MAKERERE UNIVERSITY

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF RADIOLOGY

AND RADIOTHERAPY

PHYSICS OF RADIOTHERAPY AND SIMULATION

RHS3104

BUKENYA ASHRAF

20/u/16067

BsMR

2022/2023

Content outline:

1. Physics of radiation therapy

2. Radiation therapy simulation procedures, immobilization devices, SSD and SAD simulation approaches

3. Contrast tumor localization and treatment verification.

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4. Components of the conventional and CT simulator.

5. Emergency procedures for simulator equipment failure

6. Contrast agents in the simulation process.

7. Radiographic factors to produce a quality radiograph of the treatment field.

8. Topographic anatomy and treatment fields.

9. Treatment field design and arrangements used to treat neoplastic diseases associated with each
anatomic site, skin markings/tattoos

10. Documentation of simulation/patient set-up information.

DOSE:

Dose is the energy deposited to the medium in the form of ionizations and excitations.

OR

Radiation dose can also be defined as the measure of the amount of exposure to radiation.

There ae 3 kinds of dose in radiological protection i.e.

1. Absorbed dose which is a measurable physical quantity.

2. Equivalent dose
3. Effective dose

Note: Equivalent and effective dose are specifically for radiological protection purposes.

Absorbed Dose

Is the amount of energy deposited by ionizing radiation in a given mass.

The mass can be anything: water, rock, air, people etc.

The absorbed dose is expressed in Gray (Gy) or more frequently in milligray (mGy).

1 Gy = 1 J/Kg. Also, 1Gy=100 cGy=100 Rad.

Gray (Gy). This is the amount of radiation that causes one joule to be absorbed per kilogram of irradiated
material.

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In radiation biology, clinical radiology and radiological protection the absorbed dose quantity, D,
is the basic physical quantity, and it is used for all types of ionizing radiations and any irradiation
geometry.

It is defined as the mean energy imparted in matter:

dE
D= , the SI unit, J/Kg and its special name Gray.
dm

Equivalent Dose ( H T )

Is the measure of the radiation dose to tissue where an attempt has been made to allow for the
different relative biological effects of different types of ionizing radiation.

Expressed in Sieverts (Sv) or more frequently in millisieverts (mSv)

It is biologically significant and calculated for individual organs. It is based on the absorbed dose
to an organ, adjusted to account for the effectiveness of the type of radiation.

Equivalent Dose, H T = Radiation weighting factor, W R , X Absorbed dose to the tissue or organ,
DT .

The weighting factor is independent of the type and energy of the incident radiation.

Type of radiation Radiation weighting factor, W R

X-rays, ɤ-rays, and β-particles 1
Protons 5
Neutrons Between 5 and 20(depends on energy)
α-particles 20

Effective Dose
It sums up any number of different exposures into a single number that reflects overall risk.
This is a central feature in radiological protection.
It is calculated for the whole body by the addition of equivalent doses to all organs, each
adjusted to account for the sensitivity of the organ to radiation. Effective dose is expressed in
Sieverts (Sv) or frequently millisieverts (mSv).

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Effective dose, E= ∑T (Equivalent dose to the organ, H T x Appropriate tissue weighting factor,W T
).
The tissue weighting factors are needed organs have different levels of sensitivity to radiation,
even if the equivalent dose is the same.
Tissue Tissue weighting factor, W T
Red bone marrow, colon, lungs, stomach, 0.12
breasts
Gonad 0.08
Bladder, esophagus, liver, thyroid 0.04
Bone surface, brain, salivary gland, skin 0.01
Total of the remaining tissues 0.12

NOTE;
1. dmax: the depth where the maximum dose is deposited (usually given in
Centimeters)
2. Dmax: the maximum dose as a percentage of the prescription dose (describes
the magnitude of a hot spot).
KERMA and Dose:
KERMA – Kinetic Energy Released in Media.

