Chapter 6: External Photon Beams:

Physical Aspects

BME704: Radiation Therapy

Devices - Lecture 6
Slides based on the chapter authored by
E.B. Podgorsak
of the IAEA textbook (ISBN 92-0-107304-6):
Radiation Oncology Physics:
A Handbook for Teachers and Students
Objective:
To familiarize the student with the basic principles of dose
calculations in external beam radiotherapy with photon beams.
Slide set prepared in 2006
by E.B. Podgorsak (Montreal, McGill University)
Additional content provided by B.A Standish(Toronto, Ryerson
University)
Comments to S. Vatnitsky:

[email protected]

Version 2012

IAEA
International Atomic Energy Agency

CHAPTER 6.

6.1.
6.2.
6.3.
6.4.
6.5.
6.6.
6.7.
6.8.
6.9.
6.10.
6.11.

TABLE OF CONTENTS

Introduction
Quantities used in describing a photon beam
Photon beam sources
Inverse square law
Penetration of photon beams into a phantom or patient
Radiation treatment parameters
Central axis depth doses in water: SSD set-up
Central axis depth doses in water: SAD set-up
Off-axis ratios and beam profiles
Isodose distributions in water phantoms
Single field isodose distributions in patients

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Radiation Oncology Physics: A Handbook for Teachers and Students - 6.

6.1 INTRODUCTION

Radiotherapy also referred to as radiation oncology or

therapeutic radiology is a branch of medicine that uses
ionizing radiation in treatment of malignant disease.

Radiotherapy is divided into two categories:

External beam radiotherapy
Brachytherapy

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6.1 INTRODUCTION

Ionizing photon radiation

Gamma rays (originates in nuclear gamma decay)
Used in teletherapy machines

Bremsstrahlung (electron - nucleus Coulomb interaction)

Used in x-ray machines and linacs

Characteristic x rays (electron - orbital electron interaction)

Used in x-ray machines and linacs

Annihilation radiation (positron annihilation)

Used in positron emission tomography (PET) imaging

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6.2 QUANTITIES USED IN DESCRIBING PHOTON BEAMS

Radiation dosimetry deals with two distinct entities:

Description of photon radiation beam in terms of the number and
energies of all photons constituting the beam (photon beam
spectrum).
Description of the amount of energy per unit mass (absorbed
dose) the photon beam may deposit in a given medium, such as
air, water, or biological material.

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6.2 QUANTITIES USED IN DESCRIBING PHOTON BEAMS

6.2.1 Photon fluence and photon fluence rate

Photon fluence =

dN
dA

dN is the number of photons that enter an imaginary sphere of

cross-sectional area dA.
Unit of photon fluence is cm2.

Photon fluence rate = =

fluence per unit time.

d
is defined as photon
dt

Unit of photon fluence rate is cm2 . s1.

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6.2 QUANTITIES USED IN DESCRIBING PHOTON BEAMS

6.2.2 Energy fluence and energy fluence rate

Energy fluence =

dE
dA

dE is the amount of energy crossing a unit area dA.

Unit of energy fluence is MeV cm2 .

Energy fluence rate = =

fluence per unit time.

d
is defined as the energy
dt

Unit of energy fluence rate is MeVcm2 s1

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6.2 QUANTITIES USED IN DESCRIBING PHOTON BEAMS

6.2.3 Air kerma in air

For a monoenergetic photon beam in air the air kerma in

air (Kair)air at a given point away from the source is
(Kair)air

tr
tr
=
=h

air
air

(tr/) is the mass-energy transfer coefficient for air at photon

energy h.

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6.2 QUANTITIES USED IN DESCRIBING PHOTON BEAMS

6.2.3 Air kerma in air

Kerma consists of two components: collision and radiation

K = Kcol +Krad

Collision kerma Kcolis proportional to photon fluence

and energy fluence
=h

(ab/) is the mass-energy absorption coefficient for air at photon

energy h.

