Monitor unit calculation in 6 MV irregularly shaped beams - Accuracy in clinical practice

The results of an investigation of the accuracy of monitor unit (MU) calculation in clinical shaped beams are presented. Measured doses at the reference depth on the beam central axis (isocentre) or on a beam axis representative of the irradiated area (when the isocentre lies under a block or near the edges of the block's shadow) were compared with the expected doses when calculating MUs, by applying different methods normally used in clinical practice. Empirical (areas weighted, Wrede) and scatter summation (Clarkson) methods as well as a pencil-beam based algorithm were applied. 40 irregular fields (6 MV X-rays, CLinac, Varian 6/100), divided into six categories, were considered. Dose measurements were performed with a NE2571 ionization chamber in an acrylic 30 x 30 x 30 cm³ phantom. The depths in acrylic were converted into water-equivalent depths through a correction factor derived from TMR measurements. The method of dose measurements in acrylic was found to be sufficiently accurate for the purpose of this study by comparing expected and measured doses in open square and rectangular fields (mean deviation +0.2%, SD = 0.5%). Results show that all the considered methods are sufficiently reliable in calculating MUs in clinical situations. Mean deviations between measured and expected dose values are around 0 for all the methods; standard deviations range from 1% for the Wrede method to 0.75% for the pencil-beam method. The differences between expected and measured doses were within 1% for about 3/4 of the fields when calculating MUs with all the considered methods. Maximum deviations range from 1.6% (pencil-beam) to 3% (Wrede). Slight differences among the methods of MU calculation were revealed within the different categories of blocked fields analysed. The surprising agreement between measured and expected dose values obtained by using empirical methods (area weighted and Wrede) is probably due to the fact that the reference points were positioned in a 'central' region of the unblocked areas.