Technical Publication

Monaco®
AGL Machine and Beam Model Validation Reference Manual

Document ID: E013769 / 02

Publication Date: 2025-04-15

Language: English

Non-Confidential Information and Basic Personal Data

Copyright
Copyright 2025 Elekta Solutions AB. All rights reserved. No part of this document may be reproduced in any form
without written permission from the copyright holder.

Trademarks
All trademarks of Elekta products are the property of Elekta.

Acknowledgement of other trademarks and trade names

Elekta acknowledges the trademarks and registered trademarks of other manufacturers that we use in this document.

Referenced documents
Elekta does not supply all the documents that we refer to in this document with the equipment. Elekta reserves the
right to make the decision on which of the documents we supply with the equipment.

CE Marking (Compliance with EU MDR)

Elekta maintains a Quality System that complies with all essential requirements of the European Medical Device
Regulation EU MDR (2017/745) and all other standards applicable thereunder. A Technical File is maintained for
review via Elekta directly.

Monaco

Contact information
Australia Sponsor Information
MANUFACTURER Elekta Pty Ltd is the sponsor of this device.
Elekta Solutions AB All inquiries in relation to this product to be
Hagaplan 4 made to the following:
113 68 Stockholm [email protected]
Sweden Elekta Pty Ltd
Phone: +46 8 587 254 00 Suite 10.02, Level 10
Fax: +46 8 587 255 00 146 Arthur Street
[email protected] North Sydney
NSW 2060 +61 (0) 2 8907 1800
A.B.N. 49 109 006 966

TECHNICAL SUPPORT
Contact your local Elekta representative for technical support or visit www.elekta.com.

ii © Elekta Group 2025. All rights reserved..

E013769 / 02 / 2025-04-15
 Table of Contents

Table of Contents
Table of Contents ........................................................................................................................................................ iii
1. ...Introduction .......................................................................................................................................................... 1
1.1 Document Revision History ......................................................................................................................... 1
1.2 Warnings, Cautions, Notes, Tips .................................................................................................................. 1
1.3 Abbreviations and Definitions..................................................................................................................... 2
2. ...About this document ............................................................................................................................................ 3
3. ...Prerequisites ......................................................................................................................................................... 3
4. ...Equipment............................................................................................................................................................. 4
5. ...Measurement requirements ................................................................................................................................ 4
6. ...AGL full-service workflow .................................................................................................................................... 5
7. ...AGL self-service workflow .................................................................................................................................... 6
8. ...Review Monaco AGL Machine and Beam Model Validation Package ................................................................ 7
8.1 AGL Clinic, Monaco predefined plans and templates .................................................................................. 8
8.1.1 Monaco predefined Plans.............................................................................................................. 9
8.1.2 Monaco Templates .......................................................................................................................10
8.1.3 ‘AGL CC and eMC models’ content ................................................................................................12
8.1.4 ‘tele’ content ................................................................................................................................12
8.1.5 ‘idv’ content ..................................................................................................................................13
8.2 Clinic Selection ...........................................................................................................................................13
9. ...Monaco Machine and Beam Model Validation ..................................................................................................14
9.1 Tests ...........................................................................................................................................................14
9.2 Install AGL Clinic.........................................................................................................................................15
9.2.1 Objective ......................................................................................................................................15
9.2.2 For a standalone Monaco installation:.........................................................................................15
9.2.3 For a non-standalone Monaco installation: .................................................................................17
9.2.4 Results ..........................................................................................................................................20
9.3 Import Machine and Beam Models ............................................................................................................20
9.3.1 Objective ......................................................................................................................................20
9.3.2 Procedure .....................................................................................................................................20
9.3.3 Results ..........................................................................................................................................21
9.4 Check LINAC Mechanical Scales ..................................................................................................................21
9.4.1 Objective ......................................................................................................................................21
9.4.2 Procedure .....................................................................................................................................22
9.4.3 Results ..........................................................................................................................................22
9.5 Create TU and map DICOM machine (export).............................................................................................23
9.5.1 Objective ......................................................................................................................................23
9.5.2 Procedure .....................................................................................................................................23
9.5.3 Results ..........................................................................................................................................23
9.6 Verify MC model Calibration ......................................................................................................................24
9.6.1 Objective ......................................................................................................................................24
9.6.2 Test Procedure..............................................................................................................................24
9.6.3 results ...........................................................................................................................................25
9.7 Verify CC model Calibration .......................................................................................................................25
9.7.1 Objective ......................................................................................................................................25
9.7.2 Test Procedure..............................................................................................................................25
9.7.3 Results ..........................................................................................................................................26
9.8 Validate MC model .....................................................................................................................................26
© Elekta Group 2025. All rights reserved. iii
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 Table of Contents

9.8.1 Objective ......................................................................................................................................26

9.8.2 Procedure for Monaco 5.51 and higher .......................................................................................27
9.8.3 Results ..........................................................................................................................................27
9.9 Validate CC model ......................................................................................................................................27
9.9.1 Objective ......................................................................................................................................27
9.9.2 Procedure for Monaco 5.51 and higher .......................................................................................27
9.9.3 Results ..........................................................................................................................................27
9.10 Validate EMC model .................................................................................................................................28
9.10.1 Objective ......................................................................................................................................28
9.10.2 Procedure for Monaco 5.51 and higher .......................................................................................28
9.10.3 Results .........................................................................................................................................28
9.11 Using MCU (Monaco 5.51 and higher) to compare ...................................................................................28
9.11.1 Import Data .................................................................................................................................28
9.11.2 Compare Data ..............................................................................................................................29
9.11.3 Generate Reports .........................................................................................................................31
9.12 Export to MOSAIQ .....................................................................................................................................31
9.12.1 Objective ......................................................................................................................................31
9.12.2 Procedure – Photons ...................................................................................................................31
9.12.3 Procedure - Electrons...................................................................................................................32
9.12.4 Results .........................................................................................................................................33
9.13 Submit Machine and Beam Model Validation Checklist (E013771) to Elekta ...........................................33
10. .Monaco Machine and Beam Model Validation – Extended ..............................................................................33
10.1 Verify Leaf Transmission and Offset – Photon Monte Carlo .....................................................................34
10.1.1 Objective ......................................................................................................................................34
10.1.2 Procedure ....................................................................................................................................34
10.2 Confirm Couch composition and densities...............................................................................................34
10.2.1 Objective ......................................................................................................................................34
10.2.2 Procedure ....................................................................................................................................34
10.3 Commission 3D – Photons .......................................................................................................................36
10.3.1 Objective ......................................................................................................................................36
10.3.2 Procedure ....................................................................................................................................36
10.4 Commission 3D – Electrons ......................................................................................................................38
10.4.1 Objective ......................................................................................................................................38
10.4.2 Procedure ....................................................................................................................................38
10.5 Commission IMRT/VMAT – Photon Monte Carlo ......................................................................................39
10.5.1 Objective ......................................................................................................................................39
10.5.2 Procedure ....................................................................................................................................39
11. .Automate workflow via script (Monaco 6.2.2 and above) ................................................................................40
12. .Appendices ...........................................................................................................................................................41
Appendix A: AGL Reference Detectors ...................................................................................................................41
Photon Detectors........................................................................................................................................41
Electron Detectors ......................................................................................................................................41
Appendix B: AGL Beam Model Dose Agreement ...................................................................................................42
Photons ......................................................................................................................................................42
Electron Monte Carlo ..................................................................................................................................42
Electron calculation constraints in Monaco ...............................................................................................43
Appendix C: AGL Model Calibration ......................................................................................................................45
Photon and Electron Monte Carlo ..............................................................................................................45
Appendix D: Machine Model MLC and Jaw Limits and Characterization ..............................................................46
Photon machine models ............................................................................................................................46
Electron Monte Carlo ..................................................................................................................................46
Appendix E: MLC Geometry Parameters – Photon Monte Carlo Models ...............................................................48
Appendix F: MLC Dynamic Parameters – Photon Monte Carlo Models .................................................................49
Appendix G: Monaco Plans and Templates ...........................................................................................................50
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 Table of Contents

Appendix H: Monaco Dose Sampling ....................................................................................................................54

Appendix I: Phantom Setup ..................................................................................................................................54
Appendix J: General Guidelines for Monaco Calculations on QA Phantoms .........................................................56
Phantom Selection, Setup ..........................................................................................................................56
RED adjustment..........................................................................................................................................56

© Elekta Group 2025. All rights reserved. v

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 Introduction

1. Introduction
This document provides Machine and Beam Model Validation information to support the
commissioning activity for Monaco photon and electron machine and beam models.
It is applicable to Elekta Accelerated Go Live (AGL) customers (qualified LINACs) with
Monaco 5.51.10 and higher.

1.1 Document Revision History

Date Revision Description

2019-01-09 1.0 Initial release.

2019-05-02 2.0 Monaco 5.11 ‘and higher versions’ was added.
2019-06-25 3.0 Updated company address.
2020-08-13 01 Updates for Monaco 5.51.10
Update the copyright page.
Add workflow for GPUMCD.
2025-04-15 02
Modify procedure for Monaco plans / templates.
Update appendix content for templates.

1.2 Warnings, Cautions, Notes, Tips

In this manual, warnings, cautions, notes, and tips have unique symbols and appear in a box.

WARNING Warnings are directions which, if not followed, could constitute a health
hazard or cause injury, including fatal or serious personal injuries, or
clinical mistreatment. Warnings also let you know if your health can be
endangered.

CAUTION
Cautions are directions which, if not followed, can cause database corruption
or result in systematically erroneous data output.

Notes include important, secondary context and reference information, and

NOTE
do not give instructions or related results.

