Dose Distribution and Scatter

Analysis
Photon Beam Radiotherapy
It is the choice in most of the world
It requires the following main steps after diagnosis:
- Accurate localization of the tumor and its volume
- Determination of the most appropriate beam characteristics
- Simulation of the treatment on a specially caliberated
diagnostic x-ray machine, and portal imaging
- Development of a treatment plan based on dosimetric
measurements and calculations
- Carry out the actual irradiation according to the plan
- follow up with medical tests and other therapeutic measures
Dose Distribution and Scatter Analysis
Phantoms
Depth Dose Distribution
Percentage Depth Dose
Tissue-Air Ratio
Scatter-Air Ratio
Dose Distribution and Scatter Analysis

Measuring dose distribution in patients is difficult

They are obtained from measurements in phantoms

The data are used by dose calculation systems to perdict the
dose in actual patients
Phantoms
Phantoms are usually made of water
PHANTOMS
Basic dose distribution data are usually measured
in a water phantom, which closely approximates
the radiation absorption and scattering properties
of muscle and other soft tissue

Another reason for the choice of water as a
phantom material is that it is universally available
with reproducible radiation properties.
PHANTOMS
Solid dry phantoms
tissue or water equivalent, it must have the
same
effective atomic number
number of electrons per gram
mass density
For megavoltage photon beams in the clinical range,
the necessary condition for water equivalence
same electron density (number of electrons per
cubic centimeter)
Compton effect is the
main interaction
Solid dry phantoms
Solid dry (Slab) phantoms
PHANTOMS
The electron density (r
e
)






N
A
is Avogadro's number and a
i
is the fraction
by weight of the ith element of atomic number
Z, and atomic weight A
i
.
PHANTOMS
PHANTOMS
The compositions are adjusted to achieve
the following properties:
mass attenuation coefficient
the mass energy absorption coefficient
electron mass stopping
angular scattering power ratios
Alderson Rando Phantom
anthropomorphic
phantom
Frequently used for
clinical dosimetry
Incorporates materials
to simulate various
body tissues, muscle,
bone, lung, and air
cavities
Alderson Rando Phantom
RANDO phantom
CT slice
through lung
Head with
TLD holes
Depth Dose Distribution
The absorbed dose in the patient varies with depth
The variation depends on
depth
field size,
distance from source,
beam energy
beam collimation system

An essential step in dose calculations is to establish dose depth
variation along the central axis of the beam.
Percentage depth dose, tissue-air ratios, tissue-phantom ratios
and tissue-maximum ratios---measurements made in water
phantoms using small ionization chambers
Percentage Depth Dose
Absorbed dose at any depth: d
Absorbed dose at a fixed reference depth: d
0

100
0
=
d
d
D
D
P
collimator
surface
phantom
D
d0

D
d

d
d
0

PERCENTAGE DEPTH DOSE
For orthovoltage (up to
about 400 kVp) and
lower-energy x-rays, the
reference depth is usually
the surface (d
o
= 0).
For higher energies, the
reference depth is taken
at the position of the
peak absorbed dose (d
o
=
dm).

Percentage Depth Dose
For higher energies, the reference depth is at the
peak absorbed dose ( d
0
= d
m
)
D
max
: maximum dose, the dose maximum, the
given dose
100
max
=
P
D
D
d
100
max
=
D
D
P
d
collimator
surface
phantom
D
max

D
d

d
d
m

Percentage Depth Dose
(a)Dependence on beam quality and depth
(b)Effect of field size and shape
(c)Dependence on SSD
Percentage Depth Dose
(a)Dependence on beam quality and depth

Kerma
(1) kinetic energy released per mass in the medium;
(2) the energy transferred from photons to directly ionizing
electron;
(3) maximum at the surface and decreases with depth due to
decreased in the photon energy fluence;
(4) the production of electrons also decreases with depth
Percentage Depth Dose
(a)Dependence on beam quality and depth

