
Tx) and smaller than or equal to 56x56 mm2 for all other Linacs (including Nov-
alis Tx). For non-Brainlab conical collimators refer to the documentation pro-
vided by the manufacturer of your conical collimators.

Ensure that the jaws do not overlap the circular collimator opening. Brainlab
recommends allowing the jaw size to be larger than or equal to the diameter of
the largest conical collimator plus 5 mm, but still within the recommended max-
imum field size limit.

212 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Collimator
Diameters and Jaw
Sizes

Brainlab conical collimators used with Brainlab conical collimators used with all
Novalis (non-Novalis Tx) other LINACs including Novalis Tx
Diameter of
Recommended size of Diameter of Recommended size of
largest conical
jaw-shaped field for all largest conical jaw-shaped field for all
collimator in
conical collimators collimator in conical collimators
use at site
[mm²] use at site [mm] [mm²]
[mm]
7.5 14 x 14 7.5 14 x 14
8 14 x 14 8 14 x 14
10 16 x 16 10 16 x 16
12.5 18 x 18 12.5 18 x 18
15 20 x 20 14 20 x 20
17.5 24 x 24 15 20 x 20
20 26 x 26 16 22 x 22
22.5 28 x 28 17.5 24 x 24
25 30 x 30 18 24 x 24
27.5 34 x 34 20 26 x 26
30 36 x 36 22 28 x 28
32.5 38 x 38 22.5 28 x 28
35 40 x 40 24 30 x 30
37.5 40 x 40 25 30 x 30
26 32 x 32
27.5 34 x 34
28 34 x 34
30 36 x 36
32 38 x 38
32.5 38 x 38
35 40 x 40
36 42 x 42
37.5 44 x 44
40 46 x 46
42.5 48 x 48
45 50 x 50
50 56 x 56

Technical Reference Guide Rev. 1.2 Brainlab Physics 213

Absolute Linac Calibration

Absolute Linac Calibration

Nominal Linac Output Measurement

Background The dose algorithms require as input the relation between monitor units and the absorbed
dose to water under reference conditions for a certain beam quality (see “Linac Energy” on
page 269).
This relation is defined as the nominal linac output
Nlout = D(ccal, dcal, SSDcal) / MU
and is given in Gy/100 MU with:
• the calibration field size ccal
• the calibration depth dcal
• the source-surface distance used for calibration SSDcal

214 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Setup

Figure 33Water Phantom and Chamber Setup

• To measure the nominal linac output you must use the relevant calibrated chamber
(see page 43).
• Set up the water phantom with the isocenter at water surface level (SSD = SID), with
the reference point of the active chamber volume set at the isocenter (setup position,
depth = 0 mm).
• For measurement purposes, the chamber is moved vertically downwards to a depth of
100 mm.

Technical Reference Guide Rev. 1.2 Brainlab Physics 215

Absolute Linac Calibration

Workflow Brainlab recommends following a recognized code of practice (e.g. IAEA TRS-398 or
AAPM TG-51). Alternatively, the procedure described below may also be used.

Steps
1. Set up the water phantom with the isocenter at water surface level
(SSD = SID = 1000 mm).
2. Adjust the center of the active chamber volume to coincide with the isocenter
(level of water surface) and mark this as depth zero (see Figure 33).
3. Move the chamber to the calibration depth dcal (e.g. dcal = 100 mm).
4. Set the jaw aperture to 100 x 100 mm2.
5. • Deliver 100 MU and get the dosimeter reading in Gy (apply all necessary con-
versions and corrections; e.g. chamber type, beam quality, temperature, pres-
sure, etc.).
• The result must be in Gy/100 MU.
6. We recommend repeating the last measurement three times and using the aver-
age value to increase the accuracy.

Entering
Measurement Required Entries in
Results Software
Beam Profile Editor/Physics Administration

BrainSCAN with Under Clarkson in the General Settings page:

Beam Profile
Editor up to • The measured nominal linac output in the Nominal LINAC
version 5.x Output field

iPlan RT Dose Under Circular Cone in the Circular Cone Settings page, enter:
with Beam Profile
Editor 7.x/Physics • The measured nominal linac output in the Nominal Linac
Administration Output field

Enter the following data in the Circular Cone tab of the Proper-
ties dialog:
iPlan RT Dose 4.5 • The measured nominal linac output in the Nominal Linac Out-
( o r h i g h e r) w i t h put field.
Physics Important: SSD and depth of the nominal linac output mea-
Administration surement are not entered in the Circular Cone tab. The nomi-
nal linac output setup is included in the total scatter value, see
“Scatter Factor Measurement” on page 218.

216 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Ensuring Accuracy It is also possible to use settings other than SSD = 1000 mm and calibration depth
dcal = 100 mm. However, the measurements for NLOut and the scatter reference dose
2
D ( 100 × 100mm , 0, d cal )
must be measured using the same SSD and at the same depth (see “Scatter Factor Measure-
ment” on page 218).

To obtain an accurate absorbed dose to water measurement, you must apply a

number of corrections to the dosimeter reading, e.g. beam quality (linac ener-
gy), pressure, temperature and polarity. You must consult the documentation
provided with your dosimetric equipment and the national standards applica-
ble in your country.

Technical Reference Guide Rev. 1.2 Brainlab Physics 217

Scatter Factors (Output Factors)

Scatter Factors (Output Factors)

Scatter Factor Measurement

Background The scatter factor accounts for the attenuation of the beams that is due to the collimating ef-
fect of the collimator in comparison to open field irradiation.

Setup • Use the high-resolution detector as specified under “Recommended Equipment” on

page 210 to obtain accurate data for the small fields.
• Recalibrate the x/y/z coordinates of the water phantom when changing the detector or
its orientation.
• Define the normalization depth dnorm. Usually, the normalization depth is chosen to be
an average depth of peak dose (dnorm=15 mm for a 6 MV X-ray beam). Further details
are provided under “Depth Dose Profile” on page 221.

Figure 34Setup for Measurement of Scatter (Relative Output Factor)

Because the circular cone scatter measurements are performed with a different setup and a
different detector than the absolute dose measurement of the nominal linac output (see
page 214), both measurements a and d must be linked together by a reference measure-
ment s.

218 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

No. Component
Nominal linac output measurement setup (see page 214):
a • Usually non-isocentric setup
• Calibrated ionization chamber
Reference measurement setup:
s • Same setup as a
• Same detector as used for circular cone scatter measurements d
Circular cone scatter measurements:

d • Isocentric setup with depth = dnorm

• Use the high-resolution detector as specified under “Recommended Equip-
ment” on page 210

Workflow
Steps
1. Position the detector at the isocenter at depth dnorm (SSD = 1000 mm-dnorm).
See d in Figure 34.
2. Deliver 100 MU.
3. Make three measurements for each collimator and use the average value to ac-
count for inaccurate dose delivery/measurement. Keep the jaws in the same po-
sition as for measurements of PDD/TMR and OAR.
4. Using the high-resolution detector, measure the dose in the nominal linac output
setup described in “Nominal Linac Output Measurement” on page 214:
• SID = SSD = 1000 mm
• Depth = dcal
• Field size = 100 x 100 mm (see s in Figure 34).
5. We recommend repeating the last measurement three times and using the aver-
age value to increase the accuracy.

Entering In the Beam Profile Editor/Physics Administration, select Scatter under Input Values, and
Measurement enter the corresponding values.
Results
NOTE: Depending on the large-field accuracy of the high-resolution detector, it might be
necessary to use some intermediate field size (e.g. 40x40 mm²) for a transition to a larger
detector. No measurement shall exceed the field size specifications defined by the detector
manufacturer.

Technical Reference Guide Rev. 1.2 Brainlab Physics 219

Scatter Factors (Output Factors)

Ensuring Accuracy The total scatter factor St(c) for collimator c is defined as:
2
S t ( c ) = D ( c, 0, d norm ) ⁄ D ( 100 × 100mm , 0, d cal )
Note: The nominal linac output (but measured with a different detector) is:
2
D ( 100 × 100mm , 0, d cal )
Important: St(c) has to be measured for each collimator separately using the same jaw po-
sition.

Do not use the ionization chamber, which is too large for accurate small field
dosimetry.

220 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Depth Dose Profile

Measurement Overview

Background Depth dose can be measured using one of the following options:

Option Explanation
PDD ( p e r c e n t a g e The water phantom is fixed. PDD values are measured by ad-
depth dose) justing the detector vertically along the beam axis.
TMR (tissue The detector is positioned at the isocenter. TMR values are
maximum ratio) measured by varying the water level (water surface).

Normalization Depth doses show a maximum dose at a particular depth that depends, among other things,
Depth on collimator size. However, the algorithm used for dose calculation requires all data to be
normalized to the same depth. In this section, this depth is referred to as dnorm. Usually, the
normalization depth is chosen to be the average depth of peak dose (dnorm = 15 mm for a
6 MV x-ray beam). Following this normalization instruction, it might happen that some
graphs exceed unity.
Note: TMR/PDD values can be normalized arbitrarily as this is controlled by the dose algo-
rithm.

Technical Reference Guide Rev. 1.2 Brainlab Physics 221

Depth Dose Profile

PDD Measurement

Setup • Use the relevant high-resolution detector (see page 210) with a small active volume to
get high spatial resolution.
• Recalibrate the x/y/z coordinates of the water phantom when changing the detector or
its orientation.

Figure 35Setup for Percentage Depth Dose Measurement

Workflow
Steps
1. Adjust the water surface to the selected SSD. We recommend to either use
SSD=1000 mm or an isocentric setup with SSD = 1000 mm - dnorm.
2. Use the water phantom software to measure depths from 0 to the desired depth
(at least 250 mm); see Figure 35.
3. • Activate continuous linac irradiation.
• The detector must continue to measure during movement.
4. • If the measurement system does not support continuous data detection, the fol-
lowing depths are recommended for reconstructing the PDD profile (for a
6 MV beam): 0, 5, 8, 12, 14, 15, 16, 18, 20, 25, 30, 40, 50, 75, 100, 125, 150,
175, 200, 225, 250 mm.
• For photon beams with higher energy, the depths should be modified in accor-
dance with the expected changes in the depth dose curve.

222 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Entering
Measurement Software Required Steps
Results
1) PDD data must first be converted to TMR data. The following
approximation may be used:

PDD ( c, d, SSD )
TMR ( c, d ) = --------------------------------------- ⋅ ⎛⎝ ------------------------------⎞⎠
SSD + d 2
100 SSD + d norm

BrainSCAN This approximation assumes that the phantom scatter does not de-
with Beam pend on the SSD.
Profile Editor 2) In the Beam Profile Editor, enter the following under Clarkson
up to version 5.x in the General Settings page:
• The normalization depth dnorm (in millimeters) in the Normal-
ization Depth field

Only TMR data can be entered into the TMR tables.