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6.3 PHOTON SOURCES FOR EXTERNAL BEAM THERAPY

Photon sources with regard to type of photons:

Gamma ray sources
X-ray sources

Photon sources with regard to photon energies:

Monoenergetic sources
Heterogeneous sources

Photon sources with regard to intensity distribution:

Isotropic
Non-isotropic

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6.3 PHOTON SOURCES FOR EXTERNAL BEAM THERAPY

For a given photon source, a plot of number of photons

per energy interval versus photon energy is referred to as
photon spectrum.

All photons in a monoenergetic photon beam have the

same energy h.
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6.3 PHOTON SOURCES FOR EXTERNAL BEAM THERAPY

Photons in a heterogeneous x-ray beam form a distinct

spectrum,
Photons are present in all energy intervals from 0 to a
maximum value hmax which is equal to the monoenergetic
kinetic energy of electrons striking the target.
The two spikes in the
spectrum represent
characteristic x rays;
the continuous spectrum
from 0 to hmax represents
bremsstrahlung photons.

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6.3 PHOTON SOURCES FOR EXTERNAL BEAM THERAPY

Gamma ray sources are usually isotropic and produce

monoenergetic photon beams.

X-ray targets are non-isotropic sources and produce

heterogeneous photon spectra.
In the superficial and orthovoltage energy region the x-ray
emission occurs predominantly at 90o to the direction of the
electron beam striking the x-ray target.
In the megavoltage energy region the x-ray emission in the
target occurs predominantly in the direction of the electron
beam striking the target (forward direction).

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6.4 INVERSE SQUARE LAW

In external beam radiotherapy:

Photon sources are often
assumed to be point
sources.
Beams produced by
photon sources are
assumed to be
divergent.
a/2 b/2
tan =
=
fa
fb

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6.4 INVERSE SQUARE LAW

Photon source S emits

photons and produces a
photon fluence A at a
distance fa and a photon
fluence B at distance fb.

Number of photons Ntot

crossing area A is equal

to the number of photons
crossing area B.
Ntot =AA=BB = const
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6.4 INVERSE SQUARE LAW

We assume that Ntot = const,

i.e., no photon interactions take

place in air. Therefore:

A = B b2 fb2
= 2 = 2
B A a
fa
X(fa) = (K
X(fb) (K

col
air
col
air

(fa))air
(fb))air

fb
D
med
=
=

Dmed fa

X, (Kaircol)air, and Dmed quantities all

follow the inverse square law.
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6.4 INVERSE SQUARE LAW

X(fa) = (K
X(fb) (K

Flux is
proportional to 1/
r^2

b2
fb2
= 2 = 2
a
fa
col
air
col
air

(fa))air
(fb))air

fb
D
med
=
=

Dmed fa

X, (Kaircol)air, and Dmed quantities all

follow the inverse square law.

http://en.wikipedia.org/wiki/File:Inverse_square_law.svg

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

A photon beam propagating through air or vacuum is

governed by the inverse square law.

A photon beam propagating through a phantom or patient

is affected not only by the inverse square law but also by
the attenuation and scattering of the photon beam inside
the phantom or patient.

The three effects make the dose deposition in a phantom

or patient a complicated process and its determination a
complex task.

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

For a successful outcome of patient radiation treatment it

is imperative that the dose distribution in the target volume
and surrounding tissues is known precisely and accurately.

This is usually achieved through the use of several

empirical functions that link the dose at any arbitrary point
inside the patient to the known dose at the beam
calibration (or reference) point in a phantom.

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

Dosimetric functions are usually measured with suitable

radiation detectors in tissue equivalent phantoms.

Dose or dose rate at the reference point is determined for,

or in, water phantoms for a specific set of reference
conditions, such as:
Depth in phantom z
Field size A
Source-surface distance (SSD).

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

Typical dose distribution for an external photon beam

follows a known general pattern:
The beam enters the patient
on the surface where it delivers
a certain surface dose Ds.
Beneath the surface the dose
first rises rapidly, reaches a
maximum value at a depth zmax,
and then decreases almost
exponentially until it reaches a
value Dex at the patients exit
point.