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AGL Machine and Beam Model Validation Reference Manual
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 Introduction

1.3 Abbreviations and Definitions

Table 1: Abbreviations and Definitions

Abbreviation Definition

AGL Accelerated Go Live

CAT Customer Acceptance Test
CAX Central Axis
CC Collapsed Cone
C Completed
CP Control Point
Dm Dose to Medium
Dw Dose to Water
EMC Electron Monte Carlo
EPP Elekta Physics Platform
F Fail
FFF Flattening Filter Free
GPUMCD Graphics Processing Unit Monte Carlo Dose
IMRT Intensity-Modulated Radiation Therapy
MC Monte Carlo
MCU Monaco Commissioning Utility
MLC Multi-Leaf Collimator
MU Monitor Units
N/A Not Applicable
OF Output Factor
P Pass
PDD Percentage Depth Dose
PMC Photon Monte Carlo
QA Quality Assurance
RED Relative Electron Density
TPS Treatment Planning System
TU Treatment Unit
VMAT Volumetric-Modulated Arc Therapy
WF Wedge Factor
XVMC X-ray Voxel Monte Carlo
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AGL Machine and Beam Model Validation Reference Manual
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 About this document

2. About this document

The Machine and Beam Model Validation tasks are split into BASIC and EXTENDED groups:
o BASIC
o Review Machine and Beam Model Validation Package
o Install AGL Clinic
o Import Machine and Beam Models
o Calibrate Beam Models
o Check LINAC Mechanical Scales
o Create TU and map DICOM machine for export
o Verify Beam Model Calibration
o Validate Beam Models (PDDs, Profiles, and OFs for square fields)
o Export Plan (Monaco > MOSAIQ > LINAC)
o EXTENDED
o Review Monaco MLC parameters
o Confirm Couch composition and densities
o Commission 3D photons, electrons
o Commission IMRT/VMAT, photon Monte Carlo
The BASIC section includes all the machine and beam model validation tests that require
Elekta review.
The results of the BASIC tasks need to be captured in the E013771: Machine and Beam
Model Validation Checklist document provided, signed off by the customer, and sent to
the regional Elekta Physics Support for verification. After the Elekta Physics Support team
reviews the results, the document will be signed off by Elekta Physics Support personnel
and sent back to the customer.
In the EXTENDED section, there are tasks for which Monaco tools such as phantoms,
templates, and general guidelines are provided to facilitate their deployment, but these
tasks do not require a validation action from Elekta Physics Support.

3. Prerequisites
The following activities must be completed before proceeding with the Machine and Beam Model
Validation:

• LINAC CAT
• VMAT CAT
• LINAC AGL CAT
• LINAC calibration (TG-51, IAEA TRS-398…)
• Water tank measurements as described in E013772, AGL Data Collection List
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 Equipment

• The following patients need to be ready in MOSAIQ:

Table 2: Patient information

Patient ID Last Name First Name

AGL06MV Phantom Monaco

AGL10MV Phantom Monaco
AGL15MV Phantom Monaco
AGL06FFF Phantom Monaco
AGL10FFF Phantom Monaco
AGL06MeV Phantom Monaco
AGL08MeV Phantom Monaco
AGL09MeV Phantom Monaco
AGL10MeV Phantom Monaco
AGL12MeV Phantom Monaco
AGL15MeV Phantom Monaco
AGLCouchRED Phantom Monaco
AGLSSD90ExpressQA Phantom Monaco
AGLSSD95ExpressQA Phantom Monaco

4. Equipment
The Machine and Beam Model Validation procedure in this guide requires the use of the following
equipment:

• Monaco Machine and Beam Model Validation Package

• Water tank scanning system, detectors, and electrometer
The Extended section might also require:

• IMRT/VMAT QA devices
• Solid water phantoms

5. Measurement requirements
The AGL data collection list is detailed in E013772, AGL Data Collection List, which describes the
scanned and non-scanned data to be collected for the verification of Monaco calculations in the Monaco
Commissioning Utility.
This document will be provided to the customer by the Elekta Regional Physics team.
It can also be downloaded from Elekta Care Community.

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 AGL full-service workflow

6. AGL full-service workflow

The AGL Machine and Beam Model Validation process is summarized in Figure 1. Tasks in blue are the
customer’s responsibility and those in orange are Elekta’s responsibility.

Figure 1: Machine and Beam Model Validation workflow – full-service workflow

Detailed Workflow:

• Collect the required data for BASIC validation, as described in E013772 AGL Beam Data
Collection List.
• Submit scanned, non-scanned measured data to Elekta through Elekta Physics Platform (EPP)
https://beamdata.elekta.com
• Receive from Elekta the Monaco AGL Clinic, which contains:
o The virtual phantoms and plans used to run the basic machine and beam model
validation
o AGL machine and beam models
o Photon Monte Carlo models already calibrated to the absolute dose provided by the
customer
o Photon Collapsed Cone already calibrated to the open absolute dose provided by the
customer
o Electron Monte Carlo models with AGL calibration values in Appendix C: AGL Model
Calibration.
• Receive Machine and Beam Model Validation Reports
• Install the models, create a Monaco Treatment Unit, and verify the calibration of the models
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 AGL self-service workflow

• Review the results shown on the Machine and Beam Model Validation Report
• Complete E013771 Machine and Beam Model Validation Checklist, sign off, and send it back to
Elekta for verification
• Receive back E013771 Machine and Beam Model Validation Checklist reviewed and signed off by
Elekta Physics Support representative
• Run all commissioning tests required by local regulations.

7. AGL self-service workflow

The AGL Machine and Beam Model Validation process is summarized in Figure 2. Tasks in blue are the
customer’s responsibility and those in orange are Elekta’s responsibility.

Figure 2 Machine and Beam Model Validation workflow – Monaco 5.51 and higher versions.

GPUMCD is only available to Elekta ONE | Planning customers.

Detailed Workflow:

• Collect the required data for BASIC validation, as described in the Measurement requirements
section.
• Receive from Elekta the Monaco AGL Clinic, which contains:
o The virtual phantoms and plans used to run the basic beam model validation.
o AGL beam models.
 Photon Monte Carlo machine and beam models with AGL calibration values.
 Photon GPU Monte Carlo machine and beam models with AGL calibration
values.
 Photon Collapsed Cone machine and beam models with AGL calibration values.

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 Review Monaco AGL Machine and Beam Model Validation Package

 Electron Monte Carlo machine and beam models with AGL calibration values in
Appendix C: AGL Model Calibration.
• Calibrate and install the models (see Monaco Instructions for Use (IFU))
• Create / verify a Monaco Treatment Unit and verify the calibration of the models in Monaco.
• Calculate in Monaco for the BASIC standard fields and DICOM file and MOSAIQ Export the
plan and beam doses.
• Import the measured data and the Monaco DICOM plan and beam doses in MCU and analyze in
MCU.
• Review the results and generate the Machine and Beam Model Validation Report in MCU.
• Complete E013771 Machine and Beam Model Validation Checklist, sign off, and send it back to
Elekta for verification.
• Receive back E013771 Machine and Beam Model Validation Checklist reviewed and signed off
by Elekta Physics Support representative.
• Run all commissioning tests (EXTENDED can be used for this) required by local regulations.

8. Review Monaco AGL Machine and Beam

Model Validation Package
AGL customers will be provided with items in Table 3.

Table 3: Monaco AGL Machine and Beam Model Validation Package descriptions

AGL Machine and Beam Model Validation Package Description

Item

AGL Databook (E013773) / Electronic files Summary of AGL photon and electron reference
measured data

AGL Data Collection List (E013772) Data requirements list for AGL machine and beam
model validation

AGL Clinic Monaco clinic that contains the models, phantoms, and
plans to be used during the Machine and Beam Model
Validation process
Monaco Templates Monaco plan and QA plan templates
AGL Machine and Beam Model Validation (This document) information for commissioning the
Reference Manual (E013769) Monaco AGL photon and electron machine and beam
models.

Machine and Beam Model Validation Checklist Complete with the results of the Basic Machine and
(E013771) Beam Model Validation tests

AGL documents will be provided to the Monaco customer by the Elekta

Regional Physics Support team. They are also available on Elekta Care
NOTE: Community. The AGL Clinic and Monaco templates will be delivered by the
Elekta Beam Modeling team after the evaluation of the measured data.

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 Review Monaco AGL Machine and Beam Model Validation Package

8.1 AGL Clinic, Monaco predefined plans and

templates
The Monaco AGL Clinic contains:

• AGL PMC and GPUMCD models in the ‘tele’ folder.

• AGL Collapsed Cone and electron Monte Carlo models in the ‘AGL CC and eMC
models’ folder.
• All the Validation plans, organized per energy in different patients, for example:
‘AGL06MV’, ‘AGL06MeV’ …
o “AGL” Monaco TU for PMC, CC and eMC.
o “AGLGPU” Monaco TU for GPUMCD.
• 3 virtual phantoms:
o 30x15x30 (5 mm slice)
o 60x40x60 (2 mm slice)
o 60x40x60Sl1cm (10 mm slice)
Figure 3 shows the content of the AGL Clinic. The AGL Clinic is installed under below
address.
C:\Users\Public\Public Document\CMS\FocalData\Installation\50~AGL Clinic

Figure 3: AGL Clinic structure.

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 Review Monaco AGL Machine and Beam Model Validation Package

8.1.1 Monaco predefined Plans

Table 4 describes the content of each Monaco plan in each energy-phantom in the AGL Clinic and their
main purpose with optimized study set structure.

Table 4: General Plan descriptions

SS_Step1 Monaco Plan Objective

aglxAbsDoseOpenCC Model open calibration check

aglxAbsDoseW60CC Model W60 calibration check
aglxAbsDoseGPUMCD Patient plan for calibration QA plan
aglxAbsDoseGPUMCD-QA1 Model open calibration check
aglxAbsDoseXVMC Model open calibration check

SS_Step2 Monaco Plan Objective

aglSquareGPUMCD Patient plan for QA Basic fields validation

aglSquareGPUMCD-QA1 Basic fields validation
aglSquareXVMC Basic fields validation
aglSquareOpenCC Basic fields validation
aglSquareW60CC Basic fields validation

SS_Step3 Monaco Plan Objective

aglMosaiqPhotons (FF) Export consistency check

aglMosaiqPhotonsFFFGPUMCD Export consistency check
aglMosaiqPhotonsFFFXVMC Export consistency check

SS_Step4 Monaco Plan Objective

agl3DcommissGPUMCD Patient plan for QA Extended model validation

agl3DcommissGPUMCD-QA1 Extended model validation
agl3DcommissXVMC Extended model validation
agl3DcommissOpenCC Extended model validation
agl3DcommissW60CC Extended model validation
Note: CC and wedge plans are not available for FFF machine and beam models.

Table 5: Electron / Basic and / EXTENDED plan descriptions

SS_Step1 Monaco Plan Objective

aglElectronSquare Basic fields validation

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 Review Monaco AGL Machine and Beam Model Validation Package

SS_Step2 Monaco Plan Objective

aglMosaiqElectrons Export consistency check

SS_Step3 Monaco Plan Objective

aglElectron3Dcomm Extended model validation

8.1.2 Monaco Templates

Table 6 lists all the photon + electron plans in the AGL Clinic which are also provided as a set of Monaco
Template. In addition, Monaco Templates for the Extended tests ‘Leaf Transmission, ‘Couch’ and
‘IMRT/VMAT’ are included.