• PDD values can be normalized arbitrarily. However, normaliza-
tion to a common reference depth or maximum may simplify
consistency checks. Decay rates, for example, can easily be com-
pared.
iPlan RT Dose • The PDD values for all collimators must have the same depth co-
with Beam ordinate values.
Profile Editor
• Conversion to TMR is performed by iPlan RT Dose using the
7.x/Physics
SSD and dnorm values.
Administration
• Beam Profile Editor: enter the SSD under Circular Cone in the
Circular Cone Settings page.
• Physics Administration: enter the SSD under Depth Dose in the
Circular Cone tab of the Properties dialog.

Enter the depth dose values as input values and specify under Values are ... whether your
data is based on the TMR or the PDD approach.

Ensuring Accuracy • To prevent errors due to bending of the water surface (capillary effects), move the
chamber from the bottom upwards.
• Keep the jaws in the same position as used for scatter and off-axis ratio measurements.
• PDD profiles must be measured for each collimator separately using the same jaw posi-
tion.

Do not use an ionization chamber that is too large for accurate small field do-
simetry.

Technical Reference Guide Rev. 1.2 Brainlab Physics 223

Depth Dose Profile

TMR Measurement

Setup • Use the relevant high-resolution detector (see page 210) with a small active volume to
get high spatial resolution.
• Recalibrate the x/y/z coordinates of the water phantom when changing the detector or
its orientation.

Figure 36Setup for Tissue Maximum Ratio Measurement

224 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Workflow
Steps
1. Position the detector at isocenter level.
2. Level the water surface with the active detector volume.
3. • Activate continuous linac irradiation.
• The detector must continue to measure while the tank is filled to a water level
of 250 mm above isocenter (see Figure 36).
4. • If the measurement system does not support continuous data detection, the fol-
lowing depths are recommended for reconstructing the TMR profile (for a
6 MV beam): 0, 5, 8, 12, 14, 15, 16, 18, 20, 25, 30, 40, 50, 75, 100, 125, 150,
175, 200, 225, 250 mm.
• For photon beams with higher energy, the depths should be modified in accor-
dance with the expected changes in the depth dose curve.

Entering
Measurement Required Entries in
Results Software
Beam Profile Editor/Physics Administration

BrainSCAN • The TMR values defined above can be used directly.

with Beam Profile • Under Clarkson in the General Settings page, enter the nor-
Editor up to malization depth dnorm (in millimeters) in the Normalization
version 5.x Depth field.

iPlan RT Dose • A SSD value is not needed in this case

with Beam Profile • As the Circular Cone settings cannot be left blank, use
Editor (7.x or high- SSD=1000mm or SSD=1000mm-dnorm.
er) or Physics
Administration

Enter the depth dose values as input values and specify under Values are ... whether your
data is based on the TMR or the PDD approach.

Technical Reference Guide Rev. 1.2 Brainlab Physics 225

Depth Dose Profile

Ensuring Accuracy • Keep the jaws in the same position as used for scatter and off-axis ratio measurements.
• The TMR is defined as:
TMR ( c, d ) = D ( c, 0, d ) ⁄ D ( c, 0, d norm )
• TMR values can be normalized arbitrarily. However, normalization to a common refer-
ence depth or maximum may simplify consistency checks. Decay rates, for example,
can easily be compared.
• The TMR values for all collimators need to have the same depth coordinate values.
• TMR profiles must be measured for each collimator separately using the same jaw
position.

Do not use an ionization chamber that is too large for accurate small field do-
simetry.

226 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Off-Axis Ratio Measurement

Off-Axis Ratios

Setup • Use the relevant high-resolution detector (see page 210) with a small active volume to
get high spatial resolution.
• Recalibrate the x/y/z coordinates of the water phantom when changing the detector or
its orientation.

Figure 37Setup for OAR Measurement

Technical Reference Guide Rev. 1.2 Brainlab Physics 227

Off-Axis Ratio Measurement

Workflow
Steps
1. Adjust the detector at isocenter level, 75 mm below the water surface.
2. Keep the jaws in the same position as for the measurements of Scatter and PDD/
TMR.
3. • If you are using an automatic dose measurement system, make a continuous
dose measurement in order to get the most accurate and continuous OAR
graph.
• If only a non-automatic system can be used, make sure to measure in 0.5 mm
steps in the area of steep dose fall-off, and every 3-5 mm at the flat parts of the
dose curve until the dose drops to less than 2% of the maximum dose.
4. Make sure to measure the profile in positive and negative range.

Entering
Measurement Software Required Steps
Results
According to the definition of the off-axis ratio:
OAR ( c, r, d ) = D ( c, r, d ) ⁄ D ( c, 0, d )
BrainSCAN
• Normalize the data to the dose measured on central beam axis
with Beam Profile
r = 0.
Editor up to
version 5.x • Average the corresponding data points from the negative and
positive branch.
• In the Beam Profile Editor, select OAR under Input Values,
and enter the corresponding values.
Average corresponding data points from the negative and posi-
iPlan RT Dose tive branch.
with Beam Profile
Editor (7.x or high-
• Off-axis ratios can be normalized arbitrarily.
er) or Physics • However, normalization to the dose measured on central
Administration beam axis r = 0 may simplify consistency checks (e.g. profile
width can be checked very easily).

228 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: General Beam Data Measurement

Ensuring Accuracy • All collimators must have the same radial coordinate values.
• OAR profiles have to be measured for each collimator separately using the same jaw
position.
NOTE: Alternatively OAR can be measured using dosimetry films inside a water equiva-
lent material, see Figure 37. Use enough back-scatter material below the film.

Do not use an ionization chamber that is too large for accurate small field do-
simetry.

Technical Reference Guide Rev. 1.2 Brainlab Physics 229

Off-Axis Ratio Measurement

230 Technical Reference Guide Rev. 1.2 Brainlab Physics

Circular Cone: Beam Data Checklist

Circular Cone: Beam Data Checklist

General Beam Data for Linacs

Checklist (Excel template Brainlab FORM 09-638)

Task Equipment Done

Nominal linac output (NLOut) Calibrated chamber

Relative output factor (Scatter) High-resolution detector

Measurement of PDD/TMR High-resolution detector
Off-axis ratio High-resolution detector
Prepare beam profile (BrainSCAN):
• Enter identifier, energy, NLOut, normalization depth, and jaw
field size Beam Profile Editor 5.x
• For each conical collimator: enter scatter St and paste OAR and
TMR/PDD tables
Prepare beam profile (iPlan RT Dose 4.x):
• Enter identifier and energy (General Settings)
• Enter NLOut, normalization depth and SSD (Circular Cone Set- Beam Profile Editor 7.x
tings)
• Prepare scatter St, OAR and TMR/PDD tables (Excel sheet), and
paste them into the Beam Profile Editor.
Prepare beam profile (iPlan RT Dose 4.5 or higher):
• Enter identifier (Machine Selection tab)
• Choose Accelerator and energy (Machine Selection tab)
• Enter scatter-measurement depth and PDD-SSD as well as the Physics Administration
NLOut value (Circular Cone tab). Complete all tabs and close the
properties dialog
• Prepare scatter St, OAR and TMR/PDD tables (Excel sheet), and
paste them into Physics Administration

Technical Reference Guide Rev. 1.2 Brainlab Physics 231

Off-Axis Ratio Measurement

232 Technical Reference Guide Rev. 1.2 Brainlab Physics

Entering and Processing Beam Data in Physics Administration (optional)

Entering and Processing Beam Data in

Physics Administration (optional)

Introduction

Overview

General The raw data mode of Physics Administration enables you to enter measured beam data pri-
Information or to processing. The raw data mode no longer requires you to collect the data in Excel tem-
plates.
Using Physics Administration, raw data can be converted to beam profiles, which then can
be used with machine profiles for treatment planning.
For details, please refer to the Clinical User Guide, iPlan RT Dose.
Important: At the moment, this step is optional. The Excel templates are still required for
beam data processing!
This chapter concentrates on the differences with respect to the Excel template workflow.
Thus, we strongly recommend reading the corresponding General Beam Data Measurement
chapters before using the Raw Data mode.

Technical Reference Guide Rev. 1.2 Brainlab Physics 233

Off-Axis Ratio Measurement

Pencil Beam

General The following are different in the Pencil Beam raw data mode compared to the Excel tem-
Information plate approach:
• Depth dose profiles can have individual depth-coordinate values for each field size.
• Diagonal profiles can have individual radius-coordinate values for each depth.
• For some MLCs, the field size for the diagonal profile measurement has changed, see
“Diagonal Radial Profiles” on page 236.
• Diagonal profiles must be processed with Physics Administration to get the Radial
Factors.
• Transversal profiles can have individual coordinate values for each depth.
• Transversal profiles must be entered and processed with Physics Administration to
determine Source Function Correction and radiological shift parameters.

Nominal Linac The measurement instruction setup and workflow are described in “Nominal Linac Output
Output and Measurement” on page 46 and “Open and Closed Jaw Measurement” on page 49.
Background
Leakage The Nominal Linac Output data must be entered in the Nominal Linac Output dialog of the
Pencil Beam raw data interface:

Steps
1. Enter your absolute linac calibration by defining Source Surface Distance, Mea-
surement Depth, Normalization Field Size and Nominal Linac Output.
2. Enter Leakage for Open Jaws and Leakage for Closed Jaws in the Multileaf
Background section.

Scatter Factors The measurement instruction setup and workflow are described in “Scatter Factor Measure-
(Output Factors) ment” on page 54. To enter measurement results, enter Source Surface Distance (SSD) and
measurement depth of the scatter measurement in the Scatter Data dialog.
Important: These values must be the same as the SSD and measurement depth of the Nom-
inal Linac Output measurement. Otherwise, generation of a beam profile is impossible.
If needed, adjust MLC and Jaw size values in the Scatter Table section of the dialog and en-
ter your scatter data.
• The gray fields in the sample matrix tables provided from page 71 must be measured in
all cases.
• The white fields represent MLC and jaw combinations that are not recommended for
use with Brainlab’s radiotherapy treatment planning software. Details are provided
under “Primary Jaw Positioning” on page 36.
• It is therefore not necessary to measure these larger MLC fields. Instead, it is sufficient
to enter the last mandatory value measured, e.g. in the case of a jaw setting of
60 x 60 mm² you can use the value measured for the 60 x 60 mm² MLC field (0.8710 in
Table 7 on page 98).
You can also paste an entire scatter table at once using the paste button. In this case, MLC
and jaw sizes are automatically adjusted. For more details, please refer to the Clinical User
Guide, iPlan RT Dose.

234 Technical Reference Guide Rev. 1.2 Brainlab Physics

Entering and Processing Beam Data in Physics Administration (optional)

Depth Dose Profile The measurement instruction setup and workflow are described in “Depth Dose Profile” on
page 51. Depth dose profiles can be measured in a PDD-like or TMR/TPR-like setup.
To enter measurement results:

Steps
1. Define the measurement setup (PDD or TMR/TPR like) in the Depth Dose dia-
log. If a PDD-like approach has been used, you also need to enter the SSD of the
PDD-measurement in the dialog.
2. If needed, adjust the depth dose field sizes using the Add and Remove buttons in
the control area.
3. Paste each depth dose profile in the corresponding Depth Dose Profile dialog.
Different coordinate values may be used for each field size.
4. You can also paste a table with depth dose data for several field sizes at once us-
ing Paste Profiles. In this case, field sizes are automatically adjusted. For more
details, please refer to the Clinical User Guide, iPlan RT Dose.
5. Depth dose profiles can be normalized arbitrarily. However, normalization to a
common reference depth or maximum may simplify consistency checks.

