FUNDAMENTALS OF DOSIMETRY BASED ON ABSORBED-DOSE
STANDARDS
D.W.O. Rogers
National Research Council of Canada
e-mail: drogers@physics.carleton.ca (from 2003)
WWW: http://www.physics.carleton.ca/<"drogers
This chapter is the basis of a lecture given at the AAPM s 1996 Summer School in Vancouver, BC. It has
been published by the AAPM in  Teletherapy Physics, Present and Future edited by J. R. Palta and T. R.
Mackie, pages 319  356 (AAPM, Washington DC, 1996).
David Rogers is now at the Physics Department of Carleton University, Ottawa, K1S 5B6.
ABSTRACT
This chapter reviews the fundamentals of radiation dosimetry needed to do reference dosimetry for external
beam radiotherapy when starting from an ion chamber calibrated in terms of absorbed-dose to water. It
briefly reviews the status of primary standards for absorbed dose to water. The kQ formalism developed to
utilize these absorbed-dose calibration factors is described for use in electron and photon beams. In the ideal
case, the needed kQ factors are measured for each ion chamber and beam quality of interest in the clinic.
Equations are developed for the factors needed to utilize this formalism in the proposed TG 51 dosimetry
protocol of the AAPM. Special attention is paid to the issue of specifying beam quality in terms of percentage
depth-dose at 10 cm for photon beams and R50 for electron beams. A proposal for using a reference depth of
0.6 R50 - 0.1 cm in electron beam dosimetry is discussed. Factors needed for using plane-parallel chambers
in a water phantom are also reviewed.
Contents
1. INTRODUCTION 3
2. STATUS OF ABSORBED-DOSE STANDARDS 3
3. FORMALISM USING ABSORBED-DOSE CALIBRATION FACTORS 4
4. ION CHAMBERS 5
4.A. Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4.A.1) Spencer-Attix Cavity Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4.A.2) Handling Humidity Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4.A.3) Cavity Theory with Corrections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
4.A.4) The Wall Correction Factor, Pwall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
4.A.5) The Replacement Correction Factor, Prepl = PgrPfl. . . . . . . . . . . . . . . . . . . . . 7
4.A.6) The Central Electrode Correction Factor, Pcel . . . . . . . . . . . . . . . . . . . . . . . 9
4.B. Practical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.B.1) Correction for Ion Recombination, Pion . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.B.2) Temperature and Pressure Corrections . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.B.3) Waterproofing Sleeves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5. BEAM-QUALITY SPECIFICATION 11
5.A. Why Do We Need to Specify Beam Quality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.B. Specification of Photon Beam Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.C. Specification of Electron Beam Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.C.1) Determination of R50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.C.2) The mean energy at the phantom surface, Eo . . . . . . . . . . . . . . . . . . . . . . . 14
5.C.3) Problems with stopping-power ratios using mono-energetic beams . . . . . . . . . . . . 15
5.C.4) Direct use of R50 as beam quality specifier . . . . . . . . . . . . . . . . . . . . . . . . 15
6. VALUES OF kQ 16
6.A. Calculation of kQ Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6.A.1) An equation for kQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6.A.2) Photon Beams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6.A.3) Electron Beams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.B. Measurement of kQ Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
7. SUMMARY 23
8. ACKNOWLEDGMENTS 23
9. REFERENCES 23
Dosimetry Fundamentals: 1996 AAPM Summer School page 3
1. INTRODUCTION
Accurate measurement of the dose delivered to the tumor in external beam radiotherapy is one of the
primary responsibilities of a medical physicist. In general, such measurements have been based on the use
of ion chambers calibrated in terms of exposure or air kerma and the application of a dosimetry protocol
such as the AAPM s TG 21 protocol (AAPM TG 21 1983; AAPM TG 21 1984; Schulz et al 1986) or the
IAEA s Code of Practice (IAEA 1987). These protocols were a significant step forward since they provided a
procedure which was capable of incorporating the correct physics. This came at the expense of considerable
complexity. One manifestation of this complexity is a large number of small errors and inconsistencies in
the TG 21 protocol which fortunately tend to cancel out (see e.g. my lecture at the previous summer school
which dealt with many of these issues and gave a corrected derivation of the TG 21 protocol equations
(Rogers 1992d)). However, even using the corrected protocols the overall uncertainty in the absorbed dose
assigned under reference conditions is about 3 to 4% (all uncertainty estimates in this chapter are for one
standard deviation, representing a confidence level of 68%). For extensive reviews of various dosimetry
protocols see Nath and Huq (1995) and Andreo (1993).
Much of the complexity of the TG 21 and similar protocols comes from the fact that they start from an
ion chamber calibrated free-in-air for one quantity, air kerma, and must transfer this information to obtain
another quantity, absorbed dose to water, based on a measurement in a phantom. To overcome these
complexities, primary standards laboratories have been developing standards for absorbed dose to water in
60
photon beams from Co and accelerator beams (Rogers 1992b; Shortt et al 1993; Domen 1994; Boutillon
et al 1994; Ross and Klassen 1996) and these have an uncertainty of 1% or less. Also, many improvements
in radiation dosimetry have been made in the 15 years since TG 21 was developed. To make use of this
greater accuracy and to incorporate these improvements, the AAPM has established a task group, TG-51,
to develop a new external beam dosimetry protocol. There are several approaches which could be used, but
after careful study it has been decided to base the new protocol on calibrating ion chambers in terms of
60
absorbed dose to water in a Co beam.
In this chapter I will discuss the fundamentals of ion chamber dosimetry which underlie the approach being
adopted by TG-51, with emphasis on various developments which have occurred in the last few years.
However, this is a personal contribution and although I am on TG-51, this document does not represent the
opinion of TG-51, nor does it present many of the details of the protocol since these are still evolving.
2. STATUS OF ABSORBED-DOSE STANDARDS
Three very different approaches have been used to provide standards for absorbed dose to water in photon
beams. I reviewed these at the previous summer school (Rogers 1992b) and progress has continued since
then. The most common approach is to use a graphite calorimeter to establish the absorbed dose to graphite
and then use various procedures to infer the absorbed dose to water in the same beam (Pruitt et al 1981;
Domen and Lamperti 1974). A second approach is to use the total absorption in Fricke solution of an
electron beam of known energy and charge to calibrate the solution and then use the Fricke in a small vial
to establish the dose at a point in a water phantom by assuming that the calibration of the Fricke solution
(i.e. G) does not change with beam quality (Feist 1982). A third approach is to use water calorimetry,
either to calibrate Fricke solution in the beam quality of interest (Ross et al 1984; Ross et al 1989) or use a
small volume of sealed, high-purity water in a water phantom to do a direct measurement of the absorbed
dose to water (Domen 1994; Seuntjens et al 1993). There has been a recent review of both forms of water
calorimetry by Ross and Klassen (1996).
There have been several comparisons of the standards in different national standards laboratories and there
is satisfactory agreement between the various methods at the 1% level or better (Boutillon et al 1994; Shortt
et al 1993). An important point is that each of these three methods has different types of systematic uncer-
tainties and thus the system of standards being developed is highly robust against systematic errors affecting
all the standards. The situation for air-kerma standards is different since almost all the primary standards
2. STATUS OF ABSORBED-DOSE STANDARDS
page 4 D.W.O. Rogers
in the world use the same basic approach (a graphite-walled cavity ion chamber) and thus comparisons be-
tween them cannot resolve systematic uncertainties in the technique itself. More specifically, there have been
challenges to parts of the theory underlying the air-kerma standards and different approaches in establishing
certain corrections lead to up to 1% differences in these standards, in particular between the Canadian and
US standards (Bielajew and Rogers 1992).
In summary, there is a robust system of absorbed dose to water standards in place in primary standards
60
laboratories. These standards are capable of measuring the absorbed dose not only in Co beams but in
accelerator beams.
3. FORMALISM USING ABSORBED-DOSE CALIBRATION
FACTORS
Given the existence of the high quality primary standards for absorbed dose to water and the fact that the
absorbed dose to water is the quantity which is used for reference dosimetry in radiotherapy, it makes sense
to base clinical dosimetry on absorbed-dose calibration factors for ion chambers. Ion chambers are used
because high-quality chambers are available for reasonable cost, they have the capability of making precise
and stable measurements in radiation fields encountered in the clinic, and the theory for interpreting their
output is reasonably well understood. In the last few years a formalism for such a process has been widely
discussed (Hohlfeld 1988; ICRU 1990; Rogers 1992c; Andreo 1992; Rogers et al 1994) and has been adopted
for TG 51.