Table 6: Monaco Templates

BASIC / Extended Template Name Objective

BASIC aglxAbsDoseGPUMCD Model calibration check

BASIC aglxAbsDoseXVMC Model calibration check
BASIC aglxAbsDoseOpenCC Model calibration check
BASIC aglxAbsDoseW60CC Model calibration check
BASIC aglSquareGPUMCD Basic model validation
BASIC aglSquareXVMC Basic model validation
BASIC aglSquareOpenpCC Basic model validation
BASIC aglSquareW60CC Basic model validation
BASIC aglMosaiqPhotons Mosaiq configuration check
BASIC aglMosaiqPhotonsFFFGPUMCD Mosaiq configuration check
BASIC aglMosaiqPhotonsFFFXVMC Mosaiq configuration check
BASIC ElectronSquare Basic model validation
BASIC ElectronMosaiq Mosaiq configuration check
BASIC Electron3Dcomm Extended model validation
EXTENDED agl3DcommissGPUMCD Extended model validation
EXTENDED agl3DcommisspXVMC Extended model validation
EXTENDED agl3DcommissOpenCC Extended model validation
EXTENDED agl3DcommissW60CC Extended model validation
EXTENDED aglCouchRED Couch structures RED optimization
EXTENDED aglExpressQAStep1 XVMC MLC commissioning
EXTENDED aglExpressQAStep2 IMRT plan verification
EXTENDED aglSSIMRTc119 IMRT/VMAT commissioning

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 Review Monaco AGL Machine and Beam Model Validation Package

EXTENDED aglSSIMRTheadneck119 IMRT/VMAT commissioning

EXTENDED aglVMATc119 IMRT/VMAT commissioning
EXTENDED aglVMATheadneck119 IMRT/VMAT commissioning
EXTENDED aglVMATprostate119 IMRT/VMAT commissioning
EXTENDED aglVMATanal244 IMRT/VMAT commissioning
EXTENDED aglVMATheadneck244 IMRT/VMAT commissioning

The templates will be provided by the regional Elekta Physics Support team.
A detailed description of each plan and its beams is provided in the Appendix.

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 Review Monaco AGL Machine and Beam Model Validation Package

Appendix G: Monaco Plans.

8.1.3 ‘AGL CC and eMC models’ content

Photon Collapsed Cone models for energies 6 MV, 10 MV, and 15 MV, and electron Monte Carlo models
for energies 6 MeV, 8 MeV, 9 MeV, 10 MeV, 12 MeV, and 15 MeV are in the ‘AGL CC and eMC
models’ folder as follows:

• AGL2_VERSAHD_E06_allJWset_170421
• AGL2_VERSAHD_E08_allJWset_170406
• AGL2_VERSAHD_E09_all_JWset_170406
• AGL2_VERSAHD_E10_all_JWset_170417
• AGL2_VERSAHD_E12_all_JWset_170406
• AGL2_VERSAHD_E15_V4_all_setJW_170406
• dcm_06MV_BMTv4.0.0.3
• dcm_10MV_ BMTv4.0.0.3
• dcm_15MV_ BMTv4.0.0.3
These models need to be installed in the Monaco database.

The material and thickness used as cutout material to generate the scatter
kernels of the AGL Electron Monte Carlo models is Cerrobend, 1.5 cm
thickness.
NOTE If a different material or thickness is required, the Electron Monte Carlo
models will need to be updated accordingly. In this case the models will not
be identified as AGL. If this is the case, contact the Elekta Beam Modeling
Team: [email protected].

8.1.4 ‘tele’ content

Photon Monte Carlo models for energies 6 MV, 10 MV, 15 MV, 6 MV FFF, and 10 MV FFF are in the
‘tele’ folder as follows:

• AGLpmc06MV
• AGLpmc10MV
• AGLpmc15MV
• AGLpmc06FFF
• AGLpmc10FFF
• GPUMCD_06MV
• GPUMCD_06FFF
• GPUMCD_10MV
• GPUMCD_10FFF
• GPUMCD_15MV
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8.1.5 ‘idv’ content

The CT-to-ED conversion file used with the virtual phantoms is DICOM3.RED1all. It is in the idv/cttoed
folder.

8.2 Clinic Selection

It is strongly recommended to run the Machine and Beam Model Validation in the same Monaco clinic
that will be used clinically afterwards. In the case that AGL Clinic will not be the final Monaco clinic to
be used clinically, it is necessary to copy the following content from the AGL Clinic under the customer
specific Monaco clinic (shown in Figure 4) before running the machine and beam model validation
process:

• All phantom folders:

o 30x15x30
o 60x40x60
o 60x40x60Sl10cm
o AGL06MV
o AGL06MeV
o …
• ‘AGL CC and eMC’ folder
• Content of the ‘tele’ folder to the existing ‘tele’ folder at destination clinic
• Copy cttoed file DICOM3.RED1all in the idv/cttoed/ folder into the
CustomerClinic/idv/cttoed folder

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 Monaco Machine and Beam Model Validation

Figure 4: AGL Clinic data

9. Monaco Machine and Beam Model

Validation
9.1 Tests
Table 7 describes the tests included in the ‘Basic’ section.

Table 7: Basic Tests

Basic/ Test Name Objective

Extended

B Install AGL Clinic Verify that AGL Clinic and all its contents are
correctly installed.
B Import Machine and Beam Models Import Photon Collapsed Cone and Electron Monte
Carlo models to the Monaco Physics Database.
B Check LINAC Mechanical Scales Confirm that the LINAC scale is IEC 61217 and
acknowledge the proper configuration for Monaco
Treatment Units.

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 Monaco Machine and Beam Model Validation

Basic/ Test Name Objective

Extended

B Create/Verify Treatment Unit and map Create/Verify a Treatment Unit in Monaco with all
DICOM machine for export AGL models with updated absolute dose calibration.
Configure Treatment Unit DICOM name.
B Verify photon GPU Monte Carlo model Verify the model dose calibration in Monaco.
calibration
B Verify photon Monte Carlo model Verify the model dose calibration in Monaco.
calibration
B Verify Collapsed Cone model Verify the model dose calibration in Monaco.
calibration
B Validate photon GPU Monte Carlo Verify the agreement between the customer measured
model data and AGL beam model.
B Validate photon Monte Carlo model Verify the agreement between the customer measured
data and AGL beam model.
B Validate Collapsed Cone model Verify the agreement between the customer measured
data and AGL beam model.
B Validate electron Monte Carlo model Verify the agreement between the customer measured
data and AGL beam model.
B Export to MOSAIQ Verify that photon (open and wedge) and electron
beams can be sent from Monaco to the LINAC
through MOSAIQ.

9.2 Install AGL Clinic

9.2.1 Objective
Confirm that the AGL Clinic is properly installed in Monaco. (all versions)

9.2.2 For a standalone Monaco installation:

a. Copy the ‘AGL Clinic’ provided by Elekta under
C:\Customers\Public\PublicDocuments\CMS\FocalData\Installation\
or
Copy the required content described in Clinic Selection from ‘AGL Clinic’ to the Monaco
clinic selected by the customer.
b. Navigate to FocalData -> Installation -> AGL Clinic (or Monaco clinic
selected by the customer)
c. Verify that the following folders and content exist:
i. 30x15x30
ii. 60x40x60

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iii. 60x40x60Sl1cm
iv. One phantom per photon energy, e.g. ‘AGL06MV’, including the
following regular / QA level plans in the ‘plan’ folder:
Step1 Studyset
1. aglxAbsDoseGPUMCD
aglxAbsDoseGPUMCD-QA1
2. aglxAbsDoseXVMC
3. aglxAbsDoseOpenCC
4. aglxAbsDoseW60CC
Step2 Studyset
5. aglSquareGPUMCD
aglSquareGPUMCD-QA1
6. aglSquareXVMC
7. aglSquareOpenCC
8. aglSquareW60CC
Step3 Studyset
9. aglMosaiqPhotons
Step4 Studyset
10. agl3DcommissGPUMCD
agl3DcommissGPUMCD-QA1
11. agl3DcommissXVMC
12. agl3DcommissOpenCC
13. agl3DcommissW60CC
v. One phantom per electron energy, for example: ‘AGL06MeV’,
including the following plans in the ‘plan’ folder:
Step1 Studyset
1. ElectronSquare
Step2 Studyset
2. aglMosaiqElectrons
Step3 Studyset
3. Electron3Dcomm
vi. AGLCouchRED
The AGLCouchRED patient is for users to verify the proper
couch electron density, it has 2 studysets for GPUMCD and
XVMC respectively. The predefined plans for 6MV GPUMCD
are listed below:

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1. 06MVcouchREDGPUMCD
06MVcouchREDGPUMCD-QA1
vii. AGLExpressQA
There are 2 AGLExpressQA patients for XVMC model MLC
commissioning, one is SSD 90cm, the other one is SSD
95cm. Take SSD 90cm, 6MV for instance, it has following
plans:
1. 06MVExpress
06MVStep1NonIMRT
06MVStep2IMRT
viii. tele
1. AGLpmc06MV
2. AGLpmc10MV
3. AGLpmc15MV
4. AGLpmc06FFF
5. AGLpmc10FFF
6. GPUMCD_06MV
7. GPUMCD_06FFF
8. GPUMCD_10MV
9. GPUMCD_10FFF
10. GPUMCD_15MV
ix. AGL CC & eMC models
1. AGL2_VERSAHD_E06_allJWset_170421
2. AGL2_VERSAHD_E08_allJWset_170406
3. AGL2_VERSAHD_E09_all_JWset_170406
4. AGL2_VERSAHD_E10_all_JWset_170417
5. AGL2_VERSAHD_E12_all_JWset_170406
6. AGL2_VERSAHD_E15_V4_all_setJW_170406
7. dcm_06MV_BMTv4.0.0.3
8. dcm_10MV_BMTv4.0.0.3
9. dcm_15MV_BMTv4.0.0.3
x. idv
1. cttoed / DICOM3.RED1all

9.2.3 For a non-standalone Monaco installation:

a. Click the Elekta Application button.

