One

With the aid of a diagram, explain the importance of calibrating a linear accelerator?
1. The LINAC is calibrated under standard conditions. These standard conditions allows us to know the
absolute dose at these conditions. It also ensures we are delivering the correct amount of dose to a point
within a pt.
2. At the UOW Linacs are calibrated to give = 1 cGy/MU for 10 x 10cm field, at a SAD of 100cm
delivered in a water phantom at the reference depth (dmax) on central beam axis.
3. Depending on the energy of the machine you’re using, the point of dmax will be different for each.
a. For superficial it is located on the skin surface, 6MV Linac = 1.5cm beneath the skin surface,
10MV Linac = 2.5cm beneath skin surface and 18MV = 3.5cm beneath skin surface.
4. If not at standard conditions, corrections will be needed. E.g. depths other than dmax, SADs other than
100cm and field sizes other than 10x10 and points off central axis for example if treatment conditions
are the same as calibration conditions, prescribed dose will be same as Monitor units
[Include diagram under calibration conditions]

Two
With the aid of a diagram, define and discuss the concept of percentage depth dose in
radiation therapy treatment planning. In your answer discuss the four factors it is
dependent on.
1. PDD is a patient attenuation factor
2. Percentage depth dose is the ratio of the dose on the central axis at a depth to the dose measured
at dmax ( x100). It is expressed as a percentage and is used for fixed SSD
3. It represents change in dose as we go deeper within the pt.

It relies on 4 factors. SSD, Depth, Field size and Energy

1. Beam energy increase in beam energy will increase penetrative nature of beam which would
increase PDD ex.
2. Field size increasing the field size increases amount of photons interacting with medium which
increases scattered radiation
3. Depth PDD decreases as you increase depth due to overlying tissue attenuating the dose
4. SSD increase SSD as seen in extended SSD techniques will increase PDD due to beam hardening.
Why does this happen? And how it relates to Mus. [And also draw diagram]

Question 3
Estimate the monitor units for the left field on the attached isocentric plan. The dose is
66Gy, in 33 fractions, 1 fraction per day, 5 fractions per week to the 100% prescribed
dose at the ICRU reference point (isocentre).The energy is 18MV.The wedge is a
physical wedge
1. First thing to estimate is the Mus under calibration conditions for the left field are 50 MU, this is
estimated using the formula MU = (Td/fld) / DR .
2. In this case because there is multiple field, we need to work out the Td/fld for the left field using
the Td/fld equation. I would expect to see the MU increase to compensate for the changes in WF
and OF and TMR. These factors will all affect the DR. The estimated MU will be roughly 75-78
MU.

With the aid of diagrams and reference to calibration conditions, define and explain the
rationale for using (or not) each of the factors in your calculation. Justify why you think
the monitor units you calculated are correct.
you need to draw a diagram for each and relate how they affect MU
Estimate and discuss what you think would happen to the monitor units if the wedge
was changed to an EDW. In your answer define what is meant by an EDW.
Enhanced dynamic wedge is when Y collimator Jaws is moved into the beam to achieve a wedge effect
that attenuates the radiation beam. This means that less dose will be received at the calculation so it will
It attenuates slightly less than the than a physical wedge. So instead of the wedge factor of a 15o physical
wedge being 0.8, it will be 0.85 meaning the MU will be slightly less if an EDW was used

Question 4
Explain the concept of Equivalent Square and why it is important in radiation therapy
monitor unit calculations.
Equivalence square concept allows us to equate rectangular fields back to square field sizes because it is
more convenient for physicists to measure square field sizes for MU calculation data.
Equivalent fields are fields in which the percent depth doses (PDD) and scatter are similar. Found using
sterling's law
[Example [with equation] and diagram with squares]
So, for a 10 cm x 30 cm rectangular treatment field size - equivalent square will be 15 x 15. So, the PDD
and scatter for 10 x30cm field should be the same as the PDD and scatter for a 15 x 15cm field

Question 6
With the aid of diagrams, define PSF and explain why they are used in radiation
therapy calculations.
PSF is a patient attenuation factor. It is the ratio of the dose on central axis measured in phantom at
dmax to the dose measured at same point in air (for high energy beams). PSF=Dmax/Dair
It is used to correct FF when there is shielding because FF assumes field size set on the collimators is the
same size as the pt which isn’t the case if there is shielding. It accounts for the scattering effect of the
patient or phantom.
Some departments don’t use FF but will have collimator scatter factor & NPSF which are independent of
each other
[Draw diagram/equation]

Question 7
With the aid of diagrams define and explain the difference in TMRs and TPRs. In your
answer discuss when you would use these factors and the effect they would have on
monitor unit calculation
TMR is the ratio of the dose measured on the central axis at depth to the dose measure at the same point at
dmax: TMR= Dd/Dmax
TPR is the ratio of the dose measure on the central axis at depth to the dose measure at same point at
reference depth: TMR=Dd/Dref

It is used for isocentric calculations. Same dependencies as PDD except SDD

a. TMRs used when LA are calibrated to a reference depth of dmax and value is never greater than 1
so will increase monitor units therefore more treatment time
b. TPRs are used when LA are calibrated to reference depth of 5cm or 10cm; value can greater than
1 so will decrease monitor units therefore pt are under the machine for less time
[Draw diagram/equation]