Q
One starts with an absorbed-dose to water calibration factor, ND,w, defined by:
Q
Q
Dw = MPionND,w [Gy] (1)
Q
where Dw is the absorbed-dose to water (in Gy) at the point of measurement of the ion chamber in the
absence of the chamber (the center of a cylindrical chamber and the front of the air cavity in a plane-
parallel ion chamber), M is the temperature and pressure corrected (see section 4.B.2) electrometer reading
in coulombs (C) or meter units (rdg), Pion corrects for ion chamber collection efficiency not being 100% (see
Q
section 4.B.1), and ND,w is the absorbed-dose to water calibration factor (in Gy/C or Gy/rdg) for the ion
chamber when placed under reference conditions in a beam of quality Q. In North America the calibration
factor applies under reference conditions of temperature, pressure and humidity, viz. 22ć%C, 101.3 kPa and
relative humidity between 20 and 80%. Note that because it can become significant in accelerator beams,
the inclusion of Pion in eq.(1) is different from previous North American practice for air-kerma or exposure
calibration factors where ion recombination effects were part of the calibration factor, i.e. the exposure, X,
is given by: X = MNX where NX is the exposure calibration factor.
Clearly the most direct method of clinical dosimetry is to get an ion chamber calibrated for each beam
quality Q needed for a clinic and then apply eq.(1). Since this would both be very expensive (it requires
an accelerator for the calibration) and available at very few places (the ADCL s do not have accelerators of
60
60 Co
their own), it is easier to start from an absorbed-dose calibration factor for a Co beam, viz. ND,w . In this
case, define a factor kQ such that:
60
Q
Co
ND,w = kQND,w , [Gy] (2)
60
i.e. kQ converts the absorbed-dose calibration factor for a Co beam into a calibration factor for an arbitrary
beam quality Q. In general, the value of kQ is chamber specific. Using kQ, gives:
60
Q Co
Dw = MPionkQND,w [Gy]. (3)
In an ideal world, values of kQ measured using primary standards for absorbed dose would be available for
all the ion chambers used for reference dosimetry. Such a project is underway at NRCC for accelerator
photon beams for many widely used Farmer-like ion chambers, but equivalent data will not be available
3. FORMALISM USING ABSORBED-DOSE CALIBRATION FACTORS
Dosimetry Fundamentals: 1996 AAPM Summer School page 5
for all chambers, nor for electron beams in the foreseeable future. Thus it is important to have ways of
calculating kQ, and this is discussed below after a review of the necessary fundamentals.
4. ION CHAMBERS
4.A. Theory
4.A.1) Spencer-Attix Cavity Theory
The central theory underlying ion chamber dosimetry is Spencer-Attix cavity theory(1955) which relates the
dose delivered to the gas in the ion chamber, Dgas, to the dose in the surrounding medium, Dmed by the
relationship:
med
L
Dmed = Dgas , (4)
Á
gas
med
L
where the stopping-power ratio, , is the ratio of the spectrum averaged mass collision stopping powers
Á
gas
for the medium to that for the gas where the averaging extends from a minimum energy " to the maximum
electron energy in the spectrum. The fundamental assumptions of this theory are that: i) the cavity does
not change the electron spectrum in the medium; ii) all the dose in the cavity comes from electrons entering
the cavity, i.e. they are not created in the cavity; and iii) electrons below the energy " are in charged
particle equilibrium. Unlike Bragg-Gray cavity theory, Spencer-Attix theory applies where charged particle
equilibrium of the knock-on electrons above " does not exist, which is generally the case near an interface
between media or at the edge of a beam.
There is an extensive literature on the Monte Carlo calculation of stopping-power ratios (Nahum 1978;
Andreo and Brahme 1986; ICRU 1984a; Ding et al 1995) and there is agreement between various calculations
at about the 0.1% level if the same stopping power data are used. However, there has been considerable
confusion caused by the use of a variety of different electron stopping power-data sets in earlier protocols
(see, e.g. Rogers et al (1986)). There is now a consensus to use the stopping-power data from ICRU Report
37 (1984b) (based on the work of Berger and Seltzer at NIST(1983)) and they are used exclusively here.
The TG 21 protocol used these data for electron beams but used an earlier set (which differed by over 1%
in places) for the photon beam data.
4.A.2) Handling Humidity Variation
To make use of eq.(4) requires a connection between Dgas and the charge measured from the ion chamber.
If M is the charge released in the ion chamber, then:
W M
Dgas = (Gy), (5)
e mgas
gas
W
where gives the energy deposited in a gas per unit charge released, and fortunately for ion chamber
e
gas
dosimetry, is a constant for dry air, independent of electron energy (viz. 33.97Ä…0.05 JC-1 Boutillon and
Perroche-Roux (1987)), and mgas is the mass of the gas in the cavity. One complication in ion chamber
w
W
dosimetry is that the humidity in the air causes each of the quantities , mgas and L/Á to vary by
e
gas gas
anywhere up to 1%. This has caused considerable unnecessary confusion in the TG 21 protocol (see Rogers
and Ross (1988) and Mijnheer and Williams (1985) and references therein for a complete discussion). To
handle these variations, one defines a humidity correction factor:
air
gas
W mair L
Kh = , (6)
e mgas Á
air gas
4. ION CHAMBERS
page 6 D.W.O. Rogers
which has the feature of being equal to 0.997 for relative humidity between roughly 15% and 80%. Multiplying
the right side of eq.(5) by Kh and inserting the results into eq.(4) leads to the following simplifications:
med
L
Dmed = Dair (Gy), (7)
Á
air
W M
Dair = Kh (Gy) (8)
e mair
air
med gas med
where eq.(7) has made use of the fact that L/Á L/Á = L/Á . Note that all the references
gas air air
are now to dry air, except for M . The charge released, M , is related to the measured charge below
(section 4.B.1).
4.A.3) Cavity Theory with Corrections
Unfortunately, real ion chambers are not ideal cavities. The first issue that this raises is where the cavity is
measuring the dose, a complex problem which is discussed below (section 4.A.5). However, for a cylindrical
ion chamber, in-phantom calibration factors apply with the central axis of the chamber at the point of
measurement, and for plane-parallel chambers, the point of measurement is taken as the inside face of the
front window. There are also several correction factors, as given in eq.(9) which are needed before applying
eq.(4), viz.:
med
L
Dmed = Dair PwallPflPgrPcel. (9)
Á
air
These correction factors are discussed briefly below but for an extensive review of these issues, see Nahum
(1994).
4.A.4) The Wall Correction Factor, Pwall
The Pwall correction in eq.(9) accounts for the fact that the wall and other parts of the chamber are not
usually made of the same material as the medium. This factor is designated Pwall.
In electron beams, Pwall has traditionally been assumed to be 1.00. Nahum (1988) has developed a the-
oretical model of the effect of the wall material on the electron spectrum in the cavity. It qualitatively
agrees with the experimental data in an extreme case. Based on this model, Nahum has shown that the
wall effect in electron beams due to changes in the spectrum, should be less than 1%, and usually much
less for situations of importance in clinical dosimetry. More recently, Klevenhagen (1991) and Hunt et al
(1988) have pointed out that for plane-parallel chambers, the electron backscatter from non-water materials
behind the air cavity is different from that of water and this induces a change in the ion chamber reading.
This should, in principle, be corrected for using the Pwall correction given in table 1. The corrections can
be substantial for low-energy beams. Preliminary results of Monte Carlo calculations of this effect for the
entire chamber for NACP and PTW/Markus chambers also indicate an effect of the order of 1 or 2% (Ma
and Rogers 1995).
In photon beams, the correction factor for the wall effect in the case of a chamber with a waterproofing
sheath, is given by a formula based on a slight extension of the work of Shiragai (1978) and (1979):
1
Pwall = , (10)
med air wall air sheath air
µen µen
L L L L
Ä… + Ä + (1 - Ä… - Ä)
Á Á Á Á Á Á
air wall med sheath med med
A
µen
where is the ratio of mass energy absorption coefficients for material A to material B (relating the
Á
B
doses in these materials under charged particle equilibrium in a photon beam); Ä… is the fraction of ionization
4. ION CHAMBERS 4.A. Theory
Dosimetry Fundamentals: 1996 AAPM Summer School page 7
Table 1: Pwall correction factor for plane-parallel chambers with effectively thick back walls of the materials
shown. Data from Klevenhagen (1991), based on the results of Hunt et al (1988).
Ez, energy at depth Graphite PMMA Polystyrene
of chamber(MeV)
3 1.010 1.012 1.021
4 1.009 1.011 1.018
6 1.006 1.008 1.013
10 1.004 1.005 1.009
14 1.003 1.003 1.006
20 1.001 1.001 1.002
in the cavity due to electrons from the chamber wall; Ä is the fraction of ionization in the cavity due to
electrons from the waterproofing sheath and (1 - Ä… - Ä) is the fraction due to electrons from the phantom.