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b. Click Settings.
c. Select Servers/Data Location.
d. The Monaco data location is shown in the ‘Data Location’ field.
e. Copy AGL Clinic in the \\MonacoDataLocation\Installation\ folder.
or
Copy the required content described in Clinic Selection from the ‘AGL Clinic’ to the
\\MonacoDataLocation\Installation\Monaco clinic selected by the customer.
f. Navigate to: \\MonacoDataLocation\Installation\AGL Clinic\ or Monaco
clinic selected by the customer.
d. Verify that the following folders and content exist:
i. 30x15x30
ii. 60x40x60
iii. 60x40x60Sl1cm
iv. One phantom per photon energy, e.g. ‘AGL06MV’, including the
following regular / QA level plans in the ‘plan’ folder:
Step1 Studyset
14. aglxAbsDoseGPUMCD
aglxAbsDoseGPUMCD-QA1
15. aglxAbsDoseXVMC
16. aglxAbsDoseOpenCC
17. aglxAbsDoseW60CC
Step2 Studyset
18. aglSquareGPUMCD
aglSquareGPUMCD-QA1
19. aglSquareXVMC
20. aglSquareOpenCC
21. aglSquareW60CC
Step3 Studyset
22. aglMosaiqPhotons
Step4 Studyset
23. agl3DcommissGPUMCD
agl3DcommissGPUMCD-QA1
24. agl3DcommissXVMC
25. agl3DcommissOpenCC
26. agl3DcommissW60CC

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v. One phantom per electron energy, for example: ‘AGL06MeV’,

including the following plans in the ‘plan’ folder:
Step1 Studyset
1. ElectronSquare
Step2 Studyset
2. aglMosaiqElectrons
Step3 Studyset
3. Electron3Dcomm
vi. AGLCouchRED
The AGLCouchRED patient is for users to verify the proper
couch electron density, it has 2 studysets for GPUMCD and
XVMC respectively. The predefined plans for 6MV GPUMCD
are listed below:
1. 06MVcouchREDGPUMCD
06MVcouchREDGPUMCD-QA1
vii. AGLExpressQA
There are 2 AGLExpressQA patients for XVMC model MLC
commissioning, one is SSD 90cm, the other one is SSD
95cm. Take SSD 90cm, 6MV for instance, it has following
plans:
1. 06MVExpress
06MVStep1NonIMRT
06MVStep2IMRT
viii. tele
1. AGLpmc06MV
2. AGLpmc10MV
3. AGLpmc15MV
4. AGLpmc06FFF
5. AGLpmc10FFF
6. GPUMCD_06MV
7. GPUMCD_06FFF
8. GPUMCD_10MV
9. GPUMCD_10FFF
10. GPUMCD_15MV
ix. AGL CC & eMC models
1. AGL2_VERSAHD_E06_allJWset_170421
2. AGL2_VERSAHD_E08_allJWset_170406

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3. AGL2_VERSAHD_E09_all_JWset_170406
4. AGL2_VERSAHD_E10_all_JWset_170417
5. AGL2_VERSAHD_E12_all_JWset_170406
6. AGL2_VERSAHD_E15_V4_all_setJW_170406
7. dcm_06MV_BMTv4.0.0.3
8. dcm_10MV_BMTv4.0.0.3
9. dcm_15MV_BMTv4.0.0.3
x. idv
1. cttoed / DICOM3.RED1all

9.2.4 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Install AGL Clinic”.

9.3 Import Machine and Beam Models

9.3.1 Objective
Import Photon Collapsed Cone and electron Monte Carlo models located in the ‘AGL CC and eMC
models’ folder under AGL Clinic (or Monaco clinic selected by the customer) into the Monaco physics
database.

The Photon Monte Carlo and Collapsed Cone models for Monaco users will
be delivered by the Elekta Beam Modeling Team to the customer with the
absolute dose calibration already matched to the values provided by the
customer.
NOTE
The calibration of the Electron Monte Carlo models cannot be modified by
the customer, so if it is required to update any of the values shown in the
Appendix Appendix C: AGL Model Calibration, it is necessary to contact
Elekta Physics Support.

9.3.2 Procedure
9.3.2.1 Import Photon CC and EMC models
The Photon Collapsed Cone and Electron Monte Carlo models provided in the folder ‘AGL CC and eMC
models’ need to be imported into the Monaco physics database.
To install and configure “Treatment Unit Storing”, follow the section “Configuring user rights” in Monaco
Installation and Upgrade Instructions..
Follow the directions provided in the Monaco Instructions for Use: Appendix D to store Photon Collapsed
Cone and Electron Monte Carlo models into the Monaco Physics Database, and make sure that the
instructions below are followed during the model storing process into the Physics Database:
1. Photon models must be stored first, before the electron models.
2. Do not change the name of the TU (‘AGLccemc’) in Treatment Unit Storing:
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Figure 5: Treatment Unit Storing window

3. Drag each energy in the ‘AGLccemc’ TU into the Database folder.

4. When electron energies are dragged into the ‘AGLccemc’ TU in the Database
folder, the following pop-up message displays, since the electron models have a
different name. Click Yes.

Figure 6: Treatment Unit Storing message

The Monaco Treatment Unit that includes all beam models may have any name defined by the customer.

9.3.2.2 Import PMC and GPUMCD models

Verify that the PMC beam models along with the GPUMCD beam models are existing in following
directory. Installation -> AGL Clinic ->Tele
They are ready to be mapped to the standard Treatment Unit.

9.3.3 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Import Machine and Beam
Models”.

9.4 Check LINAC Mechanical Scales

9.4.1 Objective
Verify the mechanical scales of the LINAC and configure the Monaco Treatment Units appropriately.

From Monaco Version 5.0, the gantry, collimator, and couch rotation
characterization is ruled by the Monaco Treatment Unit. The configuration
NOTE
given to the Treatment Unit will be used for all the models mapped to that
particular Treatment Unit.

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9.4.2 Procedure
The LINAC mechanical scales configuration can be checked in Integrity as follows:

Figure 7: Customize System Settings window

The LINAC must show Parameter Scales as IEC 61217.

9.4.3 Results
Complete Machine and Beam Model Validation Checklist (E013771), section “Check LINAC
Mechanical Scales”.

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9.5 Create TU and map DICOM machine (export)

9.5.1 Objective
Create a Monaco Treatment Unit that includes all the AGL photon Monte Carlo, GPUMCD beam models,
Collapsed Cone, and electron Monte Carlo models mapped with the updated absolute dose calibration.
Map the Treatment Unit name in Monaco to the DICOM name to be exported to MOSAIQ.

9.5.2 Procedure
Follow the instructions in the Monaco IFU or the Monaco Installation and Upgrade Instructions to create a
Monaco Treatment Unit in the AGL Clinic (or the chosen Monaco clinic).
Map the AGL photon Monte Carlo (XVMC orGPUMCD), Collapsed Cone (absolute dose calibration
updated by Elekta Beam Modeling Team), and electron Monte Carlo models to the Monaco TU.
The correct settings for an IEC 61217 treatment unit are shown in Figure 8.

Figure 8: Treatment Unit Characterization Configuration window (partial)

Map the Monaco Treatment Unit name to the DICOM name expected by MOSAIQ. The instructions to
map the Treatment Unit name are in the Monaco Installation and Upgrade Instructions, DICOM Settings.

9.5.3 Results
Complete E013771 Machine and Beam Model Validation Checklist section “Map Monaco Treatment Unit
and DICOM machine (export)”.

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9.6 Verify MC model Calibration

9.6.1 Objective
Verify the photon MC beam model calibration in Monaco.

9.6.2 Test Procedure

To verify the calibration dose of GPUMCD model, the following procedures must be repeated for all
Photon energies, 6MV as an example is listed below:
1. Open Monaco and login as a user with physics rights to open the Patient
Selection dialog box automatically.
2. Select the proper Installation/AGL Clinic (or the chosen Monaco clinic)
3. Select AGL06MV and click OK.
4. Access the QA plan aglxAbsDoseGPUMCD-QA (GPUMCD) and regular plan
aglxAbsDoseXVMC (PMC) according to the algorithm.
5. The first time each plan is opened, Monaco will check what TU needs to be used.
Confirm that the proposed TU by Monaco is the one created containing all the
AGL models and click Yes.

Figure 9: Monaco message, the treatment unit is “AGLGPU” for GPUMCD

models

6. Select the Monaco Treatment Unit created with the AGL models mapped for all
beams.
7. Click the Planning/Calculation Properties and set ‘Grid Spacing (cm)’ to 0.3 cm
and 0.2% as the uncertainty, per control point. This is identical for both PMC and
GPUMCD, while in GPUMCD QA plan mode, “Phantom” shall be selected for
Material Lookup Table.

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Figure 10 Calculation Properties

8. Verify that the alignment beam is added in the plans.

9. Verify that the RED of the whole phantom external contour is forced 1.0.
10. Click the Planning/Calculate button. Save the plan when the calculation is done.
11. Navigate to Tools and open Interest Points and Markers.
12. Check the Total Dose for point (0,0,10)
13. Complete E013771: Machine and Beam Model Validation Checklist section
‘Photon Collapsed Cone model Calibration Verification’ with the expected dose
(model calibration) and the Monaco calculated dose.
14. Repeat steps 1 to 12, select the appropriate phantom in step 3 (for example:
‘AGL10MV’) for the next energy to be checked.

9.6.3 results
Follow the Monaco Instructions for Use, Editing Calibration Dose for Photon Monte
Carlo Models in the Treatment Unit Mapping section.

9.7 Verify CC model Calibration

9.7.1 Objective
Verify the Collapsed Cone beam model calibration in Monaco.

9.7.2 Test Procedure

To verify the calibration dose of CC model, the following procedures must be repeated for all Photon
energies, 6MV, as an example, is listed below:
1. Open Monaco and login as a user with physics rights to open the Patient Selection
dialog box automatically.
2. Select the proper Installation/AGL Clinic (or the chosen Monaco clinic)
3. Select AGL06MV and click OK.

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4. Access the plan aglxAbsDoseOpenCC for open, aglxAbsDoseW60CC for

wedge.
5. The first time each plan is opened, Monaco will check what TU needs to be used.
Confirm that the proposed TU by Monaco is the one created containing all the
AGL models and click Yes.

Figure 11: Monaco message

6. Select the Monaco Treatment Unit created with the AGL models mapped for all
beams.
7. Click the Planning/Calculation Properties and set ‘Grid Spacing (cm)’ to 0.3 cm
and make sure the Force entire volume to be treated as water checkbox is
checked.
8. Select Electron Density in the Planning / Grid Type. Click Volume Cursor and
confirm that the value displayed for ‘G:’ is equal to ‘water.’
9. Verify that the alignment beam is added in the plans.
10. Click the Planning/Calculate button. Save the plan when the calculation is done.
11. Navigate to Tools and open Interest Points and Markers.
12. Check the Total Dose for point (0,0,10)
13. Complete E013771: Machine and Beam Model Validation Checklist section
‘Photon Collapsed Cone model Calibration Verification’ with the expected dose
(model calibration) and the Monaco calculated dose.
14. Repeat steps 1 to 12, select the appropriate phantom in step 3 (for example:
‘AGL10MV’) for the next energy to be checked.

