AAPM protocol for 40–300 kV x-ray beam dosimetry

in radiotherapy and radiobiology

C.-M. Ma, Chaira)
Radiation Oncology Dept., Stanford University School of Medicine, Stanford, California 94305-5304
and Ionizing Radiation Standards, National Research Council of Canada, Ottawa K1A 0R6, Canada
C. W. Coffeyb)
Department of Radiation Oncology, Vanderbilt Medical Center, B 902 Vanderbilt Clinic, Nashville,
Tennessee 37232-5671
L. A. DeWerdc)
University of Wisconsin, 1530 MSC Medical Physics, 1300 University Avenue, Madison, Wisconsin 53706
C. Liud)
Department of Radiation Oncology, University of Florida, Gainesville, Florida 32610-385
R. Nathe)
Department of Therapeutic Radiology, Yale School of Medicine, 333 Cedar Street, New Haven,
Connecticut 06510
S. M. Seltzerf)
Ionizing Radiation Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899
J. P. Seuntjensg)
Medical Physics Unit, McGill University, Montreal General Hospital, 1650 Avenue Cedar,
Montréal H3G 1A4, Canada and Ionizing Radiation Standards, National Research Council of Canada,
Ottawa K1A 0R6, Canada
共Received 5 March 2001; accepted for publication 12 March 2001兲
The American Association of Physicists in Medicine 共AAPM兲 presents a new protocol, developed
by the Radiation Therapy Committee Task Group 61, for reference dosimetry of low- and medium-
energy x rays for radiotherapy and radiobiology (40 kV⭐tube potential⭐300 kV). It is based on
ionization chambers calibrated in air in terms of air kerma. If the point of interest is at or close to
the surface, one unified approach over the entire energy range shall be used to determine absorbed
dose to water at the surface of a water phantom based on an in-air measurement 共the ‘‘in-air’’
method兲. If the point of interest is at a depth, an in-water measurement at a depth of 2 cm shall be
used for tube potentials ⭓100 kV 共the ‘‘in-phantom’’ method兲. The in-phantom method is not
recommended for tube potentials ⬍100 kV. Guidelines are provided to determine the dose at other
points in water and the dose at the surface of other biological materials of interest. The protocol is
based on an up-to-date data set of basic dosimetry parameters, which produce consistent dose
values for the two methods recommended. Estimates of uncertainties on the final dose values are
also presented. © 2001 American Association of Physicists in Medicine.
关DOI: 10.1118/1.1374247兴

Key words: low- and medium-energy x rays, dosimetry protocol, calibration, ionization chambers,
reference dosimetry, relative dosimetry

TABLE OF CONTENTS D. Quality assurance of the dosimetry equipment

and x-ray tube. . . . . . . . . . . . . . . . . . . . . . . . . . . . 873
I. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . 869
1. Ionization chamber. . . . . . . . . . . . . . . . . . . . . 873
A. Historical review. . . . . . . . . . . . . . . . . . . . . . . . . 869
B. Scope of this document. . . . . . . . . . . . . . . . . . . . 870 2. Electrometer. . . . . . . . . . . . . . . . . . . . . . . . . . 873
C. List of nomenclature, symbols, and units. . . . . . 870 3. Tube potential of x-ray generator. . . . . . . . . 874
II. RADIATION QUALITY SPECIFICATION IV. AIR-KERMA CALIBRATION PROCEDURES.. 874
AND DETERMINATION. . . . . . . . . . . . . . . . . . . . 871 V. FORMALISM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 874
A. Energy ranges considered. . . . . . . . . . . . . . . . . . 871 A. The in-air method: Absorbed dose to water at
B. Beam quality specifier. . . . . . . . . . . . . . . . . . . . . 871 the surface for low- and medium-energy x
C. Determination of HVL. . . . . . . . . . . . . . . . . . . . . 872 rays (40 kV⭐tube potential⭐300 kV). . . . . . . . . 875
III. EQUIPMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 872 B. The in-phantom method: Absorbed dose to
A. Phantoms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 872 water at 2 cm depth in water for
B. Dosimeters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 872 medium-energy x rays
C. Electrometers. . . . . . . . . . . . . . . . . . . . . . . . . . . . 873 (100 kV⬍tube potential⭐300 kV). . . . . . . . . . . . 875

868 Med. Phys. 28 „6…, June 2001 0094-2405Õ2001Õ28„6…Õ868Õ26Õ$18.00 © 2001 Am. Assoc. Phys. Med. 868
869 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 869

C. Other considerations in the calibration I. INTRODUCTION

measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875
A. Historical review
1. Ion collection efficiency P ion. . . . . . . . . . . . . 875
2. Polarity correction P pol. . . . . . . . . . . . . . . . . 876 Kilovoltage 共40–300 kV兲 x-ray beams continue to be used
3. End effect ␦ t. . . . . . . . . . . . . . . . . . . . . . . . . 876 in radiation therapy and radiobiology. According to a survey
4. Electrometer correction ( P elec). . . . . . . . . . . 876 conducted in 1995 by American Association of physicists in
5. Temperature–pressure correction P TP. . . . . . 876 Medicine 共AAPM兲 Radiation Therapy Committee Task
Group 61,1,2 there is renewed interest in radiotherapy treat-
6. Inverse-square consideration for in-air
ment with superficial and orthovoltage x rays, with more
calibration with close-ended cones. . . . . . . . 876
x-ray machines being ordered and installed in North America
7. Method for determination of P stem,air. . . . . . . 876
during the last few years.
8. Method for in-phantom calibration of For the dosimetry procedures, several dosimetry protocols
chambers not listed in this protocol. . . . . . . 877 are available for kilovoltage x-ray beam therapy. In 1973 the
D. Consistency between the in-air method and International Commission for Radiation Units and Measure-
the in-phantom method. . . . . . . . . . . . . . . . . . . . 877 ments 共ICRU兲 Report No. 233 recommended ‘‘the in-air
VI. GUIDELINES FOR DOSIMETRY IN OTHER method’’ for low-energy photons 共tube potential: 40–150
PHANTOM MATERIALS. . . . . . . . . . . . . . . . . . . 878 kV兲 with the backscatter factors taken from the 1961 British
VII. GUIDELINES FOR RELATIVE DOSIMETRY Journal of Radiology 共BJR兲 Supplement 10,4 and ‘‘the in-
AT OTHER POINTS IN WATER. . . . . . . . . . . . 878 phantom method’’ for medium-energy x rays 共tube potential:
A. Characteristics of clinical beams. . . . . . . . . . . . . 878 150–300 kV兲, respectively. In 1981, the National Council on
B. Recommendations for relative dose Radiation Protection and Measurements 共NCRP兲 Report No.
measurements in water. . . . . . . . . . . . . . . . . . . . . 878 695 gave a formula to calculate dose to a phantom material at
C. Electron contamination of clinical beams. . . . . . 879 a point in air 共with a minimum phantom兲 for tube potentials
VIII. EVALUATION OF UNCERTAINTIES. . . . . . . 880 10 kV through the medium-energy range 共up to 300 kV兲. A
IX. FUTURE CONSIDERATIONS. . . . . . . . . . . . . . . 880 backscatter factor was needed to calculate dose on the phan-
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . 881 tom surface. Two years later, the U.K. Hospital Physicist
APPENDIX A. THEORETICAL BASIS FOR A Association 共HPA兲 adopted the same methodology as that
CODE BASED ON AIR-KERMA CALIBRATIONS used by the ICRU Report No. 23 for low- and medium-
............................................ 881 energy x-ray beams.6 For the backscatter factors, the HPA
A.1. Low-energy x rays protocol recommended the values from the 1983 BJR
(40 kV⭐tube potential⭐100 kV). . . . . . . . . . . 881 Supplement 17.7 In 1987, the International Atomic Energy
A.2. Medium-energy x rays Agency 共IAEA兲 code of practice8 also recommended two
(100 kV⬍tube potential⭐300 kV). . . . . . . . . . 881 different formalisms for low- and medium-energy photons
APPENDIX B. DETAILS ON CONVERSION AND although the beam-quality ranges were slightly different 共low
CORRECTION FACTORS . . . . . . . . . . . . . . . . . . . . . 883 energy: tube potential 10–100 kV, medium energy: tube po-
B.1. The in-air method for low- and tential 100–300 kV兲. The backscatter factors were derived
medium-energy x rays. . . . . . . . . . . . . . . . . . . 883 from Monte Carlo calculations. The values of the chamber
B.1.1. In-air mass energy-absorption perturbation factor used by the IAEA have been the source of
coefficient ratio 关 ( ␮ ¯ en/ ␳ ) wair兴 air. . . . . . . . 883 some controversy.9–16 In 1991, the Institute of Physical Sci-
B.1.2. Backscatter factor B w . . . . . . . . . . . . . . 883 ences in Medicine Working Party 共IPSM兲17 recommended no
B.1.3. Chamber stem correction factor change in the conversion factor F given by HPA but gave a
P stem,air. . . . . . . . . . . . . . . . . . . . . . . . . . 883 new set of backscatter factors which were derived from a
combination of more recent Monte Carlo calculations and
B.2. The in-phantom calibration method for
experimental results. The more recent code of practice of the
medium-energy x rays. . . . . . . . . . . . . . . . . . . 886
Institute of Physics and Engineering in Medicine and Biol-
B.2.1. In-phantom mass energy-absorption
ogy 共IPEMB兲18 published in 1996 and the code of practice of
coefficient ratio 关 ( ␮ ¯ en/ ␳ ) wair兴 water. . . . . . 886
the Netherlands Commission on Radiation Dosimetry
B.2.2. Ion-chamber correction factor 共NCS兲19 published in 1997 further incorporated the chamber
P Q,cham. . . . . . . . . . . . . . . . . . . . . . . . . . 887 correction factors that were consistent within 2% with the
B.2.3. Sleeve correction factor P sheath. . . . . . . 887 new IAEA recommendations issued in the second edition of
B.3. Conversion factors to calculate dose in TRS-277.13
other biological materials. . . . . . . . . . . . . . . . 887 In North America, a variety of dosimetry procedures have
APPENDIX C. SUMMARY OF been used in practice, with a combination of conversion and
RECOMMENDATIONS AND WORKSHEETS . . . . 888 correction factors measured and/or taken from different
C.1. TG-61 Worksheet: Calculating dose to protocols.1,2,20 For the last few years, there have been a num-
water on the phantom surface. . . . . . . . . . . . . 890 ber of publications concerning this subject leading to the
C.2. TG-61 Worksheet: Calculating dose to formation of several dosimetry task groups outside North
water at 2 cm depth in water. . . . . . . . . . . . . 891 America and new dosimetry protocols for kilovoltage x rays.

Medical Physics, Vol. 28, No. 6, June 2001

870 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 870

The AAPM Radiation Therapy Committee Task Group 61 V C兲, it is the sign of the charge collected. Unit C 共Coulomb兲
was set up to evaluate the current situation and to recom- or rdg 共electrometer reading兲.
mend suitable dosimetry procedures for kilovoltage x-ray M : electrometer reading corrected for temperature, pres-
beam dosimetry for radiotherapy and radiobiology. sure, ion recombination, polarity effect and electrometer ac-
curacy. Unit C 共Coulomb兲.
B. Scope of this document ( ␮ tr / ␳ ) med: the mass energy-transfer coefficient for a me-
dium med. The unit is m2/kg. The mass energy-transfer co-
This protocol deals with the dosimetry of kilovoltage x efficient is the average fractional amount of incident photon
rays 共tube potential: 40–300 kV兲 for radiotherapy and radio- energy transferred to kinetic energy of charged particles as a
biology applications. It is an air-kerma-based protocol using result of the photon interactions with the medium. When
a calibration of an ionization chamber in air at a standards multiplied by the photon energy fluence (⌿⫽⌽•E), where
laboratory. This protocol is valid only when the conditions of ⌽ is the photon fluence and E the photon energy, it gives the
charged particle equilibrium are satisfied. The scope of this kerma to the medium. The mass energy-absorption coeffi-
protocol is fourfold: cient is related to the mass energy-transfer coefficient by
共1兲 calibration methodology 共dosimeter requirements and ( ␮ en / ␳ ) med⫽( ␮ tr / ␳ ) med(1⫺g). As g is generally very small
phantom configurations兲; it is often ignored for low- and medium-energy x rays, and
共2兲 determination of absorbed dose to water at reference the mass energy transfer coefficient is used for the mass
depths in water; energy-absorption coefficient. Thus, the kerma is taken as
共3兲 determination of absorbed dose to water at other depths collision kerma, and we do not distinguish collision kerma
in water; and and kerma in this protocol unless it is needed.
共4兲 determination of absorbed dose to other biological mate- (␮¯ en / ␳ ) med2
med1: the ratio of the mean mass energy-absorption
rials on the surface. coefficient for medium 2 共med 2兲 to medium 1 共med 1兲,
which is dimensionless. Each of the mean values is calcu-
lated by averaging the monoenergetic mass energy-
C. List of nomenclature, symbols, and units
absorption coefficients over the photon energy fluence spec-
The following are the symbols used in this document: trum at the point of interest either in air or at a depth in
B w : backscatter factor defined, for the reference field size water. In ionization chamber dosimetry, we usually have me-
and beam quality, as the ratio of water kerma at the surface dium 1⫽air and medium 2⫽water, in which case we have
of a semi-infinite water phantom to water kerma at that point (␮¯ en / ␳ ) wair , which is used to convert air kerma to water
in the absence of the phantom. It accounts for the effects of kerma, either free in air or at a depth in water.
phantom scatter for kilovoltage x-ray beams when the ‘‘in- N K : air-kerma calibration factor, for a specified x-ray beam
air’’ method is used for the dose determination. quality. This quantity, when multiplied with the corrected
C med
w : a factor to convert dose from water to a medium med, chamber reading, yields air kerma under the conditions that
which is dimensionless. the photon fluence spectrum and angular distributions are the
D med,z : absorbed dose to a medium med at a depth z, ex- same as that for which the calibration factor has been de-
pressed in Gy. rived, expressed in Gy C⫺1.
D w,z : absorbed dose to water at a depth z, expressed in Gy. P: air pressure inside ion chamber, in kPa. The reference
g: fraction of the energy of secondary electrons that is lost measurement pressure is P ref⫽101.33 kPa 共or 760 mm Hg兲.
in radiative processes in the medium, which is dimension- P dis: displacement correction factor to account for the ef-
less. For low-Z materials, it is less than 0.1% for photons fects due to the displacement of water by a stemless chamber
below 300 keV. 共i.e., only the air cavity and the chamber wall兲, which is
HVL: half-value layer, defined as the thickness of an absorb- dimensionless.
ing material 共usually Al or Cu兲 necessary to reduce the air- P E, ␪ : correction factor to account for the effects on the re-
kerma rate to 50% of its original value in an x-ray beam, in sponse of a stemless chamber due to the change in photon
narrow beam conditions. Unit of this quantity is ‘‘mm Al’’ energy and angular distributions between the calibration 共in
for low-energy x rays and ‘‘mm Cu’’ for medium-energy x air兲 and measurement 共in phantom兲, which is dimensionless.
rays. P pol: ionization chamber polarity effect correction factor,
HC: homogeneity coefficient, defined as the ratio of the first which is dimensionless.
half-value layer 共HVL兲 thickness to the second HVL thick- P Q,cham: overall correction factor to account for the effects
ness of a medium 共usually in Al or Cu兲, which is dimension- due to the change in beam quality between calibration and
less. measurement and to the perturbation of the photon fluence at
K air: air kerma, expressed in Gy. the point of measurement by the chamber, and the chamber
K in-med
air : air kerma in medium med, expressed in Gy. stem, which is dimensionless.
K w : water kerma, expressed in Gy. P sheath: waterproofing sheath correction factor to account for
K in-med
w : water kerma in medium med, expressed in Gy. the effects of the change in photon attenuation and scattering
M raw: uncorrected electrometer reading. If no sign is indi- due to the presence of the waterproofing sheath in a water
cated, the measurement is made collecting the same charge phantom 共if present兲, which is dimensionless.
as during calibration. If a sign 共⫹ or ⫺兲 is indicated 共see Sec. P stem,air: stem correction factor to account for the effects of

