RADIATION DOSIMETRY FOR ONCOLOGY 465
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See also PHANTOM MATERIALS IN RADIOLOGY; RADIATION DOSIMETRY FOR
ONCOLOGY; RADIATION DOSIMETRY, THREE-DIMENSIONAL; RADIATION THERAPY
TREATMENT PLANNING, MONTE CARLO CALCULATIONS IN; RADIOTHERAPY
TREATMENT PLANNING, OPTIMIZATION OF.
RADIATION DOSIMETRY FOR ONCOLOGY
MALCOM MCEWEN
National Research Council
of Canada
Ontario, Canada
INTRODUCTION
Cancer is a disease that touches everyone, either directly or
through a close friend or relative, and radiotherapy is one
of the primary modalities for treating cancer. The intent
may be a full cure or to relieve pain associated with the
cancer and it is either used alone or in conjunction with
other techniques, such as surgery or chemotherapy. The
aim of radiotherapy is to use ionizing radiation (usually
either high energy photons or electrons) to destroy the
tumor while at the same time sparing healthy tissues.
In the delivery of such treatments the quantity of interest
is the absorbed dose (defined as the energy deposited per
unit mass) as it can be used to estimate the biological effect
of the radiation (i.e., cell killing). Too high a dose will kill all
the cancerous cells, but will produce significant side effects
due to damage to other organs. Too low a dose will leave
some malignant cells alive, which can develop into a new
tumor. One of the primary concerns in radiotherapy is
therefore delivering the correct dose to destroy the tumor
with the minimum of side effects and a fine line exists
between under and over dosing. The allowable error in the
delivered dose depends on many factors, such as the type
and location of the tumor, but for some cancers can be as
little as 3–4%.
The output of the machines that produce the radiation
for radiotherapy (linear accelerators, X-ray tubes, radio-
active sources) must be known to a very high accuracy and
a great deal of dosimetry work is carried out in the radio-
therapy clinic to monitor dose delivery. For example, before
the linear accelerator (linac) can be used for patient treat-
ment, daily checks are carried out to ensure consistency of
output. In vivo dosimetry may be used to verify the patient
dose and detailed measurements are made during weekly
and monthly quality assurance sessions checking all
aspects of treatment delivery. Audits are used to check
that procedures are being followed correctly and to ensure
national consistency.
Over recent years the number of treatment modalities
has increased significantly as well as the complexities of
treatment. The oncologist today can choose from an array
of techniques including low energy X-ray tubes (usually
used for superficial tumors); low doserate or high doserate
brachytherapy, where different radioactive species are
inserted or implanted in the body; external beam therapy
using a linac (producing either photon or electron beams);
protons and heavy ions; and neutrons.
The treatment can be simple, such as a single square
field from a 60Co unit, or complex, such as Image Guided
Radiotherapy (IGRT) using a modern linac, where the
patient is imaged immediately prior to treatment, the
tumor volume verified and the dose delivered with a large
number of shaped fields.
To cover all possible radiotherapy techniques is beyond
the scope of this article, and therefore we will focus on
external beam therapy using photon and electron beams,
as this is most common and where dosimetry is most
advanced. The aim is to give a basic grounding in radiation
dosimetry for oncology together with a review of dosimetry
techniques and an up-to-date bibliography where the
reader can obtain further detail.
RADIATION MEASUREMENT AND QUANTITIES
In radiation oncology, we are interested in the relation-
ship between biological damage to cells and the radiation
producing the damage. Various attempts have been made
to define biological dosimeters [e.g., deoxyribonucleic acid
(DNA) strand breaks, chromosome aberrations], but none
have resulted in a quantity that is reproducible and can
be transferred from one situation to another: a primary
requirement for a measurement quantity. Therefore
physical quantities are used as a basis for estimating
biological effects.
Fluence
The particle fluence, F, is defined (1) as dN/da: the number
of particles dN, incident on a sphere of cross-sectional area
da. The use of a sphere expresses the fact one considers the
area perpendicular to the direction of each particle. The
energy fluence C (defined as the energy incident on a
sphere of unit area) is generally of more interest for
photons as it is more closely related to the dose deposited
(see below).
Interaction Coefficients
The stopping power S of a material is defined as the energy
lost by the charged particle (electron or positron) dE, along
466 RADIATION DOSIMETRY FOR ONCOLOGY
an increment of path dl. Ignoring energy losses due to
nuclear reactions, stopping power has two principal com-
ponents, namely, that due to collisions and that due to
radiative losses. The collision component includes all
energy losses in particle collisions that directly produce
secondary electrons and atomic excitations. It also includes
energy losses due to the production of Cerenkov radiation.
The radiative component includes all energy losses of the
primary electron that lead to bremsstrahlung production.
The collisions of the primary electrons can produce high
energy secondary electrons (d-rays) that then become
involved in independent interactions. The concept of
restricted mass collisional stopping power L is therefore
introduced to calculate the energy transferred to a loca-
lized region of interest. This region of interest is defined
by a threshold (often denoted as D) for the energy trans-
ferred to the secondary (charged) delta particles. Highly
energetic secondary particles with energy above this
threshold escape the region of interest and do not con-
tribute to the local absorbed dose and it is assumed that
electrons with energy below D have negligible range. The
restricted stopping power (LD) is therefore always lower
than the unrestricted stopping power and the choice of
the energy threshold depends on the problem at hand.