Technical Reference Guide Rev. 1.2 Brainlab Physics 235

Off-Axis Ratio Measurement

Diagonal Radial The general measurement instruction setup and workflow are described in “Radial Factor
Profiles and Radial Profile Measurement” on page 56. Diagonal profiles can be measured in a PDD-
like or TMR/TPR-like setup.
Important: To get diagonal profiles suitable for Radial Factor calculation, the following
(add-on) MLCs must not be detached for the diagonal profile measurement:
• Brainlab m3
• Siemens Moduleaf
The MLC leaves must be retracted.
To enter measurement results:

Steps
1. Define the measurement setup (PDD or TMR/TPR like) in the Diagonal Profiles
dialog. If a PDD-like approach has been used, you also need to enter the SSD of
the measurement in the dialog.
2. If needed, adjust the depths using the Add and Remove buttons in the control ar-
ea.
3. Paste each diagonal profile in the corresponding Diagonal Profile Data dialog.
Different coordinate values may be used for each depth.
4. You can also paste a table with diagonal profile for several depths at once using
Paste Profiles. In this case, depths are automatically adjusted. For more details,
please refer to the Clinical User Guide, iPlan RT Dose.
5. Diagonal profiles can be normalized arbitrarily.

After entering all diagonal profiles (and depth dose data), Radial Factors can be calculated.
Please refer to the Clinical User Guide, iPlan RT Dose for more details.

236 Technical Reference Guide Rev. 1.2 Brainlab Physics

Entering and Processing Beam Data in Physics Administration (optional)

Transversal Profiles The measurement instruction setup and workflow are described in “Film Dosimetry Mea-
surement” on page 61 and “Measurement Using a Water Phantom and High-Resolution De-
tector” on page 63.
To enter measurement results:

Step Action
1. Define the measurement setup (PDD or TMR/TPR like) in the Transversal
Profiles dialog. If a PDD-like approach has been used, you must also enter
the SSD of the measurement in the dialog.
2. If needed, adjust the depths using the Add and Remove buttons in the con-
trol area.
3. Paste each transversal profile in the corresponding Transversal Profile Data
dialog. Different coordinate values may be used for each depth and direc-
tion.
4. You can also paste a table with transversal profiles for several depths at
once using Paste Profiles. In this case, depths are automatically adjusted.
For more details, please refer to the Clinical User Guide, iPlan RT Dose.
5. Transversal profiles can be normalized arbitrarily.

After entering all transversal profiles (and after calculating the Radial Factors), Source
Function Correction and radiologic leaf shift parameters can be calculated. Please refer to
the Clinical User Guide, iPlan RT Dose for more details.

Dynamic Leaf Shift The measurement instruction setup and workflow are described in “Dynamic Leaf Shift” on
page 64.
Enter the results of the dynamic leaf shift measurement in the Dynamic Leaf Shift dialog.
The dynamic leaf shift can be calculated in the Dynamic Leaf Shift dialog.

Technical Reference Guide Rev. 1.2 Brainlab Physics 237

Off-Axis Ratio Measurement

Circular Cones

General The following are different in the Circular Cone raw data mode compared to the Excel tem-
Information plate approach:
• Nominal Linac Output setup is defined independently to the scatter setup.
• Scatter data only relate dose with circular cone to that of a reference field (and do not
include any change in setup-conditions).
• Depth dose profiles can have individual depth-coordinate values for each collimator.
• Off-Axis Ratio profiles can have individual radius-coordinate values for each collima-
tor.
All dose measurement with cones must be performed with the same jaw aperture setting!
The jaw field size must be entered in the Properties dialog of the Circular Cone raw data.

Nominal Linac The measurement instruction setup and workflow are described in “Nominal Linac Output
Output Measurement” on page 214.
Conversion to isocentric setup
If the Nominal Linac Output has been measured using a different setup (Source Surface Dis-
tance (SSD) and depth) than the scatter measurement, two additional dose values relating
Nominal Linac Output (NLOut)-setup to scatter setup need to be measured:
• Dose for the NLOut -setup using the SSD and depth of the NLOut -measurement
• Dose for Scatter-setup at the isocenter in depth of scatter-measurement (see “Scatter”
on page 240).
Both measurements must be done for the Normalization Field Size using the same detector.
Brainlab recommends repeating each measurement three times and using the average value
to increase the accuracy
Using the calibrated chamber used for NLOut measurement effectively yields to a NLOut-
measurement at the isocenter. In this case, one can directly enter the NLOut defined at iso-
center and thus avoid the need of the conversion factors. However, entering the NLOut at a
different setup may simplify comparisons of the absolute linac calibration, for example to
Pencil Beam data using the same energy.

238 Technical Reference Guide Rev. 1.2 Brainlab Physics

Entering and Processing Beam Data in Physics Administration (optional)

Figure 38Measurement setup for conversion to isocentric setup

Entering Measurement Results

The Nominal Linac Output data need to be entered in the Nominal Linac Output dialog of
the Circular Cone raw data interface. Enter your absolute linac calibration by defining
Source Surface Distance, Measurement Depth, Normalization Field Size and Nominal
Linac Output.

If necessary, dose for the NLOut setup and dose for the Scatter setup must be entered in the
Nominal Linac Output dialog as well.

Technical Reference Guide Rev. 1.2 Brainlab Physics 239

Off-Axis Ratio Measurement

Scatter The scatter factors of the Circular Cone raw data are defined at the isocenter as:
rawdata
St ( c ) = D ( c ,r = 0 ,d measurement ) ⁄ D ( c cal ,r = 0 ,d measurement )

The recommendation for the measurement depth dmeasurement is the (average) depth of peak
dose (e.g. 15 mm for a 6 MV X-ray beam). All scatter measurements must be done at the
isocenter, hence with SSD=1000 mm - dmeasurement.
ccal is the normalization field size used for the Nominal Linac Output measurement (typical-
ly 100x100 mm²), and c defines the cone.
Important: The scatter definition above is different than the definition of the (total) scatter
given in “Scatter Factor Measurement” on page 218!
Setup:

Steps
1. Use the high-resolution detector as specified under “Recommended Equipment”
on page 210 to obtain accurate data for the small fields.
Depending on the large-field accuracy of the high-resolution detector, it might
be necessary to use some intermediate field size (e.g. 40x40 mm²) for a transi-
tion to a larger detector. No measurement shall exceed the field size specifica-
tions defined by the detector manufacturer.
2. Recalibrate the x/y/z coordinates of the water phantom when changing the de-
tector or its orientation.
3. Define the measurement depth (see above).

Entering Measurement Results

Steps
1. Enter the measurement depth of the scatter data in the Properties dialog of the
Circular Cone data.
2. If necessary, use the Add and Remove buttons of the control panel area to adjust
the available cone diameters.
3. Enter the scatter value for each cone in the corresponding Circular Cone data di-
alog.

240 Technical Reference Guide Rev. 1.2 Brainlab Physics

Entering and Processing Beam Data in Physics Administration (optional)

Depth Dose Profiles The measurement instruction setup and workflow are described in “Measurement Over-
view” on page 221. Depth dose profiles can be measured in a PDD-like or TMR/TPR-like
setup.
To enter measurement results:

Steps
1. Define the measurement setup (PDD or TMR/TPR like) in the Properties dia-
log. If a PDD-like approach has been used, enter the SSD of the PDD-measure-
ment in the Properties dialog.
2. If necessary, use the Add and Remove buttons of the control panel area to adjust
the available cone diameters.
3. Paste each depth dose profile in the corresponding Circular Cone data dialog.
Each circular cone may have its own coordinate values.
4. Depth dose profiles can be normalized arbitrarily. However, normalization to a
common reference depth or maximum may simplify consistency checks. Decay
rates, for example, can easily be compared.

Off-Axis Ratio The measurement instruction setup and workflow are described in “Off-Axis Ratios” on
page 227.
To enter measurement results:

Steps
1. Average corresponding data points from the negative and positive branch.
2. Enter the OAR-measurement depth in the Properties dialog.
3. If necessary, use the Add and Remove buttons of the control panel area to adjust
the available cone diameters.
4. Paste each OAR dose profile in the corresponding Circular Cone data dialog.
Each circular cone may have its own coordinate values.
5. Off-axis ratios can be normalized arbitrarily. However, normalization to the
dose measured on central beam axis r = 0 may simplify consistency checks.

Technical Reference Guide Rev. 1.2 Brainlab Physics 241

Off-Axis Ratio Measurement

242 Technical Reference Guide Rev. 1.2 Brainlab Physics

IMRT

IMRT

Overview

Contents

Topics Covered
Section See
Deliverability of IMRT Leaf Sequences Page 244

Technical Reference Guide Rev. 1.2 Brainlab Physics 243

Deliverability of IMRT Leaf Sequences

Deliverability of IMRT Leaf Sequences

Background

Leaf Sequencing Brainlab’s radiotherapy treatment planning software creates a leaf movement pattern for
Overview IMRT fields using the built-in leaf sequencing algorithm (Figure 39). In patterns of this
kind, the leaf positions are defined at a number of control points as a function of the cumu-
lative fractional dose that has been delivered so far. Depending on the treatment delivery
system, this sequence is delivered following the control points either dynamically or in seg-
ments, with segments being converted to a series of static conformal beams.

0.0 0.33

0.67 1.0
Figure 39Example: Dynamic IMRT Leaf Movement Pattern

Correct Leaf In the illustrations above, each control point defines the leaf positions at a certain cumula-
Movement and tive fractional dose as indicated under each leaf pattern shown.
Segmental Dose
Delivery In order to correctly deliver the computed leaf movement pattern, the system (linac and
MLC) must follow the exact leaf pattern calculated as a function of the cumulative fractional
dose, and also irradiate the required fractional dose for each segment (segmental dose) ac-
curately.