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871 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 871

the change in photon absorption and scattering between the portant reason for this division is to specify a lower limit to
calibration 共in air兲 and the measurement 共in air兲 due to the the medium energy range, below which the in-phantom
presence of the chamber stem, which is dimensionless. method shall not be used.
P stem,water: combined stem correction factor to account for
the effects of the change in photon absorption and scattering
between the calibration 共in air兲 and the measurement 共in B. Beam quality specifier
phantom兲 due to the presence of the chamber stem, which is Specification of a kilovoltage x-ray beam requires knowl-
dimensionless. edge of the photon fluence spectrum at the point of interest.
T: temperature, in °C. For the calibration labs in North The half value layer 共HVL兲 solely or in combination with the
America, the reference temperature is T ref⫽22 °C. tube potential is often used to characterize the spectrum.
(W/e) air: average energy expended per unit charge of ion- HVL is specified in terms of ‘‘mm Al’’ for low-energy x
ization produced in dry air, having the value 33.97 J/C. Note rays and ‘‘mm Cu’’ for medium-energy x rays. For conve-
that the ‘‘exposure-to-dose-to-air’’ conversion coefficient de- nience, however, ‘‘mm Al’’ may also be used for x-ray
rived from this value is 0.876⫻10⫺2 Gy/R. beams with tube potentials up to 150 kV 共a superficial x-ray
z ref: reference depth in water for dose calibration measure- unit may have tube potentials from 30 to 150 kV兲.
ment, in cm. z ref⫽0 for low-energy 共up to 100 kV兲 x-ray The quality of a beam depends on many factors such as
beams. z ref can be either 0 or 2 cm for medium-energy 共100– tube potential, target angle, target material, window material,
300 kV兲 x-ray beams depending on the point of interest. and thickness, monitor chamber material and thickness, fil-
SSD: source to surface distance, in cm. This is usually a tration material and thickness, shape of collimation, and the
nominal distance because the exact position of the x-ray source-chamber distance. A measurement of HVL may be
source focal spot is not well defined. affected by the details of the experimental setup, the proce-
‘‘In-air method’’: calibration method to obtain absorbed dures and the energy dependence of the dosimeters used.
dose to water at the surface of a water phantom, based on an Section II C describes the setup for the measurement of
in-air measurement using an ion chamber calibrated free in HVL.
air. There are a variety of reports on measured x-ray spectra
‘‘In-phantom method’’: calibration method to obtain ab- essentially from the 1960s and the 1970s,25–28 that apply to
sorbed dose to water at 2 cm depth in water, based on an clinical as well as calibration and research x-ray setups. As
in-water measurement using an ion chamber calibrated free well, various programs have been developed for the calcula-
in air. tion of kilovoltage x-ray spectrum and the HVL value based
Use of the term ‘‘shall’’ and ‘‘should’’: recommendations on on the calculated spectrum 共see Refs. 29 and 34兲. Detailed
reference dosimetry and quality assurance in this protocol information about the target and the target angle, the mate-
have been systematically preceded by the term shall. These rials in the beam and their thicknesses are required for accu-
recommendations must be followed to insure the accuracy of rate HVL calculations. In general, target material, target
the absorbed dose determination using the formalisms and angle, filtration material and thickness are given by the
dosimetric data provided in this protocol. This term is not manufacturers while other factors are poorly known and may
used in the sections headed by the term ‘‘Guidelines’’ in differ from the manufacturer’s specifications.
which multiple alternatives may exist for the same purpose. It is generally considered to be insufficient to use only
‘‘Should’’ has been used in situations, where a recom- tube potential or HVL to specify a beam.21 Commonly used
mended practice may be modified by the user provided that clinical beams have been reported to have a wide range of
the replacement practice does not compromise the dosimetry HVL values corresponding to the same tube potential.1,2
accuracy. Chamber-related factors, such as N K and P Q,cham , as well as
the detector-independent mass energy-absorption coefficients
for water to air and the backscatter factors, can vary for x-ray
beams of the same tube potential but different HVL values,
II. RADIATION QUALITY SPECIFICATION AND and vice versa.22,23 Although dosimetry data are increasingly
DETERMINATION derived as a function of both tube potential and HVL,28 the
A. Energy ranges considered use of both tube potential and HVL value may not com-
pletely resolve the specification problem for all the quantities
The energy range (40 kV⭐tube potential⭐300 kV) con- involved. Moreover, in the context of a protocol, the addition
sidered in this paper is divided into two regions of clinical of a quantity in terms of which the data have to be presented
and radiobiological relevance: increases complexity and the probability of clinical errors.
共i兲 ‘‘low-energy 共or superficial兲 x rays’’: x rays generated For the specification of mass energy-absorption coefficient
at tube potentials lower than or equal to 100 kV and ratios for in-phantom dosimetry, a recent investigation has
共ii兲 ‘‘medium-energy 共or orthovoltage兲 x rays’’: x rays examined the uniqueness of the ratio of ionization at 2 cm to
generated at tube potentials higher than 100 kV. ionization at 5 cm24 but more work is required to verify the
validity of such a beam quality specifier.
Since this protocol allows for the use of the in-air method In this protocol, we separate the issue of beam quality
throughout the entire 40–300 kV energy range, the most im- specification into two main stages. The first stage deals with

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872 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 872

material 共see Fig. 1兲. For the air-kerma measurement, small-

size detectors are desirable. The beam must cover the sensi-
tive volume of the detector. The detector response shall have
limited beam-quality dependence 共within 5% between 40 and
300 kV兲 for accurate HVL measurements. The attenuator
shall be made of high-purity 共99.9%兲 material and the thick-
ness of the attenuator shall be measured with an accuracy of
0.05 mm.

FIG. 1. The experimental setup for HVL measurement. Shown in the figure III. EQUIPMENT
are source 共target兲, HVL attenuator, diaphragm, and ion chamber. The loca-
tion of the monitor chamber for normalization of the ion chamber signal, if A. Phantoms
applicable, is shown. The monitor may already be part of the x-ray setup. If
not, it must be positioned such that its response is not affected by changing When using the in-air method, the measurement is per-
the filter thickness. The ion chamber for the kerma-rate measurement must formed free in air, and no phantom is involved 共see Sec. V
be sufficiently energy independent so that a change in filter thickness causes A兲. When using the in-phantom method 共see Sec. V B兲, wa-
an insignificant change in energy dependence.
ter is the phantom material to perform the measurement and
the phantom size shall be 30⫻30⫻30 cm3 or larger. For con-
obtaining the air-kerma calibration factor N K from the stan- venience, plastic phantoms may be used for in-phantom rou-
dards lab. The chamber shall be calibrated at a beam quality tine quality assurance. However, they shall not be used for
sufficiently close to the user’s beam quality in terms of both in-phantom reference dosimetry for kilovoltage x rays as the
the tube potential and HVL to ensure the validity of the chamber correction factors and the conversion factors to de-
calibration factor in the clinical situation 共see Sec. III B兲. rive dose at a depth in water for these phantoms are not well
Preferably, the chamber should be calibrated at more than known. In addition, the water equivalence of some commer-
one x-ray quality to ensure that the user’s beam quality is cial plastics for kilovoltage x rays remains an area of active
properly covered. The second stage deals with measuring the investigation.33
absorbed dose in the user beam. At this stage HVL only is
considered to be the quality specifier. Section VIII deals with B. Dosimeters
estimates of uncertainties, which include estimates for the
Air-filled ionization chambers shall be used for reference
lack of complete beam quality specification by using only
dosimetry in kilovoltage x-ray beams. The effective point of
HVL to specify the quantity involved. For convenience, we
measurement for both cylindrical and parallel-plate cham-
only use tube potential to denote the x-ray energy range in
bers is the center of the sensitive air cavity of the chamber.
this protocol.
All measurements shall be corrected for temperature, pres-
sure, ion recombination, polarity effect, and electrometer ac-
C. Determination of HVL
curacy. The fully corrected reading is defined as M
The first HVL of an x-ray beam is defined as the thickness ⫽M rawP TPP ionP polP elec , where M raw is the raw uncorrected
of a specified attenuator that reduces the air-kerma rate in a reading 共in-air or in-phantom兲. Descriptions of the various
narrow beam to one half its original value. The determina- correction factors can be found in Sec. V C. Cognizant of
tion of HVL involves the measurement of the variation with chamber response 共from either calibration standards labora-
the attenuator thickness of air kerma at a point in a scatter- tories, comparison of known chamber, or manufacturer’s
free and narrow beam.30,31 This means that for this measure- data兲, chamber calibration factors should not vary signifi-
ment, detectors shall be used with sufficient buildup thick- cantly between two calibration beam qualities so that the
ness to eliminate the effect of contaminant electrons 共see estimated uncertainty in the calibration factor for a clinical
Sec. III B兲. beam quality between the two calibration qualities is less
Figure 1 shows the experimental setup for the HVL mea- than or equal to 2%.
surement. The beam diameter defined by the diaphragm shall For low-energy x rays with tube potentials below 70 kV,
be 4 cm or less. The thickness of the diaphragm must be calibrated soft x-ray parallel-plate chambers with a thin en-
thick enough to attenuate the primary beam to 0.1%. The trance window shall be used. Thin plastic 共low-Z, e.g., poly-
detector shall be placed at least 50 cm away from the attenu- ethylene or PMMA兲 foils or plates shall be added to the
ating material and the diaphragm. A radiographic check of entrance window, if necessary, to remove electron contami-
the alignment of the source, the diaphragm, and the detector nation and provide full buildup. When presented for calibra-
shall be performed. A monitor chamber can be used to cor- tion, it is the responsibility of the user to provide these
rect for variations of air-kerma rate especially when the air- buildup plates or foils as part of their instrument to the Ac-
kerma rate is significantly lowered by the addition of filtra- credited Dosimetry Calibration Laboratories 共ADCL兲, Na-
tion in the beam during the HVL measurement. In that case, tional Institute for Standards and Technology 共NIST兲, or Na-
it must be properly placed so that it does not perturb the tional Research Council of Canada 共NRCC兲, since the same
narrow beam by adding to the scatter component, and its plate or foils are to be used when calibrating the clinical
response is not affected by the thickness of the attenuating beam. Table I shows total buildup thickness obtained from

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873 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 873

TABLE I. Total wall thickness required to provide full buildup and eliminate dium energy x rays兲 may also be used. However, correction
effects of electron contamination during calibration of a low-energy 共⭐100 factors must then be determined experimentally by compar-
kV兲 clinical beam using thin-window plane-parallel chambers. The window
thickness of the chamber 共for example, 2.5 mg/cm2兲 should be subtracted
ing the chambers with a chamber with known correction fac-
from the values listed in this table so as to arrive at the required foil or plate tors 共see Sec. V C.8兲.
thickness for full buildup. The data are calculated from CSDA ranges in
polyethylene for the most energetic electrons using ICRU Report No. 37 C. Electrometers
tabulations 共Ref. 42兲. CSDA ranges in PMMA are about 10% higher. Note
that for in-air calibrations in medium-energy x rays 共⬎100 kV兲, cylindrical Ionization chambers are read out by the use of a charge-
chambers with walls ⬎50 mg/cm2 and without buildup cap shall be used, as or current-measuring device, normally termed an electrom-
their wall thickness is sufficient to provide full buildup. eter. This device shall be capable of reading currents on the
Tube potential Total wall thickness order of 0.01 nA, with an accumulated charge of 50–100 nC.
共kV兲 共mg cm⫺2兲 If calibrated separately from the ionization chamber, the
electrometer shall be calibrated by an ADCL, NIST or
40 3.0
50 4.0 NRCC and the correction factor applied as part of deriving
60 5.5 the corrected ion chamber reading M. This correction factor
70 7.3 is generally close to 1.000 but occasionally can differ from
80 9.1 unity by as much as 5%. If the combination of electrometer
90 11.2
and ionization chamber is calibrated together as one device
100 13.4
no separate electrometer correction is needed 共i.e., P elec⫽1兲.

D. Quality assurance of the dosimetry equipment and

x-ray tube
the calculated ranges of the most energetic electrons in poly-
ethylene based on continuous-slowing-down approximation Quality-assurance procedures shall be performed on all
共CSDA兲. The thickness of the needed plate or foils must be equipment used for the calibration. The major items are
determined by subtracting the window thickness 共for ex- listed below:
ample, 2.5 mg/cm2兲 from the total thickness listed in Table I. 1. Ionization chamber
For low energy x rays with tube potential of 70 kV or higher,
A means of monitoring the consistency of the ionization
cylindrical chambers that satisfy the chamber response re-
chamber shall be established. This shall be carried out by
quirements described above can also be used.
two or more of the following procedures:
Measurements for medium-energy x rays 共tube potential
共i兲 Use of a check source, usually Sr-90: This involves a
100–300 kV兲 are performed with the effective point of mea-
timed exposure accumulating charge or current measure-
surement of the chamber placed either at 2 cm depth in water
ment. The temperature and pressure corrected chamber read-
共in cases where the dose at greater depths is of primary in-
ing shall remain consistent within ⫾2%. Care must be exer-
terest兲 or free in air 共in cases where the surface dose is of
cised to ensure that the chamber is placed in the same
primary interest兲. Cylindrical chambers that have a calibra-
position each time.
tion factor varying with the beam quality by less than 3%
共ii兲 Redundant chambers: There shall be consistency, to
between 100 and 300 kV shall be used for reference dosim-
within 2%, in the measurement by using two or more cali-
etry. If measurements are performed in water with a nonwa-
brated chambers.
terproof chamber and a waterproofing sleeve, appropriate
共iii兲 Use of another beam, such as 60Co: Establish the
correction factors shall be applied depending on the sleeve
baseline response of the chamber at 60Co and verify the
material and thickness 共see Appendix B.2.3兲. Natural or syn-
chamber response is reproducible to within 0.2%. Account
thetic rubber sleeves shall not be used because their charac-
for the energy dependence of the chamber response, which
teristics are unknown for kilovoltage x-ray beams. Care shall
shall be verified, in the determination of the baseline cham-
be taken that there is no talcum powder involved in water-
ber response at the kV radiation quality of interest. The
proofing the chamber, since talcum particles entering the
chamber calibration for medium-energy x rays should be
cavity through the venting hole might dramatically change
consistent with the 60Co calibration to within 2%.
the chamber response.76 The air gap between chamber and
The consistency of the response of the ionization chamber
sleeve shall not be larger than 0.2 mm. Cylindrical chambers
shall be checked every time reference dosimetry is accom-
have adequate thimble thickness 共50 mg cm⫺2 or more兲 and
plished. The chamber shall be checked for constancy before
therefore do not require a buildup cap if measurements are
submitting it for calibration to the standards laboratory and
done in air.66
rechecked after it is received. The ion chamber shall be cali-
There have been extensive studies on the correction fac-
brated when first purchased, when repaired, when the con-
tors for the commonly used Farmer chamber types for the
stancy checks so demand, or once every 2 yr.
in-phantom measurement.10–12,14–16,32 Although in this pro-
tocol correction factors are provided for some ionization
chambers only 共see Appendix B.2.2兲, other cylindrical cham- 2. Electrometer
bers matching the above mentioned requirement 共i.e., no The electrometer shall be checked along with the ioniza-
more than 3% variation of their calibration factor for me- tion chamber using the above procedures. In addition, an-

Medical Physics, Vol. 28, No. 6, June 2001

874 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 874

other calibrated electrometer can be used with the same ion- TABLE II. 共a兲 Some x-ray beams provided by NIST and the ADCLs for the
L and M series. The number part of the beam code represents the tube
ization chamber and should give the same corrected reading
potential in kV of the beam. 共b兲 Ranges of x-radiation qualities relevant to
to within 0.5%. If the electrometer has a timer feature, this protocol provided by NRCC.
charge can be collected for a time interval to determine dose
rate. This dose rate shall be the same as that for the x-ray 共a兲 First HVL
Homogeneity coeff.
machine timer setting when any end effect, if present, is Beam code 共mm Al兲 共mm Cu兲 共Al兲
accounted for 共see below兲.
L40 0.50 0.59
L50 0.76 0.60
3. Tube potential of x-ray generator L80 1.83 0.57
L100 2.77 0.57
Generally the tube potential will not vary significantly. M20 0.15 0.69
Consistency of the x-ray output shall be checked routinely. If M30 0.36 0.65
it changes by more than 3%, the accuracy of settings of the M40 0.73 0.69
M50 1.02 0.66
tube potential and filament, including the accuracy and lin-
M60 1.68 0.66
earity and end effect shall be investigated.71 This shall also M80 2.97 0.67
be done as a check on an annual basis. M100 5.02 0.73
M120 6.79 0.77
M150 10.2 0.67 0.87
IV. AIR-KERMA CALIBRATION PROCEDURES M200 14.9 1.69 0.95
M250 18.5 3.2 0.98
Implementation of this protocol involves the calibration
M300 22.0 5.3 1.00
of the ionization chamber in an appropriate x-ray beam in
terms of air kerma free in air (K air) in a standards lab refer- 共b兲 First HVL
ence beam quality. Suppose that K air is the air kerma at the Peak tube potential 共mm Al兲 共mm Cu兲
reference point in air for a given beam quality and M the
40 0.09–2.15
reading 共corrected for temperature, pressure, recombination, 50 0.09–3.74
polarity effect, and electrometer accuracy兲 of an ionization 60 0.09–4.89
chamber to be calibrated with its reference point at the same 70 0.10–5.86
point. The reference point for plane parallel chambers as well 80 0.10–6.72
100 0.15–6.83
as cylindrical chambers is at the center of the cavity. The
120 1.48–8.33 0.09–1.27
field size shall be large enough to provide uniform exposure 135 1.72–8.98 0.10–1.50
of the chamber sensitive volume. The air-kerma calibration 150 0.12–1.74
factor N K for this chamber at the specified beam quality is 180 0.17–2.18
defined as: 200 0.21–2.45
250 0.40–3.49
K air 300 0.53–4.57
N K⫽ . 共1兲
M
The relation between the air kerma and the frequently used
exposure calibration factor N X is given by formed within the same series, e.g., only for the L series or