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.1 Surface dose

Surface dose:
For megavoltage x-ray beams the
surface dose is generally much
lower (skin sparing effect) than the
maximum dose at zmax.
For superficial and orthovoltage
beams zmax = 0 and the surface
dose equals the maximum dose.
The surface dose is measured with
parallel-plate ionization chambers
for both chamber polarities, with the
average reading between the two
polarities taken as the correct
surface dose value.
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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.1 Surface dose

Contributors to surface dose Ds:

Photons scattered from the
collimators, flattening filter and air.
Photons backscattered from the
patient.
High energy electrons produced by
photon interactions in air and any
shielding structures in the vicinity of
the patient.

Typical values of surface dose:

100 %
30 %
15 %
10 %

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superficial and orthovoltage

cobalt-60 gamma rays
6 MV x-ray beams
18 MV x-ray beams
23
Radiation Oncology Physics: A Handbook for Teachers and Students - 6.5.1 Slide 2

6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.2 Buildup region

Buildup dose region:

The region between the surface (z = 0) and depth z = zmax in
megavoltage photon beams is called the dose buildup region.
The dose buildup results from
the relatively long range of
secondary charged particles
that first are released in the
patient by photon interactions
and then deposit their kinetic
energy in the patient through
Coulomb interactions.

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.3 Depth of dose maximum

Depth of dose maximum zmax depends upon:

Photon beam energy (main effect)
Field size (secondary effect)

For a given field size:

zmax increases with photon
beam energy.
For 5x5 cm2 fields, the
nominal values of zmax are:
Why would field size affect depth of
dose?

Energy 100 kVp 350 kVp Co-60 4 MV

0
0
0.5
1.0
zmax(cm)

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6 MV
1.5

10 MV 18 MV
2.5
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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.3 Depth of dose maximum zmax

At a given beam energy:

For fields smaller than 55 cm2,
zmax increases with increasing
field size because of in-phantom
scatter.
For field 55 cm2, zmax reaches
its nominal value.
For fields larger than 55 cm2,
zmax decreases with increasing
field size because of collimator
and flattening filter scatter.

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6.5 PENETRATION OF PHOTON BEAMS INTO PATIENT

6.5.3 Exit dose

The dose delivered to the patient at the beam exit point is

called the exit dose.
Close to the beam exit point the dose distribution curves
slightly downwards from the dose curve obtained for a
infinitely thick phantom as a
result of missing scatter
contribution for points beyond
the dose exit point.
The effect is small and
generally ignored.

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6.6 RADIATION TREATMENT PARAMETERS

The main parameters in external beam dose delivery with

photon beams are:

Depth of treatment z
Fields size A
Source-skin distance (SSD) in SSD setups
Source-axis distance (SAD) in SAD setups
Photon beam energy h
Number of beams used in dose delivery to the patient
Treatment time for orthovoltage and teletherapy machines
Number of monitor units (MUs) for linacs

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6.6 RADIATION TREATMENT PARAMETERS

Point P is at zmax on central axis.

Point Q is arbitrary point at
depth z on the central axis.

Field size A is defined on

patients surface.

AQ is the field size at point Q.

SSD = source-skin distance.
SCD = source-collimator
distance
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6.6 RADIATION TREATMENT PARAMETERS

Several functions are in use for linking the dose at a

reference point in a water phantom to the dose at arbitrary
points inside the patient.
Some of these functions can be used in the whole energy range of
interest in radiotherapy from superficial through orthovoltage and
cobalt-60 to megavoltage
Others are only applicable at energies of cobalt-60 and below.
Or are used at cobalt-60 energy and above.

Cobalt-60 serves as a transition point linking various

dosimetry techniques.

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6.6 RADIATION TREATMENT PARAMETERS

Dosimetric functions used in the whole photon energy range:

Percentage depth dose (PDD)
Relative dose factor (RDF)

Dosimetric functions used at cobalt-60 and below:

Peak scatter factor (PSF)

Collimator factor (CF)
Scatter factor (SF)
Scatter function (S)
Tissue air ratio (TAR)
Scatter air ratio (SAR)

Dosimetric functions used at cobalt-60 and above:

Tissue maximum ratio (TMR)
Tissue phantom ratio (TPR)
Scatter maximum ratio (SMR)
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6.6 RADIATION TREATMENT PARAMETERS

6.6.1 Radiation beam field size

Four general groups of field shape are used in radiotherapy

Square (produced with collimators installed in therapy machine)
Rectangular (produced with collimators installed in therapy machine)
Circular (produced with special collimators attached to treatment
machine)
Irregular (produced with custom made shielding blocks or with
multileaf collimators)

For any arbitrary radiation field and equivalent square field

or equivalent circular field may be found. The equivalent

field will be characterized with similar beam parameters and
functions as the arbitrary radiation field.