244 Technical Reference Guide Rev. 1.2 Brainlab Physics

IMRT

Dose Deviations Deviations between the planned and delivered dose may occur if the system either cannot
position the leaves correctly according to the prescribed fractional dose, or does not irradiate
the required fractional dose for a given segment. Examples are provided below of scenarios
that may lead to significant deviations in dose delivery to the patient, especially if extreme
parameter settings such as high dose rates or a low dose per IMRT beam are combined:
1. General limitations in the leaf positioning accuracy of the MLC.
2. During dynamic IMRT delivery, the system does not reach the required positions for a
certain delivered fractional dose. This is typically the case if the maximum leaf speed
of the MLC is exceeded and a high leaf tolerance value is used (see “Dynamic IMRT
Delivery and Leaf Tolerance Settings” on page 247). As the required leaf speed for a
certain pattern depends on the dose rate and the MU of the IMRT beam set at the linac,
high dose rates in combination with a low MU per IMRT beam are more likely to result
in the described deviations (Xia et al 2002).
3. Due to the response time of the linac/MLC controller system and/or random
irregularities in the radiation stability, the delivered fractional dose per segment can
deviate from the planned fractional dose. This is particularly true in the case of small
fractional doses per IMRT segment, and may affect all IMRT modalities. For example,
if the dose per segment is 2 MU and the linac delivers this dose to within ±1 MU, the
potential segmental dose error may be as large as 50%. A higher dose rate can also
result in dose deviations. Further information on linac output stability and its influence
on IMRT delivery can be found in the publications by Grigorov G. et al (2006),
Partridge M. et al (1998), and Rajapakshe R. et al (1998).
A special case of this type of deviation involves the optional setup light field that may
be added to the IMRT sequence in order to allow the verification of patient positioning
and beam setup prior to treatment. Further details are provided under “Setup Light
Field” on page 249.

Limitation of the To avoid situations where the delivery of a dynamic leaf sequence is inaccurate, it is possi-
Leaf Speed ble to enable the leaf speed limitation within the leaf sequencing algorithm. Based on the
dose fraction of each segment and the maximum allowed leaf speed of the MLC, the algo-
rithm calculates the maximum distance per segment one leaf can travel. If a leaf violates the
maximum leaf speed limit, new segments are inserted to allow the leaf to travel the full dis-
tance in two or more segments. As a consequence, the leaf sequencing factor can be higher,
and the field size per segment can be smaller for sequences with leaf speed limitation.
If you did not use the leaf speed limitation, the software displays a warning message in the
plan status indicating that the maximum allowed leaf speed has been exceeded.
In extreme cases with very high dose rates and low MU values it may happen, that even with
the leaf speed limitation enabled the speed constraint cannot be fulfilled. In such cases you
should reduce the dose rate.

Technical Reference Guide Rev. 1.2 Brainlab Physics 245

Deliverability of IMRT Leaf Sequences

Safety Notes The scenarios described here are merely examples of possible limitations that can lead to
significant deviations between the planned and delivered dose, in the event that extreme pa-
rameters such as high dose rate and low prescribed dose are combined. These scenarios do
not provide a complete description of potential problems. It should be carefully verified
whether a combination of high dose rates with a low beam dose provides acceptable treat-
ment results, and whether this significantly shortens the overall patient treatment time.
For further information on performing machine QA in a clinical environment in order to ver-
ify the performance of the system linac/MLC, and on performing IMRT patient QA, refer
to the publications by Linthout N. et al (2003) and LoSasso, T. et al (2001).

Using a treatment delivery system with extreme parameters such as high dose
rate, low MU per beam or high leaf speed may result in inaccurate delivery of
the planned treatment dose. It is the responsibility of the physicist to ensure cor-
rect delivery of the planned treatment dose to the patient. This includes respon-
sibility for the choice of appropriate treatment parameters.

246 Technical Reference Guide Rev. 1.2 Brainlab Physics

IMRT

Dynamic IMRT Delivery and Leaf Tolerance Settings

Background The leaf sequencing patterns for dynamic IMRT treatment using a Varian linac are defined
by DMLC files. These files contain the planned leaf positions as a function of the cumula-
tive fractional dose (relative cumulative dose value) for certain segments (control points).
These files are either sent to the MLC controller by the R&V system, or may be directly ex-
ported by your Brainlab radiotherapy treatment planning software and copied to the MLC
workstation manually.

Requirements for Under normal conditions, i.e. as long as the maximum leaf speed is not exceeded, the MLC
Leaf Sequencing controller in combination with the linac can follow the planned leaf sequencing pattern with
Accuracy an acceptable accuracy (assuming a linear dependency of the leaf positions between consec-
utive segments). In order to ensure accurate delivery, the MLC workstation samples the ac-
tual leaf positions and the cumulative fractional dose delivered by the linac so far at a
particular repetition rate. These results are then compared to the values defined by the leaf
sequence.
In the case of extreme parameters, such as high dose rates combined with a low beam MU
(fractionated treatments), the maximum leaf speed of an individual MLC may be exceeded
by some leaves at certain points of the delivery. As a result, the actual leaf positions deviate
from the planned ones. If this deviation exceeds the tolerance value defined in the DMLC
file, the MLC workstation sends a beam hold signal to the linac in order to stop irradiation.
Choosing a large tolerance value to allow large deviations in leaf position may result in sig-
nificant differences between the delivered and planned IMRT dose. On the other hand,
choosing very small tolerance values may result in a large number of beam holds, which can
also increase the deviation between the planned and the delivered dose. Further information
is provided in the publication by LoSasso et al (2001).
In order to avoid situations where the leaves cannot follow the planned leaf sequence, as low
a dose rate as possible should in theory be selected on the linac. However, the selected linac
dose rate will always be a compromise between accurate and correct dose delivery to the
patient (verified by phantom measurements) and overall treatment time. In order to deter-
mine suitable initial parameters for IMRT treatments, phantom treatments must be per-
formed with various parameter settings and absolute dose measurements for the entire
irradiated volume. These measurements must then be compared to the planned/calculated
dose distribution.
The leaf position and dose errors logged by the MLC workstation (DynaLog file) may also
be used to isolate potential problems in plan delivery. Further information is provided in the
publications by LoSasso et al (2001), Xia et al (2002), and Stell et al (2004).
The leaf tolerance value can be adjusted in the R&V system. Further information on adjust-
ing this parameter is provided in the documentation for your R&V system.

Technical Reference Guide Rev. 1.2 Brainlab Physics 247

Deliverability of IMRT Leaf Sequences

Safety Notes Prior to treatment plan verification using a phantom, an analysis of the leaf position errors
that are logged by the MLC workstation (DynaLog file) may be useful in order to detect po-
tential deviations in plan delivery. For further information on handling and evaluating the
data, refer to the appropriate documentation as required.

A high leaf tolerance setting for IMRT in combination with extreme treatment
parameter settings, such as a high dose rate for a plan with a low dose per beam,
may result in inaccurate delivery of the planned treatment dose. It is the respon-
sibility of the physicist to ensure the correct delivery of the planned treatment.
This includes responsibility for the choice of appropriate treatment parameters.

248 Technical Reference Guide Rev. 1.2 Brainlab Physics

IMRT

Setup Light Field

Background The IMRT leaf sequencing pattern created by your Brainlab radiotherapy treatment plan-
ning software may optionally start with a setup light field that represents the shape of the
outer contour of the tumor. The purpose of this field is to verify correct patient and beam
setup in cases where localized CT scans are used in combination with the target positioner
overlays.
The fractional dose for the segment that is assigned to the setup light field by the treatment
planning software is very small (default value = 0.001 or 0.1%) compared to the total
planned dose for the IMRT sequence. However, due to the response time of the MLC con-
troller/linac system, the fractional dose that is delivered to the first field may be higher than
the planned one. This may significantly affect the delivered dose, especially in cases where
high dose rates are combined with a low beam dose. For this reason, the setup light field
should be deactivated if it is not required for patient setup verification. However, if the setup
light field is required, the dose rate chosen for patient treatment must be sufficiently small
in order to prevent unacceptable dose deviations during delivery.
A summary of the effect is given below. Further details on potential variations in the dose
delivered by individual IMRT segments are provided in the publications by Xia et al (2002),
Stell et al (2004), and Li et al (2003).

Setup Light Field

Segments

0.001 - Setup Light Field 0.2 - First Segment 0.4 - Second Segment
Figure 40Example Setup Light Field Sequence

• Left image: planned fractional dose of 0.001

• Center image: first IMRT segment with cumulative fractional dose of 0.2
• Right image: second IMRT segment with cumulative fractional dose of 0.4

Role of the MLC As described in previous sections, the accuracy of IMRT beam delivery depends on the in-
Controller terplay between the planned treatment sequences, the dose rate and the total prescribed dose.
With these factors correctly balanced, the MLC controller can position the leaves correctly
and without delays for the fractional dose prescribed. The MLC controller periodically sam-
ples the leaf positions and the accumulated fractional dose irradiated by the linac so far (the
current sampling time of the Varian MLC controller is about 55 ms). During each sample
interval, the MLC controller plans the next leaf position based on the current cumulative
fractional dose and the corresponding segment of the IMRT plan.

Technical Reference Guide Rev. 1.2 Brainlab Physics 249

Deliverability of IMRT Leaf Sequences

Dose Overshoot If the sampled leaf positions are outside the permitted range of planned positions (see “Dy-
namic IMRT Delivery and Leaf Tolerance Settings” on page 247), the MLC controller
sends a beam hold signal to the linac in order to stop irradiation. Due to the interval between
sampling cycles, and the signal transmission interval and linac response time, there may be
a delay of a few sampling cycles until irradiation actually stops.
As a result, the first segment of an IMRT sequence (see Figure 40 on page 249) receives a
slightly larger segmental dose than planned (dose overshoot). In subsequent segments, ran-
dom deviations may also occur, leading to either an increase or a decrease in segmental
dose. The linac dose control system stops irradiation once the prescribed MU for the IMRT
beam is reached. As a result, the last segments of the IMRT sequence receive a reduced frac-
tional dose (see Figure 40 on page 249). Effectively, the total MU applied to the beam is as
intended.
This behavior is typical for linac/MLC controller systems and is not restricted to a particular
leaf sequencing pattern. However, the relative dose deviations from a delivered plan will in-
crease in the event of high linac dose rates or a low beam dose, and will also vary depending
on the individual characteristics of the applied IMRT sequence.

Fractional Dose Per

Segment
Segm. Fractional Dose Planned Sequence

0.999 / N

0.001

SLF 1st Seg 2nd Seg ... nth Seg

Segm. Fractional Dose Delivered Sequence

0.999 / N

0.001

SLF 1st Seg 2nd Seg ... nth Seg

Figure 41Fractional Dose per Segment

The upper graph (see Figure 41 above) shows the fractional dose for the setup light field
(SLF) and a sequence of n IMRT segments as planned by the treatment planning software.
The lower graph illustrates the actual fractional dose per segment during IMRT delivery.
Due to the response time of the dose control loop, the setup light field at the start of the se-
quence is irradiated with a fractional dose that is greater than planned. As the linac stops
irradiation if the cumulative fractional dose reaches 1, the last segment(s) will receive a
smaller fractional dose. The total MU of the IMRT beam is not changed by this behavior,
but the first segment receives a higher dose and the last segment(s) receive a lower dose.
This also occurs when a setup light field is not used.

250 Technical Reference Guide Rev. 1.2 Brainlab Physics

IMRT

Activating/ For iPlan RT Dose, the setup light field can be activated/deactivated in the machine pro-
Deactivating the file using the Beam Profile Editor/Physics Administration software. Further information
Setup Light Field on activating and deactivating the export of setup light fields is provided in the iPlan RT
Dose user guide.