冉冊
only for the M series. Table II共b兲 summarizes beam-quality
W ranges available at NRCC.
N K ⫽N X 共 1⫺g 兲 , 共2兲
e air The ADCL, NIST, or NRCC may also provide a determi-
nation of the ion-collection efficiency during calibration.
where (W/e) air has the value 33.97 J/C(⫽0.876
However, because of the low dose rates used in standards
⫻10⫺2 Gy/R兲 for dry air as discussed earlier, (1⫺g)
laboratories, this should be generally unity. Ion-collection
corrects for the effect of radiative losses 共mainly due to
efficiency is a measure of the fraction of charge measured by
bremsstrahlung emission兲 by the secondary charged par-
the chamber versus the total charge released, and depends on
ticles, and g is less than 0.1% for photons below 300 keV in
the dose rate and the collecting potential and geometry of the
air.
chamber. For the implementation of the protocol, a corrected
Calibration factors N K shall be traceable to national stan-
reading 共see Sec. V C兲 shall be used. The recombination cor-
dards, i.e., from an ADCL, NIST or NRCC, preferably for a
rection can be significant for the calibration of low energy
number of x-ray beam qualities. Both tube potential and
x-ray machines at source to surface distance 共SSD兲 of a few
HVL shall be used to specify the air-kerma calibration factor.
cm where dose rates may be typically on the order of 10
Table II共a兲 shows some of the x-ray beams as provided by
Gy/min at the treatment distance.
NIST; some ADCLs provide similar beams. Note that a cali-
bration or interpolation between HVLs might be inadequate.
For example, depending on the chamber’s energy depen- V. FORMALISM
dence, significant errors may occur if one attempts interpo- For low-energy x rays 共tube potential less than or equal to
lation between lightly filtered 共L series兲 beams and medium 100 kV兲, reference dosimetry shall be performed free in air
filtered 共M series兲 beams. Interpolation may only be per- and a backscatter factor shall be used to account for the

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875 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 875

effect of the phantom scatter. For medium-energy x rays The measurement is performed at the point where dose at
共tube potential higher than 100 kV兲, two different but mutu- the phantom surface is required 共e.g., the cone end兲. If this is
ally consistent formalisms can be used. If the point of inter- not possible, the measurement shall be performed at a point
est is at the phantom surface (z ref⫽0), the measurement as close as possible to the point of interest, and corrected to
shall be performed in air and a backscatter factor shall be obtain the dose there. To this end, an inverse square correc-
used to account for the effect of the phantom scatter 共the tion can be used 共see Sec. V C.6兲.
‘‘in-air’’ method兲. If the point of interest is at a depth in
water, the measurement shall be performed at the reference B. The in-phantom method: Absorbed dose to water
depth (z ref⫽2 cm) in a water phantom and a chamber depen- at 2 cm depth in water for medium-energy x
dent correction factor 共and a waterproofing sheath correction rays „100 kVËtube potentialÏ300 kV…
if applicable兲 shall be applied to account for all differences
This method requires placing a calibrated ionization
between the in-air calibration and the measurement in the
chamber at a reference depth in a water phantom. If the
phantom 共the ‘‘in-phantom’’ method兲.
reference depth is too small there may not be enough buildup
material in the upstream direction to cover the whole cham-
ber. If the reference depth is much larger than 2 cm, the
A. The in-air method: Absorbed dose to water at the ionization signal in the chamber may be too small. There-
surface for low- and medium-energy x rays fore, this protocol has adopted a reference depth of 2 cm.
„40 kVÏtube potentialÏ300 kV…
Although the conversion and correction factors needed in the
To use the in-air calibration method for a low- and formalism are only slightly dependent on depth, the data pro-
medium-energy x-ray beam 共tube potential: 40–300 kV兲, the vided in this protocol assume a reference depth of 2 cm.
reference depth for the determination of absorbed dose is at The absorbed dose to water at the 2 cm reference depth
the phantom surface (z ref⫽0). The absorbed dose to water at (z ref⫽2 cm) in water for a 10⫻10 cm2 field defined at 100
the phantom surface shall be determined according to cm SSD shall be determined using

冋冉 冊 册
D w,z⫽0 ⫽M N K B w P stem,air
␮
¯ en
␳
w

air air
, 共3兲
D w,z⫽2 cm⫽M N K P Q,chamP sheath关共 ␮
¯ en / ␳ 兲 wair兴 water ,
where M is the chamber reading, with the center of the air
共4兲

cavity of the chamber placed at the reference depth, cor-

where M is the free-in-air chamber reading, with the center
rected for temperature, pressure, ion recombination, the po-
of the sensitive air cavity of the ionization chamber placed at
larity effect and electrometer accuracy, and N K the air-kerma
the measurement point (z ref⫽0), corrected for temperature,
calibration factor for the given beam’s quality 关see Eq. 共1兲兴.
pressure, ion recombination, polarity effect, and electrometer
P Q,cham is the overall chamber correction factor that accounts
accuracy; N K the air-kerma calibration factor for the given
for the change in the chamber response due to the displace-
beam’s quality; B w the backscatter factor which accounts for
ment of water by the ionization chamber 共air cavity plus
the effect of the phantom scatter; P stem,air the chamber stem
wall兲 and the presence of the chamber stem, the change in
correction factor accounting for the change in photon scatter
the energy, and angular distribution of the photon beam in
from the chamber stem between the calibration and measure-
the phantom compared to that used for the calibration in air.
ment 共mainly due to the change in field size兲, and
P sheath is the correction for photon absorption and scattering
关(␮
¯ en / ␳ ) wair兴 air the ratio for water-to-air of the mean mass
in the waterproofing sleeve 共if present兲 and 关 ( ␮
¯ en / ␳ ) wair兴 water
energy-absorption coefficients averaged over the incident
the ratio for water-to-air of the mean mass energy-absorption
photon spectrum. The numerical values of the conversion
coefficients, averaged over the photon spectrum at the refer-
and correction factors in Eq. 共3兲 are discussed in Appendix
ence point in water in the absence of the chamber. The nu-
B.1.
merical values of the conversion and correction factors in Eq.
P stem,air is taken as unity if, for a given beam quality, the
共4兲 are discussed in Appendix B.2.
same field size is used in the calibration and the measure-
ment. Otherwise, the guidelines in Sec. V C.7 shall be fol-
lowed to establish P stem,air . C. Other considerations in the calibration
measurement
The backscatter factor B w must include the effect of end
plates in close ended cones, if used, on the determination of The following points need to be considered in the calibra-
water kerma at the phantom surface. We have provided a tion measurement of kilovoltage x-ray beams 共consult Ap-
table with multiplicative corrections to the open cone values pendix C for detailed descriptions of the dose calibration
in Appendix B.1.2. measurement兲:
It shall be remembered that Eq. 共3兲 yields the absorbed
dose at the phantom surface under the conditions of charged 1. Ion collection efficiency P ion
particle equilibrium and in the absence of electron contami- To determine accurately the dose absorbed in the air in
nation from the primary beam 共i.e., assuming dose⫽kerma, the ionization chamber cavity, the complete collection of the
see Appendix A.1兲. This applies to open cones as well as to ions formed by the radiation is required. Some of the ions
closed cones. For some practical guidelines to deal with elec- recombine with ions of the opposite charge on their way to
tron contamination in clinical beams see Sec. VII C. the collection electrode and are not collected. Models have

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876 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 876

been developed to estimate the true number of ions formed timer plot yields the end effect. The end effect ␦ t can also be
from measurements made with two different voltages.52 The derived using a mathematical equation described by Attix57
value is usually obtained by using the normal collecting volt-
M 2 ⌬t 1 ⫺M 1 ⌬t 2
age and half that voltage.53–55 Although, recent literature ␦ t⫽ , 共7兲
suggests many small problems with this procedure, the re- M 1 ⫺M 2
cent AAPM TG51 protocol56 as well as this protocol have where M 1 and M 2 are the chamber readings for exposure
used the same procedures because the accuracy is expected time ⌬t 1 and ⌬t 2 , respectively. Coffey20 shows that the
to be better than 0.5% at normal chamber operating voltages above two methods may give slightly different results as the
of 300 V or less.56 For the procedure, let V H be the normal mathematical equation uses only two points, whereas the
H
collecting voltage for the detector, M raw be the raw chamber graphical method uses the whole time range of clinical inter-
L
reading with bias V H , and M raw the raw chamber reading at est. To ensure the accuracy of the measured end effect, the
bias V L , where V L /V H ⭐0.5. M raw
L H
and M raw are to be mea- graphical method shall be used during the machine commis-
sured once the chamber readings have reached equilibrium. sioning and annual QA. The mathematical method may be
For continuous beams, the two-voltage approach yields56 used for the monthly QA measurement.

1⫺ 冉 冊
VH
VL
2

4. Electrometer correction „ P elec…

冉 冊
P ion共 V H 兲 ⫽ H 2. 共5兲 The device used to read the signal from the ionization
M raw VH
L ⫺ chamber requires calibration as part of the instrument cali-
M raw VL
bration process. This calibration is performed at the ADCL
Generally P ion is close to unity but care should be exercised or NIST. At NRCC, electrometer and chamber are usually
when using small SSDs. If an ion chamber exhibits a correc- calibrated together, as one instrument. P elec represents the
tion factor P ion greater than 1.05, the uncertainty becomes calibration factor for the reading device only.
unacceptably large and another ion chamber with a smaller
recombination effect shall be used.56 5. Temperature – pressure correction P TP
The calibration factor assigned by a standards laboratory
2. Polarity correction P pol to an ionization chamber is based on the mass of gas 共air兲
Polarity effects depend on beam quality and cable ar- present in the volume. This mass varies with temperature and
rangement and shall be measured and corrected for. The P pol pressure when the chamber is open to the atmosphere. There-
factor can be deduced from56 fore, correction of the amount of charge collected in the

冏 冏
⫹ ⫺ chamber must be made to the reference temperature 共T ref is
M raw ⫺M raw
P pol⫽ , 共6兲 22 °C兲 and pressure 关P ref is 101.33 kPa 共760 mm Hg兲兴. The
2M raw correction required for the actual temperature and pressure is
⫹
where M raw is the reading when positive charge is collected, P ref 共 T 关 °C兴 ⫹273.2兲
⫺
M raw is the reading when negative charge is collected, and P TP⫽ . 共8兲
⫹ ⫺ P 共 T ref关 °C兴 ⫹273.2兲
M raw 共one of M raw and M raw 兲 is the reading corresponding to
the charge collected for the reference dosimetry measure-
ments 共the same as used for the chamber calibration兲. In both
6. Inverse-square consideration for in-air
⫹ calibration with close-ended cones
cases, the sign of M raw must be used and usually M raw and
⫺
M raw have opposite signs unless the background is large. Because of the finite size of an ionization chamber it is
Adequate time must be left after changing the sign of the often impossible to measure the air kerma directly at the
voltage so that the ion chamber’s reading has reached equi- cone end. The inverse-square relation can be used to derive
librium. the air kerma value at the cone end using the measured value
at an extended distance provided the effective source posi-
3. End effect ␦ t tion is known. The effective source position is generally dif-
ferent from the x-ray focal spot due to photon scattering in
The end effect is defined as the amount of time that is not the end plate. The effective source position can be deter-
accounted for by the machine timer mechanism during the mined using measurements made at different distances with
x-ray beam delivery. This amount of time usually describes the smallest chamber available, and then extrapolating to
the time difference between when the timer mechanism starts zero distance to the cone end.3,50 Note that the P stem,air value
and when the desired mA and kVp is achieved, or the finite may change 共because of its field-size dependence兲 if mea-
time required for the shutter to move from the fully closed to surements are performed at different distances.
the fully open position. A small end effect 共0.5–3 s兲 may
play a significant role in the output calibration procedure
especially for the small dose range 共3 min or less treatment 7. Method for determination of P stem,air
duration兲. The end effect for an x-ray unit can be measured P stem,air accounts for the effect of the change in photon
using the graphical extrapolation method. The graphical so- scatter from the chamber stem between the calibration in a
lution of zero exposure on an exposure versus exposure- standards laboratory and the in-air measurement in a user’s

Medical Physics, Vol. 28, No. 6, June 2001

877 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 877

beam. P stem,air should be measured by intercomparing the M ref

chamber with unknown P stem,air with a reference chamber for 共 N K P sheathP Q,cham兲 u ⫽ 共 N K P sheathP Q,cham兲 ref , 共10兲
Mu
which P stem,air is known. Let f u be the field size for which the
beam needs to be calibrated and f c the field size for which
the chamber has been calibrated at the standards laboratory.
where M u and M ref represent the in-phantom chamber read-
The effective point of measurement of the chamber under
ing of the investigated chamber and the reference chamber,
study and that of the reference chamber should be placed at
respectively, both corrected for pressure, temperature, ion
the same point in air. The stem correction P stem,air( f u ) is
recombination, and electrometer accuracy, and the other
determined from the equation:
chamber dependent quantities (N K , P Q,cham, P sheath) for the
reference chamber are provided by the ADCL, NIST, or
M 共 f c 兲 M ref共 f u 兲 NRCC, and from this protocol.
P stem,air共 f u 兲 ⫽ P 共 f 兲, 共9兲
M 共 f u 兲 M ref共 f c 兲 stem,air,ref u

where M ( f c ) and M ( f u ) represent corrected meter readings

for the chamber under study; M ref( f c ) and M ref( f u ) the cor-
rected meter readings for the reference chamber. The field D. Consistency between the in-air method and the in-
size can be changed either by changing the cone and keeping phantom method
the chambers at the same position in space or by measuring Depth-dose curves for kilovoltage x-ray beams are diffi-
at several source–chamber distances using a single cone. The cult to measure 共and therefore less accurate兲 especially near
requirements for the reference chamber are the same as for- the surface. Thus, the determination of the dose on or close
mulated for the dosimeters used for reference dosimetry to the surface might be less reliable using the in-phantom
共Sec. III B兲. However, note that the N K value for the refer- method compared to the in-air method. If the point of interest
ence chamber used for the measurement of P stem,air does not is near the surface, the method of choice for calibration for
need to be known as long as it has been established that the the therapeutic use of kilovoltage x rays is the in-air method.
response variation satisfies the requirements formulated in On the other hand, in instances where an accurate dose de-
Sec. III B. It is suggested that a Farmer type cylindrical termination at a depth of 2–3 cm is critical, the point of
chamber with flat response be used as a reference chamber interest is at a depth and the in-phantom method shall be
for the measurement of P stem,air of another chamber since it used. For example, in many animal radiology experiments
has been established that its stem effect varies by less than with large animals such as dogs, pigs, etc., the point of in-
1%.11,15 It is important that, under all circumstances, the sen- terest is at a depth of several centimeters beneath the skin.
sitive volumes of the chamber under study as well as the The in-phantom method in these cases can provide a more
reference chamber for the measurement of P stem,air be well accurate assessment of the dose because the depth-dose
covered by the radiation beam: the beam diameter should curves are more consistent when normalized at 2 cm depth
typically be 50% larger than the sensitive diameter of the rather than at the surface.
chamber. In any case, because of the overlap in methodology in the
medium-energy x-ray range, the consistency of the data sets
must be ensured. The consistency of using either the in-air or
8. Method for in-phantom calibration of chambers
in-phantom method for medium-energy x rays using the data
not listed in this protocol
sets in this protocol has been investigated.34 The procedures
For a chamber not listed in Appendix B.2.2 the chamber for the measurement of the central-axis depth-dose curves,
shall be intercompared in-phantom, in the beam of interest, which serve as a link between the dose at the reference depth
with one of the listed chamber types. To this end, both the to the dose elsewhere in a phantom, were examined. Depth-
investigated chamber and the reference chamber with known dependent correction factors were calculated using the
air-kerma calibration factor and correction factors should be Monte Carlo method for two types of detectors involved in
exposed in-phantom. Irradiation of the investigated chamber the measurement of the relative depth-dose curves. Although
should be preceded and followed by the irradiation of the the two selected detectors differed significantly in their en-
reference chamber at each radiation quality for which a cali- ergy responses, after correction, the measured depth-dose
bration factor is needed, so as to ensure machine stability and curves for both detectors agreed to within 1.5%.34 Using the
positioning reproducibility of the chambers. The point of corrected depth-dose curves to relate the dose at depth to the
measurement of both the chamber to be investigated as well dose at the surface, and using the data adopted in this proto-
as the reference chamber should be placed at the same ref- col, the consistency between the two methods was within 1%
erence depth. All measurements should be normalized to a for a 100 kV 共2.43 mm Al兲 beam and within 0.5% for a 300
monitor chamber reading placed in a position where it does kV 共3.67 mm Cu兲 beam. It was concluded that the accuracy
not affect the reading of the reference chamber or the cham- of the depth-dose measurement was essential to the consis-
ber under study 共for example, in the phantom downstream in tency study. The response of a detector needs to be known
the corner of the field兲. The overall calibration and correction accurately before it can be used for depth-dose measure-
factor for the investigated chamber can be calculated using: ments.

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878 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 878

VI. GUIDELINES FOR DOSIMETRY IN OTHER

PHANTOM MATERIALS
This protocol describes methods to determine dose to wa-
ter at a 2 cm depth in water or at the surface of a water
phantom according to the preferred calibration procedure.
However, for clinical radiotherapy and radiobiology, the
dose to biological tissues on 共or near兲 the irradiated surface is
of interest.
The surface dose for other materials 共med兲 can be calcu-
lated from

D med,z⫽0 ⫽C med
w D w,z⫽0 共11兲

with the conversion factor from dose-to-water to dose-to-

medium given by

w ⫽
C med
B med
Bw 冋冉 冊 册
␮
¯ en
␳
med

w air
, 共12兲

where 关 ( ␮
¯ en / ␳ ) med
w 兴 air represents the ratio of mass energy-
absorption coefficients medium to water averaged over the
primary photon spectrum free in air, and B med /B w the ratio
of kerma based backscatter factors medium to water. This
means that multiplication of D w,z⫽0 using the procedures
described in this protocol with C med w directly gives the dose at
the surface of a phantom of material med. The numerical
values for the factors in Eq. 共12兲 can be found in Appendix
B.3.