Absorbed dose:
(1) depends on the electron fluence;
(2) high-speed electrons are ejected from the surface and
subsequent layers;
(3) theses electrons deposit their energy a significant
distance away from their site of origin
PDD - Dependence on Beam Quality and Depth
the dose build-up region.
the skin-sparing effect.

central axis depth dose distribution for different
quality photon beams
100
max
=
D
D
P
d
Percentage Depth Dose
(b)Effect of field size and shape
Geometrical field size: the projection, on a plane
perpendicular to the beam axis, of the distal end of
the collimator as seen from the front center of the
source
Dosimetric ( Physical ) field size: the distance
intercepted by a given isodose curve (usually 50%
isodose ) on a plane perpendicular to the beam axis
PDD - Effect of Field Size and Shape
Field size
Geometrical
Dosimetrical or
physical
SAD
FS
Square Field to Rectangular fields..
10cm
10
c
m

D
Measured data for this But may treat with this
20cm
5
c
m

Square field
Rectangular field
Percentage Depth Dose
(b)Effect of field size and shape
As the field size is increased, the contribution of
the scattered radiation to the absorbed dose
increases
This increase in scattered dose is greater at larger
depths than at the depth of D max , the percent
depth dose increases with increasing field size
100
max
=
D
D
P
d
D
d
D
max
Scatter dose
Percentage Depth Dose
(b)Effect of field size and shape

Depends on beam quality
The scattering probability or cross-section
decreases with energy increase and the higher-
energy photons are scattered more
predominantly in the forward direction, the field
size dependence of PDD is less pronounced for
the higher-energy than for the lower-energy
beams
Percentage Depth Dose
(b)Effect of field size and shape

PDD data for radiotherapy beams are usually
tabulated for square fields
In clinical practice require rectangular and irregularly
shaped fields
A system of equating square fields to different field
shapes is required: equivalent square
Quick calculation of the equivalent
square field
B
A
c = 2 x
A x B
A + B
rectangular field
c
c
Percentage Depth Dose
(b)Effect of field size and shape

Quick calculation of the equivalent field
parameters: for rectangular fields


For square fields, since a = b,
the side of an equivalent square of a rectangular
field is
) ( 2 b a
b a
P
A
+

=
a
b
4
a
P
A
=
P
A
4
P
A
4
P
A
4
Percentage Depth Dose(3)--(b)Effect of field size
and shape

Equivalent circle has the same area as the
equivalent square
P
A
r =
t
4
a
b
P
A
4
P
A
4
r
Equivalent square field
Distance, Depth, Scatter
Distance
From source to point
of calculation
Depth
Within attenuating
media
Scatter
From phantom and
treatment-unit head
Inverse Square Law
The intensity of the radiation is inversely
proportional to the square of the distance.
X
1
D
1
2
= X
2
D
2
2

Source to Skin Distance
SSD=80cm
Percentage Depth Dose
(c) dependence on SSD
Photon fluence emitted by a point source of
radiation varies inversely as a square of the distance
from the source
The actual dose rate at a point decreases with
increase in distance from the source, the percent
depth dose, which is a relative dose, increases with
SSD
Mayneord F factor
S (source)
d
D
d

D
max
d
max
SSD
1
= f
1
S (source)
d
D
d

D
max
d
max
SSD
2
= f
2
r
d
r
d
PDD - Dependence on Source-Surface
Distance
Dose rate in free space from a point source varies
inversely as the square of the distance. (IVSL)
scattering material in the beam may cause deviation
from the inverse square law.
PDD increases with SSD
IVSL
dm
d
d
dm
SSD
SSD
Fig. 9.5 Plot of relative dose rate as inverse square law function
of distance from a point source. Reference distance = 80 cm
Percentage Depth Dose
(c) dependence on SSD
F1+dm
F2+dm
F1+d
F2+d
100
max
=
D
D
P
d
PDD: Distance, Depth, Scatter
Note in mathematical description of PDD
Inverse-square (distance) factor
Dependence on SSD
Attenuation (depth) factor
Scatter (field-size) factor
=
s
d d
m
K e
d f
d f
f r d P
m
. . 100 ) , , (
) (
2
1
1
1

