Conformal terminology DOS 523 Treatment Planning Have you ever laid wood or laminate flooring?

If you have, you may have noticed that the planks are constructed in such a way as to be installed only one way, with the edge of one plank fitting over top of the plank next to it. Each plank has a groove along one side and a protrusion (called a tongue) along the other side to accommodate the installation. The tongue of one plank fits inside the groove of the one next to it. On top, the planks look like they butt up against one another, but this is an illusion. If this were the case, there would be a crack between each plank and crumbs and hair could spill down inside the crack or moisture could intrude between the planks causing them to swell or warp. The leaves of the multileaf collimator (MLC) on a linear accelerator are built the same way to prevent leakage of radiation from between leaves. There is a slight overlap and each leaf slides over the one next it so radiation cannot easily escape from between the leaves when the linear accelerator is delivering a radiation treatment.1 Another design of the multileaf collimator that actually is a detriment rather than a help in treatment delivery is the fact that each leaf is a rectangle. Have you ever made a 3D figure out of legos (those tiny blocks that snap together and can be used to build just about anything)? From a small distance away, the lines can be blurred and the legos can take on any shape, even a human face. But if you look at the sculpture up close, you can see the individual blocks and the edges are not a nice smooth curve, but a series of squared-off blocks. This effect is called a scalloped effect and it has the same effect on the edge of the beam when the collimator is used for blocking. It is impossible to obtain a nice smooth curve at the blocked edges, but the smaller the width of the leaves, the more accurate the curve.2 While researching the design of the collimator leaves, I came across the following image. It was created by exposing the film to radiation and, using only the MLCs to block certain areas for precise amounts of time results in varying levels of exposure of the film, which creates the image. It was created when the Varian sales rep was setting up the new accelerator and was trying to show how precisely you can control the levels of radiation using the MLCs. I think a picture is worth a thousand words. It hangs on a lightbox in the medical physicists office (Carla Scofield) at Geisinger Wyoming Valley Cancer Center.3

1. Conversation with John Kirias, ISS representative in Radiation Oncology department at Geisinger Wyoming Valley Cancer Center. 2. Conversation with Rich Lanzendorfer, Medical Dosimetrists at Geisinger Wyoming Valley Cancer Center. 3. Conversation with Carla Scofield, Medical Physicist at Geisinger Wyoming Valley Cancer Center.