E tr
Technically, it is defined as: K=
dm

Etr is the sum of the initial transferred kinetic energies of all charged particles set in motion by
photons in mass (m).

KERMA is the energy transferred to the secondary electrons from the primary photons. It is
NOT the same as absorbed dose but it has the same basic units of measurement (J/kg). Photons
cause a cascade of electrons (through KERMA) but the electrons do the real ionizing damage
(deliver the “dose”). Since the most important interaction is Compton scatter which generally
propel electrons forward, it makes sense that the most damage done by electrons will not be
directly at the surface but will actually be slightly deeper. The depth of greatest damage or
“maximal absorbed dose” is dmax. The energy transfer from photons and the dose of energy
absorbed are related.

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In the buildup region, KERMA is greater than dose. The dose and KERMA curves eventually
cross and then descend on a relatively straight linear slope where the curves are parallel but dose
is slightly greater than KERMA(i.e. After equilibrium dose is always higher than KERMA).
The amount of dose buildup from KERMA is based on the photon energy. As photon energy
increases, the buildup region also increases and the dmax becomes deeper. There is also less
dose fall-off with depth (high energies penetrate deeper).
In general, we describe doses in percentages, in order to make curves that show the percent of
dose at depth (PDD).

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 Percent Depth dose of various photon energy spectrums with extended view of x axis.

Exposure:
Exposure (air KERMA) is charge released into air. It is used for radiation measuring devices.
When photons interact with air, an ion pair is produced, with one positive and one negative
charge.
The ICRU defines exposure (X) as the quotient of dQ by dm where dQ is the absolute value of
the total charge of the ions of one sign produced in air when all the electrons (negatrons and
positrons) liberated by photons in air of mass dm are completely stopped in air.
If we measure the difference in charge (dQ), divided by mass (dm) then we can measure
“exposure” (X) by the following equation:
dQ
X=
dm
The classical unit is the Roentgen, denoted by R.
Roentgen (R). In normal air conditions (0°C and 760 mmHg pressure), this is the amount of X-
radiation or gamma radiation that produces 2.58×10−4 coulombs of electrical charge (in the form
of ions) in one kilogram of air. C/kg.

In normal air conditions, this is the amount of radiation that produces one coulomb of electrical
charge (in the form of ions) in one kilogram of air.

Integral dose. This is the total energy absorbed in the treated volume (in J=kg×Gy).

Roentgen was originally defined as 1 R = 1 electrostatic unit (esu)/cm3 air at standard

temperature and pressure (STP) (0°C, 760 mmHg).
The current definition of 1 R = 2.58 × 10−4C/kg air .The SI unit is the Coulomb per kilogram
(C/kg).

Quantification/ measurement and standardization of dose:

When photons interact in matter, an energy pathway is initiated by which energy is transferred to
the matter via emission of charged particles which cause ionization and excitation of atoms of
the matter.

The energy is eventually manifest as heat or as some form of internal potential energy of
electrons and atoms within the matter (e.g. chemical bonds, raised electron energy levels).
Systems of detecting radiation utilize specific parts of this energy pathway. Some systems seek

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to determine energy deposited in matter by measuring the temperature rise (termed calorimetry).
Other detection systems look at chemical changes generated by irradiation of the matter
(chemical dosimetry), or utilize long-lived excited electron states (e.g. thermoluminescent
dosimetry).

Still other systems measure the ionization produced by the charged particles in order to calculate
the energy transferred to those particles (ionization chamber dosimetry).

Dose standards:

It is of particular importance in radiotherapy to ensure that a dose of radiation delivered in any

one treatment centre is consistent over time and is consistent also with that delivered in other
centre, this being a central part of ongoing quality control.

It also allows direct comparison of treatment techniques and results between centres and is
essential for multicenter clinical trials to be effective.

Consistency of measurements on a national or international basis is achieved through a process

of central standardization, with all measurements being traceable to an accepted national or
international standard.