|
|
.
|

\
|
+
+
=

s
d d
m
K e
d f
d f
f r d P
m
. . 100 ) , , (
) (
2
2
2
2

|
|
.
|

\
|
+
+
=

2
2
1
2
1
2
1
2
) , , (
) , , (
|
|
.
|

\
|
+
+

|
|
.
|

\
|
+
+
=
d f
d f
d f
d f
f r d P
f r d P
m
m
d
d
m

f
1
r
d
d
m

r
f
2
f2
d
d
m

d
d
m

f1
r
r
PDD increases with SSD
the Mayneord F Factor ( without considering changes in
scattering )
2
2
1
2
1
2
|
|
.
|

\
|
+
+

|
|
.
|

\
|
+
+
=
d f
d f
d f
d f
F
m
m
Mayneord F factor
( )
( )
( )
( )
1
2
2
2
1
2
max
1
max 2
PDD
PDD
d f
d f
d f
d f
F =
|
|
.
|

\
|
+
+
|
|
.
|

\
|
+
+
=
f
1
f
2
d
max
d F
100 105 1.5 10 1.0071
100 110 1.5 10 1.0140
100 120 1.5 10 1.026
100 110 1.5 20 1.028
If f
2
> f
1
F >1; If f
1
>f
2
F<1
Therefore for extended SSDs PDD increase
Mayneord F Factor
The inverse-square term within the PDD
PDD is a function of distance (SSD + depth)
PDDs at given depths and distances (SSD) can be corrected to
produce approximate PDDs at the same depth but at other
distances by applying the Mayneord F factor
Divide out the previous inverse-square term (for SSD
1
), multiply in
the new inverse-square term (for SSD
2
)
PDD - Dependence on Source-Surface Distance
PDD increases with SSD
Problem
The PDD for a 1010 field size, 8-cm depth, and
100-cm SSD is 65.3 (6 MV Beam).
Find the PDD for the same field size and depth for a
120-cm SSD
Assuming d
m
=1.5-cm for (6 MV x-rays).
Comment on your results
Percentage Depth Dose
(c) dependence on SSD

Under extreme conditions such as lower energy, large
field (the proportion of scattered radiation is relatively
greater), large depth, and large SSD, the Mayneord (F)
factor is significant errors

In general, the Mayneord F factor overestimates the
increase in PDD with increase in SSD
PDD - Dependence on Source-Surface Distance
PDD increases with SSD
the Mayneord F Factor
works reasonably well for small fields since the
scattering is minimal under these conditions.
However, the method can give rise to
significant errors under extreme conditions
such as lower energy, large field, large depth,
and large SSD change.

PDD Summary
Energy- Increases with Energy
Field Size- Increases with field size
Depth- Decreases with Depth
SSD- Increases with SSD
Measured in water along central axis
Effective field size used for looking up value


Calculations
SSD setupwhat is the
dose?
Use PDD
PDD = 100 at d
max
Prescription is written to
a depth d other than d
max
more dose will be given
at D max
Dose at depth, called
tumor dose (TD)
S (source)
d
D
d

D
max
d
max
SSD
1
= f
1
PDD Calculation
Given dose (dose at d
max
) =

X 100
PDD (d, s, SSD) use table in book
d = depth
S = equivalent square f.s.
SSD = the setup distance
Example:
PDD (5, 10, 80) = 78.3%
Dose and the PDD is a direct relationship
Dose at point A = Dose at point B
PDD at point A PDD at point B
PDD Problem
Given dose = TD x 100
PDD
TD = tumor dose
Given dose also called Applied dose
Given dose referring to dose at d
max

