Lecture #9 SAR Calculations

SAR: Scatter Air Ratio (aka Clarkson Scatter Technique. Jack Cunningham)

3 components of radiation beam:
primary (unattenuated)
scatter off collimators
scatter from inside phantom / patient

SAR: Can we somehow take away the primary and figure out what the scatter is? Then figure
out Primary + scatter = total.
TAR
0
+ SAR = TAR.

Measuring %dd, we use square fields. In clinic--we use rectangles. How to fit with square field
data? Effective Area.
How to fit blocked fields? Same--forced some relationship to fit it to square data. This really
runs into problems when we have a mantle in Hodgkins. Nodes in neck, axilla, superclav,
mediastinum, diaphraghm. We want to block the lungs.

splash, flash, or Spilloff = name we call the flash of a radiation field off the body
part. There is no scatter medium there--consider it to be blocked. Highly irregular
field. Physician wants to know dose at central ray and the nodes = multi-unknown problem.

In most treatment planning computers you see 3-d, brachytherapy, and Irregular field (what we
are talking about).

suppose TAR
0
= 0.469 and SAR
avg
= 0.15...
TAR = 0.619

time = 228 to give 100rad to the central ray of the field.

Not done yet... Have to do that on the other side. Turn the film over--do the PA. (difference in
depth) But now physician wants to know the dose to the mid-plain axilla. Draw the radii from
the axilla. Depth will probably change as well... Take that point, look up the radii, do the same
summation, use depth at axilla point for TAR
0
.

Now:
Tumor Dose @ axilla = TDR(axilla) * time
Tumor Dose @ Axilla = TDR(axilla) time

We know time = 228.
TDR(axilla)=(output@80.5cm)(decay)(transmission)(TAR)(80.5/(SSDaxilla+depth)2(OCR)
92rad

OCR accounts for fact that off-axis point is not at central ray--look at beam profile

Corrects output for being off-axis. But REMEMBER, we want axilla dose BOTH front and
back (double the work). If the physician wants you to calculate the Add on the super-clav
dose. 3cm from front, from back = thickness - 3cm. Cervical nodes too. Diaphragm
nodes. Mediastinal nodes = 12 calculations using SAR--a long time by hand. In early to mid-
80s--did this calculation by hand.

Johns & Cunningham came up with new algorithm. You just trace in the field, and they do the
calculations for you. Had to digitize a film or drawing of the correct distance. Really made the
time less.

What is TAR
0
? It kind of has no physics. How can we make the connection b/w a 0x0 field size
and measure it experimentally. If you have a water tank & chamber and continually decrease
field size = you would get nothing on your chamber.

Two methods to measure TAR
0
. Remember extrapolation chamber.

poor approach to find TAR
0
since 4x4 is our smallest field size...
Get a family of curves for every depth. (note, deeper means smaller TAR).

Method #2: Johns & Cunningham experiment

HVL experiments assumptions:
Small field size: Large distance b/w source & absorber and absorber & chamber = good
geometry. Do small field size (e.g. 2x2). Move chamber down to the floor. Put in water
absorber, come up with HVL for water.


Actually get a linear measurement even on linear-linear plot.. plotting relative chamber readings
against depth (change the depth of the water).

Draw radii. Label each one--look up in SAR table. Along left hand side--treatment depth. For
different radii and treatment depth, we have different SAR values.

Central ray:
TD = 100 rads
depth = 12cm
32 x 32 collimator size
SSD = 80cm
Treat over 2 week period

Look up 32x32 collimator -- guess ~90rad/min (didnt look that up)
decay: 17 + 7 = 24 days = 0.9914
Time = TD / TDR = 100 rads/(Output @
80.5cm)(decay)(transmission)(TAR)(80.5/(SSD+depth))
2

TDTDR=100rads(Output@80.5cm)(decay)(transmission)(TAR)(80.5(SSD+depth))2

TDTDR=100rads(90rad/min)(0.9914)(0.96)(TAR)(80.5(80+12))2

Need to look up SAR for each radii -- ~ 12 times. Sum of all the SARs / number of radii =
average SAR. Now we have TAR = TAR
0
+ SAR
avg
. Now we need to know TAR
0
. This is the
primary component of the radiation beam (contains no scatter). Left most column of SAR table =
0x0 field size = theoretically no scatter. That number is function of the energy and the
depth. TAR
0
= 0.469.

Now we can find
TAR = TAR
0
+ SAR
a


Need to know field size and field radii @ depth! The depth is at SSD + 12 (92cm). Have to
either have the drawing at 92cm or convert it to that. Suppose drawing taken at 80. r
1
=
16cm. The actual radii you look up on the table is 16cm * 92/80. Nobody has a drawing that you
can just measure off the radii. You always need to do the ratio.

Cant look up average radius and then look up SAR. Have to do every radius.

Throw a little difficulty:

Try to find total scatter from a ray that goes through a block