Fundamental Dosimetry

Quantities and Concepts:

Review
Introduction to Medical Physics III:
Therapy
Steve Kirsner, MS
Department of Radiation Physics

Some Definitions

SSD
SAD
Isocenter
Transverse (CrossPlane)
Radial (In-plane)
Sagittal
Coronal
Axial
Supine
Prone

Cranial
Caudal
Medial
Lateral
AP/PA
Rt. & Lt. Lateral
Superior
Inferior
RAO/RPO/LAO/LPO

Fundamentals

Review of Concepts

Distance, depth, scatter effects

Review of Quantities

PDD, TMR, TAR, PSF

(definition/dependencies)
Scatter factors
Transmission factors
Off-axis factors

Distance, Depth, Scatter

Distance

Depth

From source to
point of calculation
Within attenuating
media

Scatter

From phantom and

treatment-unit head

Distance, Depth, Scatter

Scatter Concepts

Contribution of scatter
to dose at a point

Amount of scatter is
proportional to size and
shape of field (radius).
increase with increase
in length
Think of total scatter as
weighted average of
contributions from field
radii. SAR, SMR

Equivalent Square

The equivalent
square of a given
field is the size of the
square field that
produces the same
amount of scatter as
the given field, same
dosimetric properties.

Normally represented
by the side of the
equivalent square
Note that each point
within the field may
have a different
equivalent square

Effective Field Size

The effective field size

is that size field that
best represents the
irregular-fields scatter
conditions
It is often assumed to be
the best rectangular fit
to an irregularly-shaped
field
These are only estimates
In small fields or in
highly irregular fields it
is best to perform a
scatter integration

Effective Field Size

Must Account for

flash, such as in
whole brain fields.
Breast fields and
larynx fields.

Blocking and MLCs

It is generally assumed that tertiary blocking

(blocking accomplished by field-shaping
devices beyond the primary collimator jaws)
affects only phantom scatter and not collimator
or head scatter

Examples of tertiary blocking are (Lipowitz metal

alloy) external blocks, and tertiary MLCs such as that
of the Varian accelerator

When external (Lipowitz metal) blocks are supporte by

trays, attenuation of the beam by the tray must be
taken into account

It is also generally assumed that blocking

accomplished by an MLC that replaces a jaw,
such as the Elekta and Siemens MLCs, modifies
both phantom and collimator (head) scatter.

Effective Fields
Asymmetric Field Sizes

Must Account for locaton of Central

axis or calculation point.
There is an effective field even if
there are no blocks.

cax

Calc.
Pt.

Inverse Square Law

The intensity of the radiation is

inversely proportional to the
square of the distance.
X1D12 = X2D22

Percent Depth Dose (PDD)

PDD Notes
Characterize variation
of dose with depth.

Field size is defined

at the surface of the
phantom or patient
The differences in dose
at the two depths, d0
and d, are due to:

Differences in depth
Differences in distance
Differences in field
size at each depth

PDD Dd / Dd 0

PDD: Distance, Depth,

Scatter

Note in mathematical description of PDD

Inverse-square (distance) factor

Dependence on SSD

Attenuation (depth) factor

Scatter (field-size) factor

PDD: Depth and Energy

Dependence

PDD Curves

Note change in depth of dmax

Can characterize PDD by PDD at 10-cm depth

%dd10 of TG-51

PDD: Energy Dependence

Beam Quality effects PDD primarily

through the average attenuation
coefficient. Attenuation coefficient
decreases with increasing energy
therefore beam is more
penetrating.

PDD Build-up Region

Kerma to dose
relationship

Kerma and dose

represent two different
quantities

Kerma is energy
released
Dose is energy
absorbed

Areas under both

curves are equal
Build-up region
produced by forwardscattered electrons
that stop at deeper
depths

PDD: Field Size and Shape

Small field sizes dose due to primary

Increase field size increase scatter
contribution.
Scattering probability decreases with
energy increase. High energies more
forward peaked scatter.
Therefore field size dependence less
pronounced at higher energies.

PDD: Effect of Distance

Effect of inversesquare term on PDD

As distance increases,
relative change in
dose rate decreases
(less steep slope)

This results in an
increase in PDD
(since there is less of
a dose decrease due
to distance),
although the actual
dose rate decreases

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)

SSD 2 d max

SSD 2 d
F

SSD
1 d max

SSD1 d

Mayneord F Factor

Works well small fields-minimal

scatter
Begins to fail for large fields deep
depths due to increase scatter
component.
In general overestimates the
increase in PDD with increasing
SSD.

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

The TAR

The TAR

The ratio of doses at two

points:

Equidistant from the

source
That have equal field sizes
at the points of calculation
Field size is defined at
point of calculation

Relates dose at depth to

dose in air (free space)

Concept of equilibrium
mass

Need for electronic

equilibrium constant
Kerma-to-dose
relationship

TAR Dd / Dfs

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 (dmax) 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 dmax occurs at
the surface of the phantom
or patient (i.e. kV x rays)

The PSF versus Energy as

a function of Field Size

In general, scatter
contribution
decreases as energy
increases
Note:

Scatter can
contribute as much
as 50% to the dose
a dmax in kV beams
The effect at 60Co is
of the order of a
few percent (PSF
60Co 10x10 = 1.035
Increase in dose is
greatest in smaller
fields (note 5x5,
10x10, and 20x20)

TAR Dependencies

Varies with energy like the pddincreases with energy.