There are data available in the TG 21 protocol for the various parameters needed as a function of beam
quality, including Ä… and Ä based on the measurements of Lempert et al (1983) (which I have verified using
Monte Carlo calculations, unpublished). This correction is typically 1% or less for most ion chambers but
the accuracy of the formula has not been rigorously demonstrated and there are indications that there are
problems with it (Hanson and Tinoco 1985; Gillin et al 1985; Ross et al 1994). There are also conceptual
problems with the correction factor since it uses many inaccurate assumptions in its derivation and ignores
changes in attenuation and scatter by the wall. For a complete discussion and derivation of the Pwall equation,
see Rogers (1992d) or Nahum (1994). Note that eq.(10) differs in form from that associated with the TG 21
protocol, but has the same numerical values in practice.
4.A.5) The Replacement Correction Factor, Prepl = PgrPfl.
The insertion of a cavity into a medium causes changes in the electron spectrum and the replacement
correction factor, Prepl, accounts for these changes. Prepl can be thought of as having two components, the
gradient and fluence correction factors:
Prepl = PgrPfl. (11)
The Gradient Correction Factor, Pgr.
One effect of the cavity is, in essence, to move the point of measurement upstream from the center of the
chamber. The electron fluence in the cavity is representative of the fluence in the medium at some point
closer to the source because there is less attenuation or buildup in the cavity than in the medium. This
component of Prepl is called the gradient correction, Pgr, because its magnitude depends on the dose
gradient at the point of measurement. For cylindrical chambers, these corrections depend on the gradient of
the dose and on the inner diameter of the ion chamber. The steeper the gradient, the larger the correction.
Also, the larger the radius, the larger the correction. For plane-parallel chambers in photon or electron
beams, the point of measurement at the front of the air cavity is already thought to take into account any
gradient effects and hence there is no need for a Pgr correction, even in regions with a gradient.
In electron beams, for measurements at dmax where the gradient of the dose is zero, Pgr = 1.00, but for
measurements away from dmax, Pgr becomes important for cylindrical chambers, especially for low-energy
beams where there are steep gradients.
For photons, gradient correction factors in various protocols are based on different sources. TG 21 based its
values on the work of Cunningham and Sontag (1980) which is a mixture of experiment and mostly calcula-
tions. Many other protocols have used the measured data of Johansson et al (1977) but as shown in figure 1
there are considerable differences amongst the original data, the TG 21 data and what is recommended in
the IAEA Code of Practice (1987).
It is clear that the gradient correction factor represents a significant uncertainty in present dosimetry pro-
4. ION CHAMBERS 4.A. Theory
page 8 D.W.O. Rogers
1.000
Figure 1: Value of Prepl (= Pgr in a photon
beam), for a 6.4 mm cavity, as a function
Prepl for 6.4 mm diameter cavity
of beam quality specified by TPR20. The
0.995
10
AAPM values are from TG 21, based on
the calculations of Cunningham and Sontag
(1980). The IAEA values are the effective
0.990
values (determined as described in Rogers
(1992c)) corresponding to the offsets used by
the IAEA Code of Practice (1987), which were
0.985
AAPM
nominally based on the work of Johansson
IAEA (effective)
et al (1977) which is shown as diamonds.
AAPM 60Co
60
0.980
IAEA Co
Johansson et al
0.975
0.55 0.60 0.65 0.70 0.75 0.80
TPR20,10
kqfig3
tocols. It is also worth noting that another way to correct for the gradient is used by the IAEA Code of
Practice (1987), viz. the effective point of measurement approach. This same approach is recommended
for measuring depth-dose or depth-ionization curves by the AAPM s TG 25 on electron beam dosimetry
(Khan et al 1991). The method treats the point of measurement as being slightly up-stream of the center of
the ion chamber. For electron beams, both groups recommend an offset of 0.5r where r is the radius of the
cylindrical chamber s cavity and for photon beams the shift correction is 0.75r. It must be emphasized that
if one is using a Prepl value in photon beams for reference dosimetry, then the effective point of measurement
of a cylindrical chamber must be taken as it s center.
The Fluence Correction Factor, Pfl.
The other component of Prepl is the fluence correction, Pfl, which corrects for other changes in the electron
fluence spectrum due to the presence of the cavity. Corrections for changes in the electron fluence are only
needed if the ion chamber is in a region where full or transient charged particle equilibrium has not been
established, i.e. in the buildup region or near the boundaries of a photon beam or anywhere in an electron
beam.
Fluence corrections are not required for photon dose determinations made at or beyond dmax in a broad
beam because transient electron equilibrium exists. The Fano theorem tells us that under conditions of
charged particle equilibrium the electron spectrum is independent of the density in the medium (see p
255, Attix (1986)). To the extent that the cavity gas is just low-density medium material, this theorem
tells us that the electron fluence spectrum is not affected by the cavity except in the sense of the gradient
correction discussed above, which in essence accounts for there being transient rather complete charged
particle equilibrium. Hence no fluence correction factor is needed in regions of transient charged particle
equilibrium.
In electron beams there are two competing effects. The in-scatter effect which increases the fluence in
the cavity because electrons are not scattered out by the gas and the obliquity effect which decreases
the fluence in the cavity because the electrons go straight instead of scattering. The in-scatter effect tends
to dominate, especially at low energies and Pfl can be up to 5% less than unity for cylindrical chambers
at dmax in electron beams. TG 21 tabulates recommended values for cylindrical chambers as a function
of the mean energy of the electrons at the point of measurement and recent measurements have confirmed
these values for a Farmer-like ion chamber (Van der Plaetsen et al 1994). The fluence effect is so large at
low energies that it becomes important to use plane-parallel chambers for these beams since Pfl has been
shown to be unity for well-guarded plane-parallel chambers (Mattsson et al 1981; Van der Plaetsen et al
1994). However, the AAPM s TG 39 on the calibration of plane-parallel chambers (Almond et al 1994) has
recommended non-unity values of Pfl for both the Markus and Capintec plane-parallel chambers (see fig 2).
4. ION CHAMBERS 4.A. Theory
repl
P
Dosimetry Fundamentals: 1996 AAPM Summer School page 9
Table 2: Pcel correction factor required for
farmer-like chambers with an aluminum
Beam Quality Pcel
electrode of 1 mm diameter, based on the
NAP/MeV TPR20 %dd(10)x
10
calculations of Ma and Nahum (1993). Fac-
photons
60
tors apply past dmax in photon beams and
Co 0.58 56% 0.9926(15)
near dmax or 0.6 R50 - 0.1 cm in electron
4MV 0.62 62% 0.9935(7)
beams. The %dd(10)x values exclude electron
6MV 0.67 67% 0.9930(11)
contamination (see section 5.B.). Note that
10MV 0.73 72% 0.9945(9)
Pcel as defined here is consistent with the
15MV 0.76 78% 0.9955(16)
other correction factors but is not the same
24MV 0.80 86% 0.9957(9)
as the IAEA s global Pcel correction.
electrons
<13 MeV 1.000
e"13 MeV 0.998
All the recommended values of Pfl apply ONLY at dmax since that is where they were measured (Johansson
TG-39 Fluence correction factors for plane-parallel chambers
Figure 2: The Pfl factors for plane-
1.01
parallel chambers recommended by TG 39
NACP, Exradin, Holt
(Almond et al 1994) plus cubic fits to the
1.00
curves for the Markus and Capintec cham-
bers. The factors are given as a function of
0.99
Ez (E in the figure), the mean energy at the
depth of measurement.
0.98
Markus Capintec
0.97
0.96
2 -5 3
0.95 Pfl=0.9679 +0.0091 E -0.00094 E +3.36.10 E
2 -5 3
Pfl=0.9276 +0.0138 E -0.00091 E +2.03.10 E
0.94
0 5 10 15 20
Ez / MeV
Pfl_pp
et al 1977; Van der Plaetsen et al 1994) and strictly speaking, they are not appropriate for corrections of
depth-dose curves as sometimes suggested (e.g. Khan (1991)), although this is probably better than making
no correction.
4.A.6) The Central Electrode Correction Factor, Pcel
Cylindrical chambers have central electrodes in their cavities and these have some effect on the chamber
response. For electrodes made out of the same material as the phantom, any effect of the electrode is
properly part of Pfl. Any further effects due to the electrode being made of another material is properly
part of Pwall but it is useful to separate out this effect and call it Pcel if the electrode material is different
from the wall material. The effect is non-negligible for those widely used chambers which have aluminum
electrodes to give a flat energy response in low-energy x-ray fields (e.g. many NEL and PTW chambers). A
set of highly precise Monte Carlo calculations has been reported (Ma and Nahum 1993). The first important
result of that work is that 1 mm graphite electrodes have no effect on the response in a water phantom
(as expected since Pfl is unity in photon beams and the difference between a water and graphite electrode
should be negligible). In electron beams the effects are also small (<0.2%) and are in principle included in
Pfl and/or Pwall. However, for 1 mm diameter aluminum electrodes the effect in photon beams is an increase
in response by 0.43 to 0.75%, requiring the correction factors in table 2. These data can be generated and
4. ION CHAMBERS 4.A. Theory
fl
P
page 10 D.W.O. Rogers
extrapolated using:
Pcel = 0.9862 + 0.000112(%dd(10)x). (12)
The effects in electron beams are quite small and vary with depth. However, the effect on dosimetry in
electron beams is actually larger than in photon beams because, in essence, the final dose is multiplied by
Pcel(e-)/Pcel(60Co) and the factor in the denominator is quite large (see section 6.A.3).