VII. GUIDELINES FOR RELATIVE DOSIMETRY AT

FIG. 2. Relation between tube potential and reported HVL values
OTHER POINTS IN WATER for low- and medium-energy beams as reported by North American clinics
共see Ref. 1兲.
A. Characteristics of clinical beams
Prior to the development of this protocol a survey on the
status of clinical kilovoltage x-ray dosimetry was carried
the reference depth z ref and the measured percentage depth
out.1,2 In the questionnaire, information was requested on the
dose 共PDD兲 curves. The measurement of PDD and dose pro-
tube potential and HVL for the radiation qualities in clinical
files is difficult in kilovoltage x-ray beams. Solid detectors,
use. Figure 2 shows the relation between tube potential and
attractive because of the small size of their sensitive volume
half value layer as reported by the participants. The wide
共diode detector, TLD, film兲, usually show significant beam-
range of HVL values for the same tube potential reflects the
quality dependence and/or large experimental uncertainties.
differences in target material and angle, exit window mate-
Well-designed cylindrical chambers have nearly constant en-
rial and thickness, monitor chamber material and thickness,
ergy response for tube potentials between 40 and 300 kV and
and the variations with filtration material and thickness.
are suitable for in-phantom measurements. However, the
Further information on the characteristics of clinical
measurement depth is limited to no less than the outer radius
beams can be found in Jennings and Harrison43 for x-ray
of the chamber. Parallel-plate chambers have been used for
qualities with HVL less than 0.5 mm Cu, and by Smith and
measurements at smaller depths. Those chambers designed
Sutherland44 for HVL of 0.5 mm Cu and higher. Also the
for electron beams usually have a calibration factor varying
papers by Scrimger and Connors,45 Niroomand-Rad et al.,46
with beam quality by 20%–40% in kilovoltage x rays. Sig-
Gerig et al.,47 Kurup and Glasgow,48 Aukett et al.49 and Li
nificant corrections with depth may be required for the PDD
et al.33,50 report on typical characteristics of clinical beams.
measurement with these chambers. Specifically designed thin
This material has also been reviewed in BJR Supple-
window chambers for low-energy x rays usually have a flat
ment 25.51
energy response in air but not at a depth in a phantom. For
instance, variations in chamber response of more than 10%
B. Recommendations for relative dose measurements have been observed for the Capintec PS-033 chambers.
in water
Thus, a depth-dependent correction factor may be required
The absorbed dose to water at other points in a water for these chambers to be used in the PDD measurement.
phantom can be derived from the measured dose values at Furthermore, the depth dependence of the conversion factor

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879 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 879

共from the measured ionization to absorbed dose兲 may intro- and should not be ignored. Hence, the ionization chamber
duce additional uncertainties in the measured percentage window thickness used in surface dose determination dis-
depth-dose curves.22,23 cussed above becomes an important issue radiobiologically
Although the information on suitable detectors for relative as well as dosimetrically. The consideration of the high sur-
x-ray dosimetry is far from comprehensive, some work has face dose may be even more important in intracavitary and
been performed recently to evaluate specific detector types intraoperative radiotherapy59,64 in that the irradiated epithe-
for their suitability to measure depth-dose curves in kilovolt- lial linings and tissues do not have the insensitive outer lay-
age x-ray beams.34 As a general requirement to evaluate the ers for protection and any enhanced dose is now given to
suitability of a specific detector, the relative response free in living cells. To minimize potential radiation overdose to su-
air as well as in-phantom should be compared with a well perficial tissues within the treatment field it has been
behaved 共Sec. III B兲 cylindrical chamber at depths where rea- suggested59,65 that this increase in surface dose can be re-
sonable measurements with the cylindrical chamber can be duced clinically by: 共1兲 increasing the distance from the ap-
performed. Diamond detectors and the NACP plane parallel plicator cone to the patient surface, 共2兲 inserting an equilib-
chamber have been found to require relatively small depth rium thickness of low-Z absorber between the applicator
dependent corrections in medium-energy x-ray beams34,58 al- cone and the patient surface, and 共3兲 covering the lead-lined
though one should investigate the specific device in terms of applicator walls with low-Z material of sufficient thickness
meeting the requirements for accurate relative measure- to achieve equilibrium. Alternatively, the user can measure
ments.33 Diode detectors are not suitable for relative dosim- the extent of the dose enhancement region, if present, by
etry in this photon energy range. performing measurements with a thin window chamber using
If a suitable detector for relative dosimetry cannot be plates with thicknesses that provide incomplete buildup, rela-
identified in the clinic the data from the British Journal of tive to the full buildup situation under which the chamber
Radiology Supplement 2551 shall be used. was calibrated. However, little has been reported in the lit-
erature on the factors needed to convert the measured ioniza-
tion to the dose near the skin surface.
C. Electron contamination of clinical beams
A significant low-energy x-ray dosimetry problem also
This paper deals with the determination of the absolute exists at the interface between two dissimilar materials, e.g.,
dose at the reference depth (z ref) under the conditions of full soft tissue and high-Z materials. For example, in some clini-
charge particle equilibrium, i.e., the dose value is equivalent cal situations, such as treatment of the lip, buccal mucosa,
to the kerma value 共see Appendix A兲. This requires that cali- and eyelid lesions, internal shielding is useful to protect the
brations and measurements be made using a chamber having healthy structures beyond the target volume. Lead or some
enough buildup so that it indeed measures kerma. It is par- other high-Z material may be used to reduce the transmitted
ticularly important for the in-air method that the chamber dose to an acceptable level. However, backscattered elec-
signal is not affected by the contaminating electrons gener- trons and photons from the high-Z absorber material will
ated in air and on the inside surface of the treatment cone. enhance the dose to the surrounding tissues in the immediate
The presence and specific magnitude of this electron con- vicinity upstream to the shield.
tamination, measured as increased surface dose, depends on Spiers66 describes early work on a second, particularly
the HVL of the x-ray beam, the size of the treatment cone, difficult situation in clinical dosimetry presented by soft
and the buildup of the chamber 共e.g., the window thickness tissue/bone transition zones encountered with low-energy x
of a parallel-plate chamber兲 used in the dose determina- rays. The changes in dose which occur at these interface
tions. 59–62 It has been further shown59,62 that this enhanced transition zones are difficult to measure and quantify due to
surface dose depends strongly on the material from which the difficulties associated with microscopic distances and the
the treatment cone is fabricated with up to a five-fold availability of proper dosimetry systems. Saunders and
increase in relative surface dose with lead lined treat- Peters67 reported this dose enhancement effect for 280 kV
ment cones 共2.0 cm diameter and HVL⫽3.0 mmCu兲. orthovoltage x rays. They reported a dose enhancement fac-
Klevenhagen60 reported that the relative surface dose also tor of approximately three near a polystyrene/lead interface,
changes across the radiation field with the greatest enhanced for x rays of 1.7 mm Cu HVL. Wingate et al.68 reported a
dose being in the periphery of the treatment field near the 1.5–2.2-fold increase in absorbed dose at a one micron dis-
edge of the applicator. tance upstream from a soft tissue/glass interface for superfi-
In terms of clinical radiation effects, the dose measured at cial and orthovoltage x rays. The dose enhancement fell to a
the actual surface of the skin would have little meaning be- factor of 1.2 at a distance of 5 ␮m from the interface bound-
cause of the insensitivity of the most superficial skin layers. ary. Das69 reported an up to 20-fold localized dose enhance-
However, this reported effect may have clinical ramifications ment created by the high-Z interface in kilovoltage 共60–240
depending on the depth of the radiosensitive dermal and epi- kV兲 x-ray beams. Das et al.70 reviewed kilovoltage x-ray do-
dermal layers of the overlaying skin tissues. Epidermal thick- simetry at high-Z interfaces.
nesses have been reported63 to be 4.7, 6.6 and 40.6 mg/cm2 As with the consideration of enhanced surface dose due to
on the body trunk, the arms and legs, and the fingertips, photoelectron contamination, the increased dose due to sec-
respectively. Thus the enhanced radiation dose from electron ondary scattered electrons and backscattered photons at the
contamination to the epidermis may be clinically relevant interfaces between soft tissue and high-Z materials may have

Medical Physics, Vol. 28, No. 6, June 2001

880 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 880

TABLE III. Estimated combined standard uncertainty 共1 ␴兲 in D w at the reference depth in kilovoltage x ray
beams using a chamber calibrated in-air in terms of air kerma.

Uncertainty
Type of quantity or procedure 共%兲

In-air method 共for low and medium energies兲

1 N K from standards laboratory or ADCL 0.7
2 Effect of beam-quality difference between calibration and 2.0
measurement
3 Backscatter factor B w 1.5
4 P stem,air 1.0
5 关(␮¯ en / ␳ ) air
water
兴 air 1.5
6 In-air measurement in the user’s beam 1.5
Combined standard uncertainty for D w,z⫽0 3.5
7 Conversion to dose to tissue at the phantom surface 1.0
Combined standard uncertainty for D tissue,z⫽0 3.6
8 Determination of dose at other points in water 3.0
Combined standard uncertainty for D w,z 4.7
In-phantom method 共for medium energies only兲
1 N K from standards laboratory or ADCL 0.7
2 Effect of beam-quality difference between calibration and 2.0
measurement
3 Chamber correction factor P Q,cham 1.5
4 Chamber waterproofing sheath correction factor P sheath 0.5
5 关(␮
¯ en / ␳ ) air
water
兴 water 1.5
6 In-water measurement in the user’s beam 2.0
Combined standard uncertainty on D w,z⫽2 cm 3.6
7 Determination of dose at other points in water 3.0
Combined standard uncertainty on D w,z 4.7

clinical ramifications depending on the total dose prescribed 共i兲 uncertainties in the air-kerma calibration chain,
and the radiosensitivity of the surrounding normal tissues. As 共ii兲 uncertainties in determining absorbed dose to water at
suggested by Khan71 for clinical electron beams, one could the reference depth in water,
limit the dose from secondary radiation by coating the up- 共iii兲 uncertainties in determining absorbed dose at other
stream side of the high-Z absorber with an adequate thick- points in water, and
ness low-Z material, i.e., paraffin or other bolus-like material 共iv兲 uncertainties associated with the transfer of the dose
or aluminum. to other biological tissues.

The difference in the uncertainty between the in-air and the

in-water measurement 共Table III, item 6兲 is mainly due to the
VIII. EVALUATION OF UNCERTAINTIES
uncertainty in the depth determination. The 1% uncertainty
The final uncertainty in the absorbed dose, which can be in the air-to-tissue dose conversion for the in-air measure-
delivered to the tumor in a clinical situation, should be better ment 共Table III, item 7兲 is mainly due to the uncertainty in
than ⫾5%.77 This final uncertainty comprises several com- the backscatter factor ratio in Eq. 共12兲.
ponents. The first part occurs as a result of uncertainties in
the calibration chain linking the calibration of the clinical
IX. FUTURE CONSIDERATIONS
beam to the standards laboratory 共such as N K factor, uncer-
tainties in conversion and correction factors, beam-quality The main task of this protocol is to provide recommenda-
specification uncertainties兲. The second part is associated tions for the determination of absorbed dose to water at the
with clinical uncertainties in treatment planning dose calcu- surface or at 2 cm depth in a water phantom irradiated by
lation, patient setup, immobilization, and treatment. The un- 40–300 kV x-ray beams under the reference conditions.
certainty discussion here deals only with the former compo- Guidelines are also provided for the determination of ab-
nent of the final uncertainty, i.e., the calibration of the sorbed dose to other biological materials on the surface of a
clinical beam in terms of the desired quantity 共dose to water human body and the relative measurement of dose to water
or dose to tissue兲. Table III lists the several components con- at other points in a water phantom for kilovoltage x-ray
tributing to the final uncertainty including type A and type B beams. However, many other clinically related issues, such
uncertainties. For a classification of uncertainties we refer to as those listed below, have not been addressed in this proto-
Ref. 8. Consistent with the procedures followed in this re- col. The following is a brief list of issues, which require
port, generally four sources of uncertainties can be consid- further investigation and may be addressed in a future
ered: AAPM report:

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881 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 881

共a兲 determination of absorbed dose to biological tissues at between the calibration beam and the users beam due to the
a depth in a human body; difference in field size between the two beams. This mea-
共b兲 determination of dose to water using solid phantoms; sured air kerma can be converted to water kerma, free in air,
共c兲 dosimetry for endocavitary radiotherapy 共the Papillon through the ratio of mean mass energy-transfer coefficients
technique兲; for water to air 关 ( ␮
¯ tr / ␳ ) wair兴 air , evaluated over the photon
共d兲 dosimetry for kilovoltage x-ray radiosurgery systems; fluence spectrum free in air, in the absence of a phantom. We
共e兲 biological effect of electron contamination; then have
共f兲 biological effect of photon and electron backscattering
at tissue/high-Z material interface; and K in⫺air
w ⫽M N k P stem,air关共 ␮
¯ tr / ␳ 兲 wair兴 air . 共A.2兲
共g兲 relative biological effectiveness 共RBE兲 of kilovoltage
x-ray beams. Physically, K in–air
w represents water kerma to a small mass of
water, just large enough to provide full electron buildup, but
ACKNOWLEDGMENTS small enough not to alter the primary photon fluence. The
water kerma at the surface of a water phantom K w can be
We would like to thank the AAPM Radiation Therapy calculated using the following relationship:
Committee 共RTC兲, especially Jatinder Palta and Jeff Will-
iamson for support and the RTC reviewers Bruce Gerbi, D.
K w ⫽K in⫺air
w Bw , 共A.3兲
W. O. Rogers, Bruce Thomadsen, and other members Julie
Dawson, Chris Deibel, John Gibbons, Jr., M. Saiful Huq, where B w is the backscatter factor to account for the effect of
Ellen Yorke, and Robert Zwicker for valuable discussions phantom scatter. Equation 共A.3兲 defines the backscatter fac-
and comments. tor as the ratio of water kerma at the water surface to water
kerma free in air. Generally, B w is field size, beam quality
APPENDIX A. THEORETICAL BASIS FOR A CODE and SSD dependent.
BASED ON AIR-KERMA CALIBRATIONS The absorbed dose to water D w at the water surface can
For kilovoltage x-ray beams, the absorbed dose to water is be approximated by K w with the assumption of the existence
usually determined with an ionization chamber calibrated in of charged particle equilibrium and the negligible difference
air in terms of air kerma 共or exposure兲. The commonly used between kerma and collision kerma 共i.e., assuming ( ␮ ¯ tr / ␳ ) wair
ionization chambers are generally considered to be ‘‘photon equals ( ␮
¯ en / ␳ ) air兲. For this energy range, these assumptions
w

detectors’’ as the well-known Bragg–Gray cavity theory no are justified. 共Strictly speaking, this approximation is only
longer applies to this energy range.72 valid for depths beyond the range of the contaminant elec-
In order to determine the dose to water, we start with an trons and where quasi charged-particle equilibrium has been
air-kerma measurement and then convert it to water kerma established.兲 We then arrive at
using the ratio of the mean mass energy-absorption coeffi-
cients for water to air, evaluated for the fluence spectrum at D w ⫽M •N K P stem,airB w 关共 ␮
¯ en / ␳ 兲 wair兴 air , 共A.4兲
the position of interest 共free in air or at the reference depth in
water兲. The conversion from water kerma to dose to water is where 关 ( ␮
¯ en / ␳ ) wair兴 air can be calculated from

冕 冉 ␮␳ 冊
fairly straightforward based on the fact that, for this energy
E max
range, the difference between kerma and collision kerma is en

冋冉 冊 册
共E兲 E⌽ free–air
E 共 E 兲 dE
negligible and the range of the charged particles is small, so ␮
¯ en w 0

冕 冉 ␮␳ 冊
w
that the quasi charged particle equilibrium can be assumed. ⫽ ,
␳ E max
en
This is generally true for kilovoltage x-ray beams. air air
共E兲 E⌽ free⫺air
E 共 E 兲 dE
0 air
A.1. Low-energy x rays „40 kVÏtube potential 共A.5兲
Ï100 kV…
where ⌽ free–air (E) represents the photon fluence spectrum,
For low-energy x rays 共⭐100 kV兲, the measurement is E
differential in energy E, of the incident x-ray beam at the
carried out with an ionization chamber free in air, in the
point of interest. Note that 关 ( ␮
¯ en / ␳ ) wair兴 air is independent of
absence of any phantoms. The chamber is calibrated in terms
field size as it is evaluated over the primary beam only.73
of air kerma at a radiation quality sufficiently close to what is
present in the user’s beam. The air kerma at the point of
interest in a user’s beam is given by:
A.2. Medium-energy x rays „100 kVËtube potential
K in⫺air
air ⫽M N K P stem,air , 共A.1兲 Ï300 kV…
For medium-energy x-ray beams 共tube potential 100–300
where M represents the corrected, free-in-air, ionization kV, HVL: 0.1–4 mm Cu兲, two different algorithms have
chamber reading in the user’s beam of the same beam quality been recommended by previous dosimetry protocols. For
and field size as those in the calibration, N K the air-kerma ‘‘the in-air method,’’ the air kerma is measured in air and
calibration factor at the user’s beam quality, and P stem,air a then converted to dose to water through the ratio of mass
correction factor accounting for the difference in stem effect energy-absorption coefficient for water to air and a backscat-

