Journal of Radiotherapy in
Practice
cambridge.org/jrp
Original Article
Cite this article: Bencheikh M, Maghnouj A,
Tajmouati J. (2019) Percentage depth dose
fragmentation for investigating and assessing
the photon beam dosimetry quality. Journal
of Radiotherapy in Practice 18: 280–284.
doi: 10.1017/S1460396918000687
Received: 9 August 2018
Revised: 20 October 2018
Accepted: 3 November 2018
First published online: 4 December 2018
Key words:
dosimetry quality; fragmentation; photon
beam energy; quality index; radiotherapy
efficiency
Author for correspondence:
Mohamed Bencheikh, Physics Department,
Faculty of Sciences Dhar El-Mahraz, University of
Sidi Mohamed Ben Abdellah, Fez, 30000,
Morocco. E-mail: bc.mohamed@gmail.com
© Cambridge University Press 2018.
https://doi.org/10.1017/S1460396918000687 Published online by Cambridge University Press
Percentage depth dose fragmentation for
investigating and assessing the photon
beam dosimetry quality
Mohamed Bencheikh, Abdelmajid Maghnouj and Jaouad Tajmouati
LISTA Laboratory, Physics Department, Faculty of Sciences Dhar El-Mahraz, University of Sidi Mohamed Ben
Abdellah, Fez, Morocco
Abstract
Aim: The purpose of this study is to introduce a new approach to assess the dosimetry quality
of photon beam with energy and irradiation field size. This approach is based on percentage
depth dose (PDD) fragmentation for investigating the dosimetry quality. Materials and
methods: For the investigation of the dosimetry quality of 6 and 18 MV photon beams, we
have proceeded to fragment the PDD at different field sizes. This approach checks the overall
PDD and is not restricted to the exponential decay regions, as per the International Atomic
Energy Agency Technical Reports Series No 398 and the American Association of Physicist in
Medicine Task Group 51 recommendations. Results and discussion: The 6 MV photon beam
deposited more energy in the target volume than the 18 MV photon beam. The dose delivered
by the 6 MV beam is greater by a factor of 1·5 than that delivered by the 18 MV beam in the
build-up region and the dose delivered by the 6 MV beam is greater by a factor of 2·6 than
that delivered by the 18 MV beam in the electronic equilibrium and the exponential decay
regions. Conclusion: The dose measured at different points of the beam is higher for 6 MV
than for 18 MV photon beam. Therefore, the 6 MV beam is more dosimetrically efficient than
the 18 MV beam. Using the proposed approach, we can assess the dosimetry quality by taking
into account overall PDD not only in the exponential decay region but also in the field.
Introduction
Periodically checking the beam quality is an integral part of quality assurance management in
a radiotherapy department.1,2 The use of an appropriate quality control (QC) methods to
adequately assess the photon beam quality can be a challenge for medical physicists, because to
verify the dosimetry quality the procedure that has been followed must be as accurate as
possible. On some occasions, after assessing the beam quality, minor calibrations can be made
without introducing any functioning perturbation of the Linac head.3 The required QC
programmes have been published by different international or national authorities that
recommend a fixed period of time in checking the dosimetry output quality based on absorbed
dose measurements for the Linac head calibration. The International Atomic Energy Agency
(IAEA) and the American Association of Physicist in Medicine (AAPM) recommend assessing
the beam quality using the percentage depth dose (PDD) parameter.4,5
With reference to PDD, both the international bodies recommend not assessing the beam
quality before the depth of 10 cm, whatever be the photon beam energy, in order to avoid
measuring electron contamination even though this is an integral part of the incident photon
beam. The beam quality index is an essential parameter used in beam quality assessment in
radiotherapy treatment, but it should be considered in overall PDD variation.6 Earlier, Otto
had worked on the determination of a quality index for photon beams of arbitrary field sizes in
treatments where the reference calibration conditions could not be met; however, the accuracy
of this index was not rigorously checked.7
This study aims to find a new approach for the investigation and evaluation of dosimetry
quality of the incident photon beam based on PDD sub-divisions or PDD fragmentation by
examining all the dosimetric properties of PDD sub-regions. This new approach allows to
check the beam dosimetric quality at any depth and of any field size by including all dosi-
metric particularities of all PDD sub-regions starting from the skin dose to exit dose. We
consider that it is necessary to include the dosimetry measurements due to electron con-
tamination and region of low photon energy in the beam quality procedure to ensure accuracy
of the treatment. Electron contamination and low photon energy are always present in the
incident photon beam and if not measured, it is considered as a procedural weakness.
This study is performed based on previous work, in which we studied the photon beam
quality and the impact of particle contamination on beam quality, when the flattening filter is
removed from the Linac head.8–10 For any new Linac technological development, the
 Journal of Radiotherapy in Practice 281

