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TMR, TPR, TAR, and PDD are all methods used to perform dose calculations in various clinical

situations. According to Khan and Gibbons,1 percent depth dose (PDD) and tissue-air ratio
(TAR) were traditionally used for dose calculations involving low energy beams (up to 60Co)
typically calibrated in terms of exposure rate in air or dose rate in free space. A PDD calculation
would be performed to determine how much dose would be delivered at a depth relative to
Dmax. In PDD calculations, SSD must be the same. The formula for PDD is:
P = Percent Depth Dose
Dd= Absorbed dose at any depth P= (Dd/Ddo) x 100%
Ddo = Absorbed dose at a reference depth (dmax)

The TAR method was introduced to eliminate the dependence on SSD. This was especially
important with rotational therapy calculations where the SSD is constantly changing. TAR
calculations are dependent upon the source to axis distance (SAD), which remains constant.
TAR is defined as the ratio of dose (Dd) at a given point in the phantom to the dose in free space
(Dfs) at the same point and is dependent upon depth, and field size at that depth.1 The formula for
TAR is:
Dd = dose at a given point in a phantom
Dfs = dose in free space at the same point TAR(d,rd) = Dd/Dfs
d= depth
rd = field size at that depth

Tissue phantom ratio (TPR) and tissue maximum ratio (TMR) are more current methods of dose
calculation that involve measurement in a phantom, which is better suited for higher-energy
beams.1 TPR is used instead of TAR in high energy beams because it eliminates the unreliability
of in-air measurements and is depicted with the following formula: TPR = dose in tissue/dose in
phantom (reference depth).2 TMR is similar; however, the reference dose in the phantom is at
Dmax which is represented by: TMR = dose in tissue/dose in phantom (Dmax). The TMR
method also works well for isocentric techniques because, like TAR, it is SSD independent and
only requires a fixed source to calculation point distance.3

The facility where I am doing my clinical training uses TMR for the majority of all calculations
performed. This is because TMR calculations can be used for a fixed SAD setups, is
independent of the variances in SSD for a given treatment, and the calculation method involves
measurement in a water phantom, which more closely resembles the radiation absorption and
scattering properties of muscle and other soft tissues.1 Additionally, PDD is used for calculations
when it is necessary to deliver a treatment at an extended distance. This is most common when
treating long field sizes at our clinic and the field size cannot be achieved at a normal distance.

1. Khan FM. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2014. ISBN: 978-1451182453.
2. Abing C. Introduction to Dose Calculations. [SoftChalk]. La Crosse, WI: UW-L Medical
Dosimetry Program; 2018.
3. Smith J. Medical Dosimetry Concepts Calibration and Calculations. [SoftChalk]. La Crosse,
WI: UW-L Medical Dosimetry Program; 2018.