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882 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 882

ter factor. For ‘‘the in-phantom method,’’ the air kerma at For the in-phantom measurement, use is made of a cham-
the reference depth 共⫽ 5 cm according to ICRU3 and IAEA8兲 ber, calibrated free in air in terms of air kerma at a radiation
in water is measured under the reference conditions and then quality the same as or sufficiently close to that being used to
converted to the absorbed dose at the depth of the center of irradiate the phantom. This chamber is placed at the refer-
the chamber in undisturbed water using the ratio of mass ence depth z ref in a full water phantom irradiated with a
energy-absorption coefficient for water to air and other reference field of medium-energy x rays. Due to phantom
beam-quality- and chamber-related correction factors. attenuation and scattering, the photon spectral and angular
The reason for the ICRU3 protocol to adopt the ‘‘in- distribution is different from that free in air at which the
phantom’’ measurement at 5 cm depth for medium-energy chamber is calibrated. Therefore, the calibration factor N K ,
x-ray beams results from the fact that it is difficult to make which applies to the primary radiation, does not necessarily
accurate measurements in the regions at or close to the sur- apply to the situation in the phantom. A correction factor
face of a phantom, and the dose distribution here, unlike at P E, ␪ is introduced to account for the change in calibration
greater depths, is considerably affected by the details of the factor caused by the change in photon energy E and angular
beam defining system.3 This was considered to be the reason ␪ distribution. The combined effect of the chamber stem
that the British Journal of Radiology Supplement 1174 gave free-in-air and in-phantom is usually accounted for sepa-
two distinct sets of depth–dose tables for ‘‘close-ended’’ ap- rately using an overall correction factor P stem,water . 11,15
plicators and ‘‘open diaphragms,’’ respectively. ICRU Re- Similarly we introduce the waterproofing sheath correc-
port 233 suggested that by normalizing the depth–dose tion factor P sheath , which accounts for the effect of the plas-
curves at a depth rather than at the surface the differences in tic sheath to protect a nonwaterproof chamber when used in
the recommended depth–dose curves would be virtually water.23 Furthermore, by inserting the chamber in the phan-
eliminated. The dose values at greater depths were of clinical tom, an amount of water is displaced by the air cavity and
importance as medium-energy x-ray beams were primarily the chamber walls 共the volume is equivalent to the outer
used for treating deep-seated tumors in the 1970s.3 dimensions of the chamber, excluding the stem since the
Although most of the dosimetry protocols published since effect of the stem, if present, has been accounted for sepa-
the 1970s adopted the in-phantom method for reference do- rately兲. An additional correction factor P dis is then required
simetry for medium-energy x-ray beams, the backscatter to account for the change in air kerma at the point of mea
method is the most used method for this energy range in the surement due to the displacement of water by the
clinical radiotherapy community, especially in North chamber.11,16
America.1,2 This may be explained by the fact that orthovolt- The air kerma at the reference depth z ref , K in–water
air , can be
age beams are used mainly for treating tumors close to the calculated by
surface of the skin. The primary point of interest is the dose
near the surface rather than at greater depths. Another reason K in–water
air ⫽M •N K • P E, ␪ • P stem,water• P disP sheath , 共A.6兲
is that it is more convenient to do routine calibration free in
air than in a water phantom.75 where M is the chamber reading corrected for temperature,
It is realized that the dosimeter response to kilovoltage pressure, polarity effect, and electrometer accuracy, in the
x-ray beams has not been fully investigated, especially when user’s beam at depth z ref in the water phantom. We now
placed in a phantom near the surface. The uncertainty in the introduce the overall correction factor P Q,cham which incor-
percentage depth dose measurement can be very large near porates all ‘‘beam-quality Q and chamber 共cham兲 depen-
the phantom surface, depending on the dosimeters used 共see dent’’ corrections mentioned above, except for the sheath
Sec. III B兲. It is therefore clear that if the primary point of correction P sheath since it is not directly related to the indi-
interest is at the phantom surface the in-air method shall be vidual chamber type. P Q,cham is defined as
used with the reference depth at the phantom surface in order
to reduce the uncertainty in the measured dose. On the other P Q,cham⫽ P E, ␪ • P stem,water• P dis . 共A.7兲
hand, if one is more interested in the dose at a depth 共to
Air kerma in water, measured as described above, is con-
check the dose at the critical organs兲 than at the surface, ‘‘the
verted to water kerma, using mass energy-transfer coefficient
in-phantom method’’ shall be used with the reference depth
at 2 cm depth. Better agreement in measured percentage ratios water to air, 关 ( ␮
¯ tr / ␳ ) wair兴 water averaged over the photon
depth dose curves at depths of 1 cm and greater can be fluence spectrum at the point of interest in the phantom in the
achieved when normalized to the values at 2 cm reference absence of the chamber, i.e.,

冋冉 冊 册
depth than normalized to the surface values. In addition, a
measurement at 2 cm depth provides more signal than one at ␮
¯ tr w
K w ⫽K in⫺water . 共A.8兲
5 cm. These are the main reasons why 2 cm has been chosen
air
␳ air water
here.
When the in-air method is used, the measurement is per- The absorbed dose to water D w at the reference depth in
formed with the chamber free in air and the dose to water at water can be approximated by K w with the assumption of the
the phantom surface can be calculated from Eq. 共A.4兲. Other existence of quasicharged particle equilibrium and the negli-
reference conditions are the same as described in the previ- gible difference between kerma and collision kerma. We
ous section. then have

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883 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 883

D w ⯝K w ⫽M •N K • P Q,cham• P sheath关共 ␮
¯ en / ␳ 兲 wair兴 water . 共A.9兲 TABLE IV. Ratios of average mass energy-absorption coefficients water to
air, free in air, to convert air kerma to water kerma as a function of HVL
共mm Al兲 or HVL 共mm Cu兲. The values given are from a global fit to data
As stated above, P Q,cham carries the complete chamber de- from Seuntjens et al. 共Ref. 28兲, the IPEMB 共Ref. 18兲 code of practice, and
pendence in the correction procedure except for the sheath from Ma and Seuntjens 共Ref. 35兲.
correction, whereas 关 ( ␮
¯ en / ␳ ) wair兴 water is a chamber indepen-
dent conversion factor. However, both factors are field-size First HVL
and depth dependent. 共mm Al兲 共mm Cu兲 关(␮
¯ en / ␳ ) air
w
兴 air

0.03 1.047
0.04 1.047
APPENDIX B. DETAILS ON CONVERSION AND
0.05 1.046
CORRECTION FACTORS 0.06 1.046
0.08 1.044
This Appendix contains the numerical data and proce-
0.10 1.044
dures necessary to apply the expressions based on in-air 0.12 1.043
measurements for low-energy and medium-energy x-ray do- 0.15 1.041
simetry and for the in-phantom measurements at medium 0.2 1.039
energies. 0.3 1.035
0.4 1.031
B.1. The in-air method for low- and medium-energy 0.5 1.028
x rays 0.6 1.026
0.8 1.022
1.0 1.020
B.1.1. In-air mass energy-absorption coefficient
1.2 1.018
¯ en Õ ␳ … air
ratio †„ ␮ w
‡ air 1.5 1.017
Table IV gives the values of the in-air mass energy- 2.0 1.018
3.0 1.021
absorption coefficient ratios applicable to the low-energy kV 4.0 1.025
x-ray range as a function of HVL in Al and to the medium- 5.0 1.029
energy range as a function of HVL in mm Al and Cu. The 6.0 1.034
values given are from a global fit to data from Seuntjens 8.0 1.045
et al.,28 the IPEMB18 code of practice, and from Ma and 0.1 1.020
0.2 1.028
Seuntjens.35 For simplicity, only HVL is used to specify the 0.3 1.035
beam quality. One should therefore keep in mind that the 0.4 1.043
uncertainty on this quantity is no better than ⫾1.5%. All the 0.5 1.050
sources are based on the interaction data published by 0.6 1.056
Hubbell,36 which are consistent with the more recent data by 0.8 1.068
1.0 1.076
Hubbell and Seltzer36共b兲 for kilovoltage beams. 1.5 1.085
2.0 1.089
3.0 1.100
B.1.2. Backscatter factor B w 4.0 1.106
5.0 1.109
For tube potentials 40–300 kV, the values of the water-
kerma based backscatter factor B w are given in Tables V共a兲
and V共b兲 as a function of SSD, field size, and HVL 共mm Al
for low-energy x rays, and mm Cu for medium-energy x
rays兲. The values are from Grosswendt37,38 and have been B.1.3. Chamber stem correction factor P stem,air
independently checked using the experimental data from
Klevenhagen39 and the Monte Carlo data from Knight and P stem,air accounts for the effect of the change in photon
Nahum.22 Note the large dependence of the backscatter fac- scatter from the chamber stem between the calibration in a
tors on field size in the medium-energy x-ray range. For standards laboratory and the measurement in a user’s beam.
short SSD 共⫽ 10 cm兲, backscatter factors have been given The effect of photon scattering from the chamber stem has
for beam qualities up to 4 mm Al HVL. Since the backscatter been included in the calibration factor N K for the beam qual-
factor is fundamentally a water–kerma ratio, reliable mea- ity and photon field used in the calibration. When the user’s
surements are nontrivial. Therefore, for the application of beam quality and field size match those used in the calibra-
this protocol, backscatter factors should not be measured in tion, no correction is required for the chamber stem effect.
the clinic. However, if the user’s field size is different from that used in
The backscatter factors from Table V apply to open-ended the calibration the stem effect correction may be significant.
collimators. Close-ended applicators require slightly higher The stem effect correction is well within 1% for Farmer type
backscatter factors because of scattering in the end plate. cylindrical chambers11,15 if the field size 共diameter兲 differs
Table VI shows the multiplicative correction factors to be by less than 50% for field sizes greater than 5 cm diameter.
applied to the open field values for medium-energy x rays for No stem corrections are needed for these chambers 共i.e.,
close-ended cones with a PMMA end plate of 3.2 mm.51 P stem,air⫽1兲 provided the chamber response variation satis-

Medical Physics, Vol. 28, No. 6, June 2001

884 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 884

TABLE V. Water kerma based backscatter factors B w for a water phantom as a function of field diameter 共d兲, radiation quality 共HVL兲, and source surface
distance 共SSD兲 between 共a兲 1.5 and 10 cm and 共b兲 10 and 100 cm for open-ended cones. The values are from Grosswendt 共Refs. 37 and 38兲 and have been
independently checked using the experimental data from Klevenhagen 共Ref. 39兲 and the Monte Carlo data from Knight and Nahum 共Ref. 22兲.

共a兲 HVL 共mm Al兲

SSD d
共cm兲 共cm兲 0.04 0.05 0.06 0.08 0.1 0.12 0.15 0.2 0.3 0.4 0.5 0.6 0.8 1.0 1.2 1.5 2.0 3.0 4.0

1.5 1 1.001 1.005 1.009 1.012 1.014 1.016 1.018 1.021 1.027 1.032 1.035 1.038 1.042 1.045 1.047 1.050 1.055 1.057 1.057
2 1.008 1.009 1.011 1.014 1.018 1.020 1.023 1.028 1.037 1.045 1.051 1.056 1.065 1.070 1.074 1.080 1.089 1.097 1.098
3 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.039 1.049 1.055 1.061 1.071 1.079 1.084 1.091 1.103 1.114 1.116
5 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.040 1.050 1.057 1.064 1.075 1.084 1.090 1.099 1.112 1.125 1.128
10 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.041 1.051 1.058 1.065 1.076 1.085 1.092 1.100 1.115 1.129 1.132
15 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.041 1.051 1.058 1.065 1.076 1.085 1.092 1.100 1.115 1.129 1.133
20 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.041 1.051 1.058 1.065 1.076 1.085 1.092 1.100 1.115 1.129 1.133
3 1 1.007 1.008 1.010 1.012 1.014 1.016 1.018 1.021 1.027 1.032 1.035 1.038 1.043 1.046 1.047 1.050 1.055 1.060 1.058
2 1.008 1.009 1.011 1.014 1.018 1.021 1.024 1.029 1.040 1.049 1.055 1.061 1.070 1.078 1.083 1.089 1.101 1.111 1.110
3 1.008 1.009 1.011 1.014 1.018 1.021 1.025 1.031 1.044 1.056 1.063 1.071 1.083 1.093 1.100 1.109 1.125 1.140 1.142
5 1.008 1.009 1.011 1.014 1.018 1.022 1.026 1.033 1.048 1.061 1.069 1.078 1.093 1.106 1.115 1.127 1.147 1.170 1.175
10 1.008 1.009 1.011 1.014 1.018 1.022 1.026 1.033 1.048 1.061 1.071 1.081 1.098 1.112 1.122 1.136 1.159 1.188 1.195
15 1.008 1.009 1.011 1.014 1.018 1.022 1.026 1.033 1.048 1.061 1.071 1.081 1.098 1.113 1.123 1.137 1.160 1.190 1.198
20 1.008 1.009 1.011 1.014 1.018 1.022 1.026 1.033 1.048 1.061 1.071 1.081 1.098 1.113 1.124 1.138 1.161 1.191 1.199
5 1 1.007 1.008 1.009 1.012 1.014 1.016 1.018 1.021 1.027 1.033 1.036 1.039 1.043 1.046 1.048 1.051 1.056 1.060 1.058
2 1.007 1.009 1.011 1.014 1.018 1.022 1.025 1.030 1.041 1.051 1.057 1.063 1.073 1.081 1.086 1.092 1.104 1.115 1.113
3 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.033 1.046 1.058 1.066 1.075 1.088 1.098 1.105 1.115 1.132 1.150 1.152
5 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.035 1.050 1.064 1.074 1.085 1.102 1.116 1.126 1.140 1.163 1.191 1.198
10 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.035 1.051 1.066 1.078 1.090 1.111 1.129 1.141 1.158 1.186 1.228 1.240
15 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.035 1.051 1.066 1.078 1.090 1.112 1.130 1.144 1.161 1.191 1.235 1.250
20 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.035 1.051 1.066 1.078 1.090 1.112 1.130 1.144 1.162 1.192 1.237 1.252
7 1 1.006 1.007 1.008 1.011 1.014 1.016 1.018 1.021 1.027 1.033 1.035 1.038 1.043 1.046 1.048 1.051 1.056 1.061 1.060
2 1.007 1.008 1.010 1.014 1.018 1.022 1.025 1.031 1.042 1.052 1.058 1.065 1.075 1.083 1.088 1.094 1.106 1.119 1.118
3 1.007 1.008 1.010 1.014 1.019 1.023 1.027 1.034 1.048 1.060 1.068 1.076 1.090 1.101 1.109 1.119 1.137 1.157 1.157
5 1.007 1.008 1.010 1.014 1.019 1.023 1.027 1.035 1.051 1.066 1.076 1.087 1.106 1.123 1.134 1.149 1.173 1.207 1.213
10 1.007 1.008 1.010 1.014 1.019 1.023 1.028 1.036 1.053 1.069 1.081 1.093 1.116 1.139 1.154 1.173 1.206 1.256 1.271
15 1.007 1.008 1.010 1.014 1.019 1.023 1.028 1.036 1.053 1.069 1.081 1.094 1.118 1.142 1.157 1.179 1.214 1.269 1.288
20 1.007 1.008 1.010 1.014 1.019 1.023 1.028 1.036 1.053 1.069 1.081 1.094 1.118 1.142 1.158 1.180 1.215 1.271 1.292
10 1 1.006 1.007 1.009 1.012 1.014 1.016 1.018 1.022 1.028 1.034 1.036 1.038 1.043 1.046 1.048 1.051 1.055 1.062 1.059
2 1.007 1.009 1.011 1.014 1.018 1.022 1.025 1.030 1.042 1.052 1.058 1.064 1.075 1.083 1.088 1.094 1.105 1.120 1.118
3 1.007 1.009 1.011 1.015 1.019 1.023 1.027 1.034 1.048 1.060 1.069 1.078 1.092 1.103 1.110 1.120 1.135 1.159 1.161
5 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.036 1.052 1.068 1.079 1.091 1.110 1.126 1.137 1.152 1.177 1.211 1.220
10 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.037 1.055 1.072 1.086 1.100 1.125 1.146 1.161 1.182 1.216 1.270 1.296
15 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.037 1.055 1.072 1.087 1.101 1.128 1.151 1.167 1.189 1.226 1.288 1.321
20 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.038 1.056 1.073 1.088 1.102 1.129 1.153 1.169 1.191 1.228 1.293 1.328
共b兲 HVL 共mm Al兲
SSD d
共cm兲 共cm兲 0.04 0.05 0.06 0.08 0.1 0.12 0.15 0.2 0.3 0.4 0.5 0.6 0.8 1.0 1.2 1.5 2.0 3.0 4.0 5.0 6.0 8.0