9.7.3 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Verify Photon Collapsed
Cone model Calibration”.

9.8 Validate MC model

9.8.1 Objective
Evaluate the agreement of Monaco calculations against measured PDDs and Profiles in absolute mode.

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9.8.2 Procedure for Monaco 5.51 and higher

1. The customer measures scanned and non-scanned measurements per E013772, AGL Data
Collection List.
2. The user imports the scanned and non-scanned measurements into MCU with calibration dose.
3. The user calculates the BASIC square fields in Monaco using the photon Monte Carlo algorithm
and exports DICOM RT plan and beam doses to file. Be aware that plan aglSquareGPUMCD-QA1
is for GPUMCD and plan aglSquareXVMC for PMC.
4. Import the Monaco DICOM plan and beam doses into MCU.
5. Evaluate the agreement of Monaco calculation with the measured PDD and profiles in absolute
mode and generate Machine and Beam Model Validation reports for all energies from MCU as
explained under the Section ‘MCU Verification’.
6. The user analyzes the agreement of the results and completes the Machine and Beam Model
Validation Checklist for all energies.

9.8.3 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Validate photon Monte
Carlo”.

9.9 Validate CC model

9.9.1 Objective
Evaluate the agreement of Monaco calculations against measured PDDs and Profiles in absolute mode.

9.9.2 Procedure for Monaco 5.51 and higher

1. The customer measures scanned and non-scanned measurements as per E013772, AGL Data
Collection List.
2. The user imports the scanned and non-scanned measurements into MCU with calibration dose.
3. The user calculates the BASIC square fields in Monaco with the Collapsed Cone algorithm and
exports DICOM RT plan and beam doses to file. Import the Monaco calculated DICOM plan and
beam doses into MCU. Be aware that plan CC plans are separated to aglSquareOpenCC and
aglSquareW60CC.
4. Evaluate the agreement of Monaco calculation with the measured PDD and profiles in absolute
mode and generate Machine and Beam Model Validation reports for all energies from MCU as
explained under the Section ‘MCU Verification’.
5. The user analyzes the agreement of the results and complete the Machine and Beam Model
Validation Checklist for all energies.

9.9.3 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Validate photon Collapsed
Cone”.

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9.10 Validate EMC model

9.10.1 Objective
Evaluate the agreement of Monaco calculations against measured PDDs and Profiles in absolute mode.
This operation also can be used to verify the electron model calibration dose.

9.10.2 Procedure for Monaco 5.51 and higher

1. The customer measures scanned and non-scanned measurements as per E013772, AGL Data
Collection List.
2. The user imports the scanned and non-scanned measurements into MCU with calibration dose.
3. The user calculates the BASIC square fields in Monaco with the electron Monte Carlo algorithm
and exports DICOM RT plan and beam doses to file.
4. Import the Monaco calculated DICOM plan and beam doses into MCU.
5. Evaluate the agreement of Monaco calculation with the measured PDD and profiles in absolute
mode and generate Beam Model Validation reports for all energies from MCU as explained under
the Section ‘MCU Verification’.
6. The user analyzes the agreement of the results and complete the Machine and Beam Model
Validation Checklist for all energies.

9.10.3 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Validate electron Monte
Carlo”.

9.11 Using MCU (Monaco 5.51 and higher) to

compare
Monaco Commissioning Utility (MCU) can be used to:
 compare the onsite measurements to the AGL reference data
 compare the DICOM doses for each algorithm and energy to measurements
 verify that the difference is within the specified tolerances of:
 Gamma (2%, 2mm), passing rate of 95% for PDD
 Gamma (3%, 3mm), passing rate of 95% for profiles

This section explains the steps to import and compare the Monaco computed dose to the measurements.
For more details on the different features of MCU, refer to the Monaco Commissioning Utility Online
Help.

9.11.1 Import Data

Right click in the Measurements pane on the ‘Import’ tab
Import measured scanned data

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Figure 12 MCU measurements coordinate settings

Tip: Import and compare wedge data first. From the comparison of wedged and non-wedged profiles, you
can see more easily whether the scanned measurements are imported correctly with consistent
coordinates. Otherwise, it’s necessary to adjust the coordinate settings in MCU.
Import non-scanned measurements to analyze results in absolute mode.
Import Monaco calculated DICOM RT plan with individual beam doses

9.11.2 Compare Data

Select “Absolute” from the drop-down list in the Mode group on the ‘Compare’ tab. Set the “Radius” to
0.25 cm for PMC and GPUMCD as used by Monaco, and 0 cm for Collapsed Cone and 0.25cm for
electron Monte Carlo. All the analysis can be done using “Global Gamma” method.
The required gamma criteria can be set in the ‘Deviation’ group

Figure 13 MCU comparison mode and method settings

Set the range for analysis depending on the type of measurements to compare. Some suggestions for PDD
and profiles:
a. Photons with Flattening Filter: PDD (dmax to 25 cm), profile 80% (for wedge profile, 10%)
b. Photons Flattening Filter Free: PDD (dmax to 25 cm), profile 40% or 60%
c. Electrons: PDD (dmax to Rp), profile 80%

Figure 14 MCU comparison range settings

Click ‘Run’ to run the comparison

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Analyze the plots in the ‘Results’ section. Blue represents the measured, Green the calculated and Red
shows the deviation. Analyze all the fields.

Figure 15 Scan plot

The ‘Scan Details’ tab provides the quantitative summary of the comparison:

Figure 16 Scan details tab

The green, yellow and red icons in the last column provide a quick indication to the user on how many are
passed, need attention or failed. The thresholds can be set from ‘Options’ in the File menu.

Figure 17 Pass rate

The ‘Point Doses’ tab in the ‘Results’ section provides a summary of the point dose comparison:

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Figure 18 Point Doses tab

9.11.3 Generate Reports

After analyzing the verification plots, the scan details and the point dose comparison, verify if the model
satisfies the criteria, then generate a PDF report for each algorithm and energy. Add a comment with your
site or clinic name, energy and algorithm information when generating the MCU reports as MCU doesn’t
include this information automatically.
Define the report name as “MCU_Sitename_Algorithm_Energy_Gamma Criterion” and use “_open” or
“_wedge” as the suffix for CC models. For example:
‘MCU_Sitename_pMC_6MV_2%,2mm’ for a 6MV pMC model;
‘MCU_Sitename_CC_6MV_2%,2mm_open’ for a 6MV CC model – open field;
‘MCU_Sitename_CC_6MV_2%,2mm_wedge’ for a 6MV CC model – wedged field;
Create a new folder to save all these MCU reports.
If the absolute dose has been recalibrated, add a comment into the MCU report regarding the updated
values for each energy of PMC model; For each energy of CC model, add a comment on the updated
values of open and wedge.
Send the reports along with the completed E013771 to the Elekta Regional Support team for review.
Elekta Regional support team reviews the report and the E013771. Returns the signed documents to the
customer and attaches a copy of the reports to that customer’s support case records (Salesforce CLM).

9.12 Export to MOSAIQ

9.12.1 Objective
Verify that photon (open and wedge) and electron plans can be successfully exported from Monaco to the
LINAC through MOSAIQ.

9.12.2 Procedure – Photons

1. Open Monaco and login as a user with physics rights to open the Patient
Selection dialog box automatically.
2. Select Installation/AGL Clinic (or the clinical Monaco clinic selected in ’Clinic
Selection’ section).
3. Select AGL06MV and click OK.
4. Access the Monaco plan aglMosaiqPhotons.

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5. The first time each plan is opened, Monaco will check what TU needs to be used.
Confirm that the proposed TU by Monaco is the one created containing all the
AGL models and click Yes.

Figure 19: Monaco message

6. Verify it’s 20 MU per beam, and click “Calculate”.

7. Navigate to Output and open the DICOM Export dialog box.
8. Make sure that the selected patient exists in MOSAIQ and export the Total Plan to
MOSAIQ.
9. Import and promote the plan in MOSAIQ.
10. Load the beams in Integrity.
11. For both beams ‘AsymG30C20C20’ and ‘AsymW60G30C20C20’, verify the
consistency between Monaco and the LINAC for:
12. All phantom folders:
• Energy
• Field geometry
• Gantry, Collimator, and Couch
• Wedge configuration

9.12.3 Procedure - Electrons

1. Open Monaco and login as a user with physics rights to open the Patient
Selection dialog box automatically.
2. Select Installation/AGL Clinic (or the clinical Monaco clinic selected in ‘Clinic
Selection’ section).
3. Select AGL06MeV and click OK.
4. Access the Monaco plan aglMosaiqElectrons.
5. Select the Treatment Unit with all the AGL models mapped for all beams.
6. Verify it’s 20 MU per beam, and click “Calculate”.
7. Navigate to Output and open the DICOM Export dialog box.

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8. Make sure that the selected patient exists in MOSAIQ and export the Total Plan to
MOSAIQ.
9. Import and promote the plan in MOSAIQ (Note: When you promote the plan in
MOSAIQ for electrons, change the field size to the Applicator size, and set the
type to square.)
10. Load the beams in Integrity.
11. For all beams “ApplicatorG10C20C30,” verify the consistency between Monaco
and the LINAC for:

• Energy
• Field geometry
• Applicator ID
• Gantry, Collimator, and Couch

9.12.4 Results
Complete E013771: Machine and Beam Model Validation Checklist section “Export to MOSAIQ”.

9.13 Submit Machine and Beam Model Validation

Checklist (E013771) to Elekta
Once the basic tests in Monaco Machine and Beam Model Validation of this document are completed, and
the E013771: Machine and Beam Model Validation Checklist has been filled in, contact Elekta Physics
Support to submit E013771: Machine and Beam Model Validation Checklist for final verification.
Elekta Physics Support will review the results, sign off, and send it back to the customer as a confirmation
that the basic machine and beam model validation process has been completed successfully.

10. Monaco Machine and Beam Model

Validation – Extended
Table 8 describes the tests included in the ‘Extended’ section.

Table 8: Extended Tests

Basic/Extended Test Scope Objective

E Verify Leaf Transmission and Offset Verify the Leaf Transmission and Leaf Offset
values set for the Photon Monte Carlo
models.
E Confirm Couch composition and Check the relative electron density values set
densities in Monaco for the couch.
E 3D Commissioning - Photons Pre-configured beams for asymmetric and
irregular fields verification.