4.B. Practical Considerations
4.B.1) Correction for Ion Recombination, Pion
In general, ion chambers do not collect all the charge released in the air cavity and the factor Pion corrects
for this lack of 100% charge collection.
M = MPion [C or rdg], (13)
where M is the charge released in the ion chamber and M is the charge collected. This correction is
fairly well understood (see the review by Boag (1987)) and there is a standard technique for evaluating the
correction which involves measuring the charge collected at 2 voltages and then determining the correction
required (see Weinhous and Meli (1984)). Although the TG 21 protocol recommended a voltage ratio of 2
for these measurements, the underlying theory requires a ratio of 2.5 or more.
Although this correction is reasonably well understood, ion chambers with large correction factors (say >2%
correction), should probably not be used since the uncertainty in the correction may become unacceptable.
It must be emphasized that this correction depends on the dose to the air in the ion chamber per pulse.
Thus, if either the dose rate or the pulse rate at a constant dose rate are varied, then Pion must be re-
evaluated. This variation would even affect measurement of a depth-dose curve if an instrument with a large
value of Pion was being used.
4.B.2) Temperature and Pressure Corrections
Temperature and pressure variations affect the mass of air inside an ion chamber. Since the total charge
produced depends on the product of the dose to the gas and the mass of the gas (eq.(5), it also depends on the
temperature and pressure. Since ion chambers are all calibrated under standard conditions of temperature
and pressure, i.e. for a given mass of air in them, it is essential to normalize all readings of ion chamber
charge back to these same reference conditions (To = 22ć%C and pressure at Po = 101.33 kPa, 1 atmosphere).
This is done using:
101.33 T + 273.2
M = Mo × [C or rdg], (14)
P 273.2 + 22.0
where M is the corrected reading, Mo is the uncorrected reading, T is the temperature in degrees celsius
and P is the pressure in kilopascals (not corrected to sea level).
4.B.3) Waterproofing Sleeves
Since the protocol will require absorbed-dose calibration factors measured in a water phantom and also
clinical measurements in water, the issue of how to waterproof the chamber becomes important. There
are already good chambers on the market which are waterproof. This seems like a desirable goal. But for
chambers that are not, a waterproofing sleeve will be required. In eq.(10) there is an explicit term for a
waterproofing sleeve but as mentioned, the experimental data are not in particularly good agreement with
the theory (Hanson and Tinoco 1985; Gillin et al 1985; Ross and Shortt 1992). For sufficiently thin sleeves
of PMMA (< 1 mm) or latex rubber, the experimental data show that there is less than a 0.2% effect on
the chamber response which varies little with beam quality and thus can be ignored. The various calibration
laboratories are working on a calibration protocol which will incorporate the need for such a sleeve.
4. ION CHAMBERS 4.B. Practical Considerations
Dosimetry Fundamentals: 1996 AAPM Summer School page 11
5. BEAM-QUALITY SPECIFICATION
5.A. Why Do We Need to Specify Beam Quality?
Clinically one must be able to identify accelerator beams for many reasons, and usually just referring to
the 12 MV beam or the 18 MeV beam is adequate. However, for reference dosimetry we need more precise
specification of the beam quality, Q, so that one can select the correct value of kQ in the dose equation, eq.(3).
As is shown below in fig. 9 and eq.(26), the value of kQ is dominated by the water to air stopping-power ratio
60
which varies by over 15% in clinical beams (from 1.13 for Co beams to 0.98 for 50 MeV electron beams).
5.B. Specification of Photon Beam Quality
w
The TG 21 protocol uses the quantity TPR20 to specify photon beam quality when selecting L/Á
10
air
although it also uses the nominal accelerating potential (NAP) to specify other, less sensitive quantities.
The value of TPR20 is determined by measuring the absorbed dose or ionization on the beam-axis at depths
10
of 20 cm and 10 cm for a constant source detector distance and a 10 cm x 10 cm field at the plane of the
chamber (i.e. one must move the phantom, or at least its surface).
The idea of using measured ratios of ionization or dose at two depths was first introduced in the Nordic
dosimetry protocol to specify the accelerator energy (NACP 1980). The TG 21 protocol goes one step
further and directly associates the beam quality index with the stopping-powers ratios needed. This is based
on the work of Cunningham and Schulz (1984) who found a universal curve relating these two quantities
based on analytic calculations of stopping-power ratios and TPR20 for a variety of clinical photon spectra.
10
Andreo and Brahme (1986) showed that for clinical photon spectra one could accurately calculate values of
TPR20 using Monte Carlo techniques and found a curve relating stopping-power ratios for clinical beams
10
and TPR20. They also showed that for a given NAP there are up to 1.3% variations in the stopping-power
10
ratio. It is for this reason that TPR20 is used rather than NAP. However, TPR20 is also not an ideal beam
10 10
quality specifier because there are variations of over 1% in the stopping-power ratio associated with beams of
Q
the same TPR20 (see fig 3). Since eq.(25) below shows ND,w is directly proportional to the stopping-power
10
ratio, this can be a problem for standards laboratories since their beams might not match those in the clinic,
Q
and hence the value of ND,w might not apply in the clinic for a beam of the same TPR20.
10
As seen in fig. 3, high-energy photon beams also lead to other problems with TPR20 as a beam specifier.
10
The high-energy swept beams from the racetrack microtron accelerators have considerably different curves
of stopping-power ratios vs TPR20 values compared to other  typical clinical beams . Furthermore, for
10
high-energy beams, TPR20 is an insensitive quality specifier. For example a 1% change in TPR20 for values
10 10
near 0.8 leads to a 3 MV change in the nominal accelerating potential (near 20 MV) and a 0.4% change in
the water to air stopping-power ratio. In contrast, for values of TPR20 near 0.7 a 1% change corresponds
10
to a 0.1% change in stopping-power ratio and only an 0.5 MV change in the NAP.
Manufacturers and others have often specified beam quality in terms of an NAP in MV which is not well
defined. The obvious definition in terms of the energy of the electrons from the accelerator is not very useful
because this energy is usually not well known. More importantly, the beam quality is strongly affected by the
type of beam flattening used (see LaRiviere (1989) and references therein for a good discussion). LaRiviere
proposed that the beam quality in MV should be specified in terms of %dd(10), the measured percentage
depth dose at 10 cm depth in a 10 × 10 cm2 field at a source to surface distance (SSD) of 100 cm with
Q = 10[%dd(10)-46.78]/26.09 [MV], (15)
which is a good fit to the  experimental data although there is scatter in the initial data caused by the lack
of a clear definition of Q.
Kosunen and Rogers (1993) took LaRiviere s argument one step further and showed that for any
bremsstrahlung beam above 4MV, one has a linear relationship between stopping-power ratio and %dd(10)x
5. BEAM-QUALITY SPECIFICATION
page 12 D.W.O. Rogers
spr vs. TPR spr vs. % depth dose at 10 cm depth
1.14 1.14
1.13 1.13
1.12 1.12
1.11 1.11
Mohan+60Co
1.10 1.10
60
Schiff-thin
Mohan + Co
Al-measurements
Al-meas
1.09 1.09
Pb-measurements Pb-meas
Be-meas
Be
1.08 1.08
Filtered Al
Filtered Al
NRC standards
NRC standard
1.07 1.07
racetrack
racetrack
fit
mono-energetic
1.06 1.06
1.05 1.05
0.55 0.60 0.65 0.70 0.75 0.80 0.85 55 60 65 70 75 80 85 90 95
20
krfig5
krfig2 TPR % depth dose at 10 cm depth
10
Figure 3: Water to air stopping-power ratios Figure 4: Water to air stopping-power ratios
vs TPR20 for nine families of photon spectra, vs %dd(10)x for the thick-target bremsstrahlung
10
60
demonstrating variations when using TPR20 as a & Co spectra in figure 3. The straight line
10
beam quality specifier. Flattened, i.e. practical beams shown is the fit to the sprs of the bremsstrahlung
are shown as closed symbols. From Kosunen and beams given by eq.(16) with an rms deviation of
Rogers (1993). 0.0013 and a maximum deviation of 0.003. From
Kosunen and Rogers (1993).
for the photon component of the beam. This is shown in figure 4 and the line is given by:
w
L
= 1.2676 - 0.002224(%dd(10)x). (16)
Á
air
The problem with this relationship is that it applies only for photon beams with no electron contamina-
tion. In 10 × 10 cm2 fields for beams above 10 MV, electron contamination affects the dose maximum and
hence affects %dd(10), the measured % depth dose at 10 cm. Using 2 sets of measured data which demon-
strated considerable variation from machine to machine, estimates have been made of the effects of electron
contamination on %dd(10) (see fig 5) and the linear correction needed is given by:
%dd(10)x = 1.2667 (%dd(10)) - 20.0 [for %dd(10) > 75%]. (17)
For %dd(10) < 75% one need make no adjustments, %dd(10)x = %dd(10). Especially for high energies this
approach may lead to errors of up to 2% in the assigned value of %dd(10)x but as seen below, there is only
a 0.2% error in kQ values per 1% error in %dd(10)x.