Safety Notes

Using a setup light field in combination with extreme treatment parameter set-
tings, such as a high dose rate for a plan with a low dose per beam, may result
in inaccurate delivery of the planned treatment dose. It is the responsibility of
the physicist to ensure correct delivery of the planned treatment. This includes
responsibility for the choice of appropriate treatment parameters. If a setup
light field is not required for setup verification, it should be deactivated.

Technical Reference Guide Rev. 1.2 Brainlab Physics 251

Deliverability of IMRT Leaf Sequences

Dynamic Conformal Arc Delivery

Background For dynamic arc treatments, your Brainlab radiotherapy treatment planning software inter-
nally splits an arc into equidistant increments of 10°. At each angle position, an individual
MLC field is calculated, and the leaves adapted to the contour of the PTV. Thus, each arc is
represented by a sequence of control points that define a leaf sequencing pattern as a func-
tion of the gantry angle along the arc. For arc delivery, the Varian MLC workstation is pro-
vided with information on these sequences in special arc dynamic MLC files. These files are
either provided by the R&V system or are directly exported by the TPS system and trans-
ferred manually to the MLC workstation.

Leaf Tolerance Similar to the dynamic IMRT mode (see “Dynamic IMRT Delivery and Leaf Tolerance Set-
tings” on page 247), the arc dynamic MLC files contain a leaf tolerance value that defines
the deviation between the actual and the expected leaf position that is tolerated by the sys-
tem during treatment. In contrast to the dose dynamic treatment mode in IMRT, the MLC
controller implements an MLC interlock and the treatment is interrupted in the event that
the leaf tolerance is exceeded.
Although the treatment planning software takes the limitations of the linac into account dur-
ing computation of the dynamic arc leaf sequence, treatment plans should nevertheless be
verified on phantoms using the same parameter settings as for patient treatment. Particular
care should be taken when setting parameters such as dose rate and leaf tolerance.
The leaf tolerance value can be adjusted in the R&V system. Further information on adjust-
ing this parameter is provided in the documentation for your R&V system.

Safety Notes Prior to treatment plan verification using a phantom, an analysis of the leaf position errors
that are logged by the MLC workstation (DynaLog file) may be useful in order to detect po-
tential deviations in plan delivery. For further information on handling and evaluating the
data, refer to the appropriate documentation as required.

Due to the increment size of 10 degrees for dose calculation of conformal arc
treatments, the calculated dose may be inaccurate. It is strongly recommended
to perform phantom verification for every conformal arc treatment plan.

252 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

Quality Assurance

Overview

Contents

Topics Covered
Section See
Introduction to Quality Assurance Page 254
Machine-Related Quality Assurance Page 256
Patient-Related Quality Assurance Page 259
Patient-Specific Quality Assurance Page 261

Technical Reference Guide Rev. 1.2 Brainlab Physics 253

Introduction to Quality Assurance

Introduction to Quality Assurance

Background

Importance of The establishment of a comprehensive quality assurance program is one of the most impor-
Quality Assurance tant tasks of a radiation oncology department. In order to determine the appropriate proce-
dures and processes, various publications can be referred to that provide details on the
aspects that should be considered. The most comprehensive articles on this subject are the
reports published by the IAEA (TRS-430 2004) and the AAPM Radiation Therapy Com-
mittee Task Group 40 (Kutcher et al, 1994).

Purpose of this This document is not intended as a complete guideline or working instruction. Neither does
Document it claim to be an all-inclusive checklist of the procedures to be completed before starting pa-
tient treatment. It merely describes methods generally relevant to system commissioning,
and provides references to related documents published by the international medical physics
community. The equipment, methods and tests suggested here may therefore require modi-
fication in accordance with given standards, regulations or instructions.

Overview of Quality Quality assurance procedures can be divided into:

Assurance
Procedures • Machine-related QA (see “Machine-Related Quality Assurance” on page 256)
• Patient-related QA (see “Patient-Related Quality Assurance” on page 259)
• Patient-specific QA (see “Patient-Specific Quality Assurance” on page 261)

254 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

Required Equipment

Standard Every radiotherapy department requires certain dosimetry equipment. The following stan-
Equipment dard equipment must be available in order to facilitate the necessary commissioning proce-
Requirements dures:
• Motorized water phantom tank with control software
• Various relative dose detectors (e.g. ionization chamber, diode, or diamond)
• Absolute calibrated dose detector and calibrated electrometer
• Solid water phantoms that are equipped with chamber drillings for absolute dose mea-
surements, and that also support the insertion of radiographic or radiochromatic film
• Radiographic film and a film developer machine, or radiochromatic film, a calibrated
film scanner, and film analysis and dose comparison software (or 2-dimensional array
with sufficient spatial resolution and control software)
• Optional: anthropomorphic phantom for verifying tissue heterogeneity

Equipment You must ensure that the equipment in use is properly calibrated. For the purposes of com-
Calibration parison, several devices of a similar type should be available, e.g. two or more radiation de-
tectors.

Test Requirements Testing should be performed in accordance with policy guidelines determined by the hospi-
tal director and by the medical physicist responsible for system operation. The tests required
will vary depending on the linac and beam-collimating hardware used, and on the indica-
tions to be treated using this hardware. The requirements in each case may also vary in ac-
cordance with local legislation.

Planning Software Brainlab planning software includes tools to support the quality assurance process. The
phantom mapping and measurement function, for example, and the dose export feature, al-
low the dose distribution to be evaluated and plan-film comparisons to be performed using
3rd-party software.

Technical Reference Guide Rev. 1.2 Brainlab Physics 255

Machine-Related Quality Assurance

Machine-Related Quality Assurance

Background

When is Machine- Machine-related QA must be performed whenever a part of the system is replaced or mod-
Related QA ified. You may wish to repeat machine-related QA on a regular basis (e.g. several times a
Required? year) in order to ensure appropriate accuracy for the system as a whole.

Safety Notes

Make sure that your beam data measurements are up-to-date and that dose al-
gorithms are properly configured and calibrated. Regularly check the configu-
ration and calibration using phantom measurements.

If one or more components of the treatment delivery system have been modi-
fied, exchanged or recalibrated, a revalidation of the treatment planning system
in combination with the treatment delivery system must be performed in accor-
dance with your quality assurance procedures. If components have been modi-
fied that influence the dosimetric parameters of the system, the beam data
measurements must be repeated and the revised data entered into the system
using the Beam Profile Editor/Physics Administration.

256 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

Specific Tests

Background Machine commissioning must include testing of at least the items listed below.

Imaging Units • Test e.g. by verifying the HU calibration of the CT scanner.

• Hounsfield units converted to electron density are the basis for all dose calculation
algorithms. Imaging unit accuracy is therefore essential.

Mechanical and Test the following:

Kinetic Properties
of the Linac System • Isocenter reproducibility, dependence on rotations (gantry, table, and collimator) and
Winston-Lutz testing
• Accuracy and reproducibility of localization (e.g. using localizing lasers, target posi-
tioners, or mask systems)
• Accuracy and reproducibility of leaf positions and leaf movements, and leaf position
dependence on gantry position (gravity)
• Collimator rotation accuracy test (star test, Rosca et al, 2006)

Beam Data and

Dose Calculation Test Type Should Include
• Absolute dose measurements for various field sizes covering the
complete range of treatments
• Beam profile verification with different setups and using
different detectors. Examples include depth dose distributions,
All treatment radial/transversal profiles, penumbra accuracy, regular and
modalities irregular irradiation fields, and relative comparison of 2D and
3D dose distributions for various fields and various setups.
• Interleaf and intraleaf transmission (film measurement,
Cosgrove et al, 1999)
• Independent checks of calculated MU
• Gantry movements (reliability of start-stop angles, continuous
movement, MU delivery during arcing, gantry rotation speed,
Dynamic arcs dose rate dependence, and leaf speed dependence)
(Grebe et al 2001)
• Dynamic leaf movements
• Interrupted/continued treatment
• Individual IMRT beam fluence distribution
• Dose rate dependency of the leaf movement accuracy
IMRT (Zygmanski et al, 2003; Xia et al, 2002)
(LoSasso et al 2001)
• Dynamic leaf shift (LoSasso et al, 1998)
• Interrupted/continued treatment

Technical Reference Guide Rev. 1.2 Brainlab Physics 257

Machine-Related Quality Assurance

Data Transfer • Correctness of data transfer to R&V system and linac (linac scale convention)
• Correctness of data transfer to patient positioning system such as ExacTrac

258 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

Patient-Related Quality Assurance

Background

When is Patient- Following machine commissioning, the quality assurance procedures performed should
Related QA simulate the complete patient treatment workflow. This should include treatments typically
Required? performed in the hospital, and also incorporate independent dose calculation at selected
points in a phantom. The dose in such cases can either be determined manually or using an
alternative algorithm.

Safety Notes

Measure the absolute accuracy of the iPlan treatment planning system in com-
bination with the used treatment delivery systems using phantoms. The mea-
sured accuracy must be taken into account when configuring plan parameters
in order to ensure accurate treatment delivery.

Technical Reference Guide Rev. 1.2 Brainlab Physics 259

Patient-Related Quality Assurance

Recommended Procedures

Simulation of Simulation of complete patient treatment should be performed using an anthropomorphic

Complete Patient phantom mounted to the localizer hardware (if applicable).
Treatment
• It should include all treatment steps, from CT and MR scanning through to image
fusion, treatment planning, data transfer, positioning, dose delivery to the phantom,
dose measurement and comparison of the achieved results.
• Simulation should be repeated for all possible treatment modalities, indications and
energy levels (e.g. for static/dynamic IMRT treatments, conformal/dynamic arcs, vari-
ous field sizes, and tissue inhomogeneities).

Absolute and This must be performed for single beam elements and the treatment plan as a whole using
Relative Dose suitable detector systems, for example film with a film analysis tool, distance to agreement
Measurement measures (Harms et al, 1998), gamma index (Low et al, 2003), and thermoluminescence do-
simetry.

260 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

Patient-Specific Quality Assurance

Background

When is Patient- After machine-related QA and patient-related QA have been successfully performed, and
Specific QA the treatment system is approved for patient treatment in accordance with your department’s
Required? quality standards, the following additional checks must be performed prior to every patient
treatment.

Safety Notes

Ensure proper delivery of the treatment plan to the patient. It is strongly rec-
ommended to perform a phantom verification for every treatment plan using
exactly the same parameter settings that will be used for the real patient during
actual treatment.

Technical Reference Guide Rev. 1.2 Brainlab Physics 261

Patient-Specific Quality Assurance

Pre-Treatment Patient QA

Overview Special care must be taken to ensure accurate patient positioning. To ensure correct usage
of your stereotactic hardware and positioning system, refer to the corresponding user man-
ual and perform the tasks described below.

Winston-Lutz Test • Carry out a Winston-Lutz test for isocenter and laser verification at least once a day.
• Ensure that all printouts are reviewed and signed by the physicist in charge.