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6.6 RADIATION TREATMENT PARAMETERS

6.6.1 Radiation beam field size

Equivalent square for rectangular field:

An arbitrary rectangular field with sides
a and b will be approximately equal to a
square field with side aeq when both fields
have the same area/perimeter ratio
(Days rule).
ab
aeq2
=
2(a+b) 4aeq

2ab
aeq =
a+b

Equivalent circle for square field:

An arbitrary square field with side a
will be equivalent to a circular field with
radius req when both fields have the
same area.

aeq2 = req

req =
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6.6 RADIATION TREATMENT PARAMETERS

6.6.2 Collimator factor

Exposure in air Xair, air kerma in air (Kair)air and dose to small

mass of medium in air Dmed contain two components:

Primary component is the major component.

It originates in the source, comes directly from the source, and does
not depend on field size.
Scatter component is a minor, yet non-negligible, component.
It represents the scatter from the collimator, air and flattening filter
(in linacs) and depends on the field size A.
For this course our focus is on the known
quantity of (Kair)air.

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6.6 RADIATION TREATMENT PARAMETERS

6.6.2 Collimator factor

Xair,(Kair)air, and Dmed depend upon:

Field size A
Parameter called the collimator factor (CF)
or
collimator scatter factor Sc
or
relative exposure factor (REF).

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6.6 RADIATION TREATMENT PARAMETERS

6.6.2 Collimator factor

Collimator factor is defined as:

X(10,h)

CF is normalized to 1 for the

nominal field of 1010 cm2 at the
nominal SSD for the treatment
machine.
CF > 1 for fields A exceeding
1010 cm2.
CF = 1 for 1010 cm2 field.
CF < 1 for fields A smaller than
1010 cm2.

SSD = source-skin distance.

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6.6 RADIATION TREATMENT PARAMETERS

6.6.3 Peak scatter factor

PSF gives the factor by which the radiation dose at point P in

air is increased by scattered radiation when point P is in the
phantom at depth zmax.

PSF depends upon:

Field size A
(the larger is the field
size,the larger is PSF).
Photon energyh
(except at very low
photon energies,
PSF decreases
with increasing
energy).
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6.6 RADIATION TREATMENT PARAMETERS

6.6.3 Peak scatter factor

PSF(A,h) = DP(zmax,A,f,h)
DP(A,h)

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Point in phantom
Point in air

Radiation Oncology Physics: A Handbook for Teachers and Students - 6.6.3 Slide 2

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6.6 RADIATION TREATMENT PARAMETERS

6.6.4 Relative dose factor

For a given photon beam with energy h at a given SSD, the

dose at point P (at depth zmax) depends on field size A; the
larger is the field size the larger is the dose.

The ratio of the dose at point P for field size A to the dose at
point P for field size 1010 cm2 is called the relative dose
factor RDF or total scatter factor Sc,p :
RDF(A,h) = Sc,p(A,h) =

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DP( zmax, A, f , h)
DP(zmax,10,f,h)

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6.6 RADIATION TREATMENT PARAMETERS

6.6.4 Relative dose factor

Relative dose factor:

RDF(A,h) = Sc,p(A,h) =
For A < 1010 cm
2

DP(zmax,A,f,h)
DP(zmax,10,f,h)

RDF(A,h) <1

For A = 1010 cm
RDF(A,h) =1

For A > 1010 cm

RDF(A,h) >1

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6.7 CENTRAL AXIS DEPTH DOSES IN WATER: SSD SETUP

6.7.1 Percentage depth dose

Central axis dose distributions inside the patient are usually

normalized to Dmax = 100 % at the depth of dose maximum
zmax and then referred to as percentage depth dose (PDD)
distributions.