Another approach for determining %dd(10)x has been investigated by Li and Rogers (1994). A 1 mm lead
foil is inserted in the accelerator beam immediately below the accelerator head. This removes from the beam,
all the electron contamination from the accelerator head (which is the source of the machine to machine
variation) and adds a known amount of electron contamination to the beam which can be taken into account.
For beams with %dd(10) greater than 70%, the value of %dd(10)x in the unfiltered beam is given by:
%dd(10)x = [0.9439 + 0.000804 (%dd(10))] %dd(10) - 0.15 [for %dd(10) > 70%] (18)
where %dd(10) is measured in the filtered beam. For beams with %dd(10) < 70%, electron contamination
plays no role and %dd(10)x = %dd(10) - 0.15 where %dd(10) is measured in the filtered beam. The 0.15
5. BEAM-QUALITY SPECIFICATION 5.B. Specification of Photon Beam Quality
stopping power ratio (water/air)
stopping-power ratio (water/air)
Dosimetry Fundamentals: 1996 AAPM Summer School page 13
correction of %dd(10) for electron contamination
95
LaRiviere s fit vs calc
Figure 5: Two estimates of the effects of
RPC data vs calc
electron contamination on %dd(10), based on
no contamination
90
measured data with considerable fluctuations.
adopted value
The adopted fit given by eq.(17) is shown as
the darker solid line. Modified from Kosunen
85
and Rogers (1993).
80
75
75 80 85 90
krfig7r measured %dd(10)m
corrects for the slight beam hardening by the lead filter. However, for the low-energy beams it is more direct
just to use %dd(10)x = %dd(10) where %dd(10) is measured in the unfiltered beam.
There is another aspect of measuring depth-dose curves with a cylindrical ion chamber which must be taken
into account, viz. the change in the gradient correction factor (roughly a 1% effect). There is no gradient
correction factor at dose maximum but at 10 cm depth, the correction varies with the beam quality and
chamber radius (Prepl correction, see section 4.A.5). For measuring depth-dose curves, instead of using Prepl,
this correction can be handled by treating a cylindrical or spherical ion chamber s point of measurement as
being at 0.75r upstream of the center of the chamber, where r is the radius of the chamber cavity (this is
the point of measurement used by the IAEA Code of Practice and thus different from the TG 21 values
of Prepl, as seen in figure 1). Note that for all other measurements in the TG 51 protocol, the point of
measurement of cylindrical and spherical chambers is considered to be at the center. Although the issue of
gradient corrections can be avoided by using diode detectors to measure the depth-dose curve, it is essential
to ensure the diode is actually measuring dose since they can be very sensitive to low energy components in
the beam which change with depth.
In summary, for photon beams it appears that the widely used %dd(10) is an excellent beam quality specifier.
Not only does it define a single value of the stopping-power ratio needed for photon beam dosimetry, it also
maintains its sensitivity in high-energy photon beams and is relatively easy to measure. Some care must be
taken to account for the changes in gradient effects at dmax and at 10 cm depth, and also to account for
electron contamination for beams with %dd(10)x over 70%.
5.C. Specification of Electron Beam Quality
5.C.1) Determination of R50
Most protocols specify electron beam quality in terms of the mean energy of the beam at the patient surface,
Eo, which is determined by measuring R50, the depth at which the dose in a broad beam falls to 50% of its
maximum value. With TG 21 there was some discussion about using depth-dose or depth-ionization curves
and SSD = 100 cm vs correcting to parallel beam conditions (Wu et al 1984). Although the effects are not
large, the correct procedure is to use the SSD corresponding to whatever use is being made of R50 and to
use the value of R50 from the depth-dose curve. The problem is that to determine the depth-dose curve
requires converting the ionization to dose using stopping-power ratios and these require knowledge of the
R50! One way out of this loop is to determine I50 from the depth-ionization curve (using the effective point
of measurement technique discussed in section 4.A.5) and then use the relationship developed by Ding et al
(1995):
R50 = 1.029I50 - 0.063 [cm] (2.2 < I50 < 10.2 cm). (19)
5. BEAM-QUALITY SPECIFICATION 5.C. Specification of Electron Beam Quality
theoretical %dd(10)
page 14 D.W.O. Rogers
12 MeV beam from Clinac 2100C
Figure 6: Difference between a
depth-ionization and depth-dose
110
dref
curve for a 12 MeV beam at
100
SSD = 100 cm. The depths
90
of dose and ionization maxima
80
and 50% values are shown, as
dmax
I50
well as the reference depth,
70
dref = 0.6R50 - 0.1 (cm) (dis-
60
Imax
R50
cussed in section 5.C.4). Based
50
on data from Ding et al (1997).
40
dose in water
ionization in water
30
20
10
0
0 1 2 3 4 5 6 7
depth /cm
dose_ion
This equation only applies to beams with initial energies between 5 and 25 MeV and is a more accurate
version of the correction given in the IAEA Code of Practice(1987). Below 5 MeV no correction is needed
and for higher-energy beams, fig.19 of the original paper should be used.
Another approach is to use I50 as a first approximation to R50 and to use a universal function developed
by et al. (1996) which gives the water to air stopping-power ratio as a function of depth, z, and R50 with
adequate accuracy for converting from depth-ionization to depth-dose curves, viz.:
w
L a + b(lnR50) + c(lnR50)2 + d(z/R50)
(z, R50) = (20)
Á 1 + e(lnR50) + f(lnR50)2 + g(lnR50)3 + h(z/R50)
air
for z/R50 ranging between 0.02 and 1.2, R50 ranging between 1 and 19 cm and with: a = 1.0752; b =
-0.50867; c = 0.088670; d = -0.08402; e = -0.42806; f = 0.064627; g = 0.003085; h = -0.12460. Using
these data allow direct conversion in terms of R50 without determining Eo and tables of stopping-power
ratios vs depth as a function of Eo.
A third alternative is to determine the depth-dose curve using a good-quality diode detector which responds
as a dose-detector (Rikner 1985; Khan et al 1991) and then determine R50.
5.C.2) The mean energy at the phantom surface, Eo
The TG 21 and IAEA protocols use the value of R50 (in cm) to determine the mean energy at the phantom
surface, Eo using:
Eo = 2.33R50 [MeV]. (21)
Rogers and Bielajew (1986) provided more accurate data for making this conversion which accounted for
the finite SSD used in the measurement of R50 and more accurate Monte Carlo calculations than those
that had been used to establish the 2.33 MeV/cm factor used in TG 21. These more accurate data were
recommended by TG 25 on electron beam dosimetry (Khan et al 1991). However, all of the previous Monte
Carlo calculations were done using mono-energetic electron beams. Ding et al (1996) have recently shown
that Eo and R50 do not correlate very well with the data of Rogers and Bielajew (1986) because scattered
electrons in the beam affect Eo but have little effect on R50. On the other hand, the direct electrons in the
beam, i.e. those that do not hit applicators or jaws etc, do correlate well with the previous data.
5. BEAM-QUALITY SPECIFICATION 5.C. Specification of Electron Beam Quality
relative dose
Dosimetry Fundamentals: 1996 AAPM Summer School page 15
5.C.3) Problems with stopping-power ratios using mono-energetic beams
In the TG 21 and IAEA protocols, the water to air stopping-power ratios needed for electron beam dosimetry
are based on Monte Carlo calculations for mono-energetic electron beams. However, the energy and angular
distributions of the real electron beams in the clinic have an effect on the stopping-power ratios (Andreo et al
1989; Andreo and Fransson 1989; Ding et al 1995). Figure 7 shows an example of the stopping-power ratios
Figure 7: Various Monte Carlo
realistic 20 MeV beam from an SL75/20
calculated water to air stopping-
1.11
power ratios vs depth. The
solid line represents the spr one
1.09
would obtain following TG 21, photons only
the long dash, that from the
1.07
complete simulation and the
-
e & photons
other curves include only some
1.05
-
components of the beam. Based
e only
on data from Ding et al (1995).
