Integral dose refers to the total amount of dose absorbed by the body when exposed

to radiation. There are many variables in treatment planning that can effect how
dose is distributed within a patient, such as the chosen fbeam angles, collimation,
the use of wedges and beam energy. All of these have an effect on the isodose
distribution and ultimately affect the integral dose the patient receives. For
example, the use of higher beam energies will result in less dose being delivered to
structures near the surface of the patient and also help decrease hotspots within the
treated volume, tighter collimation will result in a smaller field size and ultimately
less dose overall, and the addition of multiple fields will increase the total area of
the body receiving dose, while decreasing the overall hotspot and providing more
uniform dose coverage.
The type of treatment also greatly effects integral dose. An article by Ślosarek and
Osewski et al compared the dose delivered to the planning volume as well as the
integral dose to entire patient body using different treatment methods for prostate
cancer. For this study stereotactic, helical, and intensity modulated radiotherapy
methods were used and it was found that the same amount of dose was deposited to
the treated volume; however, the total doses delivered to the patient’s body differed
significantly.1 Of the methods used, CyberKnife and TomoTherapy delivered the
highest integral dose to the patients while the VMAT method allowed the lowest
integral dose.1 This information could have an impact on which type of treatment
plan we create for a patient. For example, a patient who has a pacemaker near the
treatment volume may require a VMAT plan instead of a Tomotherapy plan at our
facility due to the lower integral dose that can be achieved.

1. Ślosarek K, Osewski W, Grządziel A, et al. Integral dose: comparison between four

techniques for prostate radiotherapy. Rep Pract Oncol Radiother. 2015;20(2):99-
103.