TD will be < given dose (dose at d
max
) in a single field
because TD will be at a depth > d
max
PDD Problem
Example problem
PA Spine, where the Dr prescribes to spinal
cord
A patient is treated on the Cobalt 60 at 80 cm
SSD. Prescription is written to give 30 Gy in 3
Gy fxs to a depth of 5 cm with a 10 X 10 f.s.
What is the given or applied dose (dose at d
max
)?
[PDD(5,10,80,Co) = 78.3 %
Given dose= 3 Gy X 100
78.3
Given dose = 3.83 Gy
Another PDD Problem
What is the TD?
A patient is to be treated using a 6 MV linear
accelerator, at 100 cm SSD. The F.S. is 15 X 15.
3 Gy per fx to be given to d
max
. What is the dose at
a depth of 5 cm? [PDD(5,15,100,6) = 87.3]
TD = Given dose X PDD (5, 15, 100)
100
= 3 Gy X 87.9
100
= 2.64 Gy
SAD
Source to
Axis
Distance
SSD
Source to
Surface
Distance
ISOCENTER
Intersection of
Central ray and
Rotation axis
Of machine
Central Ray
Source to
Isocenter
Source
S (Source)
Primary collimator
Secondary Collimators
( X and Y Jaws and MLCs)
Flattening filter
Ion Chamber
Isocenter
Field Size (r
d
)
Beam Modifier (tray, block, wedge)
(beam modifiers change dose rate
Due to beam attenuation)
Tissue-Air ratio
The ratio of the dose ( D
d
) at a given point in the
phantom to the dose in free space ( D
f s
)
TAR depends on depth d and field size r
d
at the depth:
fs
d
d
D
D
r d TAR = ) , (
d
D
d

r
d

D
f s

r
d

phantom
Equilibrium mass
Tissue Air Ratio
Field Size(S)=AB
TAR
(s,d,Q)=
D
d
/D
air

Tissue-Air ratio
( a ) Effect of Distance
Independent of the distance from the source
(SSD)
The TAR represents modification of the dose
at a point owing only to attenuation and
scattering of the beam in the phantom
compared with the dose at the same point in
the mini phantom ( or equilibrium phantom )
placed in free air
Variation of TAR with depth
TAR Vs Depth
0
0.2
0.4
0.6
0.8
1
1.2
0 5 10 15 20 25 30 35
Depth in cm
T
A
R
TAR
Tissue-Air ratio
( b ) Variation with energy, depth, and field size
For the megavoltage beams, the TAR builds
up to a maximum at the d
m
and then
decreases with depth
As the field size is increased, the scattered
component of the dose increases and the
variation of TAR with depth becomes more
complex
Variation of TAR with field size
TAR Vs Field size
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 10 20 30 40 50 60
Side of the square field (cm)
T
A
R
TAR is independent on SSD
TAR does not depend on SSD - Why?

Ans: The distance between the Source to the
detector is not altered between measurements and
hence no inverse square law influence
TARs - Points to Remember
Field Size is defined at SAD
TAR is the ratio of phantom dose to dose in air at D
max
Independent of SSD
Depends on beam quality and depth
Value is 1.00 at depth of d
max
for FS --> 0
Position of the detector not altered between
measurements
Increase the depth by adding more water above the
point
TAR Dependencies
Varies with energy like the pdd-increases with
energy.
Varies with field size like pdd- increases with
field size.
Varies with depth like pdd- decreases with
dept.
Assumed to be independent of SSD
Backscatter factor (BSF)
Backscatter factor (BSF) depends only on the beam
quality and field size




( )
fs
dm m
D
D
r d TAR BSF
max
, = =
Backscatter factor (BSF) or Peak scatter
factor (PSF)
Backscatter
factor (BSF)
depends only
on the beam
quality and
field size