1.03
protocol/TG21,IAEA
1.01
0.99
0.97 -
e with no angular distn
0.95
0 2 4 6 8 10
spr_eg
depth in water /cm
calculated for a realistic beam simulation. The photon component of the beam and the electron spectrum
have a pronounced effect on the stopping-power ratio although the angular distribution of the electrons has
little effect. The size of the error made by assuming a mono-energetic beam varies with depth. The error
can be up to 1.2% at dmax. Thus, it is important to take into account the realistic nature of the beam when
doing stopping-power ratio calculations. Ding et al (1995) gave a general procedure which uses the size of
the bremsstrahlung tail to estimate the correction needed at dmax for a stopping-power ratio determined
assuming a mono-energetic beam.
5.C.4) Direct use of R50 as beam quality specifier
Although the procedure developed by Ding et al (1995) takes into account the realistic nature of the beam,
it is fairly complex to use, requiring several steps and, since dmax varies considerably, a complete set of
stopping-power ratios as a function of depth and incident mean energy Eo. et al. (1996) found a much
simpler solution, which by-passes much of the complexity of the previous methods and yet continues to take
into account the realistic nature of the electron beams. The essence of the proposal is to change the reference
depth for electron beam dosimetry from dmax to dref:
dref = 0.6R50 - 0.1 [cm]. (22)
For low-energy electron beams this depth corresponds closely to dmax but for higher-energy beams it is past
dmax, but still usually well above a dose of 90% (see e.g. fig.6). The surprising feature about using this
reference depth is that the water to air stopping-power ratio is given by:
w
L
(dref) = 1.2534 - 0.1487(R50)0.2144, (23)
Á
air
for all clinical beams (the raw data are shown in figure 8). The rms deviation of the data about this fit is
5. BEAM-QUALITY SPECIFICATION 5.C. Specification of Electron Beam Quality
stopping-power ratios
page 16 D.W.O. Rogers
Figure 8: Water to air stopping-power ratio
1.10
at the reference depth dref = 0.6R50 - 0.1 cm
Fit
as a function of R50. The fit is given by
Clinac 2100C
1.08
eq.(23). From et al. (1996).
SL75-20
KD2
1.06
Therac 20
MM50
1.04
NPL
1.02
1.00
0.98
0 5 10 15 20
6p0m1_fit
R50 / cm
0.16% with a maximum deviation of 0.26%. This equation replaces an entire page of stopping-power ratio
data in the TG 21 protocol and is considerably more accurate since it applies to realistic beams. Also, it
avoids the need to establish the mean energy at the surface of the phantom, a quantity which is not well
defined by R50 (see section 5.C.2).
6. VALUES OF kQ
6.A. Calculation of kQ Values
6.A.1) An equation for kQ
From eq.(1) for the dose to water in terms of the absorbed-dose calibration factor, one has:
Q
Dw
Q
ND,w = [Gy/C]. (24)
MPion
Using eqs.(8), (9) and (13) for Dair, Dw and M , gives:
w
Kh W L
Q
ND,w = PwallPflPgrPcel [Gy/C]. (25)
mair e Á
air air
W
Using eq.(2) to define kQ, substituting eq.(25) at the two beam qualities, and assuming is constant,
e
air
one has:
w
L
PwallPflPgrPcel
Á
Q
kQ = air , (26)
w
L
PwallPflPgrPcel
Á
60
air Co
where the numerator and denominator are evaluated for the beam quality Q of interest, and the calibration
60
beam quality, Co, respectively.
6.A.2) Photon Beams
Calculation of kQ for a given ion chamber in a photon beam is reasonably straight forward. One expects
this formalism to be more accurate than a formalism starting from air-kerma standards since in this case,
6. VALUES OF KQ
stopping-power ratio at reference depth
Dosimetry Fundamentals: 1996 AAPM Summer School page 17
only ratios of the same quantity at different beam qualities are needed rather than the value itself. For
example, the effective value of the factor Prepl differs by at least 0.4% and up to 0.8% for the IAEA or
TG 21 approaches (the solid and dashed lines in fig.(1)). However, the difference in the ratio of these values
is never more than 0.4% when calculating kQ. In effect, by using a primary standard for absorbed dose at
60
Co energy, the uncertainty due to Prepl is reduced because this quantity is, in some senses,  included in
the primary standard.
w
In calculating kQ with eq.(26), the values of L/Á as a function of %dd(10)x are calculated using eq.(16)
a
60
for %dd(10)x e" 62.2%, and are interpolated linearly from there (1.1277) to the Co point at 56.3%
w
(1.1335)(Kosunen and Rogers 1993). Since the variation in L/Á dominates the beam quality dependence,
a
we expect the value of kQ to be nearly linear with %dd(10)x, at least for beams with %dd(10)x > 62.2%.
Ignoring issues about the accuracy of eq.(10), it can be used to calculate the Pwall term and if a thin-
walled waterproofing sheath has been used, it can be ignored and Ä taken as 0.0 (see section 4.B.3). The
physical data needed for this Pwall equation are taken from the IAEA Code of Practice (1987) since it
uses stopping powers and mass energy absorption coefficients which are consistent with those used in the
standards laboratories. These data are tabulated as a function of TPR20. Since the variation in the overall
10
Pwall factor is small, one can use a value of TPR20 from a fit to standard clinical beam data which gives
10
(Rogers and Booth 1996):
TPR20 = -0.6391 + 0.029348 (%dd(10)x) - 0.00014498 (%dd(10)x)2 . (27)
10
Note, this equation applies to %dd(10)x with electron contamination removed and it is not accurate enough
to make the conversion from %dd(10)x to TPR20 in general: if it were, there would be no advantage in
10
changing beam quality specifiers! The variation in Pwall factors for typical thin-walled ion chambers in
photon beams is less than 1%.
The Pfl term in eq.(26) is 1.00 in a photon beam (see section 4.A.5) and thus does not enter the calculation
of kQ.
The Pgr term can be calculated using the data in fig.(1). Despite the large differences in the effective values
used by the protocols, the difference in the ratio is quite small. Since the variation in the TG 21 value is
close to the variation in the original data of Johansson et al (1977), and for continuity with past practice, it
is easiest to use the value of Pgr from the TG 21 protocol, which is based on the work of Cunningham and
Sontag (1980). This parameter is a function of beam quality and the diameter of the chamber s gas cavity.
For a Farmer-like chamber it only varies by about 0.4% as a function of beam quality.
The Pcel term, which only applies for chambers with an aluminum electrode, is calculated using eq.(12). For
a 1 mm diameter aluminum electrode (the only size for which there are data), the effect on kQ is an increase
of less than 0.4%.
Figure 9 presents calculated kQ values for an NE2571 cylindrical Farmer chamber with 0.065 g/cm2walls,
6.3 mm cavity diameter and 1 mm diameter aluminum electrode. It also shows the contribution of each of
the components in eq.(26), e.g. (Pwall)Q/(Pwall)60 = (Pwall)Q . For comparison, two additional curves
Co 60
Co
are shown. One is for the effective Prepl component from the IAEA Code of Practice and the second shows
the effect on Pwall of considering a 1 mm thick PMMA waterproofing sheath as in eq.(10). This figure
indicates, most importantly, that the stopping-power ratio dominates the change with beam quality in kQ
Q
and hence the calibration factor ND,w. Secondly, the effect of ignoring the sheath is about 0.3% at high
energies, a value which is consistent with the experimental data (see section 4.A.4). Finally, the uncertainty
in the correct value of Prepl continues to be the major uncertainty in the calculation of kQ.
For cylindrical ion chambers with walls thinner than 0.25 g/cm2, there is a  universal curve for kQ which
agrees with the individual calculations within Ä…1% and for Farmer-like chambers this is further improved to
an accuracy of Ä…0.7% (Rogers 1992c). Figure 9 shows that this is possible because the major determinant
of kQ is the stopping-power ratio and this is independent of the ion chamber. The next largest factor is the
Pwall factor and this is mostly determined by the wall material. Thus, calculated kQ values for Farmer-like
ion chambers of a particular wall material are all very nearly the same. Figure 10 shows such a set of kQ
values which apply within a few tenths of a percent for all commercial ion chambers for which calculations
6. VALUES OF KQ 6.A. Calculation of kQ Values
page 18 D.W.O. Rogers
Q
Figure 9: Calculated values of kQ and its 1.02 Q
IAEA (Pgr)60Co (Pwall,sheath)60Co
components for an NE2571 Farmer-like ion
1.01
chamber with 0.065 g/cm2 graphite walls,
inner diameter of 6.3 mm and an aluminum
1.00
electrode with 1 mm diameter. The TG 21
Q
Prepl = Pgr component (short dash) and the
Q
(Pwall)60Co (Pfl)60Co
0.99
Pcel component defined here (solid line) are
Q
almost the same. Also shown for comparison
Q
AAPM (Pgr)60Co
0.98
(spr)60Co
are the Pwall component including considera-
Q
& (Pcel)60Co
tion of a 1 mm PMMA waterproofing sheath
0.97
and the effective Prepl component based on
kQ
the IAEA Code of Practice.