PDD is thus defined as follows:

PDD(z,A,f,h) =100

DQ =100
DP

DQ
DP

DQ and DQ are the dose and dose rate, respectively, at arbitrary

point Q at depth z on the beam central axis.
DP and DP are the dose and dose rate, respectively, at reference
point P at depth zmax on the beam central axis.
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6.7 CENTRAL AXIS DEPTH DOSES IN WATER: SSD SETUP

6.7.1 Percentage depth dose

Percentage depth dose depends on four parameters:

Depth in phantom z
Field size A on patients surface
Source-surface distance f = SSD
Photon beam energy h

PDD(z,A,f,h) =100

DQ =100
DP

DQ
DP

PDD ranges in value from

0 at z
To 100 at z = zmax

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6.7 CENTRAL AXIS DEPTH DOSES IN WATER: SSD SETUP

6.7.1 Percentage depth dose

The dose at point Q in the patient consists of two

components: primary component and scatter component.
The primary component is expressed as:
2

DP

f + z

eff is the effective linear attenuation coefficient for the primary beam
in the phantom material (for example,eff for a cobalt-60 beam in
water is 0.0657 cm-1).

Why does this equation mean and define the variables.

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6.7 CENTRAL AXIS DEPTH DOSES IN WATER: SSD SETUP

6.7.1 Percentage depth dose

The dose at point Q in the patient consists of two

components: primary component and scatter component.
The scatter component at point Q reflects the relative contribution
of the scattered radiation to the dose at point Q. It depends in a
complicated fashion on various parameters such as depth, field
size and source-skin distance.
Contrary to the primary component in which the photon
contribution to the dose at point Q arrives directly from the source,
the scatter dose is delivered by photons produced through
Compton scattering in the patient, machine collimator, flattening
filter or air.

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6.7 CENTRAL AXIS DEPTH DOSES IN WATER: SSD SETUP

6.7.1 Percentage depth dose

For a constant A, f, and h, PDD(z,A,f,h) first increases

from the surface to z = zmax(buildup region), and then
decreases with z.

Example:

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6.8 CENTRAL AXIS DEPTH DOSES IN WATER: SAD SETUP

SAD setups are used in treatment of deep seated tumours

with multiple beams or with rotational beams.

In comparison with constant SSD setup that relies on PDD

distributions, the SAD setup is more practical and relies on

other dose functions such as:
Tissue-air ratio (TAR)
Tissue-phantom ration (TPR)
Tissue-maximum ratio (TMR)

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6.8 CENTRAL AXIS DEPTH DOSES IN WATER: SAD SETUP

6.8.1 Tissue-air ratio

Tissue-air ratio (TAR) was

introduced by Johns to
simplify dose calculations in
rotational radiotherapy but
is now also used for
treatment with multiple
stationary beams.

The SSD varies from one

beam to another; however,

the source-axis distance
SAD remains constant.

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6.8 CENTRAL AXIS DEPTH DOSES IN WATER: SAD SETUP

6.8.1 Tissue-air ratio

In contrast to PDD (z,A,f,h) which depends on four

parameters, TAR depends on three beam parameters:

Depth of isocentre z
Field size at isocentre AQ
Beam energy h

The field size AQ is defined at point Q which is normally

placed into the isocentre of the treatment machine.

TARs are most reliably measured with ionization chambers;

however, the measurements are much more cumbersome
than those of PDD because in TAR measurement the
source-chamber distance must be kept constant.
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6.8 CENTRAL AXIS DEPTH DOSES IN WATER: SAD SETUP

6.8.2 Relationship between TAR and PDD
2

TAR(z,AQ,h) =PSF(A,h)

PDD(z,A,f,h) f + z

100
f + zmax

*Peak Scatter Fraction relates measurement in air to phantom

(tissue)

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Dose distributions along the beam central axis are used

in conjunction with off-axis beam profiles to deliver an
accurate dose description inside the patient.

The off-axis data are usually given with beam profiles

measured perpendicularly to the beam central axis at a

given depth in a phantom.

The depths of measurement are typically at:

Depths z = zmax and z = 10 cm for verification of machine
compliance with machine specifications.
Other depths required by the particular treatment planning
system used in the department.
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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Example of beam profiles measured for two field sizes

(1010 cm2 and 3030 cm2) of a 10 MV x-ray beam at
various depths in water.