( )
fs
dm m
D
D
r d TAR BSF
max
, = =
The PSF (BSF)
The PSF (or BSF) is a special
case of the TAR when dose in
air is compared to dose at the
depth (d
max
) of maximum dose
At this point the dose is
maximum (peak) since the
contribution of scatter is not
offset by attenuation
The term BSF applies strictly
to situations where the depth of
d
max
occurs at the surface of
the phantom or patient (i.e. kV
x rays)
The meaning of Backscatter factor
For example, BSF for a 10x10 cm field for
60
Co is 1.036 means that d
max
will be 3.6%
higher than the dose in free space

This increase in dose is the result of radiation
scatter reaching the point of d
max
from the
overlying and underlying tissues
036 . 1
max
=
fs
D
D
Variation of backscatter factors with beam quality as a
function of field size
As the beam energy is increased, the scatter is further
reduced and so is the backscatter factor
Backscatter

PSF
PSF (BSF)
increases with field size, its maximum value
occurs for beams having a half-value layer
between 0.6 and 0.8 mm Cu, depending on
field size.
Thus, for the orthovoltage beams with usual
filtration, the backscatter factor can be as
high as 1.5 for large field sizes
PSF (BSF)
For megavoltage beams (Co-60 and higher
energies), the backscatter factor is much smaller.
BSF for a 10 x 10-cm field for Co-60 is 1.036. This
means that the D
max
, will be 3.6% higher than the
dose in free space
Above about 8 MV, the scatter at the depth of D
max
,
becomes negligibly small and the backscatter
factor approaches its minimum value of unity



PSF or BSF
Points to Remember
BSF(Back scatter factor) is an older term
than PSF, used for lower energies
PSF or BSF is actually a TAR value for
a depth of d
max

Useful for conversion of dose in air to
dose in tissue and vise versa
Relationship between TAR and PDD
Relationship between TAR and PDD
Conversion of Percent Depth Dose from One SSD to
Another-the TAR Method
Approximate Relationships:
PDD / TAR / BSF / TMR
Tissue Phantom Ratio
TPR(S,Q,d) = D
d
/ D
ref

Field Size(S)=AB
Tissue Maximum Ratio
TMR(S,Q,d) = D
d
/ D
max

Field Size(S)=AB
TMR Vs Depth
TMR Vs Depth
0
0.2
0.4
0.6
0.8
1
1.2
0 5 10 15 20 25 30 35
Depth in cm
T
M
R
Variation of TMR with Field Size
TMR Vs Field Size
0.72
0.74
0.76
0.78
0.8
0.82
0.84
0.86
0 10 20 30 40 50
Side of squre field (cm)
T
M
R
TPRs and TMRs
Points to Remember
Field size defined at SAD
Increases with beam quality and field size
Cousins of TAR, but with calibration in
phantom
TPR (or TMR) value is 1.00 at d
ref
for all field
sizes
TMR is a special case of TPR where reference
depth is d
max
depth i.e d
ref
= d
max

Example
A patient is to be treated with an orthovoltage beam
having a half-value layer of 3 mm Cu. Supposing that the
machine is calibrated in terms of exposure rate in air,
find the time required to deliver 200 cGy (rad) at 5 cm
depth, given the following data: exposure rate = 100
R/min at 50 cm, field size = 8 x 8 cm, SSD = 50 cm,
percent depth dose = 64.8, backscatter factor = 1.20, and
rad/R = 0.95
A patient is to be treated with Co-60 radiation. Supposing
that the machine is calibrated in air in terms of dose rate
free space, find the treatment time to deliver 200 cGy (rad)
at a depth of 8 cm, given the following data: dose rate free
space = 150 cGy/min at 80.5 cm for a field size of 10 x 10
cm, SSD = 80 cm, percent depth dose = 64.1, and
backscatter factor = 1.036