Positioning using • Attach the target positioner overlays to the target positioner.
the Stereotactic • Position the patient using the target positioner by aligning the required isocenter on the
Target Positioner
overlays with the treatment room lasers.
• Review the light field projections on the target positioner to ensure that each conformal
field is correct.

The Brainlab Stereotactic Target Positioner should only be used with printed
target positioner overlays. The scales on the target positioner itself should not
be used for positioning.

Marker-Based This applies if using Novalis Body, ExacTrac, skin markers, etc.
Positioning
• Position the patient based on the required isocenter using the selected system.
• If applicable, verify the accuracy of the position using portal film-DRR comparison.
• Check the printed beam templates for each beam using the linac light field at the speci-
fied focus-to-film distance (for example, 100 cm).
• You should also check the correspondence of the MLC shapes with the PTV projec-
tions.

If a localizer or target positioner is not used for patient positioning, an indepen-

dent check of patient positioning (for example using portal imaging, on-board
imaging, or other general plausibility checks) must be performed. A second per-
son should double check that positioning is correct.

The entire setup accuracy depends on the laser setup. Laser verification must be performed
more often than is usually required for standard radiotherapy. This may also be applicable
for other verification procedures.

Additional Tests It is the responsibility of the physicist in charge to add additional tests or checks in order to
guarantee the accuracy specified for the linac.

262 Technical Reference Guide Rev. 1.2 Brainlab Physics

Quality Assurance

General Patient QA

Recommendations • Perform dose measurement for each patient plan using a solid water phantom with a
film and absolute calibrated detectors. The results must then be compared with the dose
calculation performed using a CT scan of this phantom (phantom mapping).
• Review all treatment parameters (e.g. mechanical properties of the linac and collimat-
ing devices, dosimetric properties, prescription, patient setup, and gantry-table setup)
transferred to the R&V system before initial setup.
• Carry out an independent plan review.
• An independent calculation of the dose at a specific point in the plan is recommended.
• If applicable, verify the accuracy of patient positioning in comparison to DRRs using
portal film or EPID.
• If applicable, verify the light field projections on the target positioner to ensure that the
correct field is chosen and that the field shape is correct. Alternatively, check the
printed beam templates. Refer to the instructions provided with your stereotactic hard-
ware for the details on how to align the target positioner to the isocenter using the room
lasers.

Light Field Tests

Prior to initial treatment, a light field test must be performed.

Prior to every patient treatment, the light fields must be verified using either the
beam template printouts or the target positioner printouts. Special care must be
taken to ensure that the correct field shape is applied to each beam setup.

Technical Reference Guide Rev. 1.2 Brainlab Physics 263

Patient-Specific Quality Assurance

264 Technical Reference Guide Rev. 1.2 Brainlab Physics

Appendix 1

Appendix 1

Accuracy of Dose Algorithms

Pencil Beam and Monte Carlo

Background The IAEA test package described in IAEA-TECDOC-1540, based on measurements by

Vanselaar and Welleweerd (see the general references provided on page 271), was used to
validate the dosimetric accuracy of Brainlab’s pencil beam and Monte Carlo implementa-
tion within iPlan RT Dose. The test package comprises four different beam energies. The
Co-60 tests have not been performed because iPlan RT Dose does not support Co-machines.
From the remaining three linac energies (6, 10 and 18 MV), the lowest and the highest en-
ergy has been used. According to Vanselaar and Welleweerd, the 6 MV (Quality index
QI = 0.676) data have been obtained at an Elekta SL 15 linear accelerator, and the 18 MV
(QI = 0.770) at an Elekta SL 20. Therefore both data sets have been modeled using an Elekta
MLCi Standard MLC with 40 leaf pairs with 1 cm leaf width, each.

Definitions The deviation for a single dose point inside the open beam is calculated as
(Dcalc - Dmeas) * 100% / Dmeas,
and as
(Dcalc - Dmeas) * 100% / Dmeas,cax
for a dose point outside the penumbra. The confidence limit is defined as
|average deviation| + 1.5 * standard deviation,
with the standard deviation calculated as the geometrical average of the deviations. The fol-
lowing tables summarize the results for 6 and 18 MV for pencil beam and Monte Carlo.

Technical Reference Guide Rev. 1.2 Brainlab Physics 265

IAEA Test 6 MV
Pencil Beam Monte Carlo
Test# Description Confidence Confidence
Average Average
Limit Limit

1a-c Square -0.6% 1.5% -0.1% 2.0%

2a-b Rectangular 0.0% 2.4% 0.0% 1.7%
3 Short SSD -0.4% 1.2% +0.1% 1.5%
6 Off-center plane -0.2% 1.6% -0.3% 1.8%
8a-b Lung inhomogeneity -0.2% 1.7% -0.6% 1.9%
8c Bone inhomogeneity -0.6% 1.4% -0.1% 1.0%
9 Oblique incidence +0.8% 1.7% +0.2% 1.6%
10a-b Missing tissue +5.4% 12% -0.6% 2.6%
11 Asymmetrically open +2.2% 4.7% +0.5% 2.2%
Figure 42Test Package Results for 6 MV Dose Calculations

IAEA Test 18 MV
Pencil Beam Monte Carlo
Test# Description Confidence Confidence
Average Average
Limit Limit

1a-c Square -0.4% 2.0% +0.5% 2.3%

2a-b Rectangular -0.1% 2.0% +0.8% 1.7%
3 Short SSD -0.4% 2.7% +1.2% 2.6%
6 Off-center plane -0.5% 2.2% +0.7% 1.9%
8a-b Lung inhomogeneity -0.4% 1.3% -0.5% 2.2%
8c Bone inhomogeneity 0.0% 0.6% -0.1% 0.9%
9 Oblique incidence +0.1% 1.5% -0.1% 1.9%
10a-b Missing tissue +4.2% 9.3% +0.1% 2.2%
11 Asymmetrically open +0.6% 1.6% -0.2% 1.5%
Figure 43Test Package Results for 18 MV Dose Calculations

266 Technical Reference Guide Rev. 1.2 Brainlab Physics

Appendix 1

Circular Cone

Background The circular cone algorithm is verified to reproduce the input parameters entered into the
Beam Profile Editor/Physics Administration inside a homogeneous water phantom within
1%. This is the case for the absolute calibration, depth dose curves, output factors and the
off-axis ratios.

Technical Reference Guide Rev. 1.2 Brainlab Physics 267

268 Technical Reference Guide Rev. 1.2 Brainlab Physics
Appendix 2

Appendix 2

Linac Energy

Specification of Linac Energy

Nominal Linac The following table shows the most frequent photon energies. The Brainlab dose algorithms
Energy pencil beam and Monte Carlo are released for the Beam Quality Indices from QI = 0.61 to
QI = 0.80. The following table provides the related nominal linac energy.

Figure 44Specification of Linac Energy

Source: British Journal of Radiology - Supplement 25, “Central Axis Depth Dose Data for
Use in Radiotherapy: 1996”

Technical Reference Guide Rev. 1.2 Brainlab Physics 269

270 Technical Reference Guide Rev. 1.2 Brainlab Physics
Appendix 3

Appendix 3

Bibliography

References

General • Alfonso, R., Andreo, P. et al.: A new formalism for reference dosimetry of small and
nonstandard fields. Med. Phys. 35 (11); 2008; 5179-5186
• Almond, P. R., Biggs, P. J.; AAPM’s TG-51 protocol for clinical reference dosimetry of
high-energy photon and electron beams. Med. Phys. 26 (9); 1999; 1847-1870
• Chang, Z., et al.: Dosimetric characteristics of Novalis Tx system with high definition
multileaf collimator. Med. Phys. 35 (10); 2008; 4460-4463.
• Das, I. J., et al.: Accelerator beam data commissioning equipment and procedures:
Report of the TG-106 of the Therapy Physics Committee of the AAPM. Med. Phys. 35
(9); 2008; 4186-4215
• Grebe et al.: Dynamic arc radiosurgery and radiotherapy: Commissioning and verifica-
tion of dose distributions. Int. J. Radiation Oncology Biol. Phys. 49 (5); 2001; 1451-60
• IAEA-TECDOC-1540, Specification and Acceptance Testing of Radiotherapy Treat-
ment Planning Systems. IAEA; April 2006
• IAEA TRS-398; Absorbed dose determination in External Beam Radiotherapy. IAEA
Technical Report Series No. 398; 2006;
• Rice, R. K., Hansen, J. L., Svensson, G. K., Siddon, R. L.; Measurements of dose distri-
butions in small 6MV x-rays. Phys. Med. Biol. 32; 1987; 1087-1099
• Sauer, O. A. et al.: Measurement of output factors for small photon beams. Med.Phys.
34 (6); 2007; 1983-1988
• Schneider et al.; The calibration of CT Hounsfield Units for radiation treatment plan-
ning. (1996) Phys. Med. Biol. 41 pp 111-124.
• Vanselaar, J. and Welleweerd, H., Application of a test package in an intercomparison
of the photon dose calculation performance of treatment planning systems used in a
clinical setting. Radiotherapy & Oncology 60; 2001; 203-213
• Winkler P. et al.: Dose-response characteristics of an amorphous silicon EPID. Med.
Phys. 32 (10); 2005; 3095-3105
• Yin et al.: Dosimetric characteristics of the Novalis shaped beam surgery unit. Med.
Phys. 29 (8); 2002; 1729-38

Technical Reference Guide Rev. 1.2 Brainlab Physics 271

Quality Assurance • Cosgrove et al.: Commissioning of a multi-leaf collimator and planning system for
stereotactic radiosurgery. Radiother. Oncol. 50; 1999; 325-36
• Grebe et al.: Dynamic arc radiosurgery and radiotherapy: Commissioning and
verification of dose distributions. Int. J. Radiation Oncology Biol. Phys. 49 (5); 2001;
1451-60
• Harms, W. B., et al.: A software tool for the quantitative evaluation of 3D dose
calculation algorithms. Med. Phys. 25 (10); 1998; 1830-1836
• IAEA TRS-430; Commissioning and Quality Assurance of Computerized Planning
Systems for Radiation Treatment of Cancer. IAEA Technical Report Series No. 430;
2004
• Kutcher, G. J., et al.: Comprehensive QA for Radiation Oncology: Report of AAPM
Radiation Therapy Committee Task Group 40. Med. Phys. 21 (4); 1994; 581-618
• LoSasso, T. et al.: Comprehensive quality assurance for the delivery of intensity
modulated radiotherapy with a multileaf collimator used in the dynamic mode. Med.
Phys. 28 (11); 2001; 2209-2219
• LoSasso, T. et al.: Physical and dosimetric aspects of a multileaf collimation system
used in the dynamic mode for implementing intensity modulated radiotherapy. Med.
Phys. 25 (10); 1998; 1919-1927
• Low, D. A. et al.: Evaluation of the gamma dose distribution comparison method. Med.
Phys. 30 (9); 2003; 2455-2464
• Rosca, F., et al.: An MLC-based linac QA procedure for the characterization of
radiation isocenter and room lasers' position. Med. Phys. 33 (6); 2006; 1780-1787
• Zygmanski, P. et al.: Dependence of fluence errors in dynamic IMRT on leaf-positional
errors varying with time and leaf number. Med. Phys. 30 (10); 2003; 2736-2749

