1

Shands James
February 14, 2016
Attenuation Project
The Effect of a Blocking Tray on Monitor Unit Calculations
Objective: The objective of this project is to determine the effect that a blocking tray has on the
number of monitor units (MU) required to deliver the desired dose from a field to the target.
Materials/Methods: Using the Eclipse treatment planning system (TPS), a plan was created to
treat the right femur of a patient at isocenter. The fields were planned for a Varian 23IX treatment
machine using 6 MV beams. A parallel opposed beam arrangement was used with blocks and
Lucite blocking trays were used to shape the fields. The plan was then printed out and the MU
and beam specifications were noted.
Next, the tray factor was calculated for a Varian 23IX machine. A total of 20 cm of solid
water blocks were used as a phantom. An Xradin A12 chamber was placed in the chamber hole at
a depth of 10cm which left 10 cm of solid water under the chamber to ensure enough backscatter
to obtain an accurate reading. A depth of 10 cm was chosen because of its distance from the dose
build-up region as the tray will effect that area.1The dose was measured by a Premier 3000
electrometer next to the treatment machine console.

Figure 1: Diagram of ion chamber set up under machine

The constant treatment machine parameters to measure the tray factor are as follows:
Field size: 10x10 cm
Depth: 10 cm
Dose rate: 600MU/min.
100 MU per measurement
90 cm Source Surface Distance (SSD)
The first set of measurements included 3 trials of 100 MU with 6 MV energy at the above
conditions without the blocking tray. Then the blocking tray was added to the set up and all other
conditions remained the same. Another 3 trials of 100 MU were measured and recorded. This
process was repeated with the 23 MV energy and the results were recorded.
Results:
The tray factor accounts for the extra material within the beam path that attenuates the
beam. The tray factor for each energy was calculated using the following formula:
2

Tray Factor=

Dose with trayfield

Dose without tray field

6MV Measurements:
Trial Number
1
2
3
Average

Without Tray
-16.277 nC
-16.266 nC
-16.277 nC
-16.273 nC

With Tray
-15.788 nC
-15.782 nC
-15.784 nC
-15.785 nC

Table 1: Data of measurements with and without tray for 6 MV energy.

15.785 nC
Tray Factor = 16.273 nC

= .970

23 MV Meaurements:
Trial Number
1
2
3
Average

Without Tray
-19.105 nC
-19.094 nC
-19.096 nC
-19.098 nC

With Tray
-18.760 nC
-18.754 nC
-18.762 nC
-18.759 nC

Table 2: Data of measurements with and without tray for 23 MV energy.

18.759 nC
Tray Factor= 19.098 nC

= .982

Clinical Application: Occasionally, a treatment may need to calculated by hand for treatment
delivery (perhaps for a cord compression) or for a second check of the TPS. There are several
factors that are considered when calculating MUs for a treatment. The formula for an SAD MU
calculation is found below3:

MU =

Dose per fraction(cGy)

(cal . factor )(TMR)(S c)(Sp)(WF)(TF )(OAR)( ISF)

Where TMR is the tissue-max ratio, Sc is the collimator scatter factor, Sp is the phantom
scatter factor, WF is the wedge factor, TF is the tray factor, OAR is the off axis ratio, and ISF is
the inverse square factor. Not all of these variables will be needed in every calculation and can be
equated to 1 or left out.
The presence of a blocking tray in the field will affect the number of MUs required to
deliver the prescribed dose per fraction. A blocking tray adds extra material that the beam has to
penetrate before reaching then target and is attenuated as it passes through thus requiring more
MUs to deliver the prescribed dose.2
AP Beam Calculation:
The treatment parameters for the AP beam of the right femur plan are shown below:

The TPS calculated that 171 MUs would be needed to treat a target with 150 cGy to a
depth of 5.0 cm from the AP beam.
Variable
Dose per beam
Calibration factor
Eq. Square of Collimator
Eq. Square of Block
Sc
Sp
TMR(f,d)
Tray Factor

AP Beam
150 cGy
1 cGy/MU
12.7 cm
11 cm
1.009
1.003
TMR(11x11cm, 6.0 cm)= .902

.970 (from my measurements)

Table 3: Variables for AP beam

Using the values from Table 3, an MU calculation can be performed.