0.96
NE2571
0.95
55 60 65 70 75 80 85 90
fig8
%dd(10)
have been done (although there is slightly more spread than in the original paper (Rogers 1992c) since the
Pcel correction has been included here).
Figure 10: Calculated values of kQ for
cylindrical Farmer-like ion chambers with the
1.00
kQ for chambers of walls
walls shown. These values apply within a few
shown
tenths of a percent for all chambers studied
0.99
(Rogers (1992d), updated).
0.98
0.97
A-150
C-552
Delrin
0.96
graphite
PMMA
0.95
0.94
55 60 65 70 75 80 85 90
standard_kQ
%dd(10)
Figure 11 compares the present results to results that would be obtained using previous protocols and the
data in them. The change from TG 21 values is not large, and mostly accounted for by the change in
the underlying stopping powers being used now. However, the difference would be slightly larger if there
were no aluminum electrode since this was not considered in TG 21 and it affects this chamber. Also, part
of the difference comes from the uncertainty introduced by interpolating the previous AAPM data which
was presented as a function of TPR20 whereas here %dd(10)x is used. The IAEA values differ considerably
10
60
because of how they treated Co beams as a special case. Note also that the IAEA s correction for the
central electrode only  kicks-in for high-energy beams (%dd(10)x >87%), but when it does, the value it
uses is close to that used here (although the definitions differ so that Pcel(IAEA) = Pcel(Q)/Pcel(60Co)).
PROT, a program for calculating kQ for arbitrary chambers has been written (Rogers and Booth 1996). It is
based on the program described earlier (Rogers 1992c) but updated to take into account the changes described
above. It will be made available via the WWW at the address given at the beginning of this references.
There are also several very extensive sets of calculated kQ values available in the literature (Andreo 1992;
Rogers 1992c) but these are given as a function of TPR20 and do not include the Pcel correction used here.
10
6. VALUES OF KQ 6.A. Calculation of kQ Values
Q
k and its components
Q
k
Dosimetry Fundamentals: 1996 AAPM Summer School page 19
Figure 11: Values of kQ for
current (%dd from TPR)
NE2571 cylindrical chamber 1.00
with 0.065 g/cm2 graphite
TG-21
walls, cavity of 6.3 mm and
1 mm diameter aluminum elec-
0.99
trode. Results use eq.(27). Part
of the difference for TG 21 is
that previous data are tabulated
0.98
vs TPR20 and require a conver-
10 IAEA
sion from %dd(10)x to TPR20.
10
The current results are also
0.97
current
shown using this approach to
show the variations introduced.
0.96
kQ for NE2571
0.95
55 60 65 70 75 80 85 90
%dd(10)
kQ_fig9
6.A.3) Electron Beams
Calculation of kQ for electron beams is considerably more complex than for photon beams since the quantities
in the numerator and denominator of eq.(26) are different, not just the same quantities at slightly different
beam qualities as in the photon beam case. Also, for electron beams one must handle plane-parallel chambers
since these are recommended for use in low-energy beams.
For cylindrical chambers, the denominator of eq.(26) is calculated in the same manner as in section 6.A.2).
60
For plane-parallel chambers the denominator evaluated in Co beams requires some new considerations. The
stopping-power ratio is the same as in the cylindrical chamber case. The Prepl factor for plane-parallel cham-
bers is unity (see section 4.A.5). The Pcel factor is unity since there are no central electrodes. The Pwall
factor is not covered by eq.(10) which only applies to chambers where the wall uniformly surrounds the
cavity. For plane-parallel chambers, the front wall is often much thinner than the rest of the chamber and of
a different material. Also, any insulator material immediately behind the cavity may have a dramatic effect
on the response (up to 5%) and Pwall must take this into account (Rogers 1992a; Almond et al 1994). In the
TG 39 report on electron beam dosimetry with plane-parallel chambers (which, for consistency with TG 21
60
did not use the ICRU Report 37 stopping powers being used here), values of Pwall in a Co beam were
provided for the case in which the phantom material matched the major component of the chamber (graphite
for an NACP chamber, PMMA for a Markus chamber, etc). For the present purposes, we need the value of
Pwall in a water phantom, which also implies there may be a waterproofing cap on the plane-parallel cham-
ber. Using the same methods as previously, I have done a further series of Monte Carlo calculations and
derived the necessary values for various commercial plane-parallel chambers (see table 3). Note that these
60
values are for Co only, and since values of Pwall are not usually available for other photon beam qualities,
plane-parallel chambers are not suitable for absorbed-dose measurements in photon beams until there are
measured values of Pwall, or preferably kQ, available.
With Pwall values available, all the factors in the denominator of eq.(26) are known (the denominator
60
Co
is just ND,w /Ngas in TG 21 terminology). These values of the denominator are calculated and have a
relatively large systematic uncertainty. Once it is decided how to waterproof each of these chambers properly,
something some of the manufacturers have already done, it would be preferable to have these values measured.
For the numerator in eq.(26) for kQ for electron beams, the stopping-power ratio term is given by eq.(23)
since these values are all for the reference depth, 0.6R50 - 0.1 cm. I will take the Pwall term to be unity, with
6. VALUES OF KQ 6.A. Calculation of kQ Values
Q
k
page 20 D.W.O. Rogers
Table 3: Pwall correction factor for plane-parallel chambers in a phantom of the major material of the
60
chamber or water, irradiated by Co beams (Rogers tted). Uncertainties shown are statistical (68%
confidence) and there is an inherent 1% systematic uncertainty. For the in-water case, it is assumed a 1 mm
slab of the major material of the chamber is used for waterproofing.
60
Chamber (major material) Pwall in Co beam
in homogeneous phantom in water with 1 mm sheath
Attix Chamber (RMISW) 1.012(3) 1.023(3)
Capintec PS033 (polystyrene) 0.948(1) 0.974(3)
Exradin P11 (polystyrene) 0.991(5) 1.021(3)
Holt (polystyrene) 0.992(2) 0.994(4)a)
Markus (PMMA) 0.992(2) 0.998(2)
NACP (graphite) 1.018(2) 1.018(2)b)
PTB/Roos (PMMA) 0.995(2) 1.002(2)
a)
4 mm polystyrene front face in place over entire sheet.
b)
Thin mylar sheet over front graphite face for waterproofing.
the caveat expressed in section 4.A.4), that for plane-parallel chambers, there may be a need to include a
factor varying between 1.0 and 1.02, depending on the energy and material of the back wall of the chamber.
The Pcel factor for cylindrical chambers with 1 mm aluminum electrodes is 1.000 or 0.998 as given in table 2.
The remaining correction in the numerator of eq.(26) for electron kQ values is Prepl = PflPgr. For plane-
parallel chambers there is no problem with the gradient correction, Pgr, which is taken to be 1.00 in electron
beams because the point of measurement is taken at the front of the air cavity. For well-guarded plane-
parallel chambers, Pfl is also taken as unity, but this is not the case for the Markus and Capintec chambers
(section 4.A.5), and their tabulated Pfl values are given here by the expressions in fig 2 using the same
techniques as described below for estimating the mean energy, Ez, at dref. Also, most data for these
chambers have been measured at dmax and there are likely variations at other depths.
For cylindrical chambers, handling these correction factors is more complex. Values of Pfl for cylindrical
chambers are a function of chamber radius and the mean energy at the point measurement and these values
are given in TG 21 (see section 4.A.5). Despite the fact that these values are only known for dmax and we now
need them at dref, we will assume that the values in TG 21 still apply (and encourage some measurements
to establish the correct value). For low-energy beams these values apply because dref is still at dmax. At
higher energies, the correction becomes less important and thus the approximation being used is probably
acceptable. We still need to evaluate Ez, the mean energy at the point of measurement. Traditionally this
is given by the Harder relationship:
Ez = Eo(1 - z/Rp), (28)
where Eo is the mean energy at the surface and Rp is the practical range (ICRU 1984a). This parameter-
ization unfortunately breaks with the proposed beam quality specification in terms of R50. However, it is
possible to recast the data on Pfl so that the value of Pfl at dref is given as a function of R50 and the cavity
radius. An approximate value of Eo is given by 2.33R50 and fitting data for Rp and R50 from Ding and
Rogers (1995), one can write:
Rp = 1.271R50 - 0.23 [cm]. (29)
Putting these relationships together leads to the data in fig 12. Note that because the reference depth, dref,
is deeper than dmax for high energies, the Pfl correction is significant, even at high energies (it is about 0.98
for a Farmer-like chamber at dref in a 20 MeV beam).