10 1 1.006 1.007 1.009 1.012 1.014 1.016 1.018 1.022 1.028 1.034 1.036 1.038 1.043 1.046 1.048 1.051 1.055 1.062 1.059 1.057 1.056 1.053
2 1.007 1.009 1.011 1.014 1.018 1.022 1.025 1.030 1.042 1.052 1.058 1.064 1.075 1.083 1.088 1.094 1.105 1.120 1.118 1.118 1.119 1.110
3 1.007 1.009 1.011 1.014 1.018 1.022 1.026 1.033 1.047 1.060 1.069 1.078 1.092 1.103 1.110 1.120 1.135 1.159 1.161 1.161 1.161 1.152
5 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.036 1.052 1.068 1.079 1.091 1.110 1.126 1.137 1.152 1.177 1.211 1.220 1.224 1.226 1.219
10 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.037 1.055 1.072 1.086 1.100 1.125 1.146 1.161 1.182 1.216 1.270 1.296 1.308 1.314 1.312
15 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.037 1.055 1.072 1.087 1.101 1.128 1.151 1.167 1.189 1.226 1.288 1.321 1.336 1.345 1.348
20 1.007 1.009 1.011 1.015 1.019 1.023 1.028 1.038 1.056 1.073 1.088 1.102 1.129 1.153 1.169 1.191 1.228 1.293 1.328 1.346 1.357 1.362
20 1 1.006 1.007 1.008 1.011 1.014 1.016 1.018 1.022 1.028 1.034 1.036 1.039 1.043 1.046 1.049 1.052 1.057 1.061 1.059 1.058 1.056 1.053
2 1.006 1.008 1.010 1.014 1.018 1.022 1.025 1.031 1.043 1.053 1.059 1.065 1.075 1.083 1.089 1.095 1.107 1.116 1.118 1.118 1.119 1.112
3 1.006 1.008 1.010 1.014 1.019 1.024 1.028 1.035 1.049 1.061 1.069 1.077 1.092 1.105 1.112 1.122 1.138 1.158 1.162 1.165 1.167 1.158
5 1.006 1.008 1.010 1.014 1.019 1.024 1.029 1.037 1.054 1.070 1.080 1.091 1.112 1.131 1.143 1.158 1.183 1.215 1.226 1.234 1.240 1.236
10 1.006 1.008 1.010 1.014 1.019 1.024 1.029 1.039 1.057 1.074 1.088 1.102 1.129 1.155 1.173 1.196 1.235 1.291 1.317 1.334 1.348 1.354
15 1.006 1.008 1.010 1.014 1.019 1.024 1.030 1.039 1.058 1.075 1.090 1.104 1.133 1.162 1.182 1.208 1.252 1.321 1.356 1.380 1.401 1.414
20 1.006 1.008 1.010 1.014 1.019 1.024 1.030 1.039 1.058 1.076 1.091 1.106 1.136 1.165 1.186 1.213 1.258 1.334 1.373 1.402 1.426 1.444
30 1 1.006 1.007 1.008 1.011 1.015 1.017 1.019 1.022 1.027 1.032 1.035 1.038 1.043 1.047 1.050 1.053 1.058 1.063 1.061 1.059 1.057 1.053
2 1.006 1.008 1.010 1.014 1.018 1.022 1.025 1.031 1.042 1.052 1.058 1.064 1.074 1.084 1.090 1.096 1.108 1.120 1.122 1.122 1.120 1.110
3 1.006 1.008 1.010 1.014 1.019 1.023 1.027 1.034 1.048 1.061 1.069 1.077 1.093 1.107 1.115 1.125 1.140 1.164 1.167 1.168 1.169 1.158
5 1.006 1.008 1.010 1.014 1.019 1.024 1.029 1.037 1.053 1.069 1.079 1.090 1.111 1.130 1.142 1.157 1.182 1.221 1.237 1.242 1.242 1.237
10 1.006 1.008 1.010 1.014 1.019 1.024 1.029 1.039 1.057 1.074 1.088 1.102 1.130 1.157 1.175 1.199 1.238 1.298 1.333 1.350 1.360 1.367
15 1.006 1.008 1.010 1.014 1.019 1.024 1.030 1.039 1.058 1.076 1.091 1.106 1.136 1.165 1.185 1.212 1.257 1.332 1.381 1.403 1.414 1.434

Medical Physics, Vol. 28, No. 6, June 2001

885 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 885

TABLE V. 共Continued.兲

共b兲 HVL 共mm Al兲

SSD d
共cm兲 共cm兲 0.04 0.05 0.06 0.08 0.1 0.12 0.15 0.2 0.3 0.4 0.5 0.6 0.8 1.0 1.2 1.5 2.0 3.0 4.0 5.0 6.0 8.0

20 1.006 1.008 1.010 1.014 1.019 1.024 1.030 1.039 1.058 1.076 1.091 1.107 1.138 1.169 1.190 1.218 1.265 1.350 1.404 1.428 1.441 1.472
50 1 1.006 1.007 1.008 1.011 1.014 1.016 1.018 1.021 1.027 1.033 1.035 1.038 1.042 1.045 1.047 1.051 1.057 1.065 1.062 1.059 1.055 1.052
2 1.006 1.007 1.009 1.013 1.018 1.022 1.025 1.031 1.043 1.053 1.058 1.064 1.073 1.081 1.087 1.095 1.107 1.121 1.122 1.121 1.119 1.112
3 1.006 1.007 1.009 1.013 1.018 1.023 1.027 1.034 1.049 1.062 1.070 1.078 1.093 1.106 1.114 1.124 1.142 1.163 1.167 1.169 1.170 1.160
5 1.006 1.007 1.009 1.013 1.018 1.023 1.028 1.037 1.054 1.070 1.081 1.093 1.113 1.132 1.143 1.159 1.185 1.226 1.235 1.241 1.246 1.242
10 1.006 1.007 1.009 1.013 1.018 1.023 1.029 1.038 1.057 1.076 1.091 1.106 1.134 1.159 1.177 1.202 1.244 1.309 1.336 1.352 1.363 1.375
15 1.006 1.007 1.009 1.013 1.018 1.023 1.029 1.039 1.058 1.077 1.093 1.110 1.140 1.169 1.190 1.218 1.265 1.346 1.387 1.411 1.428 1.448
20 1.006 1.007 1.009 1.013 1.018 1.023 1.029 1.039 1.058 1.077 1.094 1.110 1.142 1.173 1.195 1.224 1.273 1.363 1.414 1.443 1.463 1.493
100 1 1.006 1.007 1.008 1.011 1.014 1.016 1.018 1.022 1.028 1.034 1.036 1.038 1.042 1.044 1.046 1.050 1.056 1.062 1.061 1.059 1.056 1.053
2 1.006 1.008 1.010 1.014 1.018 1.022 1.025 1.031 1.043 1.053 1.058 1.064 1.072 1.080 1.085 1.094 1.107 1.121 1.122 1.120 1.118 1.112
3 1.006 1.008 1.010 1.014 1.019 1.023 1.027 1.035 1.050 1.063 1.070 1.078 1.092 1.104 1.112 1.123 1.142 1.163 1.168 1.169 1.170 1.162
5 1.006 1.008 1.010 1.014 1.019 1.023 1.028 1.037 1.055 1.071 1.082 1.093 1.113 1.131 1.143 1.160 1.188 1.225 1.234 1.240 1.244 1.243
10 1.006 1.008 1.010 1.014 1.019 1.023 1.029 1.039 1.058 1.077 1.091 1.106 1.134 1.158 1.177 1.202 1.245 1.311 1.334 1.351 1.366 1.381
15 1.006 1.008 1.010 1.014 1.019 1.023 1.029 1.039 1.059 1.078 1.094 1.110 1.140 1.169 1.190 1.219 1.269 1.354 1.391 1.417 1.440 1.460
20 1.006 1.008 1.010 1.014 1.019 1.023 1.029 1.039 1.059 1.078 1.095 1.111 1.143 1.172 1.195 1.226 1.278 1.375 1.419 1.451 1.480 1.508
HVL 共mm Cu兲
SSD d
共cm兲 共cm兲 0.1 0.2 0.3 0.4 0.5 0.6 0.8 1.0 1.5 2.0 3.0 4.0 5.0
10 1 1.062 1.057 1.056 1.054 1.052 1.050 1.046 1.043 1.037 1.033 1.026 1.021 1.017
2 1.120 1.118 1.119 1.113 1.108 1.106 1.103 1.097 1.081 1.071 1.057 1.046 1.038
3 1.159 1.161 1.161 1.155 1.150 1.147 1.143 1.135 1.116 1.102 1.081 1.067 1.054
5 1.210 1.224 1.226 1.221 1.217 1.214 1.209 1.199 1.170 1.151 1.122 1.101 1.082
10 1.269 1.306 1.316 1.313 1.311 1.310 1.307 1.294 1.254 1.227 1.186 1.154 1.126
15 1.287 1.335 1.348 1.348 1.348 1.348 1.347 1.332 1.289 1.260 1.213 1.178 1.146
20 1.292 1.344 1.361 1.362 1.362 1.363 1.364 1.349 1.303 1.273 1.225 1.188 1.155
20 1 1.061 1.058 1.055 1.054 1.053 1.051 1.048 1.045 1.038 1.033 1.024 1.020 1.018
2 1.116 1.118 1.119 1.114 1.110 1.107 1.102 1.097 1.084 1.074 1.056 1.046 1.039
3 1.158 1.164 1.168 1.161 1.155 1.152 1.147 1.140 1.122 1.107 1.082 1.067 1.057
5 1.214 1.232 1.242 1.238 1.233 1.229 1.219 1.209 1.184 1.164 1.127 1.104 1.088
10 1.290 1.331 1.352 1.353 1.353 1.349 1.339 1.326 1.291 1.260 1.204 1.168 1.141
15 1.320 1.377 1.407 1.412 1.415 1.411 1.403 1.389 1.350 1.316 1.251 1.207 1.174
20 1.333 1.397 1.434 1.441 1.447 1.443 1.436 1.421 1.381 1.345 1.278 1.230 1.194
30 1 1.063 1.060 1.056 1.054 1.052 1.050 1.047 1.044 1.038 1.033 1.024 1.020 1.018
2 1.120 1.122 1.119 1.113 1.108 1.105 1.101 1.096 1.084 1.073 1.056 1.046 1.038
3 1.164 1.168 1.169 1.161 1.155 1.152 1.146 1.139 1.121 1.107 1.084 1.068 1.055
5 1.220 1.242 1.242 1.239 1.235 1.231 1.221 1.211 1.184 1.164 1.130 1.106 1.087
10 1.297 1.348 1.363 1.366 1.367 1.360 1.347 1.332 1.292 1.263 1.214 1.177 1.147
15 1.330 1.401 1.417 1.429 1.438 1.433 1.422 1.405 1.360 1.327 1.270 1.226 1.189
20 1.348 1.426 1.446 1.464 1.478 1.473 1.464 1.446 1.399 1.364 1.302 1.254 1.213
50 1 1.065 1.059 1.054 1.053 1.052 1.050 1.047 1.045 1.038 1.034 1.025 1.020 1.018
2 1.121 1.121 1.118 1.114 1.111 1.108 1.103 1.097 1.084 1.073 1.056 1.047 1.040
3 1.163 1.169 1.170 1.163 1.157 1.154 1.148 1.140 1.121 1.106 1.084 1.069 1.057
5 1.225 1.240 1.247 1.244 1.240 1.235 1.226 1.214 1.184 1.163 1.131 1.108 1.089
10 1.308 1.350 1.367 1.372 1.376 1.371 1.360 1.344 1.304 1.274 1.222 1.184 1.152
15 1.345 1.408 1.433 1.443 1.452 1.450 1.446 1.428 1.379 1.346 1.285 1.237 1.195
20 1.361 1.439 1.471 1.486 1.499 1.498 1.495 1.478 1.428 1.391 1.325 1.272 1.226
100 1 1.062 1.059 1.055 1.053 1.052 1.050 1.047 1.045 1.038 1.034 1.025 1.020 1.018
2 1.121 1.121 1.117 1.114 1.111 1.108 1.104 1.098 1.085 1.074 1.057 1.047 1.040
3 1.163 1.169 1.170 1.165 1.160 1.156 1.150 1.142 1.122 1.107 1.085 1.070 1.057
5 1.224 1.239 1.245 1.243 1.241 1.237 1.227 1.217 1.188 1.167 1.132 1.109 1.090
10 1.310 1.349 1.370 1.378 1.383 1.378 1.369 1.353 1.311 1.278 1.226 1.188 1.155
15 1.353 1.413 1.447 1.456 1.463 1.461 1.458 1.441 1.393 1.356 1.291 1.244 1.204
20 1.373 1.446 1.490 1.502 1.513 1.514 1.516 1.499 1.447 1.406 1.334 1.282 1.237

fies the requirements formulated in Sec. III B. For low- should not be used for reference dosimetry 共or cone factor兲
energy parallel-plate chambers, however, this correction may for fields different from that used in the calibration. Further
be several percent because of their large chamber body.19 In investigations are needed to systematically determine stem
general, the stem effect corrections for parallel-plate cham- effect corrections for these chamber types. A procedure for
bers are not well known. Because of this, these chambers measuring P stem,air is described in Sec. V C.7.

Medical Physics, Vol. 28, No. 6, June 2001

886 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 886

TABLE VI. Multiplicative correction factors to the backscatter factors listed TABLE VIII. Overall chamber correction factors P Q,cham for common cylin-
in Table V for use with close-ended cones as a function of HVL 共mm Cu兲 drical chambers in medium-energy x-ray beams. The data applies to 2-cm
and field diameter d. The values are for a 3.2 mm PMMA ( ␳ depth in the phantom, and 10⫻10 cm2 field size. The data are from
⫽1.19 g/cm3) end plate. The data are derived from BJR Supplement 25 Seuntjens et al. 共Ref. 40兲.
共Ref. 51兲.
Chamber type
HVL 共mm Cu兲
NE2611
d 共cm兲 0.5 1 2 3 HVL Capintec PTW Exradin or
共mm Cu兲 NE2571 PR06C N30001 A12 NE2581 NE2561
4.5 1.006 1.005 1.004 1.004
5.6 1.006 1.006 1.005 1.004 0.10 1.008 0.992 1.004 1.002 0.991 0.995
6.8 1.007 1.006 1.006 1.004 0.15 1.015 1.000 1.013 1.009 1.007 1.007
7.9 1.008 1.007 1.006 1.005 0.20 1.019 1.004 1.017 1.013 1.017 1.012
9.0 1.008 1.008 1.006 1.006 0.30 1.023 1.008 1.021 1.016 1.028 1.017
11.3 1.009 1.008 1.007 1.006 0.40 1.025 1.009 1.023 1.017 1.033 1.019
13.5 1.009 1.009 1.008 1.007 0.50 1.025 1.010 1.023 1.017 1.036 1.019
16.9 1.010 1.010 1.009 1.008 0.60 1.025 1.010 1.023 1.017 1.037 1.019
22.6 1.011 1.011 1.009 1.008 0.80 1.024 1.010 1.022 1.017 1.037 1.018
1.0 1.023 1.010 1.021 1.016 1.035 1.017
1.5 1.019 1.008 1.018 1.013 1.028 1.014
TABLE VII. Ratio of average mass energy-absorption coefficients of water to 2.0 1.016 1.007 1.015 1.011 1.022 1.011
air at 2 cm depth in water, for a 10⫻10 cm2 field size, SSD⫽50 cm, as a 2.5 1.012 1.006 1.012 1.010 1.017 1.009
function of first HVL 共in mm Cu or mm Al兲. The data are from Ma and 3.0 1.009 1.005 1.010 1.008 1.012 1.006
Seuntjens 共Ref. 35兲. 4.0 1.004 1.003 1.006 1.005 1.004 1.003

First HVL

共mm Cu兲 共mm Al兲 关(␮

¯ en / ␳ ) air
w
兴 water

0.1 2.9 1.026 B.2. The in-phantom calibration method for

0.2 4.8 1.032 medium-energy x rays
0.3 6.3 1.037
0.4 7.5 1.041
0.5 8.5 1.046 B.2.1. In-phantom mass energy-absorption
0.6 9.3 1.050 ¯ enÕ ␳ … air
coefficient ratio †„ ␮ w
‡ water
0.8 10.8 1.055
1 12.0 1.060 Table VII gives values of 关 ( ␮ ¯ en / ␳ ) wair兴 water for the
1.5 14.2 1.072 medium-energy range at 2 cm depth and a 10 cm⫻10 cm
2 15.8 1.081
field size. Figure 3 illustrates the variations of the values of
3 17.9 1.094
4 19.3 1.101 关(␮¯ en / ␳ ) wair兴 water when the field size differs significantly from
5 20.3 1.105 the reference field size of 10⫻10 cm2. The data are from Ma
and Seuntjens.35

FIG. 3. Dependence on field surface area for different energies of the ratio of
the mass energy-absorption coefficient water to air at 2 cm depth in water.
Data are normalized to the reference field size of 10⫻10 cm2 at an SSD of FIG. 4. Field size dependence of P Q,cham at the reference depth 共2 cm兲.
50 cm. Half value layers corresponding to the kV values are: 0.88 mm Al Correction factor to P Q,cham to account for field size dependence for fields
共50 kV兲, 2.65 mm Al 共100 kV兲, 0.57 mm Cu 共150 kV兲, 1.7 mm Cu 共200 significantly differing from the standard 10 cm⫻10 cm. These values can be
kV兲, and 4.3 mm Cu 共300 kV兲 共see Ref. 35兲. applied to all the chambers in Table VIII.

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887 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 887

TABLE IX. Water proofing sleeve correction factors P sheath for PMMA, polystyrene, and nylon sleeves of thickness t when using cylindrical chambers for in
water phantom measurements in medium-energy x-ray beams. The data applies to 2 cm depth in the phantom, and 10⫻10 cm2 field size. The data are from
Ma and Seuntjens 共Ref. 23兲.