evaluation procedure of the beam quality should be reviewed in
order to assure a high degree of accuracy in dosimetry evaluation.
Materials and Methods
The dosimetry quality assessment is crucial to ensure radio-
therapy quality and accuracy. The IAEA TRS 398 recommends
assessing the beam quality index using tissue phantom ratio
(TPR) as a quotient of PDD at a depth of 20 cm to 10 cm for field
size of 10 × 10 cm2. However, the AAPM Task Group 51
recommends assessing the beam quality as per PDD at a depth of
10 cm by using a lead slab at the exit window of Linac head of
thickness x which varied with photon beam energy to remove
electron contamination.4,5
These protocols allow the evaluation of the beam quality at a
depth of 10 cm whatever be the photon beam energy and aim to
avoid electron contamination and low photon energy. This
avoidance can have negative impact on the accuracy if there is an
abnormal functioning of a beam modifier in the Linac head. In
fact, electron contamination and low photon beam energy are an
integral part of the photon beam and are always present in the
incident beam.
Measurements of PDD
In this study, dose measurements are measured for two photon
beam energies, 6 and 18 MV, produced by Varian Clinac 2100
(Varian, Palo Alto, CA, USA). These beam energies are more
commonly used in clinical practice. The measurements were
performed in a water phantom of volume 40 × 40 × 40 cm3, as
recommended by the Swiss Society of Radiobiology and Medical
Physics (SSRMP).11
The PTW 30013 chamber (Physikalisch Technische Werk-
stätten (PTW) Freiburg, Germany) was used for the PDD mea-
surements of both 6 and 18 MV photon beams. MEPHYSTO
software (PTW, Freiburg, Germany) was used to drive the ion
chamber for data acquisition at increments of 2·5 mm in depth.
All PDD measurements were carried out under conditions of
temperature of 20°C and the pressure of 101·3 Pa and humidity of
50%. The uncertainty of PDD measurements was found to be
<2% and this included all the uncertainties of experimentation
and the uncertainty of the measurements of the devices used.
According to IAEA TRS 389, the PDD measurements are
measures and the PDD curve is formed by three regions: build-up
dose region, electronic equilibrium region and exponential decay
region. Figure 1 illustrates the PDD sub-regions of 6 MV photon
beam for field size of 10 × 10 cm2.
To demonstrate the PDD dependence on beam energy,
Figure 2 gives the PDD variation in two photon beam energies of
6 and 18 MV for field size of 10 × 10 cm2.
It is obvious from Figure 2 that PDD varies with photon beam
energy for the same irradiation field size. The depth of maximum
dose of 6 MV photon beam is at 1·5 cm and the depth of max-
imum dose of 18 MV photon beam is at 3 cm.
PDD fragmentation
The PDD fragmentation is aimed to investigate the dosimetric
particularities in each PDD fragment of the PDD curve from the
skin dose (depth = 0 mm) to exit dose (depth = 300 mm). This
approach included the dosimetric properties of all PDD sub-
regions and it was not restricted to the dosimetric properties of
one sub-region of the exponential decay region, as recommended
by IAEA TRS 398 and AAPM TG 51. To accurately investigate
the overall dosimetric properties of the PDD, the PDD curve was
sub-divided into seven sub-regions. In agreement with TRS 398,
the PDD sub-region was measured from 10 to 20 cm. Table 1
presents the depth intervals of seven PDD sub-regions for both
photon beam energies, 6 and 18 MV.
We have introduced an investigation parameter Q based on
the PDD method that was used in earlier studies.12,13 The PDD
method is expressed as an empirical formula relating the TPR and
PDD as follows:
TPR20;10 = 1:2661; PDD20;10 = 0:0595 (1)
where,
PDD20
PDD20;10 = (2)
PDD10
In Equation (2) we have generalised for seven PDD sub-
regions instead of one region as required in TRS 398, where the
bordering depths are 20 cm and 10 cm. Equation (3) calculates the
investigation parameter Q using the formula:
PDDd2
Qd2 ;d1 = (3)
PDDd1
where d1 and d2 are the depths bordering the PDD sub-regions
and d1 < d2.
After determining the parameter Q for each PDD sub-region,
normalisation of Q is introduced to standardise the parameter
variation with each photon beam energy and to conceal the
dependence on the beam energy. The normalised Q is symbolised
by Q and it is defined as a quotient of Q of each PDD sub-region
to Q of overall PDD. The Q is expressed in Equation (4) as