In order to ensure consistency of dose measurement between centres, it is necessary for

measurements to be traceable back to the appropriate national standard. Dose measuring
instruments within individual hospitals (the field instruments) are used to measure the radiation
beams of radiotherapy treatment units. These are calibrated periodically against a secondary
standard instrument.

The secondary standard instruments are reserved solely for this purpose and are not used to make
routine beam measurements. Each secondary standard instrument is calibrated periodically by
the Standards Laboratory by comparing the response against national reference level instruments
that are in turn compared annually with the national standard instrument. The national standards
are themselves compared at intervals with equivalent standard instruments developed by
standards laboratories in other countries.

Radiotherapy treatment units, such as linear accelerators and kV therapy units, have in-built dose
measuring instruments that monitor and determine the amount of dose delivered – these

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instruments are known as monitor chambers. Field instruments are used to calibrate these
monitor chambers so that each monitor unit delivers a known amount of radiation.

These field instruments may be used to determine not only the amount of radiation delivered, but
also the pattern of deposition of energy within matter by measuring dose at different points
within the matter. They may be used also to calibrate other dose measuring equipment designed
for special purpose measurements, such as in-vivo dosimeters.

Methods of measuring dose

1. Free-air ionization chambers:
The free-air, or standard, ionization chamber is an instrument used in the measurement of
exposure in roentgens.
Generally, such a primary standard is used only for the calibration of secondary instruments
designed for field use.

In a free-air chamber an x-ray beam originating from a focal spot S, is defined by the diaphragm
D, and passes centrally between a pair of parallel plates.
A high voltage is applied between the plates to collect ions produced in the air between the
plates.
The ionization is measured for a length L defined by the limiting lines of force to the edges of
the collection plate C.
The lines of force are made straight and perpendicular to the collector by a guard ring G.

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Electrons produced by the photon beam in the specified volume (shaded) must spend all their
energy by ionization of air between the plates.

Such a condition can exist only if the range of the electrons liberated by the incident photons is
less than the distance between each plate and the specified volume.

In addition, for electronic equilibrium to exist, the beam intensity (photon fluence per unit time)
must remain constant across the length of the specified volume, and the separation between the
diaphragm and the ion-collecting region must exceed the electron range in air.

If ΔQ is the charge collected in Coulombs and p is the density (kg/m3) of air, then the exposure
Xp at the center of the specified volume (point P) is:

∆Q 1
XP = X R
p . A p . L 2.58 X 10−4

Where A p – is the cross-sectional area (in meters squared) is of the beam at point P and L (in
meters) is the length of the collecting volume.

Accurate measurements with a free-air ionization chamber require considerable care.

(a) Correction for air attenuation;

(b) Correction for recombination of ions;

(c) Correction for the effects of temperature, pressure, and humidity on the density of air.

(d) Correction for ionization produced by scattered photons.

NOTE: There are limitations on the design of a free-air chamber for the measurement of
roentgens for high-energy x-ray beams.

As the photon energy increases, the range of the electrons liberated in air increases rapidly. This
necessitates an increase in the separation of the plates to maintain electronic equilibrium. Too
large a separation, however, creates problems of non-uniform electric field and greater ion
recombination.

Although the plate separation can be reduced by using air at high pressures, the problems still
remain in regard to air attenuation, photon scatter, and reduction in the efficiency of ion

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collection. Because of these problems, there is an upper limit on the photon energy above which
the roentgen cannot be accurately measured. This limit occurs at about 3 MeV.

Free-air ionization chambers are too delicate and bulky for routine use. Their main function is in
the standardizing laboratories where they can be used to calibrate field instruments.

2. Thimble chambers:

A thimble chamber is an ionization chamber that has a central electrode (the collector electrode)
in a volume of air that is contained by a thimble-shaped cap/wall which is coated by a special
material to make it electrically conducting. It forms the HT electrode which fits closely onto a
metallic stem.

