Eliason 1

Alecia Eliason
February 17, 2017
Lucite Block Tray Attenuation

Lucite Block Tray Attenuation of Radiation

Objective: To demonstrate the principle of radiation attenuation by placing a lucite block tray in
the path of the beam, calculating the transmission factor and appropriately applying it to a patient
treatment calculation.

Purpose: Any device placed in the path of a radiation beam changes the dose delivered to the
patient via attenuation.1 This beam interference must be accounted for with a transmission factor
(Cattn) when performing monitor unit calculations in order to accurately calculate radiation dose.
A transmission factor is a ratio of dose with a device in the path of a radiation beam to the dose
without the device in the beam, as demonstrated here1:

(1)

dose with device in radiation beam

Cattn =
dose without device in radiation beam

Specifically, the lucite block trays upon which cerrobend field-shaping blocks are
mounted are inserted into the head of a linear accelerator directly in the radiation beams path,
consequently attenuating the beam. Therefore, using Equation 1, the block tray transmission
factor can be calculated by using the following formula:

(2)

dose with block tray in radiation beam

Cattn =
dose without block tray in radiation beam

Methods and Materials: An Elekta Infinity linear accelerator was used as the radiation source
for data collection. Both 6 MV photons and 18 MV photons were employed at an SSD of 100
cm, with outputs recorded at a depth of dmax specific to beam energy (1.5 cm and 3 cm,
respectively) as well as at 10 cm. 3 symmetric field sizes (10x10 cm, 20x20 cm and 30x30 cm)
were also tested for each energy and depth mentioned previously so to report an accurate
transmission factor while accounting for different field sizes. A PTW ion chamber was placed at
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measurement depth in solid water, and outputs were read on a Standard Imaging Supermax
electrometer. 100 monitor units (MU) were delivered per measurement. Measurements were
recorded with and without a 3/8 inch lucite block tray inserted into the head of the linear
accelerator.

Figure 1. Ion chamber measuring dose at 10 cm depth in solid water with 100 SSD.

Figure 2. Lucite block tray placement.

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Results: Measurements (nC) with and without the lucite block tray in place were recorded in
Tables 1 and 2, for 6 MV photons and 18 MV photons respectively. Each measurement displayed
in Tables 1 and 2 is an average of 3 measurements recorded per setting.

Table 1. 100 MU 6 MV photons at 100 SSD, results displayed in nC

10x10 cm 10x10 cm 20x20 cm 20x20 cm 30x30 cm 30x30 cm

with lucite with lucite with lucite
tray tray tray
1.5 cm 17.9 17.09 18.79 18.06 19.13 18.5
depth
10 cm 12.24 11.68 13.29 12.71 13.66 13.12
depth

Table 2. 100 MU 18 MV photons at 100 SSD, results displayed in nC

10x10 cm 10x10 cm 20x20 cm 20x20 cm 30x30 cm 30x30 cm

with lucite with lucite with lucite
tray tray tray
3.0 cm 17.75 17.23 18.69 18.22 18.99 18.62
depth
10 cm 14.01 13.58 14.74 14.33 15.01 14.62
depth

The block tray factor for each setting was calculated using Equation 2 and is displayed in
Table 3.

Table 3. Calculated block tray factor

6 MV 18 MV 6 MV 18 MV 6 MV 18 MV
10x10 cm 10x10 cm 20x20 cm 20x20 cm 30x30 cm 30x30 cm
1.5 cm 0.95 0.96 0.97
depth
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3.0 cm 0.97 0.97 0.98

depth
10 cm 0.95 0.97 0.96 0.97 0.96 0.97
depth

Discussion: The results displayed in Table 3 show that the block tray factor increases slightly as
field size increases. Scatter increases as field size increases2; therefore, more dose (scatter +
primary) reaches the ion chamber with larger field sizes, resulting in a larger block tray factor.
Results also reveal a slightly larger block tray factor with higher energy. Higher energy photon
beams have greater penetrating power, while lower energy beams have less. Higher energy
beams will then be less attenuated by a lucite block tray, consequently leading to a higher tray
factor. Overall, the results verify that a 3/8 inch lucite block tray attenuates approximately 3% of
the incident radiation beam.