Varies with field size like pddincreases with field size.
Varies with depth like pdddecreases with dept.
Assumed to be independent of SSD

The TPR and TMR

Similar to the TAR, the

TPR is the ratio of
doses (Dd and Dt0) at
two points equidistant
from the source

Field sizes are equal

Again field size is defined
at depth of calculation
Only attenuation by
depth differs

The TMR is a special

case of the TPR when t0
equals the depth of dmax

TPR Dd / Dt 0

TPR/TMR Dependencies

Independent of SSD
TMR increases with Energy
TMR increases with field size
TMR decreases with depth

Relationship between fundamental depthdependent quantities

From: ICRU 14

PDD / TAR / BSF Relation

Approximate
Relationships:
PDD / TAR / BSF / TMR

BJR Supplement 17

Limitations of the
application of inversesquare corrections

It is generally believed
that the TAR and TMR are
independent of SSD
This is true within limits

Note the effect of purely

geometric distance
corrections on the
contribution of scatter

Effect of scatter vs.

distance:
TMR vs. field size

The TMR (or TAR or PDD)

for a given depth can be
plotted as a function of
field size

Shown here are TMRs at

1.5, 5.0, 10.0, 15.0,
20.0, 25.0, and 30.0 cm
depths as a function of
field size

Note the lesser increase

in TMR as a function of
field size

This implies that

differences in scatter are
of greater significance in
smaller fields than larger
fields, and at closer
distances to calculation
points than farther
distances

Varian 2107 6 MV X Rays (K&S

Diamond)

Scatter Factors

Scatter factors describe

field-size dependence
of dose at a point

Need to define field

size clearly

Often wise to separate

sources of scatter

Many details
Scatter from the head
of the treatment unit
Scatter from the
phantom or patient

Measurements
complicated by need
for electronic
equilibrium

Kerma to dose, again

Wedge Transmission

Beam intensity is also

affected by the
introduction of beam
attenuators that may be
used modify the beams
shape or intensity

Such attenuators may

be plastic trays used to
support field-shaping
blocks, or physical
wedges used to modify
the beams intensity

The transmission of
radiation through
attenuators is often
field-size and depth
dependent

The
Dynamic
Wedge
Enhanced Dynamic Wedge (EDW)
Wedged dose distributions
can be produced without
physical attenuators

With dynamic wedges, a

wedged dose distribution is
produced by sweeping a
collimator jaw across the
field duration irradiation

The position of the jaw as a

function of beam irradiation
(monitor-unit setting) is
given the wedges
segmented treatment table
(STT)

The STT relates jaw position

to fraction of total monitorunit setting

The determination of
dynamic wedge factors is
relatively complex

Gibbons

Off-Axis Quantities

To a large degree,
quantities and concepts
discussed up to this point
have addressed dose
along the central axis of
the beam
It is necessary to
characterize beam
intensity off-axis

Two equivalent quantities

are used

Off-Axis Factors (OAF)

Off-Center Ratios (OCR)

These two quantities are

equivalent

OAF ( x, d ) Dd , x / Dd ,0
where x = distance offaxis

Off-Axis Factors:
Measured Profiles

Off-axis factors are extracted from measured profiles

Profiles are smoothed, may be symmetrized, and are

normalized to the central axis intensity

Off-Axis Factors:
Typical Representations
OAFs (OCRs) are
often tabulated
and plotted versus
depth as a
function of
distance off axis

Where distance off

axis means radial
distance away from
the central axis
Note that, due to
beam divergence,
this distance varies
with distance from
the source

Varian 2100C SN 241 6 MV Open-Field Off-Axis

Factors
1.05
1.04
Off-Axis Factor

1.03

Depth 1.7

1.02

Depth 5.0

1.01

Depth 10

1.00

Depth 15

0.99

Depth 20

0.98
0.97

Depth 25

0.96

Depth 30

0.95
0.00

0.02

0.04

0.06

Off-Axis "Tangent"

0.08

0.10

Off-Axis Wedge
Corrections

Descriptions vary of off-axis

intensity in wedged fields

Measured profiles contain

both open-field off-axis
intensity as well as
differential wedge
transmission
We have defined off-axis
wedge corrections as
corrections to the central
axis wedge factor

Open-field off-axis
intensity is divided out of
the profile
The corrected profile is
normalized to the central
axis value

Examples

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
dd at 120 ssd = 1.026 x 0.668 = 0.685

Example Problems

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.

DD at 10 cm for 10 x 10 is 0.668.
Given Dose is 200/0.668 = 299.4
cGy

Examples

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 = 12cm2
dd for 12 x 12 field at 5cm =.866
dd for 12 x 12 field at 12 cm = .608
Dose to cord = 200/.866 x .608 = 140.4 cGy

Examples

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.
dd at 6cm=0.810; dd at 9cm=.686 ; dd 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

Examples

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 cm2
TMR at 6cm = .8955
TMR at 3 cm = .9761
Dose to node = (200/.8955) x .9761 x (100/97)2 = 231.7
cGy

Examples

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

Examples

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