Wednesday 15.5.

13
C Boylan
12.15 pm

Monitor Unit Calculations

Chris Boylan
 FSD or
SCD SSD

Field Size

dmax
d
 What is a monitor unit?

Patient A
Patient B
100cGy
to target

Requires more radiation from linac, Requires less radiation, as

due to more tissue to travel through less attenuation of beam

Higher number of MU Fewer MU

 Linac Calibration
• 1 Monitor Unit from the linac delivers 1cGy
to the patient for a certain reference
condition
• Different centres use different reference
conditions
• Two main reference conditions, for…
– Fixed FSD treatments
– Isocentric treatments
 Fixed FSD Treatments
• Calibrate linac so that 1MU gives 1cGy to
dmax at 100cm FSD for a 10x10cm field
size
• Uses ‘Percentage Depth Dose’ (PDD)
tables to get the dose at depth for a
particular field size and FSD
 6M V CENTRAL AXIS % DEPTH DOSE

FSD 100 cm

SURFA CE A REA (sq cm)

DEPTH
(cm) 10 20 40 60 80 100 150 200 300 400 600 900 1600

1 .6 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0
2 9 9 .5 9 9 .4 9 9 .4 9 9 .3 9 9 .3 9 9 .2 9 9 .2 9 9 .1 9 9 .1 9 9 .1 9 8 .9 9 8 .9 9 8 .7
3 9 4 .5 9 4 .7 9 5 .2 9 5 .2 9 5 .2 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3
4 8 9 .3 8 9 .9 9 0 .7 9 1 .0 9 1 .1 9 1 .3 9 1 .3 9 1 .4 9 1 .6 9 1 .6 9 1 .6 9 1 .7 9 1 .9
5 8 4 .3 8 5 .1 8 6 .1 8 6 .6 8 6 .7 8 6 .9 8 7 .2 8 7 .5 8 7 .7 8 7 .8 8 7 .9 8 8 .1 8 8 .4
Attenuation
6
7
7 9 .3
7 4 .6
8 0 .5
7 5 .9
8 1 .7
7 7 .4
8 2 .2
7 8 .2
8 2 .5
7 8 .5
8 2 .8
7 8 .8
8 3 .2
7 9 .4
8 3 .6
7 9 .8
8 3 .9
8 0 .3
8 4 .1
8 0 .6
8 4 .3
8 0 .9
8 4 .6
8 1 .1
8 5 .1
8 1 .7
and inverse
8
9
7 0 .2
6 6 .1
7 1 .6
6 7 .5
7 3 .2
6 9 .3
7 4 .1
7 0 .2
7 4 .5
7 0 .7
7 4 .9
7 1 .2
7 5 .6
7 2 .0
7 6 .1
7 2 .6
7 6 .6
7 3 .2
7 7 .0
7 3 .6
7 7 .4
7 4 .1
7 7 .8
7 4 .5
7 8 .4
7 5 .2
square
10 6 2 .2 6 3 .6 6 5 .5 6 6 .5 6 7 .1 6 7 .6 6 8 .4 6 9 .0 6 9 .9 7 0 .4 7 0 .9 7 1 .4 7 2 .1

11 5 8 .4 5 9 .9 6 1 .8 6 2 .9 6 3 .6 6 4 .1 6 5 .1 6 5 .8 6 6 .6 6 7 .2 6 7 .7 6 8 .3 6 9 .1
12 5 5 .0 5 6 .4 5 8 .4 5 9 .4 6 0 .2 6 0 .8 6 1 .9 6 2 .5 6 3 .4 6 4 .0 6 4 .7 6 5 .3 6 6 .1
13 5 1 .8 5 3 .3 5 5 .1 5 6 .3 5 7 .1 5 7 .7 5 8 .7 5 9 .5 6 0 .4 6 1 .0 6 1 .8 6 2 .5 6 3 .4
14 4 8 .6 5 0 .2 5 2 .1 5 3 .2 5 4 .0 5 4 .7 5 5 .7 5 6 .4 5 7 .5 5 8 .2 5 9 .0 5 9 .6 6 0 .6
15 4 5 .8 4 7 .3 4 9 .2 5 0 .4 5 1 .2 5 1 .8 5 2 .9 5 3 .6 5 4 .8 5 5 .5 5 6 .3 5 7 .0 5 8 .0