The remaining problem in the evaluation of eq.(26) for electron beams is that of Pgr at dref. For low-energy
beams where dref is at dmax, Pgr = 1.0, and the same is true for plane-parallel chambers at all energies.
However, in general this correction depends on the specific depth-dose curve being measured and hence
cannot be tabulated. Because of this fact, for electron beams one has:
kQ = kR kgr, (30)
50
6. VALUES OF KQ 6.A. Calculation of kQ Values
Dosimetry Fundamentals: 1996 AAPM Summer School page 21
1.00
Figure 12: Values of Pfl at a depth of dref
Pfl at dref = 0.6 R50 - 0.1 cm
vs R50 for cylindrical ion chambers. Based
0.99
on data in TG 21 from Johansson et al (1977)
3 mm
and using the techniques from Rogers and
Booth (1996) to relate the various parameters. 0.98
5 mm
0.97
6.4 mm
0.96
diameters of cylindrical
chambers
0.95
7 mm
0.94
0 2 4 6 8 10 12 14 16
Pfl_R50
R50 /cm
where:
w
L
PwallPflPcel
Á
air R50
kR = w , (31)
50
L
PwallPflPgrPcel
Á
60
air Co
and:
kgr = 1. - 0.5rcavG/100, [for cylindrical chambers ] (32)
= 1.0 [for plane-parallel chambers or at dmax] (33)
where1 rcav is the radius of the chamber s cavity in mm and G is the dose gradient at dref (% change in
dose per mm, which can be taken as the percentage change in the ion chamber reading going from dref to
dref + 0.5rcav2 divided by 0.5rcav). et al. (1996) have shown G is typically 1% or less, and hence kgr is within
1.6% of unity for a Farmer-like chamber. This kgr correction is equivalent to using the point of measurement
for cylindrical chambers recommended by the IAEA Code of Practice (1987) and the AAPM s TG 25 (Khan
et al 1991).
With all of the above in place, it is possible to present curves of kQ values for plane-parallel chambers (fig.13)
and curves of kR for cylindrical chambers (fig.14). Unfortunately, these curves cannot be generalized
50
as easily as in the case for photon beams. For the NACP, Exradin, Attix, Holt and PTB/Roos plane-
parallel chambers, the differences between the curves are completely determined by the value of Pwall for the
60
chamber in a water phantom irradiated by a Co beam although recall that possible variations with Pwall
in the electron beams have not been included. For the Markus and Capintec chambers, the effect of Pfl also
plays a significant role, especially for the lower energies. For the cylindrical chambers, several factors are at
work causing the differences seen in fig. 14. For one thing, Pfl is strongly affected by the radius of the cavity
60
(see fig. 12). Also, the values of Pwall in the Co beam vary by 2.8%, or 1% going from the thin to thick
walls for the chambers with air-equivalent plastic C552 walls. For the NE2571 chamber, the central electrode
effect increases kR by 0.7% for low energy beams and 0.5% for beams above 13 MeV. The shoulder in this
50
curve is at the transition point in the Pcel correction.
Another approach which would make the kQ curves more similar, is to define kQ for electron beams with
respect to an absorbed-dose calibration factor in a reference electron beam (presumably at high energies since
60
primary standards can be more easily developed there). In this case, instead of using a Co calibration
factor in eq.(3), one uses the electron beam calibration factor:
Q e
Dw = MPionkQNe [Gy]. (34)
D,w
1
Eq.(32) was published as kgr = 1. + 0.5rcavG/100.
2
This was published as dref - 0.5rcav.
6. VALUES OF KQ 6.A. Calculation of kQ Values
fl
electron fluence correction, P
page 22 D.W.O. Rogers
0.96 0.96
Holt
PR05 C552
0.95 kQ vs R50 at dref 0.95
NE2571 gr,al electrode
0.94 0.94
0.93 0.93
Capintec
Markus
PR06 C552
0.92 0.92
Exradin A12
PTB/Roos
0.91 0.91
C552
0.90 0.90
0.89 0.89
NACP
0.88 0.88
NE2581 A-150
0.87 0.87
Exradin P11
0.86 0.86 kR vs R50
PTW2333
50
Attix
0.85 0.85
cylindrical chambers at dref
plane-parallel chambers
0.84 0.84
0 2 4 6 8 10 12 14 16 0 2 4 6 8 10 12 14 16
R50 /cm R50 /cm
kQ_pp
kR50
Figure 13: Calculated values of kQ for plane- Figure 14: Calculated values of kR for commonly
50
parallel chambers used in a water phantom at dref. used cylindrical ion-chambers. Values apply for
Chambers are assumed waterproofed as described in measurements at dref in a water phantom.
table 3.
The advantage of this equation is that, except for differences in Pfl, the kQ or kR curves will be identical
50
60
for different detectors. To handle this in a protocol based on Co absorbed-dose calibration factors requires
60
Co
an extra piece of data, viz. kel, the ratio of Ne to ND,w . In this case, in electron beams one has:
D,w
60
Q e Co
Dw = MPionkQkelND,w (35)
Note that the factor kel is just the standard kQ for the beam quality chosen for the reference electron beam.
6.B. Measurement of kQ Values
As mentioned above (section 3.), the ideal situation is to have kQ values measured using primary standards
of absorbed dose for all beam qualities of interest for all chambers which are used in the clinic. This is
impossible, especially since there are no primary standards in place for electron beams in North America.
However, on the photon side, there have been a variety of measurements reported (Shortt et al 1993; Boutillon
et al 1994; Ross et al 1994; Guerra et al 1995; Vatnitsky et al 1995), not all of which use primary standards,
and not many of which have sorted out the issues of beam quality specification (see section 5.B.). At the
present time there is a major project underway at NRC which will use primary standards at several photon
beam qualities to calibrate 3 each of 6 widely used Farmer-like cylindrical chambers and specify the beam
quality in a wide variety of manners to elucidate the best manner of doing this. Seuntjens et al (1996) are
reporting on this work at this years AAPM meeting. The already published data has shown clearly that
the calculated values of kQ are accurate within about 1% but there are demonstrable problems with beam
quality specification using TPR20 which can lead to 0.5% problems or more. Furthermore, there are known
10
problems with the calculated Pwall factors at about the 0.5% level. Within the next year, there should be a
large amount of reliable data available for photon beams, which will both allow measured data to be used
for many common detectors, or allow calculations to be done with considerable accuracy.
For electron beams, the promise of directly measured kQ factors is further in the future. In the meantime,
it would be very useful if further investigations were done on fluence and gradient corrections at the new
reference depth, dref and on the measurement of water phantom Pwall factors for plane-parallel chambers in
60
Co beams.
6. VALUES OF KQ 6.B. Measurement of kQ Values
50
R
k
Q
ref
k at d
Dosimetry Fundamentals: 1996 AAPM Summer School page 23
7. SUMMARY
To summarize, there have been a large number of improvements in the understanding of radiation dosimetry
in the 15 years since TG 21 was developed. The most important feature is that there are now primary
standards of absorbed dose to water which can be used in accelerator photon beams and hence the ability
to make clinical measurements at the 1% level under reference conditions is, in principle, here. The new
TG-51 protocol will incorporate the use of these new standards and a variety of new approaches which should
make clinical dosimetry both simpler and more accurate. Since the assigned clinical doses will not usually
be very different from those assigned using TG 21, the transition should not be as difficult as it was when
adopting TG 21. The ADCL s and national standards laboratories are already working on procedures for
providing the absorbed-dose calibration factors needed instead of air-kerma calibration factors. Since the
overall TG 51 protocol should be much simpler and easier to understand than the TG 21 protocol, it is
hoped that people will adopt it quickly and with little hassle.
This document does not present the TG 51 protocol, and many details which are dealt with in the protocol
have been left out. However, the current draft of the protocol is prescriptive in nature, with the intention of
making it easy to use. This chapter is actually much longer than the current draft of the protocol itself.
8. ACKNOWLEDGMENTS
I have benefited from many thought provoking discussions with my colleagues on TG 51, viz. Peter Almond,
Peter Biggs, Bert Coursey, Will Hanson, Saiful Huq, Ravi Nath, and early on, Herb Attix. I would also
like to thank my colleagues at NRC (Carl Ross, Jan Seuntjens, Charlie Ma, Ken Shortt, Norman Klassen
and Alex Bielajew) for much work in this area plus Alan Nahum, David Burns, Pedro Andreo and Klaus
Hohlfeld for stimulating discussions over the years.
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e-mail: dave@irs.phy.nrc.ca
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60
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10
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