120 6 MV 18 MV
120
Build-up region
100
100

80 80
PDD (%)

PDD (%°)

Exponentiel decay region

60 60

40 40

20 Electronic equilibrium region 20

0 0
0 50 100 150 200 250 300 350 0 50 100 150 200 250 300 350
Depth d (mm) Depth (mm)

Figure 1. PDD variation as a function of depth for 6 MV photon beam. Figure 2. PDD variation as a function of depth for two photon beam energies.

https://doi.org/10.1017/S1460396918000687 Published online by Cambridge University Press

 282 Mohamed Bencheikh et al.

follows: Figure 3 shows Q variation as a function of irradiation field

size in two sub-regions of the build-up dose region.
Qd2 ;d1 From Figure 3, the normalised Q is above 1 for both photon
Q= (4)
Q0;300 beam energies of 6 and 18 MV. It means that the photon beam
delivers the majority of its energy in the build-up dose region. So,
where Qd2 ;d1 for a PDD sub-region ranges from d1 to d2; Q0;300 is in case A, the Q value decreased rapidly with field size, whereas in
the overall PDD curve. case B, the Q value decreased slowly with field size.
Here we have demonstrated that the build-up dose varies with
beam energy and field size. The photons of the lower energy
Results and Discussion (6 MV) deposit more energy in this region than the photons of a
Build-up dose quality analysis high energy (18 MV). This dependence on photon beam energy
should be included in the evaluation procedure of the beam
The build-up dose region ranges from 0 mm to depth of max- quality.
imum dose. In this region, the PDD is fragmented into two sub-
regions, as shown in Table 1; therefore, the dosimetry quality is Electronic equilibrium quality analysis
investigated by calculation of Q on two depth intervals A and B
(Table 1). The electronic equilibrium region ranges on bordering regions of
maximum dose. Figure 4 shows the variation in Q in the elec-
Table 1. Depth intervals of each PDD sub-region tronic equilibrium region as a function of field size for photon
beam energies of 6 and 18 MV.
Photon beam PDD region in the TRS Depths bordering the PDD sub-
It can be observed from Figure 4 that in the electronic equi-
energy 398 region
librium region, the Q decreased slightly in field size for 6 MV
6 MV Build-up of dose A: d1 = 0 mm and d2 = 15 mm photon beam for small field but it is approximately constant for
B: d1 = 5 mm and d2 = 15 mm field size greater than 12 × 12 cm2, but the Q value increased with
Electronic equilibrium A: d1 = 12·5 mm and field size for 18 MV photon beam (Figure 4). These discrepancies
d2 = 17·5 mm can be used as a basis to assess the photon beam quality in the
B: d1 = 10 mm and d2 = 20 mm electronic equilibrium region. Again, the dosimetry quality has
shown that it varied with photon beam energy and also with field
Exponential decay A: d1 = 50 mm and d2 = 100 mm
B: d1 = 100 mm and size. It varied from one sub-region of PDD to another (Figures 3
d2 = 200 mm and 4).
C: d1 = 200 mm and
d2 = 300 mm
Exponential decay quality analysis
Overall PDD d1 = 0 mm and d2 = 300 mm
The exponential decay region ranges from depth of maximum
18 MV Build-up of dose A: d1 = 0 mm and d2 = 30 mm dose to exit dose (depth of 300 mm). It is characterised by
B: d1 = 10 mm and d2 = 30 mm exponential photon beam attenuation with depth. The beam
quality index is calculated on this PDD sub-region as recom-
Electronic equilibrium A: d1 = 25 mm and d2 = 35 mm
B: d1 = 22·5 mm and mended by IAEA TRS 398 protocol.12 In our study, we have
d2 = 37·5 mm determined the parameter Q for three sub-regions in the expo-
nential decay region.
Exponential decay A: d1 = 50 mm and d2 = 100 mm To understand the dosimetric properties in the exponential
B: d1 = 100 mm and
d2 = 200 mm decay region with field size and the overall PDD for both photon
C: d1 = 200 mm and beam energies 6 and 18 MV, the parameter Q is determined for
d2 = 300 mm three sub-regions of the PDD.
Figure 5 presents the Q variation in the exponential decay
Overall PDD d1 = 0 mm and d2 = 300 mm
region with field size.