16 4 3 .1 4 4 .5 4 6 .4 4 7 .4 4 8 .2 4 8 .9 5 0 .1 5 1 .0 5 2 .1 5 2 .9 5 3 .7 5 4 .4 5 5 .5
17 4 0 .6 4 1 .9 4 3 .8 4 4 .9 4 5 .7 4 6 .4 4 7 .6 4 8 .4 4 9 .6 5 0 .3 5 1 .2 5 2 .0 5 3 .0
18 3 8 .1 3 9 .5 4 1 .3 4 2 .5 4 3 .3 4 3 .9 4 5 .1 4 6 .0 4 7 .2 4 7 .9 4 8 .8 4 9 .6 5 0 .7
19 3 6 .0 3 7 .3 3 9 .0 4 0 .1 4 0 .9 4 1 .5 4 2 .8 4 3 .7 4 4 .9 4 5 .6 4 6 .5 4 7 .4 4 8 .5
20 3 3 .8 3 5 .2 3 6 .8 3 8 .0 3 8 .7 3 9 .3 4 0 .5 4 1 .4 4 2 .7 4 3 .5 4 4 .4 4 5 .2 4 6 .3

21 3 1 .9 3 3 .2 3 4 .8 3 5 .9 3 6 .7 3 7 .3 3 8 .4 3 9 .3 4 0 .5 4 1 .3 4 2 .3 4 3 .1 4 4 .2
22 3 0 .1 3 1 .3 3 2 .8 3 3 .9 3 4 .6 3 5 .2 3 6 .5 3 7 .3 3 8 .5 3 9 .3 4 0 .3 4 1 .0 4 2 .2
23 2 8 .3 2 9 .5 3 1 .0 3 2 .0 3 2 .8 3 3 .4 3 4 .5 3 5 .4 3 6 .6 3 7 .4 3 8 .4 3 9 .2 4 0 .3
24 2 6 .7 2 7 .8 2 9 .3 3 0 .3 3 1 .0 3 1 .6 3 2 .7 3 3 .6 3 4 .8 3 5 .6 3 6 .5 3 7 .4 3 8 .5
25 2 5 .2 2 6 .3 2 7 .7 2 8 .7 2 9 .4 3 0 .0 3 1 .1 3 1 .9 3 3 .1 3 3 .9 3 4 .8 3 5 .7 3 6 .7

26 2 3 .8 2 4 .8 2 6 .2 2 7 .1 2 7 .8 2 8 .4 2 9 .5 3 0 .3 3 1 .5 3 2 .2 3 3 .1 3 4 .0 3 5 .1
27 2 2 .5 2 3 .4 2 4 .8 2 5 .7 2 6 .4 2 6 .9 2 8 .0 2 8 .8 2 9 .9 3 0 .7 3 1 .5 3 2 .4 3 3 .5
28 2 1 .3 2 2 .1 2 3 .4 2 4 .3 2 5 .0 2 5 .5 2 6 .5 2 7 .3 2 8 .4 2 9 .1 3 0 .0 3 0 .9 3 1 .9
 Fixed FSD Calculations
• To calculate monitor units required, you
need to get back to reference conditions
• For fixed FSD, you need to correct for…
– Field size (‘output factor’ OF) – get from chart
– Depth (PDD) – get from chart
– Inverse square law (ISL) = (FSD/100)2

MU = Dose per fraction x ISL

OF x PDD
 Fixed FSD
• Example 1.
A clinician prescribes 250cGy per fraction to the
spine, 5cm deep, from a 6MV beam with an
FSD of 90cm. The field size is 6x6cm. How
many monitor units are required?

MU = Dose per fraction x ISL

OF x PDD
 1.08

• Dose per fraction = 1.06

1.04

250cGy

Relative Output Factor

1.02

• Depth = 5cm
1.00

0.98

• Field size = 6x6cm 0.96

0.94

• FSD = 90cm 0.92

5 10 15 20 25 30

Side of Square Field (cm)

• ISL = (90/100)2 = 0.81 6M V CENTRAL AXIS % DEPTH DOSE

FSD 100 cm

• PDD = 0.861
SURFA CE A REA (sq cm)

• OF = 0.9675
DEPTH
(cm) 10 20 40 60 80 100 150 200 300 400 600 900 1600

1 .6 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0 1 0 0 .0
2 9 9 .5 9 9 .4 9 9 .4 9 9 .3 9 9 .3 9 9 .2 9 9 .2 9 9 .1 9 9 .1 9 9 .1 9 8 .9 9 8 .9 9 8 .7
3 9 4 .5 9 4 .7 9 5 .2 9 5 .2 9 5 .2 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3 9 5 .3
4 8 9 .3 8 9 .9 9 0 .7 9 1 .0 9 1 .1 9 1 .3 9 1 .3 9 1 .4 9 1 .6 9 1 .6 9 1 .6 9 1 .7 9 1 .9

