Clinical Dosimetry in Radiotherapy: Karl L. Prado, PH.D., FACR, FAAPM
Clinical Dosimetry in Radiotherapy: Karl L. Prado, PH.D., FACR, FAAPM
Clinical Dosimetry in Radiotherapy: Karl L. Prado, PH.D., FACR, FAAPM
CLINICAL DOSIMETRY IN
RADIOTHERAPY
Karl L. Prado, Ph.D., FACR, FAAPM
Advertencia:
Dose Ratios and MU Calculations
Our Goals:
A. Actually understand
things like PDDs,
Inverse Square,
TMRs, Scatter
Factors, and other
such physics terms …
B. And then be able to
use them in
calculations of
Not as scary as you think! accelerator monitor-
units
Objectives
Understand the basic concepts underlying radiation
dosimetry
Recognize the fundamental quantities that are used
to describe these basic radiation dosimetry concepts
Apply radiation dosimetry concepts and quantities
in calculations of dose in clinical radiation-oncology
practice situations
Clinical Dosimetry
Fundamental Quantities MU Calculations
Think measurements Apply measured data
made in a water to clinical dose
phantom calculations
Define quantities: the Specifically – calculate
ratio of doses at two the monitor-unit setting
points: one point on the treatment unit
different than the other that will deliver an
because of distance, intended dose
depth, and conditions of
scatter
The next couple of hours
First talk about how we
characterize dose
deposition in a medium
… “dosimetry” (dose
ratios)
Then talk about dose-
calculation methods …
Perform an accelerator
monitor-unit (MU)
calculation
Sample Dose Calculation Problem
A patient’s whole brain is to be treated.
The prescribed dose is 300 cGy per fraction, (10
fractions, 30 Gy total dose).
Radiation and technique are 6 MV x rays, parallel-
opposed right and left lateral fields
Prescribed dose is to isocenter.
Number of fractions
Fieldsize at Point P
larger
More scatter
1D Dose Distributions
Dosimetry Concepts in 1 Dimension
Percent Depth Dose (PDD)
PDD Notes
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 (scatter)
Field size is defined at
the surface of the
phantom or patient
PDD Dd / Dd 0
PDD: Depth and Energy
Dependence
PDD Curves - Characteristics
Note change in depth of dmax
Can characterize beam quality (energy) using
PDD at 10-cm depth
Build-up
Region
What leads
to Build-up
Effect?
PDD Build-up Region
Kerma to dose
relationship
Kerma and dose represent
two different quantities
Kerma is energy released
Dose is energy absorbed
Build-up region produced
by forward-scattered
electrons that stop at
deeper depths
Areas under both curves
are equal
PDD: Distance, Depth, Scatter
Note that in mathematical description of PDD:
Inverse-square (distance) factor
Dependence on SSD
Attenuation (depth) factor
Scatter (field-size) factor
PDD: Effect of Distance
Effect of inverse-square
term on PDD
As distance increases,
relative change in dose
rate decreases (less steep
slope)
Less Inverse-Square effect
This results in an increase in
PDD (since there is less of
a dose decrease due to
distance), although the
actual dose rate decreases
PDD Example
If the dose in a 10x10 cm2 field at
the depth of dmax in water 100 cm
SDD is 200 cGy, what is the dose
at a depth of 10 cm?