HVL PMMA 共Lucite兲 ␳ ⫽1.19 g/cm3 Polystyrene ␳ ⫽1.06 g/cm3 Nylon ␳ ⫽1.14 g/cm3

共mm Cu兲 共mm Al兲 t⫽0.5 mm t⫽1 mm t⫽2 mm t⫽3 mm t⫽0.5 mm t⫽1 mm t⫽2 mm t⫽3 mm t⫽0.5 mm t⫽1 mm t⫽2 mm t⫽3 mm

0.1 3.0 0.998 0.995 0.991 0.986 0.995 0.990 0.981 0.972 0.996 0.992 0.985 0.978
0.2 4.7 0.998 0.996 0.993 0.989 0.996 0.993 0.987 0.980 0.997 0.994 0.989 0.984
0.3 6.1 0.998 0.997 0.994 0.991 0.997 0.995 0.989 0.984 0.998 0.995 0.991 0.987
0.4 7.4 0.999 0.997 0.995 0.993 0.998 0.996 0.991 0.987 0.998 0.996 0.993 0.989
0.5 8.5 0.999 0.998 0.996 0.994 0.999 0.996 0.993 0.990 0.999 0.997 0.994 0.992
0.6 9.5 0.999 0.998 0.996 0.995 0.999 0.997 0.994 0.992 0.999 0.997 0.995 0.993
0.8 11.0 0.999 0.998 0.997 0.996 0.999 0.998 0.996 0.994 0.999 0.998 0.996 0.995
1.0 12.1 1.000 0.999 0.998 0.997 1.000 0.999 0.997 0.996 1.000 0.999 0.997 0.996
1.5 13.9 1.000 0.999 0.999 0.999 1.000 0.999 0.998 0.998 1.000 0.999 0.998 0.998
2 15.2 1.000 1.000 1.000 0.999 1.000 0.999 0.999 0.998 1.000 1.000 0.999 0.998
3 17.6 1.000 1.000 1.000 1.000 1.000 0.999 0.999 0.999 1.000 1.000 0.999 0.999
4 19.4 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000
5 20.9 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000

B.2.2. Ion-chamber correction factor P Q ,cham

P Q,cham accounts for the change in chamber response due
to the change in beam characteristics 共energy and angular
distribution兲 between calibration and measurement, and of TABLE X. Free-in-air ratios of mass energy-absorption coefficients of bio-
logical tissue to water for application in conjunction with the in-air method.
the change in photon fluence at the reference point in the
The data are for SSD⫽50 cm. Except for bone, these values can be used as
cavity compared to that in water in the absence of the cham- C med as defined in Eq. 共12兲. For bone, the data in this table shall be com-
w
ber and the chamber stem. Values are derived from measure- bined with the ratio of backscatter factor bone-to-water as given in Table XI
ments and calculations by Seuntjens et al.,11 Ma and w . The data are from Ma and Seuntjens 共Ref. 35兲.
to arrive at C med
Nahum,14–16 Seuntjens and Verhaegen,31 and Seuntjens
‘‘Free-in-air’’ mass energy-absorption coefficient ratio
et al.40 Table VIII gives the values of P Q,cham for commonly of the specified tissues to water
used cylindrical chamber types as a function of HVL. The
field-size dependence of this factor at 2 cm depth is 1% or ICRU 4-
element ICRU ICRU
smaller. Figure 4 can be used to estimate this correction to
HVL soft striated ICRP ICRP compact
P Q,cham if the field size is significantly smaller than 10 共mm Al兲 共mm Cu兲 tissue muscle lung skin bone
⫻10 cm2. The uncertainty of the P Q,cham factor was esti-
0.3 0.917 1.016 1.031 0.890 4.200
mated to be about 1.5%.
0.4 0.918 1.020 1.035 0.893 4.289
0.5 0.919 1.022 1.037 0.895 4.335
0.6 0.920 1.024 1.039 0.897 4.382
B.2.3. Sleeve correction factor P sheath 0.8 0.921 1.028 1.043 0.901 4.475
Table IX gives the values of P sheath for sleeves used to 1.0 0.923 1.031 1.046 0.904 4.494
1.2 0.925 1.031 1.046 0.907 4.469
insulate cylindrical chambers when placed in a water phan- 1.5 0.927 1.032 1.047 0.910 4.427
tom, as a function of the sleeve thickness t and HVL. The 2.0 0.930 1.032 1.047 0.915 4.350
data are from Monte Carlo calculations and experiments by 3.0 0.934 1.032 1.045 0.922 4.179
Ma and Seuntjens.23 Field-size and SSD dependence of a 1 4.0 0.939 1.030 1.042 0.929 3.975
mm sleeve is less than 0.2% for PMMA, nylon, and 5.0 0.943 1.028 1.039 0.935 3.769
6.0 0.947 1.026 1.036 0.940 3.557
polystyrene.23 The uncertainty of the P sheath factor was esti- 8.0 0.955 1.021 1.030 0.950 3.133
mated to be about 0.5%. 0.1 0.934 1.032 1.045 0.921 4.209
0.2 0.942 1.029 1.040 0.934 3.808
0.3 0.947 1.026 1.036 0.940 3.561
B.3. Conversion factors to calculate dose in other 0.4 0.952 1.023 1.032 0.946 3.314
biological materials 0.5 0.956 1.020 1.029 0.952 3.068
0.6 0.960 1.018 1.026 0.957 2.859
This protocol provides guidelines to determine dose to 0.8 0.964 1.015 1.022 0.961 2.657
other biological tissues on the surface of a human body for 1.0 0.967 1.012 1.018 0.965 2.456
clinical radiotherapy and radiobiology. In this section tables 1.5 0.975 1.006 1.009 0.975 1.952
are provided to convert the dose to water to dose to other 2.0 0.981 1.001 1.003 0.980 1.637
3.0 0.986 0.996 0.997 0.985 1.280
materials at the surface. The data have been supplied for 4.0 0.988 0.994 0.994 0.987 1.128
ICRU four-element soft tissue, ICRU striated muscle, ICRU 5.0 0.990 0.992 0.992 0.989 1.026
compact bone, ICRP lung, and ICRP skin. The photon mass-

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888 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 888

TABLE XI. Ratios of the kerma-based backscatter factors, bone to water, for photon beams 50–300 kV 共0.05–5
mm Cu兲 with different field sizes at various SSD for Eq. 共12兲. The data are from Ma and Seuntjens 共Ref. 35兲.

HVL B bone /B w
SSD
共cm兲 共mm Cu兲 共mm Al兲 1⫻1 cm2 2⫻2 cm2 4⫻4 cm2 10⫻10 cm2 20⫻20 cm2

10 0.05 1.6 0.958 0.929 0.897 0.861 0.854

0.1 2.9 0.976 0.945 0.905 0.853 0.838
0.5 8.5 1.019 1.011 0.974 0.910 0.875
1 12.0 1.031 1.041 1.026 0.974 0.943
2 15.8 1.038 1.065 1.077 1.047 1.023
3 17.9 1.037 1.066 1.092 1.086 1.070
4 19.3 1.028 1.053 1.082 1.087 1.075
5 20.3 1.022 1.043 1.074 1.087 1.078

30 0.05 1.6 0.958 0.926 0.889 0.850 0.833

0.1 2.9 0.976 0.940 0.894 0.837 0.809
0.5 8.5 1.019 1.011 0.981 0.887 0.833
1 12.0 1.031 1.042 1.033 0.959 0.902
2 15.8 1.038 1.067 1.083 1.043 0.989
3 17.9 1.037 1.067 1.101 1.090 1.047
4 19.3 1.029 1.055 1.088 1.091 1.065
5 20.3 1.023 1.045 1.077 1.091 1.079

50 0.05 1.6 0.958 0.927 0.891 0.847 0.827

0.1 2.9 0.975 0.942 0.897 0.832 0.800
0.5 8.5 1.018 1.009 0.977 0.881 0.825
1 12.0 1.031 1.040 1.032 0.958 0.894
2 15.8 1.038 1.066 1.085 1.047 0.983
3 17.9 1.036 1.069 1.100 1.095 1.048
4 19.3 1.028 1.057 1.084 1.094 1.066
5 20.3 1.022 1.047 1.072 1.094 1.080

energy-absorption coefficient values were taken from 共2兲 Ionization chambers of choice 共Sec. III B兲: 70–300 kV
Hubbell36 while the composition of the biological tissues was cylindrical ionization chamber, and 40–70 kV parallel plate
taken from the ICRU reports.41,42 共soft x ray兲 ionization chamber.
Table X presents ratios of mass energy-absorption coeffi- The effective point of measurement for both cylindrical
cients averaged over the photon fluence spectrum free in air and parallel plate chambers is the center of the sensitive air
of several biological tissues of interest relative to water. The cavity of the chamber.
backscatter factor ratios relative to water for any of the tis- 共3兲 The appropriate ionization chamber共s兲 shall be cali-
sues 共except bone兲 considered in Table X does not differ
brated for at least two beam qualities sufficiently close to,
from unity by more than 1% for commonly used field sizes
and bracketing the user’s beam qualities 共in terms of both
and can therefore be ignored.34 For bone, Table XI shows the
tube potential and HVL兲. More than one beam quality is
ratios of the backscatter factors, bone to water, for photon
beams 50–300 kV 共0.875–20.8 mm Al兲 with different field required to ensure that the energy dependence of the cham-
sizes at various SSD. ber response satisfies the requirements enunciated in Sec.
III B. Chamber calibration factors shall be directly traceable
to national standards 共from an ADCL, NIST, or NRCC兲.
APPENDIX C. SUMMARY OF RECOMMENDATIONS 共4兲 For parallel plate chambers, buildup of appropriate
AND WORKSHEETS thickness 共Table I兲 and material 共polyethylene, PMMA兲 must
be present at the time of ADCL, NIST, or NRCC calibration.
The following is a summary of the recommendations from
Furthermore, for parallel-plate chambers the same buildup
this protocol, which is intended to assist the clinical physicist
with the measurements in the clinic necessary to complete materials must be present for all ionization measurements
the Worksheets and hence determine the correct absorbed performed at clinical and/or research sites including determi-
dose. nation of HVL, reference dosimetry, and chamber evaluation
共1兲 Water is the phantom material for absolute dose de- measurements 共Sec. III B兲.
termination when the point of interest is as a depth of 2 cm 共5兲 Before ionization data measurements, the clinical
for beams of tube potential greater than 100 kV. Plastic physicist shall examine the equipment for appropriate func-
phantoms 共other than PMMA兲 may be used for in-phantom tion. This analysis of equipment performance includes the
routine quality assurance for convenience. ionization chamber, the electrometer, and the x-ray unit. Spe-

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889 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 889

cifically, the x-ray unit shall be assessed for proper function- center of the sensitive air cavity, along the central axis.
ing of the kV, the mA, and the timer including timer linear- 共8兲 All ionization chamber measurements M raw shall be
ity, accuracy, and end effect 共Sec. III兲. corrected for temperature and pressure, ion recombination,
共6兲 HVL measurements shall be performed with the ap- polarity effects, and electrometer calibration effects 共Sec.
propriate chamber 共and buildup materials兲 and in the sug- V C兲.
gested geometry as indicated in Fig. 1 共Sec. II C兲. 共9兲 If the clinical physicist’s standard chamber is not in-
共7兲 For energies 40–100 kV, routine dose calibration cluded in within the list of chambers in the various correc-
measurements are performed in air, for energies greater than tion factor tables, the chamber shall be relatively compared
100 kV, and depending on the point of interest, dose calibra- against a chamber, which is included in the respective tables
tion measurements are performed either in air or at a depth of 共Sec. V C兲.
2 cm in water. For measurements taken in air, measurements 共10兲 All dose conversion factors and correction factors
are performed at the point where the dose at the phantom dependent on energy shall be determined by tabular look-up
surface is required 共e.g., the cone end兲. If this is not possible, as a function of the HVL of the user’s beam. For in-air
the measurement should be performed at a point as close as measurements, the correction factor of P stem,air shall be in-
possible to the point of interest, and corrected to obtain the cluded in the dose equation 共Sec. V A兲; for in-water mea-
dose there. To this end, an inverse square correction can be surements the additional correction factors of P sheath shall be
used 共see Sec. V C兲. For measurements taken in water, the included in the dose equation 共Sec. V B兲. For B w and other
physicist is cautioned on the use of natural or synthetic rub- correction factors, it is preferred to use the tabular data pro-
ber sleeves for water proofing the chamber because talcum vided in this paper rather than user-determined experimental
powder particles can enter the chamber and strongly affect values. Unless properly analyzed, user-determined values
the response. PMMA, polystyrene, or nylon shall be used for may contain uncertainties associated with specific assump-
water protective covering 共Sec. III B兲. The reference point of tions, which are greater than the uncertainties contained
the parallel plate as well as cylindrical chamber type is at the within the tabular data 共Appendix B兲.

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890 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 890

C.1. TG-61 Worksheet: Calculating dose to water on the phantom surface

Name: Date:

共1兲 X-ray unit: , Tube potential: kV, HVL: mm 共Al or Cu兲

SSD: cm, Field size: cm2

共2兲 Ion chamber and electrometer calibration. Date of last calibration:

Ion chamber: , Calibration factor N K ⫽ Gy/C
Electrometer: , Calibration factor P elec ⫽ C/scale unit

共3兲 Chamber signal: M raw ⫽ scale units

共4兲 Temperature T⫽ °C, Pressure P ⫽ 冉

kPa ⫽mm Hg•
101.33
760.0 冊
To normalize to 22 °C and 1 atm:

273.2⫹T 关 °C兴 101.33

P TP⫽ • ⫽
295.2 P 关 kPa兴

共5兲 Total radiation time: t⫽ min, end effect: ␦ t ⫽ min

1⫺ 冉 冊
VH 2
VL

冉 冊
共6兲 Recombination correction P ion⫽ H 2 ⫽
M raw V H
L ⫺
M raw VL

共 7 兲 Polarity correction P pol⫽ 冏

M⫹ ⫺
raw⫺M raw
2M raw
冏 ⫽

共8兲 Corrected chamber reading M ⫽M rawP elecP TPP ionP pol ⫽ C

共9兲 Backscatter factor 共Table V, Table VI兲: Bw ⫽

共10兲 Mass energy-absorption coefficient ratio water to air 共Table IV兲:

冋冉 冊 册
¯ en w
␮
␳ air
air
⫽

共11兲 Stem correction in air 共Sec. V C兲: P stem,air ⫽

共 12兲 Dose to water: D w ⫽M N K B w P stem,air

␮
冋冉 冊 册
¯ en w
␳ air
air
⫽ Gy

Dw
共 13兲 Dose rate: D w⫽ ⫽ Gy/min
t⫹ ␦ t

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891 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 891

C.2. TG-61 Worksheet: Calculating dose to water at 2 cm depth in water

Name: Date:

共1兲 X-ray unit: , Tube potential: kV, HVL: mm 共Al or Cu兲

SSD: cm, Field size: cm2

共2兲 Ion chamber and electrometer calibration. Date of last calibration:

Ion chamber: , Calibration factor N K ⫽ Gy/C
Electrometer: , Calibration factor P elec ⫽ C/scale unit

共3兲 Chamber signal: M raw ⫽ scale units

共4兲 Temperature T⫽ °C, Pressure P ⫽ 冉

kPa ⫽mm Hg•
101.33
760.0 冊
To normalize to 22 °C and 1 atm:
273.2⫹T 关 °C兴 101.33
P TP⫽ • ⫽
295.2 P 关 kPa兴

共5兲 Total radiation time: t⫽ min, end effect: ␦ t ⫽ min

VH 2
1⫺
VL 冉 冊
冉 冊
共6兲 Recombination correction P ion⫽ H 2 ⫽
M raw V H
L ⫺
M raw VL

共 7 兲 Polarity correction P pol⫽ 冏 ⫹

M raw
2M raw
⫺
⫺M raw
冏 ⫽

共8兲 Corrected chamber reading M ⫽M rawP elecP TPP ionP pol ⫽ C

共9兲 Chamber correction factor 共Table VIII, Fig. 4, Table IX兲:

P Q, chamP sheath ⫽

共10兲 Conversion factor 共TableVII, Fig. 3兲:

冋冉 冊 册
¯ en w
␮
␳ air
water
⫽

共 11兲 Dose to water: D w ⫽M N K P Q chamP sheath 冋冉 冊 册

␮
¯ en w
␳ air
water
⫽ Gy

Dw
共 12兲 Dose rate: D w⫽ ⫽ Gy/min
t⫹ ␦ t

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892 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 892

a兲 21
Electronic mail: [email protected] J. R. Greening, ‘‘The derivation of approximate x-ray spectral distribu-
b兲
Electronic mail: [email protected] tions and an analysis of x-ray quality specifications,’’ Br. J. Radiol. 36,
c兲
Electronic mail: [email protected] 363–371 共1960兲.
d兲 22
Electronic mail: [email protected] R. T. Knight and A. E. Nahum, ‘‘Depth and field-size dependence of
e兲
Electronic mail: [email protected] ratios of mass-energy-absorption coefficient, water-to-air, for kV X-ray
f兲
Electronic mail: [email protected] dosimetry,’’ in Proceedings of the IAEA International Symposium on
g兲
Electronic mail: [email protected] Measurement Assurance in Dosimetry 共IAEA, Vienna, 1994兲, pp. 361–
1
C.-M. Ma, C. W. Coffey, L. A. De Werd, C. Liu, R. Nath, S. M. Seltzer, 370.
23
and J. Seuntjens, ‘‘Status of kilovoltage x-ray beam dosimetry in radio- C.-M. Ma and J. P. Seuntjens, ‘‘Correction factors for water-proofing
therapy,’’ In Proceedings of Kilovoltage X-ray Beam Dosimetry for Ra- sleeves in kilovoltage x-ray beams,’’ Med. Phys. 24, 1507–1513 共1997兲.
24
diotherapy and Radiobiology, edited by C.-M. Ma and J. P. Seuntjens K. R. Rosser, ‘‘An alternative beam quality index for medium-energy
共MPP, Madison, 1999兲, pp. 27–42. x-ray dosimetry,’’ Phys. Med. Biol. 43, 587–598 共1998兲.
2 25
C.-M. Ma, C. W. Coffey, L. A. DeWerd, C. Liu, R. Nath, S. M. Seltzer, E. R. Epp and H. Weiss, ‘‘Experimental study of the photon energy
and J. Seuntjens, ‘‘Dosimetry of kilovoltage x-ray beams for radio- spectrum of primary diagnostic x-rays,’’ Phys. Med. Biol. 11, 225–238
therapy,’’ Med. Phys. 23 共abstract兲 共1996兲. 共1966兲.
3 26
ICRU, ‘‘Radiation dosimetry: Measurement of absorbed dose in a phan- L. H. J. Peaple and A. K. Burt, ‘‘The measurement of spectra from x-ray
tom irradiated by a single beam of x- or gamma rays,’’ ICRU Report No. machines,’’ Phys. Med. Biol. 14, 73–85 共1969兲.
23, ICRU, Washington D.C., 1973 共unpublished兲. 27
W. W. Seelentag, W. Panzer, G. Drexler, L. Platz, and F. Santner, ‘‘A
4
‘‘Central-axis depth-dose data for use in radiotherapy,’’ Br. J. Radiol. 10, catalogue of spectra for the calibration of dosemeters,’’ Report GSF Ber-
共1961兲. icht 560, Gesellschaft für Strahlen- und Umweltforschung GmbH, Mu-
5
NCRP Report 69, ‘‘Dosimetry of x-ray and gamma ray beams for radia- nich, 1979 共unpublished兲.
28
tion therapy in the energy range 10 keV to 50 MeV,’’ NCRP Publica- J. Seuntjens, H. Thierens, and O. Segaert, ‘‘Response of coaxial Ge共Li兲
tions, Washington DC, 1981 共unpublished兲. detectors to narrow beams of photons for stripping of x-ray bremsstrah-
6
HPA, ‘‘Revised code of practice for the dosimetry of 2 to 35 MeV x-ray, lung spectra,’’ Nucl. Instrum. Methods Phys. Res. A 258, 127–131
and of caesium-137 and cobalt-60 gamma-ray beams,’’ Phys. Med. Biol. 共1987兲.
28, 1097–1104 共1983兲. 29
R. Birch and M. Marshall, ‘‘Computation of Bremsstrahlung x-ray spec-
7
‘‘Central axis depth dose data for use in radiotherapy,’’ Br. J. Radiol. 17, tra and comparison with spectra measured with a Ge共Li兲 detector,’’ Phys.
共1983兲. Med. Biol. 24, 505–517 共1979兲.
8 30
IAEA, Absorbed Dose Determination in Photon and Electron Beams: An E. D. Trout, J. P. Kelley, and A. C. Lucas, ‘‘Determination of half value
International Code of Practice, Technical Report Series, Vol. 27 共IAEA, layer,’’ Am. J. Roentgenol. 84, 729 共1960兲.
31
Vienna, 1987兲. C. A. Carlsson, ‘‘Differences in reported backscatter factors for low-
9
U. Schneider, B. Grosswendt, and H. M. Kramer, ‘‘Perturbation correc- energy x-rays: a literature study,’’ Phys. Med. Biol. 38, 521–531 共1993兲.
32
tion factor for x-rays between 70 and 280 kV,’’ in Proceedings of the J. Seuntjens and F. Verhaegen, ‘‘Dependence of overall correction factor
IAEA International Symposium on Dosimetry in Radiotherapy 共IAEA, of a cylindrical ionization chamber on field size and depth in medium-
Vienna, 1988兲, Vol. I, pp. 141–148. energy x-ray beams,’’ Med. Phys. 23, 1789–1796 共1996兲.
10 33
J. Seuntjens, H. Thierens, A. Van der Plaetsen, and O. Segaert, ‘‘Deter- X. A. Li, C.-M. Ma, and D. Salhani, ‘‘Measurement of percentage depth
mination of absorbed dose to water with ionisation chambers calibrated dose and lateral beam profile for kilovoltage x-ray therapy beams,’’ Phys.
in free air for medium-energy x-rays,’’ Phys. Med. Biol. 33, 1171–1185 Med. Biol. 42, 2561–2568 共1997兲.
共1988兲. 34
C.-M. Ma, X. A. Li, and J. Seuntjens, ‘‘Consistency study on kilovoltage
11
J. Seuntjens, H. Thierens, and U. Schneider, ‘‘Correction factors for a x-ray beam dosimetry for radiotherapy,’’ Med. Phys. 25, 2376–2384
cylindrical chamber used in medium-energy x-ray beams,’’ Phys. Med. 共1998兲.
Biol. 38, 805–832 共1993兲. 35
C.-M. Ma and J. P. Seuntjens, ‘‘Mass energy-absorption coefficient and
12
K. E. Rosser, ‘‘Measurement of absorbed dose to water for medium- backscatter factor ratios for kilovoltage x-ray beams,’’ Phys. Med. Biol.
energy x-rays,’’ NPL Report No. RSA共EXT兲33, 1992 共unpublished兲. 44, 131–143 共1999兲.
13
IAEA, Absorbed Dose Determination in Photon and Electron Beams; An 36
共a兲 J. H. Hubbell, ‘‘Photon mass attenuation and energy-absorption coef-
International Code of Practice, 2nd ed., Technical Report Series, Vol. ficients from 1 keV to 20 MeV,’’ Int. J. Appl. Radiat. Isot. 33, 1269–
277 共IAEA, Vienna, 1997兲. 1290 共1982兲; 共b兲 J. H. Hubbell and S. M. Seltzer, ‘‘Tables of x-ray mass
14
C.-M. Ma and A. E. Nahum, ‘‘Monte Carlo calculated correction factors attenuation coefficients and mass energy-absorption coefficients 1 keV to
for a NE2571 chamber in medium-energy photon beams,’’ in Proceed- 20 MeV for elements Z⫽1 to 92 and 48 additional substances of dosi-
ings of the IAEA International Symposium on Measurement Assurance in metric interest,’’ Report No. NISTIR 5632 NIST, Gaithersburg, MD,
Dosimetry 共IAEA, Vienna, 1994兲, pp. 371–382 1995 共unpublished兲.
15 37
C.-M. Ma and A. E. Nahum, ‘‘Monte Carlo calculated stem effect cor- B. Grosswendt, ‘‘Dependence of the photon backscatter factor for water
rections for NE2561 and NE2571 chambers in medium-energy x-ray on source-to-phantom distance and irradiation field size,’’ Phys. Med.
beams,’’ Phys. Med. Biol. 40, 63–72 共1995兲. Biol. 35, 1233–1245 共1990兲.
16 38
C.-M. Ma and A. E. Nahum, ‘‘Calculations of ion chamber displacement B. Grosswendt, ‘‘Dependence of the photon backscatter factor for water
effect corrections for medium-energy x-ray dosimetry,’’ Phys. Med. Biol. on irradiation field size and source-to-phantom distance between 1.5 and
40, 45–62 共1995兲. 10 cm,’’ Phys. Med. Biol. 38, 305–310 共1993兲.
17 39
S. C. Klevenhagen, R. J. Auckett, J. E. Burns, R. M. Harrison, R. T. S. C. Klevenhagen, ‘‘Experimentally determined backscatter factors for
Knight, A. E. Nahum, and K. E. Rosser, ‘‘Report of the IPSM working x-rays generated at voltages between 16 and 140 kV,’’ Phys. Med. Biol.
party on low- and medium-energy x-ray dosimetry,’’ Phys. Med. Biol. 34, 1871–1882 共1989兲.
36, 1027–1038 共1991兲. 40
J. P. Seuntjens, L. Van der Zwan, and C.-M. Ma, ‘‘Type dependent
18
S. C. Klevenhagen, R. J. Aukett, R. M. Harrison, C. Moretti, A. E. correction factors for cylindrical chambers for in-phantom dosimetry in
Nahum, and K. E. Rosser, ‘‘The IPEMB code of practice for the deter- medium-energy x-ray beams,’’ in Proceedings Kilovoltage X-ray Beam
mination of absorbed dose for x-rays below 300 kV generating potential Dosimetry for Radiotherapy and Radiobiology, edited by C.-M. Ma and
共0.035 mm Al–4 mm Cu HVL; 10–300 kV generating potential,’’ Phys. J. P. Seuntjens 共MPP, Madison, 1999兲, pp. 159–74.
Med. Biol. 41, 2605–2625 共1996兲. 41
International Commission on Radiation Units and Measurements, Tissue
19
NCS 共Netherlands Commission on Radiation Dosimetry兲, ‘‘Dosimetry of Substitutes in Radiation Dosimetry and Measurement, ICRU Report No.
low and medium-energy x-rays, a code of practice for use in radiotherapy 44, Bethesda MD, 1989 共unpublished兲.
42
and radiobiology,’’ NCS Report No. 10, NCS, Delft, The Netherlands, International Commission on Radiation Units and Measurements, Stop-
1997 共unpublished兲. ping Powers for Electrons and Positrons, ICRU Report No. 37, Be-
20
C. W. Coffey in Calibrations of Low-energy X-ray units in Advances in thesda, MD, 1984.
43
Radiation Oncology Physics, edited by J. Purdy, Medical Physics Mono- W. A. Jennings and R. M. Harrison, ‘‘X rays: HVL range 0.01 to 8.0 mm
graph 19 共AAPM, New York, 1992兲, pp. 148–180. Al,’’ Br. J. Radiol. 17, 1–22 共1983兲.

Medical Physics, Vol. 28, No. 6, June 2001

893 Ma et al.: AAPM’s TG-61 protocol for kilovoltage x-ray beam dosimetry 893

44
C. W. Smith and W. H. Sutherland, ‘‘X rays: half-value layer range 0.5 low-energy x-ray dosimetry caused by electron contamination,’’ Phys.
mm–4.0 mm Cu,’’ Br. J. Radiol. 17, 23–36 共1983兲. Med. Biol. 36, 1111–1116 共1991兲.
45 61
J. W. Scrimger and S. G. Connors, ‘‘Performance characteristics of a R. L. Stem and H. D. Kubo, ‘‘Considerations for superficial photon do-
widely used orthovoltage x-ray therapy unit,’’ Med. Phys. 13, 267–269 simetry,’’ Med. Phys. 22, 1469–1470 共1995兲.
共1986兲. 62
J. E. Aldrich, J. S. Meng, and J. W. Andrew, ‘‘The surface doses from
46
A. Niroomand-Rad, M. T. Gillin, F. Lopez, and D. F. Grimm, ‘‘Perfor- orthovoltage x-ray treatments,’’ Med. Dosim. 17, 69–72 共1992兲.
63
mance characteristics of an orthovoltage x-ray therapy machine,’’ Med. J. T. Whitton, ‘‘New values for epidermal thickness and their impor-
Phys. 14, 874–878 共1987兲. tance,’’ Health Phys. 24, 1–8 共1973兲.
47 64
L. Gerig, M. Soubra, and D. Salhani, ‘‘Beam characteristics of the Thera- X. A. Li, C.-M. Ma, D. Salhani, and O. Agboola, ‘‘Dosimetric evaluation
pax DXT300 orthovoltage therapy unit,’’ Phys. Med. Biol. 39, 1377– of a widely used kilovoltage x-ray unit for endocavitary radiotherapy,’’
1392 共1994兲. Med. Phys. 25, 1464–1471 共1998兲.
48 65
R. G. Kurup and G. P. Glasgow, ‘‘Dosimetry of a kilovoltage radio- L. Ma, C.-M. Ma, J. F. Nacey, and A. L. Boyer, ‘‘Determination of cone
therapy x-ray machine,’’ Med. Dosim. 18, 179–186 共1993兲. effects on backscatter factors and electron contamination for superficial
49
R. J. Aukett, D. W. Thoms, A. W. Seaby, and J. T. Gittings, ‘‘Perfor- x-rays,’’ in Proceedings Kilovoltage X-ray Beam Dosimetry for Radio-
mance characteristics of the Pantak DXT-300 kilovoltage x-ray treatment therapy and Radiobiology, edited by C.-M. Ma and J. P. Seuntjens 共MPP,
machine,’’ Br. J. Radiol. 69, 726–734 共1996兲. Madison, 1999兲, pp. 297–290.
50 66
X. A. Li, D. Salhani, and C.-M. Ma, ‘‘Characteristics of orthovoltage F. W. Spiers, ‘‘Transition-zone dosimetry,’’ in Radiation Dosimetry, 2nd
x-ray therapy beam at extended SSD for applications with end plates,’’ ed., edited by H. Attix and E. Tochilin 共Academic, New York, 1969兲, pp.
Phys. Med. Biol. 42, 357–370 共1997兲. 847–850.
51 67
‘‘Central axis depth dose data for use in radiotherapy,’’ Br. J. Radiol. 25, J. E. Saunders and V. G. Peters, ‘‘Backscattering for metals in superficial
共1996兲. therapy with high energy electrons,’’ Br. J. Radiol. 47, 467–470 共1974兲.
52 68
J. W. Boag, in ‘‘Ionization chambers,’’ Radiation Dosimetry, edited by F. C. L. Wingate, W. Gross, and G. Failla, ‘‘Experimental determination of
H. Attix and W. C. Roesch 共Academic, New York, 1966兲, Vol. 2, pp. absorbed dose from x-rays near the interface of soft tissue and other
1–72. material,’’ Radiology 79, 984–999 共1962兲.
53 69
J. W. Boag, ‘‘General recombination in ionization chambers with spa- I. J. Das, ‘‘Forward dose perturbation at high atomic number interfaces in
tially non-uniform ionization intensity—two special cases,’’ Int. J. Ra- kilovoltage x-ray beams,’’ Med. Phys. 24, 1781–1792 共1997兲.
diat. Phys. Chem. 7, 243–249 共1975兲. 70
I. J. Das, J. D. Chapman, F. Verhaegen, and D. E. Zellmer, ‘‘Interface
54
J. W. Boag, in ‘‘Ionization chambers,’’ The Dosimetry of Ionizing Radia- dosimetry in kilovoltage photon beams,’’ in Proceedings of Kilovoltage
tion, edited by K. R. Kase, B. E. Bjarngard, and F. H. Attix 共Academic, X-ray Beam Dosimetry for Radiotherapy and Radiobiology, edited by
New York, 1987兲, Vol. II, pp. 169–244. C.-M. Ma and J. P. Seuntjens 共MPP, Madison, 1999兲, pp. 239–260.
55
P. R. Almond, ‘‘Use of a Victoreen 500 electrometer to determine ion- 71
F. M. Khan, The Physics of Radiation Therapy, 2nd ed. 共Williams and
ization chamber collection efficiencies,’’ Med. Phys. 8, 901–904 共1981兲. Wilkins, Baltimore, MD, 1994兲, pp. 43–44, 394–399.
56 72
P. R. Almond, P. J. Biggs, B. M. Coursey, W. F. Hanson, M. Saiful-Huq, C.-M. Ma and A. E. Nahum, ‘‘Bragg-Gray theory and ion chamber do-
R. Nath, and D. W. O. Rogers, ‘‘AAPM’s TG-51 protocol for clinical simetry in photon beams,’’ Phys. Med. Biol. 36, 413–428 共1991兲.
73
reference dosimetry of high-energy photon and electron beams,’’ Med. A. E. Nahum and R. T. Knight, ‘‘Consistent formalism for kV x-ray
Phys. 26, 1847–1870 共1999兲. dosimetry,’’ in Proceedings of the IAEA International Symposium on
57
F. H. Attix, Introduction to Radiological Physics and Radiation Dosim- Measurement Assurance in Dosimetry 共IAEA, Vienna, 1994兲, pp. 451–
etry 共Wiley, New York, 1986兲, pp. 358–360. 459.
58 74
J. P. Seuntjens, A. H. L. Aalbers, T. W. M. Grimbergen, B. J. Mijnheer, ‘‘Central axis depth dose data for use in radiotherapy,’’ Br. J. Radiol. 11,
H. Thierens, J. Van Dam, F. W. Wittkamper, J. Zoetelief, M. Piessens, 共1972兲.
75
and P. Piret, ‘‘Suitability of diamond detectors to measure central axis B. Owsley, C. Coffey, and J. Sayeg, ‘‘Wall requirements for a thin win-
depth kerma curves for low and medium-energy x-rays,’’ in Proceedings dow parallel plate chamber for the output measurements of a superficial
Kilovoltage X-ray Beam Dosimetry for Radiotherapy and Radiobiology, x-ray machine- a forgotten principle?,’’ Med. Phys. 17, 510 共1990兲.
edited by C.-M. Ma and J. P. Seuntjens 共MPP, Madison, 1999兲, pp. 76
W. F. Hanson, D. J. Arnold, R. J. Shalek, and L. J. Humphries, ‘‘Con-
227–238. tamination of ionization chambers by talcum powder,’’ Med. Phys. 15,
59
M. B. Podgorsak, L. J. Schreiner, and E. B. Podgorsak, ‘‘Surface dose in 776–777 共1983兲.
77
intracavitary orthovoltage radiotherapy,’’ Med. Phys. 17, 635–640 A. Brahme, ‘‘Dosimetric precision requirements in radiation therapy,’’
共1990兲. Acta Radiol.: Oncol. 23, 379–391 共1984兲.
60
S. C. Klevenhagen, D. D’Souza, and I. Bonnefoux, ‘‘Complications in

Medical Physics, Vol. 28, No. 6, June 2001