• MU = 250 x 0.81
5 8 4 .3 8 5 .1 8 6 .1 8 6 .6 8 6 .7 8 6 .9 8 7 .2 8 7 .5 8 7 .7 8 7 .8 8 7 .9 8 8 .1 8 8 .4

6 7 9 .3 8 0 .5 8 1 .7 8 2 .2 8 2 .5 8 2 .8 8 3 .2 8 3 .6 8 3 .9 8 4 .1 8 4 .3 8 4 .6 8 5 .1
7 7 4 .6 7 5 .9 7 7 .4 7 8 .2 7 8 .5 7 8 .8 7 9 .4 7 9 .8 8 0 .3 8 0 .6 8 0 .9 8 1 .1 8 1 .7

0.9675 x 0.861
8 7 0 .2 7 1 .6 7 3 .2 7 4 .1 7 4 .5 7 4 .9 7 5 .6 7 6 .1 7 6 .6 7 7 .0 7 7 .4 7 7 .8 7 8 .4
9 6 6 .1 6 7 .5 6 9 .3 7 0 .2 7 0 .7 7 1 .2 7 2 .0 7 2 .6 7 3 .2 7 3 .6 7 4 .1 7 4 .5 7 5 .2
10 6 2 .2 6 3 .6 6 5 .5 6 6 .5 6 7 .1 6 7 .6 6 8 .4 6 9 .0 6 9 .9 7 0 .4 7 0 .9 7 1 .4 7 2 .1

= 243
11 5 8 .4 5 9 .9 6 1 .8 6 2 .9 6 3 .6 6 4 .1 6 5 .1 6 5 .8 6 6 .6 6 7 .2 6 7 .7 6 8 .3 6 9 .1
12 5 5 .0 5 6 .4 5 8 .4 5 9 .4 6 0 .2 6 0 .8 6 1 .9 6 2 .5 6 3 .4 6 4 .0 6 4 .7 6 5 .3 6 6 .1
13 5 1 .8 5 3 .3 5 5 .1 5 6 .3 5 7 .1 5 7 .7 5 8 .7 5 9 .5 6 0 .4 6 1 .0 6 1 .8 6 2 .5 6 3 .4
14 4 8 .6 5 0 .2 5 2 .1 5 3 .2 5 4 .0 5 4 .7 5 5 .7 5 6 .4 5 7 .5 5 8 .2 5 9 .0 5 9 .6 6 0 .6
15 4 5 .8 4 7 .3 4 9 .2 5 0 .4 5 1 .2 5 1 .8 5 2 .9 5 3 .6 5 4 .8 5 5 .5 5 6 .3 5 7 .0 5 8 .0

16 4 3 .1 4 4 .5 4 6 .4 4 7 .4 4 8 .2 4 8 .9 5 0 .1 5 1 .0 5 2 .1 5 2 .9 5 3 .7 5 4 .4 5 5 .5
17 4 0 .6 4 1 .9 4 3 .8 4 4 .9 4 5 .7 4 6 .4 4 7 .6 4 8 .4 4 9 .6 5 0 .3 5 1 .2 5 2 .0 5 3 .0
18 3 8 .1 3 9 .5 4 1 .3 4 2 .5 4 3 .3 4 3 .9 4 5 .1 4 6 .0 4 7 .2 4 7 .9 4 8 .8 4 9 .6 5 0 .7
19 3 6 .0 3 7 .3 3 9 .0 4 0 .1 4 0 .9 4 1 .5 4 2 .8 4 3 .7 4 4 .9 4 5 .6 4 6 .5 4 7 .4 4 8 .5
 Isocentric Treatments
• Calibrate linac so that
SSD
1MU gives 1cGy to 100cm
dmax at 100cm SCD
for a 10x10cm field
size
dmax
• Use Tissue Maximum
Ratio (TMR) table to
get dose for a
particular depth and
field size
 6MV TMR Table
Side of Square Field (cm)
Depth(cm) 4 5 6 7 8 9 10 12 15

1.5 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000
2 0.995 0.996 0.997 0.997 0.997 0.998 0.998 0.998 0.997