The central axis profile

values are scaled by
the appropriate PDD
value for the two fields.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Combining a central axis dose distribution with off-axis

data results in a volume dose matrix that provides 2-D
and 3-D information on the dose distribution in the
patient.

The off-axis ratio OAR is usually defined as the ratio of

dose at an off-axis point to the dose on the central beam

axis at the same depth in a phantom.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Megavoltage beam profiles consist of three regions:

Central region represents the central portion of the profile
extending from the central axis to within 1 cm to 1.5 cm of the
geometric field edges of the beam.
Penumbra is the region close to geometric field edges where the
dose changes rapidly and depends on field defining collimators,
the finite size of the focal spot (source size) and the lateral
electronic disequilibrium.
Umbra is the region outside of the radiation field, far removed
from the field edges. The dose in this region is low and results
from radiation transmitted through the collimator and head
shielding.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

For each of the three beam profile regions there are

specific requirements to optimize the clinical photon beam:

The dose profile in the central region should meet flatness and
symmetry specifications.
The dose profile in the penumbral region should have a rapid falloff
with increasing distance from the central axis (narrow penumbra)
to optimize beam sharpness at the target edge.
The dose profile in the umbral region should be close to zero dose
to minimize the dose delivered to tissues outside the target
volume.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Ideal dose profile:

Central region:
constant dose from
target centre to edge
of target.
Penumbra: zero width.
Umbra: zero dose.

Actual dose profile:

Central region: profile flat in 80 % of central portion of the field.
Penumbra is typically defined as the distance between 80 % and 20 %
dose on the beam profile normalized to 100 % at the central axis.
Umbra is typically less than 1 % of the dose on the central axis.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

Geometric or nominal field size is:

Indicated by the optical light field of the treatment machine.
Usually defined as the separation between the 50% dose level
points on the beam profile measured at the depth of dose
maximum zmax.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

In the central region, the off-axis points of the beam profile

are affected:

For cobalt-60 beams,

by the inverse square
law dose fall-off and
the increased phantom
thickness as the off-axis
distance increases.
For linacs, by the energy
of electrons striking
the target, by the atomic
number of the target,
and the atomic number
and shape of the flattening
filter.
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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

The total penumbra is referred to as the physical penumbra

and consists of three components:
Geometric penumbra
results from the finite
source size.
Scatter penumbra
results from in-patient
photon scatter
originating in
the open field.
Transmission penumbra
results from beam
transmitted through
the collimation device.
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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

6.9.1 Beam flatness

Beam flatness F is assessed by finding the maximum

Dmax and minimum Dmin dose point values on the beam
profile within the central 80 % of the beam width.

Beam flatness F is defined as:

F =100

Dmax Dmin
Dmax +Dmin

Standard linac specifications require that F 3 %when

measured in a water phantom at a depth z = 10 cm with

SSD = 100 cm for the largest field size available
(typically 4040 cm2).

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6.9.1 Beam flatness

Compliance with the flatness specifications at a depth

z = 10 cm in water results in:
Over-flattening at zmax, manifesting itself in the form of horns
in the profile.
Under-flattening at depths exceeding z = 10 cm. This
underflattening becomes progressively worse as the depth z
increases beyond z = 10 cm.

The over-flattening and under-flattening of the beam

profiles is caused by the lower beam effective
energies in off-axis directions compared with the
central axis direction.

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

6.9.1 Beam flatness

Typical profiles measured in water with a 4040 cm

field at SSD = 100 cm. The data for depths z = 10 cm

and z = zmax are used for verification of compliance with
standard machine specifications.

F =100

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Dmax +Dmin

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6.9 OFF-AXIS RATIOS AND BEAM PROFILES

6.9.2 Beam symmetry

Beam symmetry S is usually determined at zmax to

achieve maximum sensitivity.

Typical symmetry specifications for a 4040 cm field:

2

Any two dose points on a beam profile, equidistant from the

central axis point, should be within 2 % of each other.
Areas under the zmax beam profile on each side (left and right) of
the central axis extending to the 50 % dose level (normalized to
100 % at the central axis point) are determined.