The central electrode passes through the inside of the stem and is insulated from the metallic
stem by a suitable high-quality insulator material such as amber or polythene.

The other electrode is a rod of low-atomic-number material such as graphite or aluminum held
in the center of the thimble but electrically insulated from it.
A suitable voltage is applied between the two electrodes to collect the ions produced in the air
cavity. Most of the ionization produced in the cavity air is caused by electrons that are liberated
in the surrounding wall (for at least up to 2 MeV photons) and enter the air cavity.
Therefore, in order for the thimble chamber to be equivalent to a free-air chamber, the thimble
wall should be air equivalent as this would ensure that the energy spectrum of electrons liberated
in the thimble wall is similar to that in air.
A potential difference (the polarizing voltage) applied between the outer cap and the inner
electrode drives apart any ion pairs produced in the trapped air and prevents ion recombination,
but which is insufficiently large to cause ionization of the air itself so that in the absence of

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ionizing radiation no current flows. A voltage gradient of a few hundred volts per millimeter is
generally sufficient for this purpose.

In the presence of ionizing radiation, ionization within the air results in the ion pairs being
separated, and with the ions of one sign (depending upon the polarity of the polarizing voltage)
being collected on the central electrode.

The electrometer is generally ‘floating’, in that the input to it can be at any voltage level with
respect to ground without this affecting the reading. In use, the aluminium stem is held at ground
potential and the electrometer is floated to the level of the polarizing voltage, so that exposed
conductive parts carry no electrical risk to operators. This arrangement allows easy reversal of
polarizing voltage as required.

When the chamber is introduced into a photon beam, photo-electric and Compton interactions in
the walls of the chamber generate electrons that traverse the air cavity, causing ionization of the
air.

The wall of the thimble must be sufficiently thick to ensure that all the electrons crossing the air
cavity originate in the wall and not in the surrounding material. The wall must therefore be at
least as thick as the range of the electrons produced by the photon interactions. However, the
wall of the chamber will also attenuate the photon beam and this attenuation will need to be
taken into account. If the wall is thick, the attenuation will be large.

Practical ionization chambers such as the Farmer chamber have a wall thickness of about 1 mm.
This is sufficient to produce electronic equilibrium for photons generated at kV energies, but is
insufficient for megavoltage energies when an additional tight-fitting build-up cap is needed to
increase the effective wall thickness. This is particularly important when measurements are made
in a phantom constructed from material that differs markedly from the wall material.

The calibration factor of a thimble chamber varies with photon energy. This calibration corrects
for wall attenuation, differences in the mass attenuation coefficient between the wall material
and water, and perturbations to the photon beam caused when the chamber (and its associated
build-up cap, where applicable) are inserted into a water phantom, thereby displacing water.

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Ionization of the air volume within the cap of a thimble chamber results in a flow of charge onto
the collecting electrode. The rate of flow of charge will depend upon the mass of air within the
cavity and on the radiation beam intensity. A balance must be made between the physical size of
the chamber and on the ability to measure the charge with sufficient accuracy.

Chambers with large air volumes (200–2000 ml) must be used to measure the very low dose
rates associated with radiation protection measurements. Chambers with air volumes 10 – 60 ml
are used for measurement of diagnostic radiology beams while chambers with air volume of 0.6
ml are suitable for measurement of radiotherapy beams.

The effective atomic number of the wall is generally a little less than that of air. It is closer to
that of carbon (Z = 6). As a consequence, such a wall should give rise to less ionization in the air
cavity than a free-air wall.