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Basic/Extended Test Scope Objective

E 3D Commissioning - Electrons Pre-configured beams for shaped beams

verification.
E IMRT/VMAT Clinical IMRT/VMAT plans for verification.

The customer can find the predefined plans for the ‘Extended’ tests in each photon phantom, there is also
corresponding Monaco templates in AGL package.
Before running any calculation in Monaco with a QA device virtual phantom, read the Appendix J:
General Guidelines for Monaco Calculations on QA Phantoms.

10.1 Verify Leaf Transmission and Offset – Photon

Monte Carlo
10.1.1 Objective
As described in 8.2, there are 2 phantoms for the PMC model MLC commissioning. Select the phantom
based on the SSD accordingly. Photon is specified energy by energy. E.g., For 06MV, it has 2 QA plans:
Step1NonIMRT and Step2IMRT. Check that the values for Leaf Transmission and Leaf Offset in the
Monaco photon Monte Carlo beam models are optimal.

10.1.2 Procedure
Step1IMRT QA Plan contains “3ABUT”, “20x20”, “10x10”, “DMLC1”, “7SegA” and “FOURL” beams
that can be used to assess the Leaf Transmission and the Leaf Offset set in the Monaco beam models.
Step2IMRT QA plan has HIMRT and HDMLC beams to evaluate the final performance of the optimized
MLC parameters.
The specific procedure will depend on the QA device used.
The beams need to be delivered to the QA device properly setup, calibrated, and calculated in Monaco in
the correct virtual phantom with the appropriate relative electron density applied.
‘aglExpressQAStep1’ and ‘aglExpressQAStep2’template can be loaded in any Monaco phantom.
For detailed information on the Monaco MLC parameters optimization process, please refer to (E011596):
Post Modeling Adjustment of MLC Parameters.

10.2 Confirm Couch composition and densities

10.2.1 Objective
There is a dedicated phantom for couchRED verification in AGL package. The phantom is supposed to
confirm the RED values for the Elekta couch structures. Select the algorithm-based studyset accordingly to
perform the CouchRED verification.

10.2.2 Procedure
The Elekta standard couch is modeled in Monaco as two structures: Foam Core and Carbon Fiber. The
Monaco physicist user needs to determine what the most optimum values for those two structures are.
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Figure 20: Monaco couch: Carbon Fiber and Foam Core structures

The default RED value of the couch from the Library or the template may be different to those in your
clinic. You need to verify and edit the values as necessary before calculation. As starting values, the
customer might use the following:

Table 9: Relative Electron Density starting values for Couch structures

Couch Structure Relative Electron Density

Starting Value

Carbon Fiber 0.6

Foam Core 0.05

To evaluate the couch attenuation, the customer can use the predefined ‘CouchRED’ QA Plans provided. It
contains two static 10 cm x 10 cm beams with gantry 0°, 30°, 180° and 210°, with 100 MU for each beam,
and a dynamic 10 cm x 10 cm Posterior Arc and 10 cm x 10 cm Arc with 200 MU and 400MU
respectively.
Due to the voxelization of the couch, it is recommended to evaluate the beams to find the best set of
relative electron density values for Foam Core and Carbon Fiber.
The customer needs to decide what method to use to evaluate RED for the couch structures, and whether to
use a QA device, a solid water phantom with an ion-chamber or another dosimetry method.
The ‘aglCouchREDGPUMCD’ and ‘aglCouchREDXVMC’ Monaco template can be loaded in any
Monaco phantom.

CAUTION Don’t forget to import the couch and include it for the parent plan dose
calculation. If the couch is not included in the parent plan, then Monaco
removes the dose of the QA plan on opening without any warning.

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10.3 Commission 3D – Photons

10.3.1 Objective
Evaluate the agreement between measurements and Monaco calculations for 3D photon beams:
rectangular, asymmetric, and irregular.

10.3.2 Procedure
The ‘agl3DcommOpenCC’, ‘agl3DcommW60CC’, ‘agl3DcommXVMC’ and ‘agl3DcommGPUMCD-
QA1’ plans can be used for the verification of 3D static plans, where the customer will find asymmetric,
rectangular, and special shapes:

Table 10: 3D Commissioning Plans – Photons

Monaco Plan PHOTON Beam ID Beam Description
Configuration Description

3DcommGPUMCD-QA1, Open 24 Asy01 10x10 off-centered

3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 25 Asy02 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 26 Asy03 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 27 Asy04 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 28 Asy05 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 29 Asy06 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 30 Asy07 10x10 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 31 Asy08 10x15 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 32 Asy09 10x15 off-centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 33 A0303 3x3 off-centered
3Dcomm XVMC,
3DcommOpenCC

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Monaco Plan PHOTON Beam ID Beam Description

Configuration Description

3DcommGPUMCD-QA1, Open 34 02x20 02x20 centered

3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 35 20x02 20x02 centered
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 36 Oval Oval-shape
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 37 C C-shape
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 38 T T-shape
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 39 Circle Circle-shape
3Dcomm XVMC,
3DcommOpenCC
3DcommGPUMCD-QA1, Open 40 Irreg Irregular-shape
3Dcomm XVMC,
3DcommOpenCC
3DcommW60CC W60 41 AsyUL 10x15 off-centered
3DcommW60CC W60 42 AsyLL 10x15 off-centered
3DcommW60CC W60 43 AsyLW 10x15 off-centered
3DcommW60CC W60 44 AsyRW 10x15 off-centered
3DcommW60CC W60 45 OvalW60 Oval-shape
3DcommW60CC W60 46 CW60 C-shape
3DcommW60CC W60 47 TW60 T-shape
3DcommW60CC W60 48 CircleW60 Circle-shape
3DcommW60CC W60 49 IrregW60 Irregular-shape

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The 3Dcommiss plans are divided in Monaco between GPUMCD, PMC, CC-open, and CC-wedged as:

• agl3DcommGPUMCD-QA1
• agl3DcommXVMC
• agl3DcommOpenCC
• agl3DcommW60CC
The customer needs to decide what method to use for evaluating the dose agreement between
measurements and Monaco, and whether to use a QA device, a solid water phantom with an ion-chamber
or another dosimetry method.
The ‘agl3DcommGPUMCD’, ‘agl3DcommXVMC’, ‘agl3DcommOpenCC’ and ‘agl3DcommW60CC’
Monaco templates can be loaded in any Monaco phantom.

10.4 Commission 3D – Electrons

10.4.1 Objective
Evaluate the agreement between measurements and Monaco calculations for beams with a cutout.

10.4.2 Procedure
The ‘Electron3Dcomm’ Monaco plan can be used for the verification of a beam with cutout plans, where
the customer will find:

Table 11: Beams included in the ‘3DcommissElectrons’ QA Plan

Monaco Plan ELECTRON Beam Description

Applicator ID

aglElectron3Dcomm 6 cm x 6 cm 12 06x06circleR2cm

aglElectron3Dcomm 14 cm x 14 cm 13 14x14rect3x12
aglElectron3Dcomm 25 cm x 25 cm 14 25x25rect3x24

The customer needs to decide what method to use for evaluating the dose agreement between
measurements and Monaco, and whether to use a QA device, a solid water phantom with an ion-chamber
or another dosimetry method.

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10.5 Commission IMRT/VMAT – Photon Monte Carlo

10.5.1 Objective
Evaluate the agreement of representative clinical IMRT/VMAT plans.

10.5.2 Procedure
The Monaco IMRT/VMAT templates in Table 12 can be used for the verification of Step & Shoot and
VMAT plans.
These plans have been generated based on test cases from AAPM TG-119 ‘IMRT commissioning:
Multiple institution planning and dosimetry comparisons’ (Med. Phys. 36 (11), November 2009), and
AAPM Medical Physics Practice Guideline 5.a (Journal of Applied Clinical Medical Physics, Vol. 16, No.
5, 2015).

Table 12: Monaco IMRT/VMAT Templates

Template Name Beams Objective

aglSSIMRTc119 9 beams each 40 degrees IMRT-SS commissioning

aglSSIMRTheadneck119 9 beams each 40 degrees IMRT-SS commissioning
aglVMATc119 1 beam IMRT-VMAT commissioning
aglVMATheadneck119 1 beam IMRT-VMAT commissioning
aglVMATprostate119 1 beam IMRT-VMAT commissioning
aglVMATanal244 1 beam IMRT-VMAT commissioning
aglVMATheadneck244 1 beam IMRT-VMAT commissioning

The customer needs to decide what method to use for the verification of clinical plans, including which
measuring device, phantom and analysis method.
The following is a suggested procedure:
1. Select any phantom.
Import couch and verify and set the RED of the couch as explained in
2. Confirm Couch composition and densities.
3. Create a simple 3D plan, say 10x10 cm2, as the parent plan, including the couch in the dose
calculation.
4. Right click the Parent plan 10x10 and create a QA plan.
5. Select phantom your QA device.
6. Import the plan template.
7. Check the option ‘Remove all existing beams prior to importing new beams.’

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Figure 21 Import template

8. After importing the templates, verify the RED of the couch and the QA device in the ‘Structures’
control.

11. Automate workflow via script (Monaco

6.2.2 and above)
In the AGL package, there is both predefined plans per phantom and corresponding beams’ template. As
well as the manual workflow described, users can utilize the script to facilitate the end-to-end
commissioning workflow. The script is built from Monaco 6.2.2 and is available on Elekta Care
Community.

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 Appendices

12. Appendices
This section contains additional information regarding the AGL models:

• AGL Reference Detectors

• AGL Beam Model Dose Agreement
• AGL Models Calibration
• Machine Model MLC and Jaw Limits and Characterization
• MLC Geometry Parameters – Photon Monte Carlo Models
• MLC Dynamic Parameters – Photon Monte Carlo Models
• Monaco Plans and Templates
• Monaco Dose Sampling
• Phantom Setup
• General Guidelines for Monaco Calculations on QA Phantoms

Appendix A: AGL Reference Detectors

For reference purposes, the detectors used to collect AGL reference data are provided in
the following tables:

Photon Detectors
Table 13: Detectors used for Photon Measurements

Measurement Field size range Detector

PDD ≥ 2 cm x 2 cm Sun Nuclear 0.125 cc scanning chamber

Profile < 5 cm x 5 cm Sun Nuclear Edge detector
Profile ≥ 5 cm x 5 cm Sun Nuclear 0.125 cc scanning chamber
OF 2 cm x 2 cm ≤ rxr ≤ PTW 3D PinPoint
4 cm x4 cm
OF ≥ 4 cm x 4 cm Sun Nuclear 0.125 cc scanning chamber
WF ≥ 5 cm x 5 cm Sun Nuclear 0.125 cc scanning chamber

Electron Detectors
Table 14: Detectors used for Electron Measurements

Applicator /
Measurement Detector
Energy

PDD All Sun Nuclear 0.125 cc scanning chamber

Profile All Sun Nuclear 0.125 cc scanning chamber
Applicator factors All Sun Nuclear 0.125 cc scanning chamber
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Appendix B: AGL Beam Model Dose Agreement

The agreement between measured data and AGL beam model Monaco calculations is expected to satisfy
the following criteria:

Photons
Absolute mode
PDDs and Profiles normalized based on the output factors.
Table 15 presents the global gamma criteria to be satisfied by at least 95% of the points from dmax to 25
cm depth for PDDs and from CAX to 80% of central axis dose for Profiles.