272 Technical Reference Guide Rev. 1.2 Brainlab Physics

Appendix 3

Quality Assurance - • AAPM Reports (http://www.aapm.org/pubs/reports/)

Further Reading • Agazaryan et al.: Patient specific quality assurance for the delivery of intensity modu-
lated radiotherapy. J. Appl. Clin. Med. Phys. 4 (1); 2003; 40-50
• Agazaryan et al.: A methodology for verification of radiotherapy dose calculation. J.
Neurosurg. (Suppl. 3) 101; 2004; 356-61
• Clark et al.: Penumbra evaluation of the Varian Millenium and the Brainlab m3 multi-
leaf collimators. Int. J. Radiation Oncology Biol. Phys. 66 (4); 2006; S71-S75
• Leavitt et al.: Comparison of interpolated vs. calculated micro-multileaf settings in
dynamic conformal arc treatment. Med. Dosim. 25 (1); 2000; 17-21
• Li et al.: A new approach in dose measurement and error analysis for narrow photon
beams (beamlets) shaped by different multileaf collimators using a small detector. Med.
Phys. 31 (7); 2004; 2020-32
• Linthout et al.: Evaluation of dose calculation algorithms for dynamic arc treatments of
head and neck tumors. Radiother. Oncol. 64; 2002; 85-95
• Linthout et al.: A simple verification of monitor unit calculation for intensity modu-
lated beams using dynamic mini-multileaf collimation. Radiother. Oncol. 71; 2004;
235-41
• Solberg et al.: Conformal radiosurgery using a dedicated linac and micro multileaf col-
limator. In: Kondziolka (ed) Radiosurgery; Basel; Karger; vol. 3; 2000; 53-63
• Verellen et al.: Assessment of the uncertainties in dose delivery of a commercial system
for linac-based radiosurgery. Int J Radiation Oncology Biol Phys 44 (2); 1999; 421-33
• Wong: Quality assurance devices for dynamic conformal radiotherapy. J. Appl. Clin.
Med. Phys. 5 (1); 2004; 1-8
• Xia et al.: Physical characteristics of a miniature multileaf collimator. Med. Phys. 26
(1); 1999; 65-70

Pencil Beam • Mohan R, Chui C, Lidofsky L; Energy and angular distributions of photons from medi-
cal linear accelerators. (1985) Med. Phys. 12 pp 592 - 597.
• Mohan R, Chui C, Lidofsky L; Differential pencil beam dose computation model for
photons. (1986) Med. Phys. 13 pp 64 - 73.
• Mohan R, Chui C; Use of fast fourier transforms in calculating dose distributions for
irregularly shaped fields for three-dimensional treatment planning. (1987) Med. Phys.
14 pp 70 - 77.

Technical Reference Guide Rev. 1.2 Brainlab Physics 273

Circular Cone and • AAPM Report No. 54: Stereotactic Radiosurgery (1995). Published by American.
Clarkson Institute of Physics.
• Bjarngard B E, Tsai J S, Rice R K; Doses on the central axis of narrow 6MV x-ray
beams. (1990) Med. Phys. 17 pp 794-799.
• Brahme A; Correction of a measured distribution for the finite extension of the
detector. (1981) Strahlentherapie 157 pp 258 - 259.
• Clarkson J R; A note on depth dose in fields of irregular shape. (1941) Brit. J. Radiol.
14 p265.
• Dawson J, Schroeder N J, Hoya J D; Penumbral measurement in water for high energy
X rays. (1986) Med. Phys. 13 pp 1011 - 1114.
• Hartmann G. H. (Editor) Quality Assurance Program on Stereotactic Radiosurgery:
Report from a Quality Assurance Task Group. (1995) Published by Springer-Verlag,
Berlin Heidelberg.
• Heydarian M, Hoban P W, Beddoe A H; A comparison of dosimetry techniques in
stereotactic radiosurgery. (1996) Phys. Med. Biol. 41 pp 93-110.
• Luxton G, Jozsef G, Astrahan M A; Algorithm for dosimetry of multiarc linear-
accelerator stereotactic radiosurgery. (1991) Med. Phys. 18 pp 1211 - 1221.
• Podgorsak E, Oliver A, Pla M, Lefebvre P Y, Hazel J; Dynamic stereotactic
radiosurgery. (1988) Int. J. Radiat. Oncol. 14 pp 115 - 126.
• Serago C F, Houdek P V, Hartmann G H, Saini D S, Serago M E, Kaydee A; Tissue
maximum ratios (and other parameters) of small circular 4, 6, 10,15 and 24MV x-ray
beams for radiosurgery. (1992) Phys. Med. Biol. 37 pp 1943 - 1956.
• Shibata C H, Motta H C, Beddar A S, Higgins P D, Higgins P D, Shin K; Influence of
detector size in photon profile measurement. (1991) Phys. Med. Biol. 36 pp 621-631.

274 Technical Reference Guide Rev. 1.2 Brainlab Physics

Appendix 3

Monte Carlo • AAPM Task Group Report No 105: Issues associated with clinical implementation of
Monte Carlo-based external beam treatment planning, Medical Physics 34 (2007)
4818-4853.
• Berger M J, Hubbell J H: XCOM: Photon cross sections on a personal computer,
Technical Report NBSIR 87-3597 (1987) National Institute of Standards and
Technology, Gaithersburg, MD.
• Berger M J: ESTAR, PSTAR, and ASTAR: Computer programs for calculating
stopping-power and range tables for electrons, protons, and helium ions, Technical
Report NBSIR 4999 (1993) National Institute of Standards and Technology,
Gaithersburg MD.
• Dobler B, Walter C, Knopf A, Fabri D, Loeschel R, Polednik M, Schneider F, Wenz F,
Lohr F: Optimization of extracranial stereotactic radiation therapy of small lung lesions
using accurate dose calculation algorithms, Radiation Oncology 1 (2006) 45.
• Fippel M: Fast Monte Carlo dose calculation for photon beams based on the VMC
electron algorithm, Medical Physics 26 (1999) 1466-1475.
• Fippel M: Efficient particle transport simulation through beam modulating devices for
Monte Carlo treatment planning, Medical Physics 31 (2004) 1235-1242.
• Fippel M, Haryanto F, Dohm O, Nüsslin F, Kriesen S: A virtual photon energy fluence
model for Monte Carlo dose calculation, Medical Physics 30 (2003) 301-311.
• Fippel M, Kawrakow I, Friedrich K: Electron beam dose calculations with the VMC
algorithm and the verification data of the NCI working group, Physics in Medicine and
Biology 42 (1997) 501-520.
• Fippel M, Laub W, Huber B, Nüsslin F: Experimental investigation of a fast Monte
Carlo photon beam dose calculation algorithm, Physics in Medicine and Biology 44
(1999) 3039-3054.
• ICRU Report No 46: Photon, Electron, Proton and Neutron Interaction Data for Body
Tissues, International Commission on Radiation Units and Measurements (1992).
• International Electrotechnical Commission: Radiotherapy equipment, coordinates,
movement and scales, IEC 1217 (1996).
• Kawrakow I: Accurate condensed history Monte Carlo simulation of electron transport.
I. EGSnrc, the new EGS4 version, Medical Physics 27 (2000) 485-498.
• Kawrakow I, Fippel M: Investigation of variance reduction techniques for Monte Carlo
photon dose calculation using XVMC, Physics in Medicine and Biology 45 (2000)
2163-2183.
• Kawrakow I, Fippel M, Friedrich K: 3D Electron Dose Calculation using a Voxel based
Monte Carlo Algorithm (VMC), Medical Physics 23 (1996) 445-457.
• Krieger T, Sauer O A: Monte Carlo- versus pencil-beam-/collapsed-cone-dose
calculation in a heterogeneous multi-layer phantom, Physics in Medicine and Biology
50 (2005) 859-868.
• Press W H, Flannery B P, Teukolsky S A, Vetterling W T: Numerical Recipes in C: The
Art of Scientific Computing, Second Edition, Cambridge University Press (1992).
• Reynaert N, van der Marck S C, Schaart D R, Van der Zee W, Van Vliet-Vroegindeweij
C, Tomsej M, Jansen J, Heijmen B, Coghe M, De Wagter C: Monte Carlo treatment
planning for photon and electron beams, Radiation Physics and Chemistry 76 (2007)
643-686.

Technical Reference Guide Rev. 1.2 Brainlab Physics 275

 • Rogers D W O, Faddegon B A, Ding G X, Ma C M, We J, Mackie T R: BEAM: A
Monte Carlo code to simulate radiotherapy treatment units, Medical Physics 22 (1995)
503-524.
• Vanderstraeten B, Chin P W, Fix M, Leal M, Mora G, Reynaert N, Seco J, Soukup M,
Spezi E, De Neve W, Thierens H: Conversion of CT numbers into tissue parameters for
Monte Carlo dose calculations: a multi-centre study, Physics in Medicine and Biology
52 (2007) 539-562.

276 Technical Reference Guide Rev. 1.2 Brainlab Physics

Appendix 3

IMRT • Boyer A, Xing L, Luxton G, Chen Y, Ma C; IMRT by dynamic MLC. (Springer-Verlag

2000) The Use of Computers in Radiation Therapy (XIIIth ICCR, Heidelberg) pp160-
163
• Grigorov G. et al.: Dosimetry limitations and dose correction methodology for step-
and-shoot IMRT. Phys. Med. Biol. 51; 2006; 637-652
• Linthout N. et al.: Quality Assurance for BrainSCAN at Brussels, Academic Hospital
of Free University of Brussels (AZ VUB). Brainlab Clinical Application Paper; 2003
• Li, J. et al.: Validation of dynamic MLC-controller log files using a two-dimensional
diode array. Med Phys. 30 (5), 2003, 799-805
• Llacer J; Inverse radiation treatment planning using the Dynamically Penalized
Likelihood method. (1997) Med. Phys. 24 pp1751-1764.
• Llacer J, Veklerov E, Nunez J; Statistically Based Image Reconstruction for Emission
Tomography. (1989) Int. J. of Imaging Systems and Technology 1 pp132-148.
• Llacer J; Bayesian smoothing for iterative inverse radiation treatment planning. (1998)
presented at AAPM'98.
• LoSasso, T. et al.: Comprehensive quality assurance for the delivery of intensity
modulated radiotherapy with a multileaf collimator used in the dynamic mode. Med.
Phys. 28 (11); 2001; 2209-2219
• LoSasso, T. et al.: Physical and dosimetric aspects of a multileaf collimation system
used in the dynamic mode for implementing intensity modulated radiotherapy. Med.
Phys. 25 (10); 1998; 1919-1927
• Partridge M. et al.: Linear accelerator output variations and their consequences for
megavoltage imaging. Med. Phys. 25 (8); 1998; 1443-1452
• Rajapakshe R. et al.: Output stability of a linear accelerator during the first three
seconds. Med. Phys. 23 (4); 1996; 517-519
• Stell, A. et al.: An extensive log-file analysis of step-and-shoot intensity modulated
radiation therapy segment delivery errors. Med Phys 31 (6), 2004, 1593-1602
• Wu Q, Mohan R; Algorithms and functionality of an intensity modulated radiotherapy
optimization system. (2000) Med. Phys. 27 pp701-711.
• Xia, P. et al: Communication and sampling rate limitations in IMRT delivery with
dynamic multileaf collimator system. Med. Phys. 29 (3); 2002; 412-423
• Zygmanski, P. et al.: Dependence of fluence errors in dynamic IMRT on leaf-positional
errors varying with time and leaf number. Med. Phys. 30 (10); 2003; 2736-2749