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6.9.2 Beam symmetry

S
S

is calculated from
=100

arealeft arearight
arealeft +arearight

and should be less than 2 %.

Practical options for determination of areas under the

profile curve with a hard copy of the profile are:
using a planimeter
OR
counting squares on graph paper.

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6.9.2 Beam symmetry

The areas under the

zmax profile can often
be determined using
an automatic software
option on the water
tank scanning device
(3-D isodose plotter).

S =100

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arealeft +arearight

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Physical characteristics of radiation beams are usually

measured in phantoms under standard conditions:
Homogeneous, unit density phantom
Flat phantom surface
Perpendicular beam incidence

Central axis depth dose data in conjunction with dose

profiles contain complete 2-D and 3-D information about

the radiation beam.

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Planar and volumetric dose distributions are usually

displayed with isodose curves and isodose surfaces,
which connect points of equal dose in a volume of
interest.

The isodose curves and surfaces are usually drawn at

regular intervals of absorbed dose and are expressed as

a percentage of the dose at a specific reference point.

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

An isodose chart for a given single beam consists of a

family of isodose curves usually drawn at regular
increments of PDD.

Two normalization conventions are in use:

For SSD set-ups, all isodose values are normalized to 100 % at
point P on the central beam axis (point of dose maximum).
For SAD set-ups, the isodose values are normalized to 100 % at
the isocentre.

The isodose charts for an SSD set-up are thus plots of

PDD values; isodose charts for an SAD set-up are plots

of either TAR or TMR (outside of scope for this course).
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For SSD set-ups, all isodose

values are normalized to 100 %
at point P on the central beam
axis (point of dose maximum at
depth zmax).

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For SAD set-ups, the isodose

values are normalized to 100 %
at the isocentre.

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Parameters that affect the single beam isodose

distribution are:
Beam quality
Source size
Beam collimation
Field size
Source-skin distance
Source-collimator distance

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Treatment with single photon beams is seldom used

except for superficial tumours treated with superficial
or orthovoltage x rays.

Deep-seated tumours are usually treated with a

combination of two or more megavoltage photon
beams.

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Isodose distributions for various photon radiation beams:

orthovoltage x rays, cobalt-60 gamma rays, 4 MV x rays, 10 MV x rays

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6.10 ISODOSE DISTRIBUTIONS IN WATER PHANTOMS

Isodose charts are measured with:

Ionization chambers
Solid state detectors such as diodes
Standard radiographic film
Radiochromic film

In addition to direct measurements, isodose charts may

also be generated by calculations using various algorithms
for treatment planning, most commonly with commercially
available treatment planning systems (TPSs).

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

Phantom measurements are normally characterized by:

Flat phantom surface
Perpendicular beam incidence
Homogeneous, unit density phantom

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

Clinical situations are usually more complex:

The patients surface may be curved or of irregular shape,
requiring corrections for contour irregularities.
The beam may be obliquely incident on patients surface requiring
corrections for oblique beam incidence.
Some tissues such as lung and bone have densities that differ
significantly from that of water, requiring corrections for tissue
heterogeneities (also called inhomogeneities).

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

Isodose distributions in patients are determined by one of

two radically different approaches:
Correction-based algorithms use depth dose data measured in
water phantoms with a flat surface and normal incidence in
conjunction with various methods to correct for irregular patient
contours, oblique beam incidence, and different tissue densities.
Model-based algorithms obviate the correction problem by
modeling the dose distributions from first principles and
accounting for all geometrical and physical characteristics of the
particular patient and treatment.

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

6.11.1 Corrections for irregular contours and beam obliquity

A radiation beam striking an irregular or sloping patient

surface produces an isodose distribution that differs from

the standard distributions obtained with normal beam
incidence on a flat phantom surface.

Two approaches are used to deal with this problem:

The flat phantom / normal incidence isodose distribution is
corrected numerically to obtain the actual dose distribution in the
patient.
To achieve flat phantom / normal incidence distributions in a
patient the physical effect can be compensated for through the
use of wedges, bolus materials or special compensators.

