title: A reduction in the AAPM TG-36 reported peripheral dose distributions with tertiary multileaf collimation. American Association of Physicists in Medicine Task Group 36.
abstract: OBJECTIVE
  The American Association of Physicists in Medicine Task Group 36 (AAPM TG-36) data can be used to estimate peripheral dose (PD) distributions outside the primary radiation field. However, the report data apply to linear accelerators not equipped with tertiary multileaf collimators (MLCs). Peripheral dose distributions consist of internal scatter, collimation scatter, transmission through collimation, head leakage, and room scatter. Tertiary MLCs may significantly reduce the PD due to a reduction in collimation scatter, transmission through collimation, and head leakage. Measurements were performed on a multimodality linear accelerator, equipped with a tertiary MLC, to determine PD distributions as a function of energy, field size, distance from the primary radiation field edge, MLC position, and collimator orientation.
  
  
  METHODS
  Measurements were made using an ionization chamber embedded in a 20 x 40 x 120-cm3 water-equivalent plastic phantom with the secondary collimator and MLC settings of 10 x 10, 15 x 15, 20 x 20, 25 x 25 cm2, and with the MLC fully retracted. Data were taken along the longitudinal axis of the machine for 6 and 18 MV photons. Peripheral dose distributions were evaluated with the collimator set to 180 and 90 degrees. Rotation of the collimator allowed measurements parallel and orthogonal to the direction of motion of the MLC.
  
  
  RESULTS
  For both photon energies, peripheral doses measured on a MLC machine were lower than the TG-36 data. When the collimator is rotated by 90 degrees, placing the lower jaws and the MLC leaves along the plane of interest, PD was reduced by as much as a factor of three compared with PDs measured with the MLC fully retracted and the collimator rotated to 180 degrees. PDs measured with the MLC fully retracted and collimator rotated to 180 degrees were comparable to the TG-36 data. Measured PDs were lower when the MLC was used to shape the field than when the MLC was fully retracted.
  
  
  CONCLUSIONS
  A strategic orientation of the collimator with a tertiary MLC can reduce PD distributions by more than a factor of two. This decrease significantly lessens or eliminates the need for external lead shielding to reduce the critical organ dose. This method can be used even when Lipowitz metal blocking (such as for mantle fields) is used, with the MLC leaves oriented along the longitudinal plane.
authors.affiliation: Division of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA. mutic_s@castor.wustl.edu
authors.forename: S
authors.initials: S
authors.lastname: Mutic
authors.forename: E E
authors.initials: EE
authors.lastname: Klein
mesh_terms: D010315:Particle Accelerators / Q000592:standards*; D019047:Phantoms, Imaging; D055585:Physical Phenomena; D010825:Physics; D016634:Radiosurgery / Q000295:instrumentation* / Q000592:standards; D011879:Radiotherapy Dosage / Q000592:standards*; D012542:Scattering, Radiation