Technical Reference Guide Rev. 1.2 Brainlab Physics 277

278 Technical Reference Guide Rev. 1.2 Brainlab Physics
Appendix 4

Appendix 4

What’s New in this Revision of the Technical Reference

Guide

List of Changes from Revision 1.0 to Revision 1.1

General Apart from minor improvements to improve clarity, revision 1.1 of this Technical Refer-
Information ence Guide Brainlab Physics includes the following changes to revision 1.0:

• Added three new Safety Notes in “Safety Notes” on page 15 (paragraphs 5, 12 and 16).
• Added references to the AAPM TG-106 Report on Page 40, Page 142, and Page 206.
• Added “Verification of Radiologic Field Corrections” on page 66.
• Modified the detector requirement for all Pencil Beam and Monte Carlo depth dose
measurements in chapters 5 and 8: it is recommended to use the ionization chamber
instead of the small ionization chamber for large field depth dose measurements.
• Added additional field sizes for the Pencil Beam depth dose measurements in chapter 5
for the following MLCs:
- Brainlab m3
- Brainlab Novalis
- Novalis Tx (Standard Irradiation Mode)
- Siemens 160
- Siemens ModuLeaf
- Varian 120 (Standard Irradiation Mode)
• Added Monte Carlo Beam Data Checklists for the following MLCs in chapter 8:
- Elekta Beam Modulator
- Siemens ModuLeaf
- Varian 120 (SRS)
• Modified Warning in “General Measurement Requirements” on page 211.
• Added “Primary Jaw Settings for the Use with Circular Cones” on page 212.

Technical Reference Guide Rev. 1.2 Brainlab Physics 279

List of Changes from Revision 1.1 to Revision 1.2

General Apart from minor improvements to improve clarity, revision 1.2 of this Technical Reference
Information Guide, Brainlab Physics includes the following changes to revision 1.1:
• Description of an optional Pencil Beam and Circular Cone raw data import/data enter-
ing mode in Physics Administration (see “Entering and Processing Beam Data in Phys-
ics Administration (optional)” on page 233), that allows data processing
• New measurement descriptions, in case the new data import and processing tool is used
• The definition of the effective point of measurement is updated using international
standards (e.g. IAEA TRS-398)
• Monte Carlo Measurement checklists are updated for the following MLCs in chapter 8:
- MHI MLC 60
- Novalis Tx
- Siemens 160
- Siemens Moduleaf
- Varian 120

280 Technical Reference Guide Rev. 1.2 Brainlab Physics

Index

Index
A Pencil Beam ................................................ 112
Beam Data for Varian 80
Absolute Linac Calibration Monte Carlo ................................................ 185
Circular Cone ............................................... 214 Pencil Beam ................................................ 116
Pencil Beam ................................................. 46 Beam Data Measurement ................................... 196
Adaptive Grid ................................................. 34 Brainlab Imaging Couch Top ................................. 22

B C
Background Leakage Carbon Fiber
Pencil Beam ................................................. 49 Dose Build-Up ............................................... 22
Beam Data Checklists CE Certification ................................................ 13
Pencil Beam ................................................. 71 Circular Arc
Beam Data for Brainlab m3 Arc Simulation ............................................. 200
Pencil Beam ................................................. 72 Beam Data Measurement.................................. 196
Beam Data for Elekta Beam Modulator Dose Calculation ..................................... 197, 200
Pencil Beam ................................................. 76 Monitor Unit Calibration .................................. 199
Beam Data for Elekta MLCi Off-Axis Ratio ............................................. 198
Monte Carlo ................................................ 155 Tissue Maximum Ratio.................................... 197
Pencil Beam ................................................. 80 Total Scatter Factor ........................................ 198
Beam Data for MHI MLC 60 Circular Cone
Monte Carlo ................................................ 158 Algorithm................................................... 195
Pencil Beam ................................................. 84 General Beam Data Measurement ........................ 205
Beam Data for Novalis Circular Cone Algorithm .................................... 196
Pencil Beam ................................................. 88 Limitations ................................................. 203
Beam Data for Novalis Tx (SRS) Coordinate Systems
Monte Carlo ................................................ 164 Monte Carlo ................................................ 145
Pencil Beam ................................................. 92
Beam Data for Novalis Tx (Standard Irradiation Mode
Monte Carlo ................................................ 167
Beam Data for Novalis Tx (Standard Irradiation Mode) D
Pencil Beam ................................................. 96
Beam Data for Novalis/Brainlab m3 Data Correction
Monte Carlo ................................................ 161 Monte Carlo ................................................ 147
Beam Data for Siemens 160 Depth Dose Profile
Monte Carlo ................................................ 176 Circular Cone .............................................. 221
Pencil Beam ................................................ 104 Pencil Beam .................................................. 51
Beam Data for Siemens 3-D Documentation ................................................. 19
Pencil Beam ................................................ 100 Dose Build-Up ................................................. 22
Beam Data for Siemens 3-D (58 Leaves) Dose Detectors ............................................... 255
Monte Carlo ................................................ 170 Dynamic Conformal Arc ...................................... 35
Beam Data for Siemens 3-D (82 Leaves) Delivery .................................................... 252
Monte Carlo ................................................ 173 Dynamic Leaf Shift
Beam Data for Siemens ModuLeaf Pencil Beam .................................................. 64
Pencil Beam ................................................ 108
Beam Data for Varian 120
Monte Carlo ................................................ 191
Beam Data for Varian 120 (SRS)
F
Pencil Beam ................................................ 120 Field Measurement ............................................ 24
Beam Data for Varian 120 (Standard Irradiation Mode) Field Setup ..................................................... 22
Pencil Beam ................................................ 124 Film Dosimetry Measurement
Beam Data for Varian 52 Pencil Beam .................................................. 61
Monte Carlo ......................................... 179, 182

Technical Reference Guide Rev. 1.2 Brainlab Physics 281

Index

G N
General Beam Data for Linacs Nominal Linac Output Measurement
Circular Cone ............................................... 231 Circular Cone .............................................. 214
Pencil Beam .................................................. 46

H
High-Resolution Detector .................................... 63
O
Hotline Information ........................................... 12 Off Axis Ratio (OAR) ....................................... 198
Off-Axis Ratios
Circular Cone .............................................. 227
Output Factors
I Circular Cone .............................................. 218
Imaging Couch Top ........................................... 22 Pencil Beam .................................................. 54
Indications for Use ............................................ 18

P
J Patient-Related Quality Assurance ......................... 259
Jaw Measurement Patient-Specific Quality Assurance ........................ 261
Pencil Beam ................................................. 49 PDD and TMR Measurement
Jaw Overlap ................................................... 36 Pencil Beam .................................................. 51
PDD Measurement
Circular Cone .............................................. 222
Pencil Beam .................................................... 26
L Adaptive Grid Calculation ............................. 26, 34
Algorithm................................................ 25, 26
Language Information ........................................ 13
Fast Fourier Transformation ................................ 26
Leaf Sequences
Fluency Distribution ......................................... 26
IMRT ........................................................ 244
General Beam Data .......................................... 39
Leaf Tolerance Settings...................................... 247
Limitations .............................................. 36, 38
Light Field
Path Length Correction ................................. 26, 34
Setup ........................................................ 249
Range of Measured Values.................................. 37
Pencil Beam Theory
Convolution .................................................. 28
Differential ................................................... 27
M Fluence Matrix ............................................... 29
Machine-Related Quality Assurance ....................... 256 Idealized Dose Distribution ................................. 29
Measurement Requirements Introduction .................................................. 26
Circular Cone ............................................... 211 Kernel ......................................................... 28
Pencil Beam ................................................. 45 Monitor Unit Calibration .................................... 32
Measurements in Air Monoenergetic ............................................... 26
Monte Carlo ................................................ 148 Nominal Linac Output ....................................... 30
Measurements in Water Radial Factors ................................................ 31
Monte Carlo ................................................ 149 Source Function Correction ................................. 28
Monte Carlo Source-Isocenter Distance................................... 30
Algorithm ................................................... 129 Source-Surface Distance .................................... 30
Beam Data Checklists...................................... 151 Tissue Maximum Ratio...................................... 33
Dose Computation Engine ................................. 136 Total Dose .................................................... 30
General Beam Data ........................................ 141 Total Scatter Factor .......................................... 32
Modeling of the Collimating System ..................... 134 Phantoms ..................................................... 255
Virtual Energy Fluence Model ............................ 132 Primary Jaw Positioning ...................................... 36
X-Ray Voxel................................................ 131
Monte Carlo Algorithm ...................................... 130
Monte Carlo Parameters ..................................... 138
Q
Quality Assurance ........................................... 254
Equipment Calibration .................................... 255

282 Technical Reference Guide Rev. 1.2 Brainlab Physics

Index

Equipment Requirements .................................. 255 Water Phantom................................................. 63

Machine-Related ........................................... 256 Water Phantom Measurements
Patient-Related ............................................. 259 Pencil Beam .................................................. 63
Patient-Specific ............................................. 261
Phantoms.................................................... 255

R
Radial Profiles
Pencil Beam ................................................. 56
Radiation Fields ............................................... 24
Radiochromatic Film ........................................ 255
Radiographic Film ........................................... 255
Range of Measured Values
Circular Cone ............................................... 203
Ray Tracing.................................................... 34
Recommended Equipment
Circular Cone ............................................... 210
Monte Carlo ................................................ 144
Recommended Measurement Equipment
Pencil Beam ................................................. 43

S
Scatter Factor Measurement
Circular Cone ............................................... 218
Pencil Beam ................................................. 54
Setup Light Field ............................................. 249
Skin Dose Build-Up .......................................... 22
System Use
General Information ........................................ 14

T
Technical Support ............................................. 12
Tissue Maximum Ratio ....................................... 33
TMR Measurement
Circular Cone ............................................... 224
Trademarks
3rd-Party ..................................................... 13
Brainlab ...................................................... 13
Training ........................................................ 18
Transversal Profile
Pencil Beam ................................................. 59
Typographical Conventions .................................. 11

U
User Guides.................................................... 19

W
Warranty ....................................................... 13

Technical Reference Guide Rev. 1.2 Brainlab Physics 283

Index

284 Technical Reference Guide Rev. 1.2 Brainlab Physics

www.brainlab.com Art. No. 60911-82EN