Clinical Application: A Non-Hodgkin lymphoma patient was prescribed 3000 cGy to be

delivered in 20 fractions of 150 cGy each to the hemiabdomen. Due to the required high doses to
large abdominal fields, it was necessary to create a custom cerrobend block for one PA field to
effectively lower the dose to the patients right kidney. This block, of course, was mounted on a
3/8 inch lucite block tray, so a block tray transmission factor was taken into account when
calculating the dose for this field. The kidney-blocked field accounted for less than 9% of the
total prescribed dose, with 17 cGy delivered per fraction. Figures 3 and 4 illustrate the treatment
plan with the blocked left kidney apparent. Figure 5 shows the DRR of the field with the custom
cerrobend block. The monitor unit equation for the blocked field, using factors shown in Table 4,
is as follows3:

(3)
Dose per field(cGy)
MU=
cGy
Dose rate ( )
MU
x Scp x TMR x Cattn x ISF

Since the linear accelerator used for this project was calibrated at 100 SAD to a depth of
dmax (1 cGy/MU) and the blocked equivalent square for the example field is just less than 20
cm, the tray factor used (per measurements previously documented) for the following
calculations will be 0.97.
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Table 4. Field parameters for MU calculations

Field dose per fraction (cGy) 17

Energy (MV) 18
Reference dose rate (cGy/MU) 1.0
2
Equivalent square (cm ) 18
Depth (cm) 22
Scp (cGy/MU) 1.04
8
TMR (18x18 cm field size, depth=22 0.68
cm) 4
Cattn 0.97
ISF 1.0

The following monitor unit calculation demonstrates the use of the block tray factor. Also
demonstrated is the same calculation without the block tray factor.

MU calculation WITH the block tray factor:

17
MU = = 24.4 MU
1.0 x 1.048 x 0.684 x 0.97 x 1.0

MU calculation WITHOUT the block tray factor:

17
MU = = 23.7 MU
1.0 x 1.048 x 0.684 x 1.0
The difference between these two calculations substantiates the 3% beam attenuation
attributed to the lucite block tray.
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Figure 3. Transverse slice at isocenter showing field with blocked left kidney.

Figure 4. Sagittal view of blocked left kidney field.

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Figure 5. DRR of PA field blocking left kidney.

Treatment parameters for another clinical example of a plan requiring custom cerrobend
blocks is demonstrated in Figure 6. Of note is the different tray factors used for different energies
and equivalent field sizes; a 6 MV photon beam with 13.02x13.02 cm equivalent square uses a
tray factor of 0.956 and a 18 MV photon beam with 13.69x13.69 cm equivalent square uses 0.97,
both of which are consistent with my reported results.
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Figure 6. Treatment parameters for mantle fields with custom cerrobend blocks.
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Conclusion. Although not used as frequently as in the past, effective photon-beam shielding of
vital organs using cerrobend blocks instead of MLC leaves is sometimes necessary, especially for
structures requiring blocking which are in the middle of an open field. When a cerrobend block is
deemed appropriate for treatment, the dose attenuated by the lucite tray on which the block is
mounted must be accounted for via a block tray factor in dose calculations. Omitting this tray
factor in calculations when a lucite block tray is in place may lead to underdose of patient
treatment volumes. To the other extent, incorrectly adding a tray factor to a dose calculation
when a block is not used for treatment may cause patient overdose. Using appropriate factors in
dose calculations are crucial to accurate delivery of radiation per the prescription.

References:

1. Stanton R, Stinson D. Applied Physics for Radiation Oncology. Madison, WI: Medical Physics
Publishing; 1996.

2. Bentel GC. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill; 1996.

3. Khan FM, Gibbons JP. Khans The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014.