A thimble chamber could be used directly to measure exposure if

(a) It was air equivalent; for the thimble chamber to be air equivalent, the effective atomic
number of the wall material and the central electrode must be such that the system as a whole
behaves like a free-air chamber. The most commonly used wall materials are made either of
graphite (carbon), Bakelite, or a plastic coated on the inside by a conducting layer of graphite or
of a conducting mixture of Bakelite and graphite
(b) Known cavity volume
(c) Sufficient wall thickness was to provide electronic equilibrium.
Under the above conditions, the exposure X is given by:
Q 1
X= p . v x A

Where Q is the ionization charge liberated in the cavity air of density p and volume v;
A is the fraction of the energy fluence transmitted through the air-equivalent wall of equilibrium
thickness. The factor A is slightly less than 1.00 and is used here to calculate the exposure for the
energy fluence that would exist at the point of measurement in the absence of the chamber.

Thimble chambers are always calibrated against a free-air chamber for x-rays up to a few
hundred kilovolts.

At higher energies the thimble chambers are calibrated against a standard cavity chamber with
nearly air-equivalent walls (e.g., graphite) and accurately known volume.

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Desirable characteristics of a thimble chamber:

1. There should be minimal variation in sensitivity or exposure calibration factor over a wide
range of photon energies.

2. There should be suitable volume to allow measurements for the expected range of exposures.
3. There should be minimal variation in sensitivity with the direction of incident radiation.

4. There should be minimal stem “leakage.” A chamber is known to have stem leakage if it
records ionization produced anywhere other than its sensitive volume.

5. The chamber should have been calibrated for exposure against a standard instrument for all
radiation qualities for which exposure is to be measured.

6. There should be minimal ion recombination losses.

3. Farmer chamber

The thimble wall is made of pure graphite and the central electrode is of pure aluminum.
The insulator consists of polytrichlorofluoroethylene (PTCFE).
There are three electrodes in a well-guarded ion chamber:
1. Central electrode or the collector- This collects the ionization charge and delivers the
current to a charge-measuring device, an electrometer.
2. Thimble wall
3. Guard electrode.
The electrometer is provided with a dual polarity high-voltage source to hold the collector at a
high bias voltage.
The thimble is at ground potential and the guard is kept at the same potential as the collector.

Most often the collector is operated with a positive voltage to collect negative charge.

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Components of a Farmer chamber:
Chamber wall: The thimble wall material of a Farmer-type chamber may be graphite or plastic
such as PMMA (acrylic), nylon, A.E. (air-equivalent) plastic, and T.E. (tissue-equivalent)
plastic. In the case of a plastic thimble, the inner surface of the wall is made conducting with a
thin coating of graphite.

Outer Electrode: The outer electrode is the thimble wall (if made of a conducting material) or
the inner surface of the thimble wall coated with a conducting material.

Central Electrode: The central electrode consists of a thin aluminum rod. It is the collector
electrode that delivers the ionization current to a charge-measuring device, the electrometer.

Guard Electrode: A cylindrical conductor that wraps around the insulator surrounding the
central electrode in the stem of the chamber.

A second insulator wraps around the guard electrode, separating the guard from the outer
electrode. The guard is kept at the same potential as the central electrode. Because there is no
potential difference between the guard and the central electrode, any charge leakage does not get
to the central electrode. The function of the guard is to reduce the leakage of any extraneous
charge to the collecting electrode.

The guard also passes ground loop and capacitive field noise currents away from the signal-
carrying central electrode, significantly improving the signal to noise ratio.

Chamber (or cavity) volume: Because the thimble is vented to the outside, the cavity volume
determines the mass of air in the cavity and, therefore, the sensitivity (charge measured/unit
exposure) of the chamber. Farmer-type chambers have a cylindrical cavity with a nominal
volume of 0.6 ml.

Note: Stem effect: The stem effect arises out of radiation-induced signal in the chamber stem
and the cable, if exposed. The stem effect originating in the stem is directly related to the length
of the unguarded stem. The amount of stem effect (originating either in the stem or the cable) is a
function of energy as well as type of beam (photon or particle). Fully guarded Farmer-type
chambers have almost immeasurable stem effect. However, the stem effect must be checked
periodically.