150 cGy

MU =

(.902 ) ( 1.009 ) (1.003 ) (.97)

(1 cGy
MU )

= 169 MU

To demonstrate the effect that a tray can have on the required MU for a beam to deliver
dose, a separate calculation will be performed.
150 cGy

MU =

(.902 ) ( 1.009 ) (1.003 )

(1 cGy
MU )

= 164 MU

A hand calculation with the tray requires 169 MU and only 164 MU without the tray.
Five more MUs are required to deliver the same dose to the target due to the attenuation of the
beam by the blocking tray.

PA Beam Calculation:

The TPS calculated that 210 MUs would be required to deliver a dose of 150 cGy to a
target at a depth of 11.4 cm. Using a MU hand calculation will determine the accuracy of the
TPS within a tolerance of +/- 5%. Below is a table of values needed to use the MU formula for
the PA beam:
Variable
Dose per beam
Calibration factor
Eq. Square of Collimator
Eq. Square of Block
Sc
Sp
TMR(f,d)
Tray Factor

PA Beam
150 cGy
1 cGy/MU
12.7 cm
11 cm
1.009
1.003
TMR(11x11 cm, 12.2cm) = .734

.970 (from my measurements)

Table 4: Variables for PA beam.

Using the values from Table 4, an MU calculation of PA beam can be performed:

150 cGy

MU =

(.734 ) (1.009 )( 1.003 ) (.97)

(1 cGy
MU )

= 208 MU

A comparison of calculations of the PA beam with and without the tray factor:
150 cGy

MU =

(.734 ) (1.009 )( 1.003 )

(1 cGy
MU )

= 202 MU

A hand calculation with the tray requires 208 MU and only 202 MU without the tray. Six
more MUs are required to deliver the same dose to the target due to the attenuation of the beam
by the blocking tray.
Double Checking the TPS with a hand calculation:
It is important to double check what the TPS calculates with a hand calculation to make
sure the simulated plan seems accurate. For the AP beam, the TPS determined that 171 MU
would be needed to deliver a dose of 150 cGy to a depth of 5.0 cm. The AP hand calculation
determined that 169 MU would be needed. So the TPS and hand calculation were within 1.2%
which is within the +/- 5% tolerance. The TPS calculated 210 MU for the PA beam and the hand
calculation determined 208 MU would be needed. This is a 0.91% difference which is again
within the +/-5% tolerance.
Hypothetical Clinical Situation:
Suppose that during the course of treatment for the above patient, a staff member forgot
to put in the blocking tray in the PA beam for 1 treatment. What would be the difference in dose
delivered when the blocking tray was accidentally left out (although, this would depend highly
on the block itself in reality)?

cGy = ((208 MU )(1 cGy / MU )(.734)(1.009)(1.003) ) = 155 cGy

As demonstrated above, leaving the tray out would deliver 5 extra cGy which is a 3% overdose.
Conclusion:As shown in the calculation of each beam with and without the tray factor included,
it is important to account for a tray or other object in the beam path. To not account for these
objects results in an under dosing of the patient due to the attenuation of the beam by the
accessory. In the same way calculating a MU setting accounting for a tray, but not using it during
the treatment results in an over dose of the patient. It is also important to note that the exact
numerical factor assigned to these beam modifiers is energy dependent. The tray factor for a 6
MV beam is slightly smaller than that of a 23 MV beam meaning the presence of a tray will less
of an effect on the number of MUs required. This is the case because of the greater penetrating
power of a 23 MV compared to 6 MV beam.

References
1. Gibbons, JP, Antolak, JA, Followill, DS, et al. Monitor Unit Calculations for External photon
and Electron beams: Report of the AAPM Therapy Physics Committee Task Group No. 71. Med.
Phys. 2014; 41(3): 17.
2. McDermott PN, Orton CG. The Physics and Technology of Radiation Therapy. Madison, WI:
Medical Physics Publishing; 2010: 13-5.
3. Bentel, GC. Radiation Therapy Planning. 2nd ed. Colombia: McGraw-Hill Companies, Inc;
1996: 249.