(a) 6 MV 18 MV (b) 6 MV 18 MV
3.5
Normalized investigation parameter

6
Normalized investigation parameter

3
5
2.5
4
2
3
1.5
2
1
1 0.5

0 0
0 10 20 30 0 10 20 30
Side of square field (cm) Side of square field (cm)
Figure 3. Q variation for build-up dose region as a function of field size.

https://doi.org/10.1017/S1460396918000687 Published online by Cambridge University Press

 Journal of Radiotherapy in Practice 283

(a) 6 MV 18 MV (b) 6 MV 18 MV
3 3

Normalized investigation parameter

Normalized investigation parameter

2.5 2.5

2 2

1.5 1.5

1 1

0.5 0.5

0 0
0 10 20 30 0 10 20 30
Side of square field (cm) Side of square field (cm)
Figure 4. Q variation for electronic equilibrium region as a function of field size.

(a) 6 MV 18 MV
(b) 6 MV 18 MV
1.8
1.8

Normalized investigation parameter

Normalized investigation parameter

1.6
1.6
1.4 1.4

1.2 1.2

1 1
0.8 0.8
0.6 0.6
0.4 0.4
0.2 0.2
0 0
0 10 20 30 0 10 20 30
Side of square field (cm) Side of square field (cm)

(c) 6 MV 18 MV
2.5
Normalized investigation parameter

1.5

0.5

0
0 5 10 15 20 25 30
Side of square field (cm)
Figure 5. Q variation for exponential decay region as a function of field size.

It can be seen from Figure 5, the dosimetry quality varied with and at any sub-regions of exponential decay region. For example,
depth in the exponential decay region and is not limited to middle the 6 MV photon beam has Q value >1 and the 18 MV photon
regions, as recommended by IAEA TRS 398 protocol. Q is located beam has Q < 1 (Figures 5a–5c).
above to 1 for 6 MV and below 1 for 18 MV.
As a generalisation of our approach, for a photon beam with
energy <6 MV, we found a Q value >1 and for a beam with an
Conclusion
energy >18 MV, the Q value is <1 in the overall exponential
decay region for field size less than 15 × 15 cm2. However, IAEA The findings of this work are based on an experimental study of
TRS 398 and AAPM TG 51 limit the beam quality determination beam quality by introducing a new approach based on frag-
on field size of 10 × 10 cm2.12 On the basis of these results, we mentation of PDD curves into seven sub-regions. On the basis of
were able to make a distinction between photon beams used in the proposed approach, we can assess the dosimetry quality by
radiotherapy treatment at any field size smaller than 15 × 15 cm2 taking into account overall PDD not only in the exponential

https://doi.org/10.1017/S1460396918000687 Published online by Cambridge University Press

 284
decay region but also in the field. This new approach of the beam
quality assessment is more accurate than in current calibration
methods as recommended by the IAEA and AAPM.10
According to this new approach, the 6 MV photon beam is
more dosimetric efficient than an 18 MV photon beam.
Acknowledgements. The authors would like to thank Varian Medical Sys-
tems who provided us with the Varian Clinac 2100 dosimetry data and
afforded the opportunity to study the Varian linear accelerator technology and
to contribute to its future development.
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