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Measurement of dose and dose rate

When an ionization chamber is irradiated, a flow of ions is collected by the collecting electrode.
The ions may be ‘accumulated’ and the total charge determined by the electrometer. Such a
measurement would be used to determine the radiation dose delivered over the course of the
irradiation.

The accumulation of charge is effectively achieved by collecting the charge in a capacitor: the
voltage across the capacitor plates increases with the charge stored. The rate at which dose is
delivered may be obtained by dividing the measured dose by the irradiation time. This will
produce an average value for the dose rate over the irradiation time, although the actual dose
rate may vary during the irradiation period.

The actual dose rate at any time point within the irradiation period may be determined by
measuring the rate of flow of charge. This is achieved by measuring the potential difference
produced as the charge flows through a known high-value resistor.

The charge levels referred to above are extremely small for typical radiotherapy doses, typically
of the order of nanocoulombs, and dose rate measurements may involve currents of tens of
picoamps. The electrometer instrument that measures them must be carefully designed to avoid
introducing instrument-induced charges and voltage differences that may interfere with the
measurements. Modern instruments are based around purpose-designed high impedence
operational amplifiers with low noise levels, able to measure either dose or dose rate, and
which can operate over a range of current and charge levels.

Operational amplifier:

The operational amplifier is designated as a triangle with two input points.

The negative terminal is called the inverting terminal and the positive one is the noninverting
position. This implies that a negative voltage applied to the inverting terminal will give a
positive amplified voltage and a positive voltage applied to the noninverting terminal will also
give a positive amplified voltage.

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A negative feedback connection is provided, which contains either a capacitor or a resistor.

In the integrate mode, the charge Q collected by the ion chamber is deposited on the feedback
capacitor C.

The voltage V across C is read by a voltmeter and is given by Q/C, where C is the capacitance.
Measurement of this voltage is essentially the measurement of ionization charge.

In the rate mode, the capacitor is replaced by a resistance R.

Irradiation of the chamber causes an ionization current I to flow through the resistor, generating
a voltage V = IR across the resistance.

The measurement of this voltage reflects the magnitude of the ionization current.

For total capacitative or resistive feedback circuits, the closed-loop gain of the operational
amplifier is unity (i.e., the output voltage is given by the voltage across the feedback element).

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If a variable fraction of the output voltage is fed back to the input as by a voltage divider,

the electrometer can be converted into a direct-exposure reading (R or R/min) instrument for a
given chamber and a given quality of radiation.

SPECIAL CHAMBERS;

While the thimble chamber described above is suitable for many dosimetry situations, there are
circumstances that require alternative chamber designs:

1. For the measurement of low energy photons, the wall of a thimble chamber causes too much
attenuation such that the calibration factor is large and varies rapidly with energy. This may lead
to considerable uncertainties in measurement of dose

2. The wall of a thimble chamber will also produce too much build up for dose measurements
close to the surface for megavoltage radiation

3. In measurement of electron beams, the cylindrical air volume of a thimble chamber causes
significant perturbation of the beam that must be corrected for.

Extrapolation chamber

An ionization chamber for measuring surface dose in an irradiated phantom.

The beam enters through a thin foil window that is carbon coated on the inside to form the upper
electrode.

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The lower or the collecting electrode is a small coin-shaped region surrounded by a guard ring
and is connected to an electrometer.

The electrode spacing can be varied accurately by micrometer screws.

By measuring the ionization per unit volume as a function of electrode spacing, one can estimate
the incident dose by extrapolating the ionization curves to zero electrode spacing. The
extrapolation chambers of the type described above have been used for special dosimetry (e.g.,
the measurement of dose in the superficial layers of a medium and the dosimetry of electrons and
β particles).

Plane-parallel chambers

Sometimes also called parallel-plate chambers.

Are similar to the extrapolation chambers except for the variable electrode spacing.

The electrode spacing of the plane-parallel chambers is small but fixed.

