Tongue and Groove

Tongue and groove effect is when MLC leaves slide against each other via this
tongue and groove design in order to reduce the amount of leakage or
transmission of radiation through closed leaves. The leaves have notches in them to
tightly fit next to each other which create almost a maze type look that the beam
cannot easily penetrate through. Tongue and groove can reduce dose leakage by
about 14% to 33% in Siemens, Varian, and Elekta machines in that order. 1 They
each have their own method of tongue and groove MLC arrangement but they all
serve the same purpose.
IMRT plans use MLC segments for shaping dose and requires about ten times the
amount of monitor units a standard 3D plan would use. Because of this, leaking
through the leaves can add up quickly. This tongue and groove design better
controls the amount of extra dose that is possible.

Figure 1: Different MLC tongue and groove methods per manufacture 2

Scalloped Effect
Scalloped effect is when the edges of the MLCs are not even and dose distribution
can follow this jagged pattern. As our linear accelerators and understanding of the
mechanics advances, the scalloped effect is something we typically are not
concerned with in terms of it affecting our isodose distributions. The edges of the
MLCs will not be able to conform perfectly to round edges of PTV/tumors; they will
overcover and undercover spots due to the square leaf edge.
Secondary electrons and scatter photons make up for the harsh edges that MLC
fields create. The dose pattern will not follow the rigged edges of the leaves; this
allows the dose distribution to still remain smooth and more rounded than it would
be rigged. It has been tested that even with a single field the 90% line does not

show a differences between MLC use (in terms of scalloped field edge) and the use
of a cerrobend cutout. 3

Figure 2: Differences in dose distribution in MLC sizes as recorded with

radiographic film at 6MV4
Scalloped effect was more of a concern when converting from cerrobend shapes to
MLCs was being introduced. Studies on different anatomical treatment sites have
been done and all have concluded that MLCs were an acceptable replacement with
insignificant differences in dose distribution. Now, MLCs are even smaller and the
motions of the machine are even smoother; jagged edges in MLCs are small enough
that they are not noticeable when planning today. One MLC setting found in Pinnacle
is to push the leaves inbound, outbound, or average (crossbound) to the edge of the
target. This means the MLC corners will stop inside the edge of the target,
completely at the end contours of the target, or the commonly used average in

between the inside and out. This is what can help create adequate (or inadequate if
the wrong setting it chosen) coverage and dose distribution of the target. 3

Figure 3: Inbound, outbound, and cross-bound options for MLC leave

pushing3
1. Washington CM. Principles and Practice of Radiation Therapy. 3rd ed. St.
Louis, Mo.: Mosby Elsevier; 2010:339.
2. Hariri S, Shahriari M. Suggesting a new design for multileaf collimator leaves
based on Monte Carlo simulation of two commercial systems. J Appl Clin Med
Phy. 2010;11(3). doi:10.1120/jacmp.v11i3.3101.
3. Khan FM. Potish RA. Treatment Planning in Radiation Oncology. Philadelphia,
PA: Lippincott Williams & Wilkins; 2000: 160-163.
4. Liu Y, Shi C, Tynan P, Papanikolaou N. Dual layer MLC dosimetric
characteristics for small field and IMRT applications. J Appl Clin Med Phy.
2008;9(2). doi:10.1120/jacmp.v9i2.2709