PDD Dd / Dd 0
Dd Dd 0 PDD
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)
TPR and TMR: More current quantities
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 TPR Dd / Dt 0
of the TPR when t0 equals
the depth of dmax
TMR (and PDD) vs. Field Size:
Scatter contribution 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,
TMR / PDD / TAR Relationships
From: ICRU 14
TMR / PDD Relationship
Scatter Factors
Characterize scatter
Scatter factors
describe field-size
dependence of dose
at a point
Often wise to
separate sources of
scatter
Scatter from the head
of the treatment unit
Scatter from the
phantom or patient
Measurements
complicated by need
for electronic
equilibrium
Khan
Transmission Factors: Wedges
Beam intensity is also
affected by the
introduction of beam
attenuators that may be
used modify the beam’s
shape or intensity
Such attenuators may be
plastic trays used to support
field-shaping blocks, or
physical wedges used to
modify the beam’s intensity
The transmission of
radiation through
attenuators is often field-
size and depth dependent
Wedged field PDDs
The Dynamic Wedge
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 wedge’s “segmented
treatment table (STT)
The STT relates jaw position to
fraction of total monitor-unit Gibbons
setting
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 OAF ( x, d ) Dd , x / Dd ,0
equivalent
where x = distance off-axis
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
1.02
Scatter Factors
From accelerator head
From phantom (patient)
2D Dose Distributions
Combine 1D Dosimetry Concepts
Family of Beam Profiles
Hourglass
Shape
Parallel Opposed Fields
Physical Penumbra
Is the region of the
beam not irradiated by
entire source
Accelerator source
diameter is about 2 mm
Depends on source size,
distance from the source
to beam-definition
device, and distance
from source to
measurement plane
Penumbrae
Penumbrae of radiation
beams include scatter as
well as physical
characteristics
Common definition is distance
between 80% and 20% 1
6MV3X3, d = 100 mm
isodose 0.9
0.8
penumbrae depend on
Relative Dose
0.6
0.4
response -26 -24 -22 -20 -18 -16 -14 -12 -10 -8
Crossline position (mm)
Make a picture
Now … let’s reason this through ..
Output: From Relative Dose Ratios
to Absolute Dose
Standard calibration geometry
The geometry used to determine the dose output of the treatment
unit
Treatment units are calibrated such that their absolute dose is known at a
single point (the calibration point) in a predetermined (standard) geometry
Calibration geometries are SAD Calibration and SSD Calibration
Calibration Point
Calibration Point
SAD SSD
Calibration Calibration
Introduction
Standard calibration point and geometry (SAD)
For linear accelerators in the Department of Radiation
Oncology, University of Maryland School of Medicine,
and commonly elsewhere, this point is located at dmax in a
water phantom, 100 cm SAD, along the central axis of an
open 10x10 field.
The unit is calibrated such that a dose equal to 1.0 cGy is
delivered to this point per 1 Monitor Unit (MU) setting
Introduction
Standard calibration geometry (SSD)
Other radiation oncology centers, UT M.D. Anderson
Cancer Center for example, use an SSD calibration
geometry
At these centers, this point is located at dmax in a water
phantom, 100 cm SSD, along the central axis of an
open standard field, most commonly the 10x10 field.
At this point (note – farther from the source), the unit is
calibrated such that 1 monitor unit (MU) is equal to 1.0
cGy
Introduction
Corrections to standard geometry
At depths other than dmax, distances other than the standard SAD
or SSD, and for field sizes other 10x10, and points off of the
central axis, corrections become necessary
Depth corrections are PPDs or TMRs,
Distance corrections are Inverse-Square corrections, and
Field-size corrections are Scatter Factors.
Corrections for points away from the central axis of the beam are
Off-Axis Factors
Corrections are also necessary to account for transmission through
beam attenuators such as wedges
These corrections are given in tabulated beam data where
relationships to the standard geometry have been established
Corrections to standard geometry: Summary
D MU SC SP TMR OAF TF
• where it is assumed that output (scatter) factors are given by SC and
SP, and where it is also assumed that the calibrated output = 1.0
cGy/MU at the SAD.
• Note that no inverse-square term is needed since the distance to the
point of dose normalization is equal to the distance to the point of dose
calibration (i.e. both the point of dose normalization and the point at
which output is defined are the same).
SSD Beams / SAD Calibration
When the treatment unit is calibrated in a “SAD” geometry, then
for “SSD” beam calculations, the formalism becomes:
D MU SC SP PDD OAF TF
Di DRx wt i
i
wt
Formalism: Summary
For SAD beams and SAD calibration:
Di
MUi
SC SP TMR OAF TF
For SSD beams and SAD calibration:
Di
MUi
SC SP ISq PDD OAF TF
Back to our Sample Problem …
A patient’s whole brain is to be treated.
The prescribed dose is 30 Gy total dose, 300 cGy
per fraction, 10 fractions, 5 fractions per week.
Radiation and technique are 6 MV x rays, parallel-
opposed right and left lateral fields; prescribed
dose is to isocenter.
Fields are 20x18, mlc-shaped
Clinical Dosimetry