A thin wall or window (e.g., foils of 0.01- to 0.03-mm-thick Mylar, polystyrene, or mica) allows
measurements practically at the surface of a phantom without significant wall attenuation.

By adding layers of phantom material on top of the chamber window, one can study the
variation in dose as a function of depth, at shallow depths where cylindrical chambers are
unsuitable because of their larger cavity volume.

The small electrode spacing in a plane-parallel chamber minimizes cavity perturbations in the
radiation field. This feature is especially important in the dosimetry of electron beams where

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cylindrical chambers may produce significant perturbations in the electron fluence due to the
presence of their large air cavity.

Chamber polarity effects:

It is sometimes found that for a given exposure the ionic charge collected by an ion chamber
changes in magnitude as the polarity of the collecting voltage is reversed. There are many
possible causes of such polarity effects.

With the chamber operating under saturation conditions, major causes of the polarity effects
include the following:

 High-energy electrons such as Compton electrons ejected from the central electrode by
high-energy photons constitute a current (Compton current) independent of gas (cavity
air) ionization. This may add to or reduce the collector current, depending on the polarity
of the collecting electrode. In addition, some of these electrons may stop in the collector
but may not be entirely balanced by ejection of recoil electrons from the collector.
These are minimized by making the collecting electrode very thin.
Errors due to these causes are likely to be appreciable for parallel-plate chambers with
small electrode spacing.
However, the true ionization current in these cases can be determined by taking the mean
of two currents obtained by reversing the chamber polarity.

 Extracameral current collected outside the sensitive volume of the chamber may cause
the polarity effect. Such a current may be collected at inadequately screened collector
circuit points. Also, irradiation of the cable connecting the chamber with the
electrometer can cause the extracameral current as well as the Compton current.
The errors caused by these effects can be minimized but not eliminated by reversing the
chamber polarity and taking the mean value of the collector current.
Generally, the chamber polarity effects are relatively more severe for measurements in
electron beams than photon beams, and in addition, the effect increases with decreasing

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 electron energy. Therefore, it is important to determine polarity effects of a chamber at
various depths in a phantom.
The polarity effect is very much dependent on chamber design and irradiation
conditions.
Many of the polarity effects and stem leakage can be minimized in the design of the
chamber and the associated circuitry. Also, the adequacy of the chamber voltage is an
important factor in minimizing some of the other polarity.
Finally, it is recommended that the difference between the ionization currents measured
at positive and negative polarizing potential should be less than 0.5% for any radiation
beam quality.

Environmental conditions:

If the ion chamber is not sealed, its response is affected by air temperature and pressure.

In fact, most chambers are unsealed and communicate to the outside atmosphere. Because the
density of air depends on the temperature and pressure, in accordance with the gas laws, the
density of air in the chamber volume will likewise depend on these atmospheric conditions.

The density or the mass of air in the chamber volume will increase as the temperature decreases
or pressure increases. Since exposure is given by the ionization charge collected per unit mass of
air, the chamber reading for a given exposure will increase as the temperature decreases or as the
pressure increases.

Calibration laboratories provide chamber calibration factors for reference environmental

conditions of temperature T o = 22°C and pressure PO= 760 mmHg or 101.33 kilopascal (kPa) (1
atmosphere). The temperature and pressure correction, PTP, at different conditions is given by:

Note: Temperatures in the above equations are converted to the absolute scale of temperature (in
degrees Kelvin) by adding 273.2 to the Celsius temperatures

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AAPM TG-21

Used in calibration of a chamber and measuring dose.

Very complicated with many correction factors.

TG-21 has fallen out of use in the modern era as TG-51 is both simpler and more accurate.

Where; Dmed =dose to the medium (what you want to find out).

M = charge measured on the electrometer.

N gas= calibration of gas cavity in terms of absorbed dose to the gas per unit charge or
electrometer reading – unique for each ionization chamber.