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

6.11.1 Corrections for irregular contours and beam obliquity

Methods for correcting the standard flat surface / normal

incidence isodose distributions for contour irregularities
and oblique beam incidence are:
Effective SSD method
TAR or TMR method
Isodose shift method

These methods are applicable for:

Megavoltage x rays with angles of incidence up to 45o.
Orthovoltage beams with angles of incidence up to 30o.

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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

6.11.1 Corrections for irregular contours and beam obliquity

Effective SSD method for

determination of dose at
arbitrary point S in patient:
The isodose chart is shifted
to the flat surface level at
the CC contour.

What to shift
point s to point p
along beam
central axis

The PDD value for point S is

read to get PDD.
The reading is corrected
by an inverse square
factor.
PDDcorr

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cc
2 is patient contour
f + zmax cc is flat detector surface
=PDD(z,A,f,h)

f + h + zmax cc is also flat detector surface

h is missing patient thickness
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6.11 SINGLE FIELD ISODOSE DISTRIBUTIONS IN PATIENTS

6.11.2 Missing tissue compensation

Wedge filters are used to even out the isodose surfaces

for photon beams striking relatively flat patient surfaces

under an oblique beam incidence.

Two types of wedge filter are in use:

Physical wedge is made of lead, brass, or steel. When placed in a
radiation beam, the wedge causes a progressive decrease in the
intensity across the beam and a tilt of isodose curves under
normal beam incidence.
Dynamic wedge provides the wedge effect on isodose curves
through a closing motion of a collimator block during irradiation.

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6.11.2 Missing tissue compensation

Two parameters are of

importance for wedges:

Wedge transmission factor is
defined as the ratio of doses at
zmax in a water phantom on the
beam central axis (point P) with
and without the wedge.
Wedge angle is defined as the
angle through which an isodose
curve at a given depth in water
(usually 10 cm) is tilted at the
central beam axis under the
condition of normal beam
incidence.
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6.11.2 Missing tissue compensation

Bolus is tissue equivalent material placed directly onto

the patients skin surface:

To even out irregular patient contour.

To provide a flat surface for normal beam incidence.

In principle, the use of bolus is straightforward and

practical; however, it suffers a serious drawback: for

megavoltage photon beams it results in the loss of the
skin sparing effect in the skin covered with the bolus
(i.e., skin sparing effect occurs in the bolus rather than in
the patient).

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6.11.2 Missing tissue compensation

Compensators are used to produce the same effect as

the bolus yet preserve the skin sparing effect of
megavoltage photon beams.

Compensator is a custom-made device that mimics the

shape of the bolus but is placed in the radiation beam at

some 15 cm 20 cm from the skin surface to preserve
the skin sparing properties of the radiation beam.

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6.11.2 Missing tissue compensation

Typical compensator materials are:

Lead
Special low melting point alloys such as Cerrobend (Lipowitzs
metal).
Water equivalent materials such as wax.

Since compensators are placed at some distance from

the skin surface, their shape must be adjusted for:

Beam divergence
Linear attenuation coefficient of the compensator material.
Reduction in scatter at various depths in patient.

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6.11.4 Model based algorithms

Model based algorithms for computation of dose distribution

in a patient are divided into three categories:

Primary dose plus first order Compton scatter method is rudimentary

as it assumes a parallel beam of monoenergetic photons and ignores
inhomogeneities and scattering above the first order.
Convolution-superposition method accounts for the indirect nature of
dose deposition from photon interactions, separating the primary
interactions from the transport of scattered photons and charged
particles produced through primary photon interactions.
Monte Carlo method uses well established probability distributions
governing the individual interactions of photons and secondary
charged particles and their transport through the patient.

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6.11.4 Model based algorithms

Monte Carlo simulation can be used directly to compute

photon dose distributions for a given patient and
treatment geometry.

The current limitation of direct Monte Carlo calculations is

the time required to calculate the large number of
histories needed to reduce stochastic or random
uncertainties to acceptable levels.

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6.11.4 Model based algorithms

Advances in computer technology will, within a few years,

reduce Monte Carlo calculation times to acceptable levels
and make Monte Carlo methods the standard approach
to radiotherapy treatment planning.

The electron densities for various tissues of individual

patients are obtained with CT scanners or CT simulators

and form an essential component of any Monte Carlo
based dose distribution calculation.

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