Determine the time required to deliver 200 cGy (rad) with a
Co-60 ray beam at the isocenter which is placed at a 10 cm
depth in a patient, given the following data: SAD = 80 cm,
field size = 6 x 12 cm (at the isocenter), dose rate free space at
the SAD for this field = 120 cGy/min and TAR = 0.68 1
The depth dose for a 6 MV beam at 10 cm
depth for a 10 x 10 field; 100 cm SSD is
0.668. What is the percent depth dose if
the SSD is 120 cm.
F=((120 +1.5)/(100+1.5))
2
x((100
+10)/(120 +10))
2

F= 1.026
PDD at 120 SSD = 1.026 x 0.668 = 0.685
What is the given dose if the dose prescribed
is 200 cGy to a depth of 10 cm. 6X, 10 x 10
field, 100 cm SSD.

PDD at 10 cm for 10 x 10 is 0.668.
Given Dose is 200/0.668 = 299.4 cGy
A single anterior 6MV beam is used to deliver 200
cGy to a depth of 5cm. What is the dose to the cord
if it lies 12 cm from the anterior surface. Patient is
set-up 100 ssd with a 10 x 15 field.

Equivalent square for 10 x 15 = 12cm
2

PDD for 12 x 12 field at 5cm =.866
PDD for 12 x 12 field at 12 cm = .608
Dose to cord = 200/.866 x .608 = 140.4 cGy
A patient is treated with parallel opposed fields to
midplane. The patient is treated with 6 MV and has a
lateral neck thickness of 12cm. The field size used is 6 x 6.
The prescription is 200 cGy to midplane. What is the dose
per fraction to a node located 3 cm from the right side.
The patient is set-up 100 cm SSD.

PDD at 6cm=0.810; PDD at 9cm=.686 ; PDD at 3 cm=
0.945
Dose to node from right= (100/.810) x 0.945 =116.7 cGy
Dose to node from left = (100/.810) x .686 = 84.7 cGy
Total dose = 116.7 + 84.7 = 201.4 cGy
A patient is treated with a single anterior field. Field
Size is 8 x 14. Patient is set-up 100 cm SAD.
Prescription is 200 cGy to a depth of 6cm. A 6 MV
beam is used for treatment. What is the dose to a node
that is 3 cm deep? Assume field size is at isocenter.

Equivalent square of field is 10.2 cm
2

TMR at 6cm = .8955
TMR at 3 cm = .9761
Dose to node = (200/.8955) x .9761 x (100/97)
2
= 231.7
cGy


A patient is treated with parallel opposed 6 MV fields.
The patients separation is 20 cm. Prescription is to
deliver 300 cGy to Midplane. Field size is 15 x
20.(100cm SAD) What is the dose to the cord on
central axis if the cord lies 6cm from the posterior
surface?

Equivalent square is 17.1
TMR at 10 cm = .8063
TMR at 6 cm = .9088
TMR at 14 cm = .7041
Dose to the Cord from the Anterior
(150/.8063) x (100/104)
2
x .7041 = 121 cGy
Dose to the Cord from the Posterior
(150/.8063) x (100/96)
2
x .9088 = 183 cGy
Total dose to the cord
183 +121 = 304 cGy
Tissue-Air ratio
( d ) calculation of dose in rotation therapy
d=16.6
Scatter-Air Ratio(SAR)
Calculating scattered dose in the medium
The ratio of the scattered dose at a given point in
the phantom to the dose in free space at the
same point
TAR(d,0): the primary component of the beam

) 0 , ( ) , ( ) , ( d TAR r d TAR r d SAR
d d
=
d
D
d

r
d

D
f s

r
d

phantom
Equilibrium mass
Scatter-Air Ratio--Dose calculation in irregular
fields: Clarksons Method




Based on the principle that the scattered component
of the depth dose can be calculated separately from
the primary component
SAR TAR TAR + = ) 0 (
= TAR
= SAR
Average tissue-air ratio
Average scatter-air ratio
TAR ( 0 ) = tissue-air ratio for 0 x 0 field