Pion= correction factor for ion recombination.

Prepl = correction factor for perturbation of fluence due to the chamber being present.

Pwall = correction factor for the wall of the chamber

In TG-21-dose to a medium is based on air KERMA (exposure) measurement calibration and has
many variables that require reference to tables of stopping power ratios and mass energy
absorption coefficients.

AAPM TG-51

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Slightly more accurate but immensely more simple and based on an absorbed dose-to-water
calibration factor.

The equation is as follows:

Where:
Q
D W = dose to water at the reference point in beam quality Q/ exposure in roentgens (R).

M = charge measured with the electrometer/ chamber reading (coulombs) measured under
equilibrium conditions and corrected for any polarity effect.
k Q= Quality conversion factor that is specific to each thimble chamber and energy – should be
listed on the packaging of the thimble chamber or on a table in the TG-51 protocol.
By definition, k Q = 1.000 for a 60Co beam with any chamber.
60 Co
N D , w = Absorbed dose-to-water calibration factor for 60Co

Thermoluminescent dosimetry (TLD)

Thermoluminescence is the phenomenon where a material luminesces (emits significant amounts
of light–glows) when it is heated. In a solid crystalline material, there is forbidden energy zone
between the valance band and conduction band where no electron can exist. When the crystal is
excited by radiation, traps appear, and electrons coming from the valance band or returning from
the conductive band are caught in these traps.

Thus, some of the energy transferred from the radiation to the crystal is deposited. If this crystal
is heated to a certain temperature, the electrons gain enough energy to release themselves from

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these traps and return to the valance band, and the energy they release when they do so is emitted
as light (i.e., luminescence). This luminescence can be measured by an electrometer.
Crystals that exhibit this phenomenon include LiB4O7, LiF, CaF2and CaSO4, and these are used
in TLDs.
TLDs can separately measure gammas, X-rays, beta particles and thermal neutrons with energies
of between 10 keV and 10 MeV.
TLDs have been largely replaced by OSLDs in the modern era.
Optically Stimulated Luminescence Dosimeter (OSLD):

It rides on the same concept as TLD; Ionizing radiation causes electrons in crystal’s electron
orbitals to jump to a higher state and instead of relaxing to the ground state, they are trapped due
to impurities (usually magnesium) in the crystal lattice but instead of heating the material, it can
be stimulated with laser to release the trapped electrons.

One example material is Aluminum oxide doped with carbon and it releases luminescence of 420
nm when illuminated with a stimulation light of 540 nm

Radiation Dosimetry
The quality of radiation depends on the type of radiation, its energy and its penetrating ability.
These characteristics should be experimentally measurable and confirmable.
Several physical measurements, measuring techniques, and units help to increase radiotherapy
efficacy, in accordance with the principle of primum non nocere.
Dosimetric measurements are performed in patients, and water or tissue-equivalent phantoms
and physical treatment parameters are determined.
Phantom
Phantoms are models constructed from tissue-equivalent material and used to determine the
radiation absorption and reflection characteristics of a human body or a specific organ.
Phantom materials are equivalent to human tissues in terms of their characteristics under X-ray
and electron irradiation.
Soft tissue, bone and lungs are equivalent of real density. Soft tissues are mimicked by heat-
hardened plastic material. The effective atomic number of soft tissue is 7.30±1.25%, and its
density is 0.985±1.25g/cm 3. Although lung has the same atomic number as soft tissue (7.30), its
density is 0.32±0.01 g/cm3.

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The bones used in a phantom are real human bones, and the same cavities exist as in the human
body.
The phantom is divided into slices of 2.5 cm thickness. There are drilled holes of 2.5–6 mm
diameter for TLD insertion in each slice.

Beam Geometry:
Accurate delivery of a radiation dose to patient depends on the precise positioning of the patient
and radiation source. The geometric parameters linking the source and target (tumor at treatment

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