Table 15: AGL Gamma Analysis Criteria for Photons satisfied by at least 95% of the
points

Global Gamma Criteria (Dose difference, Distance to Agreement)

PDD (2%, 2 mm)

Profile (3%, 3 mm)

OF agreement: better than ±1.5%

Electron Monte Carlo

Absolute mode
PDDs and Profiles normalized based on the applicator factors.
Table 16 presents the global gamma criteria to be satisfied by at least 95% of the points from dmax to Rp
cm depth for PDDs and from CAX to 80% of central axis dose for Profiles.

Table 16: AGL Gamma Analysis Criteria for Electron Monte Carlo satisfied by at
least 95% of the points

Global Gamma (Dose difference, Distance to Agreement)

Criteria

PDD 2%, 2 mm
Profile 3%, 3 mm (*)

Applicator factors agreement: better than ±2%

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(*) This agreement is based on comparisons done with the same geometry
configuration for Monaco calculations and measurements (both with cutout,
since Monaco does not allow electron calculations without cutout). When it is
not possible to compare data obtained with the same geometry configuration,
NOTE an expected agreement of (4%, 4 mm) should be achievable instead; in this
case, no adjustments to the beam should be made based on that comparison.
See ‘Electron calculations constraints in Monaco’ in Appendix B: AGL Beam
Model Dose Agreement for more information about expected differences
comparing data with different geometry configurations.

Electron calculation constraints in Monaco

Due to Monaco calculation constraints (only calculations with port cutouts are allowed), the comparison
between Monaco calculations and measurements with standard inserts might show increased discrepancies,
mostly around the edges of the profiles. The following shows an example for 20 cm x 20 cm applicator, 6
MeV, 1 cm depth of Monaco calculation (with cutout) vs. scanned profiles collected with cutout, and
Monaco calculation (with cutout) vs. scanned profiles without cutout (using the standard insert):

20 x 20 cm – 6 MeV – 1 cm depth

Figure 22: Monaco calculation vs. Measured taken with cutout

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Figure 23: Monaco calculation vs. Measured taken with standard insert

As described in E013772, AGL Data Collection List, electron data must be measured using Elekta
standard insert for each applicator (since Monaco electron Monte Carlo models are generated based on
measured data with the standard insert).
It is recommended as part of an extended electron commissioning to evaluate the results of measurements
vs. Monaco calculations using Cerrobend cutouts.

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Appendix C: AGL Model Calibration

Table 18 lists the absolute calibration for the electron Monte Carlo models provided inside the ‘AGL CC
and eMC’ folder

Photon and Electron Monte Carlo

The absolute dose calibration for the Monte Carlo electron AGL Beam Models provided within the
Monaco AGL Clinic is the following:

Table 17: Photon absolute dose calibration

Energy (MV) SSD (cm) Depth (cm) Dose per MU (cGy)

06 90 10 0.811
10 90 10 0.876
15 90 10 0.914
06FFF 90 10 0.807
10FFF 90 10 0.872
06MVW60 90 10 0.215
10MVW60 90 10 0.245
15MVW60 90 10 0.251

Table 18: Electron absolute dose calibration

Size depth 1.3 1.7 1.9 2.17 2.5 2.7

(cm)

Applicator SSD (cm) 6 MeV 8 MeV 9 MeV 10 MeV 12 MeV 15 MeV

(cm x cm) cGy/MU cGy/MU cGy/MU cGy/MU cGy/MU cGy/MU

6x6 100 0.880 0.920 0.938 0.937 0.970 0.982

10x10 100 1.000 1.000 1.000 1.000 1.000 1.000
14x14 100 1.033 0.999 0.991 0.979 0.991 0.981
20x20 100 1.032 0.996 0.990 0.975 0.991 0.991
25x25 100 1.040 1.001 0.980 0.974 0.991 0.992

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Appendix D: Machine Model MLC and Jaw Limits and

Characterization
Photon machine models
Table 19 provides detailed information about the MLC implementation in the Monaco photon beam
models.

Table 19: MLC and Jaw limits and characterization – Photon modes

Model Parameter Values

Photon Monte Carlo Leaf pair numbers 80 pairs

and Collapsed Cone Leaf width (cm) 0.5 cm
Guard leaves number 2 guard leaves
Interdigitation Yes
Min field size 0.5 cm x 0.5 cm
Max field size 40 cm x 40 cm

Electron Monte Carlo

Table 20 shows the auto tracking values for MLC and Jaw for each energy-applicator combination.

Table 20: MLC and Jaw auto tracking values

Energy / Reference values (cm)

Applicator
Width1, Width2, Length1, Length2

6 MeV
6 cm x 6 cm 8.10, 8.10, 7.40, 7.40
10 cm x 10 cm 10.90, 10.90, 10.20, 10.20
14 cm x 14 cm 12.90, 12.90, 12.30, 12.30
20 cm x 20 cm 15.10, 15.10, 14.30, 14.30
25 cm x 25 cm 18.00, 18.00, 17.30, 17,30
8 MeV
6 cm x 6 cm 8.00, 8.00, 7.30, 7.30
10 cm x 10 cm 11.30, 11.30, 10.60, 10.60
14 cm x 14 cm 12.60, 12.60, 11.90, 11.90
20 cm x 20 cm 15.20, 15.20, 14.40, 14.40
25 cm x 25 cm 17.70, 17.70, 16.90, 16.90

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9 MeV
6 cm x 6 cm 8.00, 8.00, 7.00, 7.00
10 cm x 10 cm 11.00, 11.00, 10.00, 10.00
14 cm x 14 cm 11.70, 11.70, 10.70, 10.70
20 cm x 20 cm 14.00, 14.00, 13.00, 13.00
25 cm x 25 cm 15.70, 15.70, 15.70, 15.70
10 MeV
6 cm x 6 cm 7.70, 7.70, 7.00, 7.00
10 cm x 10 cm 11.00, 11.00, 10.00, 10.00
14 cm x 14 cm 11.30, 11.30, 10.50, 10.50
20 cm x 20 cm 13.40, 13.40, 12.80, 12.80
25 cm x 25 cm 15.90, 15.90, 15.20, 15.20
12 MeV
6 cm x 6 cm 7.70, 7.70, 7.00, 7.00
10 cm x 10 cm 9.60, 9.60, 8.90, 8.90
14 cm x 14 cm 10.60, 10.60, 9.90, 9.90
20 cm x 20 cm 13.30, 13.30, 12.70, 12.70
25 cm x 25 cm 16.30, 16.30, 15.40, 15.40
15 MeV
6 cm x 6 cm 7.70, 7.70, 7.00, 7.00
10 cm x 10 cm 9.50, 9.50, 8.50, 8.50
14 cm x 14 cm 9.80, 9.80, 9.20, 9.20
20 cm x 20 cm 12.80, 12.80, 12.20, 12.20
25 cm x 25 cm 15.80, 15.80, 15.00, 15.00

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Appendix E: MLC Geometry Parameters – Photon

Monte Carlo Models
In this section, the MLC Geometry parameters for the XVMC Photon Monte Carlo models are shown.

CAUTION The MLC Geometry parameter values in the AGL models are not
optimal and it is the user’s responsibility to optimize these values as
part of commissioning, before clinical use.

Table 20: MLC Geometry parameters – Photon Monte Carlo models

Photon Monte Carlo Parameters in Monaco Beam Models

MLC Geometry parameter 6 MV 10 MV 15 MV 6 MV 10 MV

FFF FFF

Static Leaf Gap (mm) 0.10 0.10 0.10 0.10 0.10

Leaf Transmission 0.0050 0.0030 0.0020 0.0050 0.0050
Leaf Groove Width (mm) 0.4 0.4 0.4 0.4 0.4
TJaw Transmission 0.0050 0.0030 0.0050 0.0050 0.0050
PJaw Transmission 1.0000 1.0000 1.0000 1.0000 1.0000
Interleaf Leakage 3.00 1.00 3.00 3.00 3.00
Leaf Tip Leakage 1.10 1.10 1.10 1.10 1.10
TJaw Tip Leakage 1.03 1.03 1.03 1.03 1.03
PJaw Tip Leakage 1.00 1.00 1.00 1.00 1.00
TJaw Plane Position (mm) 432.0 432.0 432.0 432.0 432.0
PJaw Plane Position (mm) 317.7 317.7 317.7 317.7 317.7
TJaw Backscatter 0.000 0.000 0.000 0.000 0.000
PJaw Backscatter 0.000 0.000 0.000 0.000 0.000
Leaf Offset (mm) 0.00 0.00 0.00 0.00 0.00

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Appendix F: MLC Dynamic Parameters – Photon

Monte Carlo Models
In this section, the MLC Dynamic parameters for the Photon Monte Carlo models (XVMC and GPUMCD)
are shown.

CAUTION The MLC Dynamic parameter values in the AGL models are not
optimal and it is the user’s responsibility to optimize these values as
part of commissioning, before clinical use.

Table 21: MLC Dynamic parameters – Photon Monte Carlo models

Photon Monte Carlo Parameters in Monaco Beam Models

MLC Dynamic parameter 6 MV 10 MV 15 MV 6 MV 10 MV

FFF FFF

Max. Leaf Travel Per Second (mm) 32.00 32.00 32.00 32.00 32.00
Max. TJaw Travel Per Second (mm) 32.00 32.00 32.00 32.00 32.00
Max. PJaw Travel Per Second (mm) 30.00 30.00 30.00 30.00 30.00
Max. Gantry Travel Per Second (deg) 5.5 5.5 5.5 5.5 5.5
Max. Collimator Travel Per Second (deg) 0.0 0.0 0.0 0.0 0.0
Min. Dose Rate (MU/min) 75.00 75.00 75.00 175.00 240.00
Max. Dose Rate (MU/min) 500.00 550.00 550.00 1400.00 2200.00
Continuous Dose Rate Checked Checked Checked Checked Checked
Beam Startup Time (sec) 1.00 1.00 1.00 1.00 1.00
Min.MU Per Static CP 1.00 1.00 1.00 2.00 2.00
Min.MU Per Dynamic CP 1.20 1.20 1.20 1.20 1.20
Min. Gantry Deg Per CP (deg) 1.5 1.5 1.5 1.5 1.5
Open Guard Leaves Checked Checked Checked Checked Checked

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Appendix G: Monaco Plans and Templates

The beams included in each Monaco Validation Plan are described in this section.