3 0.971 0.973 0.974 0.977 0.978 0.979 0.979 0.980 0.980

4 0.940 0.943 0.946 0.949 0.951 0.953 0.954 0.956 0.958

5 0.904 0.910 0.915 0.919 0.922 0.926 0.928 0.931 0.935

6 0.869 0.876 0.882 0.888 0.892 0.897 0.900 0.905 0.910 Only
7 0.835 0.843 0.850 0.857 0.863 0.867 0.871 0.877 0.884
attenuation
8 0.800 0.810 0.818 0.826 0.832 0.838 0.843 0.851 0.860

9 0.767 0.777 0.786 0.795 0.801 0.808 0.814 0.823 0.833

10 0.735 0.745 0.755 0.765 0.772 0.779 0.786 0.796 0.808

11 0.703 0.714 0.725 0.735 0.742 0.750 0.758 0.768 0.781

12 0.672 0.684 0.695 0.706 0.714 0.722 0.729 0.741 0.755

13 0.644 0.656 0.667 0.677 0.686 0.696 0.703 0.715 0.730

14 0.616 0.629 0.640 0.651 0.659 0.668 0.676 0.689 0.705

15 0.591 0.603 0.614 0.624 0.633 0.642 0.650 0.664 0.681
 Isocentric Treatments
• To calculate monitor units required, you
need to get back to reference conditions
• For isocentric treatments, you need to
correct for…
– Field size (‘output factor’ OF) – get from chart
– Depth – get from TMR table

MU = Dose per fraction

OF x TMR
 Isocentric Treatments
• Example 2.
A clinician prescribes 100cGy per fraction to the
centre of a patient’s head in a whole-brain
treatment. An isocentric parallel pair of 6MV
fields are used. Depth to isocentre for each
beam is 12cm and each field size is 15x15cm.
How many monitor units are required per beam?

MU = Dose per fraction

OF x TMR
 1.08

• Dose per fraction = 1.06

1.04

100cGy

Relative Output Factor

1.02

• Field size = 15x15cm

1.00

0.98

• Depth = 12cm
0.96

0.94

0.92

5 10 15 20 25 30

Side of Square Field (cm)

• OF = 1.032
• TMR = 0.755 Depth(cm) 4 5 6 7
6MV TMR Table
Side of Square Field (cm)
8 9 10 12 15
1.5 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000
2 0.995 0.996 0.997 0.997 0.997 0.998 0.998 0.998 0.997
3 0.971 0.973 0.974 0.977 0.978 0.979 0.979 0.980 0.980

• MU = .
4 0.940 0.943 0.946 0.949 0.951 0.953 0.954 0.956 0.958

100 . 5
6
0.904
0.869
0.910
0.876
0.915
0.882
0.919
0.888
0.922
0.892
0.926
0.897
0.928
0.900
0.931
0.905
0.935
0.910
7 0.835 0.843 0.850 0.857 0.863 0.867 0.871 0.877 0.884

1.032 x 0.755 8
9
0.800
0.767
0.810
0.777
0.818
0.786
0.826
0.795
0.832
0.801
0.838
0.808
0.843
0.814
0.851
0.823
0.860
0.833
10 0.735 0.745 0.755 0.765 0.772 0.779 0.786 0.796 0.808

= 128.3 11
12
0.703
0.672
0.714
0.684
0.725
0.695
0.735
0.706
0.742
0.714
0.750
0.722
0.758
0.729
0.768
0.741
0.781
0.755
13 0.644 0.656 0.667 0.677 0.686 0.696 0.703 0.715 0.730

÷ 2 = 64.2MU per beam 14

15
0.616
0.591
0.629
0.603
0.640
0.614
0.651
0.624
0.659
0.633
0.668
0.642
0.676
0.650
0.689
0.664
0.705
0.681
 Other Examples
• Example 3.
A patient requires treatment to the thigh.
The prescribed dose is 20Gy in 10
fractions to 5cm deep at 120cm FSD. A
single 6MV beam is used with a field size
of 10x10cm. How many MU are required?

(supplementary information:
6MV PDD at 100cm FSD, 10x10, 5 deep = 86.9%)
• Example 4.
For the previous thigh example, which
would have the biggest effect on the
dose? Would the dose go up or down?
a) Doubling the field size
b) Introducing a wedge into the beam
c) Reducing the FSD to 100cm
• Example 5.
From the data below, calculate the number of
MU required for the lateral fields of this
isocentric three-field plan for the whole brain.

Wedge factor = 0.4

TMR = 0.782
OF = 0.9
Depth = 10cm
Dose per fraction = 100cGy

Beams are weighted equally (i.e. contribute

same dose) at the isocentre.