Table 22: AGL Clinic – Monaco Plans

Plan / Template Name Beam Description Beam ID MU Segments /

# CP
(IMRT/VMAT)

aglxAbsDoseGPUMCD -
AlignAbs 1 100
aglxAbsDoseGPUMCD-QA1

aglxAbsDoseXVMC 10x10Cali 2 100

aglxAbsDoseOpenCC
aglxAbsDoseW60CC 10x10W60Cali 3 100
aglSquareGPUMCD AlignSquare 4 0 -
aglSquareGPUMCD-QA1
aglSquareXVMC
aglSquareOpenCC
02x02 5 100
03x03 6 100 -
04x04 7 100 -
05x05 8 100 -
07x07 9 100 -
10x10 10 100 -
15x15 11 100 -
20x20 12 100 -
30x30 13 100 -
40x40 14 100 -
05x40 15 100
40x05 16 100
aglSquareW60CC AlignSquareW60 17 0 -
05x05W60 18 100
10x10W60 19 100 -
20x20W60 20 100 -
40x30W60 21 100 -
aglMosaiqPhotons (for FF photons) AsymG30C20C20 22 20
AsymW60G30C20C20 23 20
aglMosaiqFFFGPUMCD AsymG30C20C20 22 20

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Plan / Template Name Beam Description Beam ID MU Segments /

# CP
(IMRT/VMAT)

aglMosaiqFFFXVMC AsymG30C20C20 23 20
agl3DcommGPUMCD Asy01 24 100 -
agl3DcommGPUMCD-QA1
agl3DcommOpenCC
agl3DcommXVMC
Asy02 25 100 -
Asy03 26 100 -
Asy04 27 100 -
Asy05 28 100 -
Asy06 29 100 -
Asy07 30 100 -
Asy08 31 100 -
Asy09 32 100 -
A0303 33 100 -
02x20 34 100 -
20x02 35 100 -
Oval 36 100 -
C 37 100 -
T 38 100 -
Circle 39 100 -
Irreg 40 100 -
agl3DcommW60CC AsyUL 41 100 -
AsyLL 42 100 -
AsyLW 43 100 -
AsyRW 44 100 -
OvalW60 45 100 -
CW60 46 100 -
TW60 47 100
CircleW60 48 100 -
IrregW60 49 100 -
CouchRED
MVCouchREDGPUMCD Host10x10 1 100
MVCouchREDGPUMCD-QA1 MVG0 1 100
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Plan / Template Name Beam Description Beam ID MU Segments /

# CP
(IMRT/VMAT)

MVG30 2 100
MVG180 3 100
MVG210 4 100
MV10x10PostArc 5 200
MV10x10Arc 6 400
MVCouchREDXVMC Host10x10 1 100
MVCouchREDXVMC-QA1 MVG0 1 100
MVG30 2 100
MVG180 3 100
MVG210 4 100
MV10x10PostArc 5 200 12
MV10x10Arc 6 400 12
ExpressQA
MVExpress Host10x10 1 100
MV3ABUT 1 150 3
MV20x20 2 100
MV10x10 3 100
MVStep1NonIMRT (QA plan)
MVDMLC1 4 360 2
MV7SEGA 5 700 7
MVFOURL 6 400 4
MVStep2IMRT (QA plan) MVHIMRT 7 200 40
MVHDMLC 8 200 40
aglSSIMRTc119 (template ONLY) G0 113.98 6
G40 105.05 7
G80 60.3 3
G120 54.56 3
G160 114.34 9
G200 129.82 7
G240 68.67 3
G280 52.23 4
G320 97.66 7
aglSSIMRTheadneck119 (template ONLY) G0 168.53 10

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Plan / Template Name Beam Description Beam ID MU Segments /

# CP
(IMRT/VMAT)

G40 54.02 7
G80 35.04 5
G120 41.05 5
G160 108.72 13
G200 118.23 13
G240 39.53 4
G280 31.83 6
G320 66.70 6
aglVMATc119(template ONLY) 1 beam 876.47 137
aglVMATheadneck119(template ONLY) 1 beam 768.54 81
aglVMATprostate119(template ONLY) 1 beam 523.71 58
aglVMATanal244(template ONLY) 1 beam 1173.50 215
aglVMATheadneck244(template ONLY) 1 beam 856.76 318
aglElectronSquare AlignSquare 1 0 -
06x06 2 100
10x10 3 100 -
14x14 4 100
20x20 5 100 -
25x25 6 100 -
aglMosaiqElectrons 06x06G10C20C30 7 20 -
10x10G10C20C30 8 20 -
14x14G10C20C30 9 20 -
20x20G10C20C30 10 20 -
25x25G10C20C30 11 20 -
aglElectron3Dcomm 06x06circleR2cm 12 100
14x14rect3x12 13 100
25x25rect3x24 14 100

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Appendix H: Monaco Dose Sampling

For photon Monte Carlo calculations, it is recommended to use Mean Dose from the Monaco Interest
Points and Markers control when sampling point doses on regions with low dose gradient.
A typical value for the sphere radius to be used for Monaco sampling Dose is 2 mm.

Appendix I: Phantom Setup

The Monaco Patient Dose Grid creation is explained in Monaco Voxelized Patient Model Reference
Manual (E057813).
It describes how, depending on the voxel size and the relative position of the first isocenter inside the
patient contour, a fraction of the first dose layer voxels will be outside the patient contour:

Figure 24: Virtual phantom showing voxel fraction outside of the external contour

This might have a very small effect for photon beams, but can be significant for electron beams, showing
an artificial shift of ½ of the voxel size on the PDD curves.
Several plans provided inside the Monaco AGL Clinic take care of this behavior by setting a first beam
labeled as “Alignment” with an appropriate isocenter position such that the Patient Dose Grid gets defined
showing no Dose Voxel outside the patient contour:

Figure 25: Virtual phantom showing perfect anterior alignment between dose grid
and external contour

A calculation grid spacing of 2 mm is used for most of the absolute dose verification plans in AGL Clinic.
The ‘Alignment’ beam is therefore placed at an SSD of 99.9 cm to adjust for the ½ voxel outside the
external contour. The rest of the beams are then added to 100 cm isocenter. This technique takes case of
the effect of voxelization on the PDD curve or the point dose calculation.

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Figure 26: Monaco Calculation settings for the absolute dose verification plans

Figure 27: ‘Alignment’ beam to align dose grid with the external contour

For further tests for which new plans or other phantoms are used, it is recommended to add a first beam to
the plan to align the Dose Grid with the appropriate isocenter as described above and then add the rest of
the beams with the desired isocenter.

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Appendix J: General Guidelines for Monaco

Calculations on QA Phantoms
IMRT/VMAT QA requires measurements taken on the QA device and Monaco calculations in a virtual
phantom that properly simulates the geometry, material, and setup.
This section provides general guidelines on how to setup QA phantoms in Monaco for calculations and
RED adjustment.
phantoms are:

• Select the appropriate virtual phantom

• Reproduce measurement setup
• Adjust RED

Phantom Selection, Setup

There are several QA devices for which the vendors provide virtual phantoms to be used in the TPS for
dose calculation.
For other devices, 2D-arrays in general, the selection of the phantom to be used in Monaco might depend
on if the verification is done using nominal gantry angles or collapsing all beams to gantry 0.
If nominal angles are used, the virtual phantom geometry in Monaco must match the real geometry of the
device.
Otherwise, if the beams are all collapsed to gantry 0, any cubic homogeneous virtual phantom can be used,
properly selecting the isocenter depth, at the effective depth.
The virtual phantoms that can be found in the ‘QA Clinic’ in Monaco are shown below:

Figure 28: Virtual Phantoms in the QA Clinic

RED adjustment
The RED in Monaco might need a fine adjustment for QA devices made of PMMA (or any other non-
tissue-like material).
This tweaking must be done before any absolute dose calculation is performed.

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To evaluate the RED value set in Monaco, the comparisons between measured and calculations must be
done in relative mode.
The general steps for the RED optimization are:
1. Measure 10 cm x 10 cm and 20 cm x 20 cm in the QA device.
2. Set RED in Monaco to the expected value (for example: RED=1.16 for PMMA).
3. Calculate 10 cm x 10 cm and 20 cm x 20 cm in Monaco in the proper virtual phantom.
4. Export the Monaco calculated dose and compare in relative mode against 10 cm x 10 cm and 20
cm x 20 cm measurements.
Each QA device measures the dose using a different geometry of detectors, so the way to identify if the
RED value is optimal or not might vary among devices. In general, what needs to be analyzed is the
agreement between computed and measured dose at shallow and deep depths. When the RED value is
optimum, then the agreement at both shallow and deep depths in a relative model should be satisfactory.
The following are two examples: one for ArcCHECK, and another for Delta4 (X geometry), to show the
impact of the RED:

Example: ArcCHECK
Comparisons between calculations and measurements for 10 cm x 10 cm and 20 cm x 20 cm for RED =
1.16 and RED = 1.12 are shown in the following figures:

Figure 29: Calculations and measurements comparisons for RED = 1.16 and RED =
1.12 for 10 cm x10 cm

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Figure 30: Calculations and measurements comparisons for RED = 1.16 and RED =
1.12 for 20 cm x 20 cm

Example: Delta 4
For this example, only 20 cm x 20 cm is shown, but generally, it is recommended to run the evaluation for
10 cm x 10 cm and 20 cm x 20 cm to identify the optimum value for RED.
The comparison below shows Monaco calculations for RED = 1.16 and RED = 1.19.
As can be observed, for Delta 4 (X geometry), one possible procedure to evaluate the RED is to analyze
the agreement (in relative mode) in a horizontal profile, since the diodes within a horizontal line will be
located at different depths:

Figure 31: Monaco calculations for RED= 1.19

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Figure 32: Monaco calculations for RED = 1.16

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