For problems involving ionization chambers, a frequently
used threshold value is 10 keV since the range of a 10 keV
electron in air is approximately 2 mm (the typical dimen-
sion of the air cavity of an ionization chamber). The
parameter LD is also known as the linear energy transfer
(LET).
In practice, mass stopping powers (S/r, L/r) are
generally used so that it is easier to compare the properties
of materials with very different densities (e.g., air and
water). A complementary quantity is the scattering power
T, which describes the increase in the mean square scat-
tering angle of the electron beam as it passes through a
material.
For photon beams, there are a much larger number of
possible interactions with the medium, the dominant ones
in the energy range of interest being the photoelectric
effect, Compton effect, pair production, coherent (Rayleigh)
scattering, and nuclear photoeffect. The total interaction
cross-section is simply the sum of all the individual cross-
sections. The attenuation coefficient, m, tends to be used
rather than cross-sections as it describes the probability
per unit thickness that a photon will undergo an inter-
action while traversing a material. As for stopping
powers, the effect of density is removed and for dosimetric
purposes two further coefficients are defined. The mass
energy-transfer coefficient mtr/r relates the energy trans-
ferred from the photon to kinetic energy of charged par-
ticles and is used in the determination of kerma (see
below). The mass energy absorption coefficient men/r takes
account of the fact that some of the energy transferred to
charged particles is not deposited locally, but lost as
bremsstrahlung.
Kerma
Kerma (kinetic energy released per unit mass), is intro-
duced because neutral particles (photons and neutrons)
kg1.
deposit their energy in two steps: (1) interaction of the
photon with an atom resulting in the transfer of energy to
charged particles (predominantly electrons), and (2) depo-
sition of that energy in the medium via Coulomb interac-
tions (excitation and ionization). The dose contributed
through direct interactions between photons or neutrons
and the absorbing material will generally be negligible
compared with this two-step process. Reference 1 gives
the definition of kerma as:
dEtr
K¼ (1)
dm
where dEtr is the kinetic energy transferred from photons
to electrons in a volume element of mass dm. Total kerma
can be split into two parts: collisional and radiative kerma.
Collisional kerma, Kcol, leads to the production of electrons
that dissipate their energy as ionization near electron
tracks in the medium. Radiative kerma, Krad, leads to
the production of bremsstrahlung as the charged particles
are decelerated in the medium.
For a monoenergetic photon spectrum, energy E, with
fluence F, equation 1 becomes
mtr
K ¼ FE (2)
r
where (mtr/r) is the mass energy transfer coefficient. For a
polyenergetic photon beam, equation 2 becomes an integral
over the full photon spectrum. As the photon energy
increases, the maximum energy of the secondary electrons
increases, the concept of a localized energy transfer begins
to break down and kerma is therefore generally limited to
photon energies below 3 MeV.
Absorbed Dose
The absorbed dose is defined as the mean energy imparted
(absorbed) per unit mass. It is a nonstochastic quantity in
that one is not measuring single events-the interaction
between an incident photon or electron and a molecule—
but the mean energy arising through the interaction of the
radiation field with the material it passes through. As the
mass of a sample decreases the energy per unit mass will
become more random (stochastic). Whereas kerma is only
defined for neutral particles, absorbed dose applies both to
photon and electron beams.
Reference 2 applies this definition of absorbed dose in
the situation where there is a small volume of the medium,
which is thermally isolated from the remainder:
dE dEh dEs
Di ¼ ¼ þ (3)
dm dm dm
where Di is the mean absorbed dose in the absorber of
material i, and mass dm; dE is the mean energy imparted
to the absorber by the radiation beam (photons or elec-
trons); dEh is the energy appearing as heat; and dEs is the
energy absorbed by chemical reactions (which may be
positive or negative). The left-hand relation is independent
of the measurement technique while the right-hand rela-
tion represents one of the most common methods for
determining dose: the measurement of heat. The unit of
absorbed dose is the gray (Gy); 1 Gy ¼ 1 J

It can be inferred from the definitions above that
collision kerma and absorbed dose should be related in
someway, since they both deal with the deposition of
energy in a localized area. If a state of charged particle
equilibrium exists (and assuming no energy losses due to
bremsstrahlung) then the absorbed dose will be equal
to the kerma (conservation of energy). Charged particle
equilibrium (CPE) exists at a point in the medium if the
number and energy of charged particles entering a volume
is equal to that leaving. True CPE only exists in the
special case where there is no attenuation of the photon
beam. In general there is always some photon attenua-
tion, but there is said to be transient charged-particle
equilibrium (TCPE), since the spectrum of charged par-
ticles changes very little as the photon beam penetrates
the medium. Transient charged-particle equilibrium
exists at the center of a broad photon beam at depths
away from the surface (the depth at which TCPE is
established depends on the incident photon energy and
spectrum). For the general case, where TCPE exists
and there are bremsstrahlung energy losses, the dose is
kg1), which represents a
given by
D ¼ Kcol ¼ Kð1  gÞ (4)
where g is the fraction of the energy that is lost to
bremsstrahlung. For a 60Co beam, g has a value of 0.003.
Absorbed dose is also related to the photon energy
fluence at a point in a medium irradiated by a photon
beam under conditions of transient charged particle
equilibrium by
 
m
D ¼ C en b (5)
r that any measuring instrument will perturb the
where b is the ratio of absorbed dose to collision kerma at a
point. As written, equation 5 is valid for a monoenergetic
photon beam; for a realistic (broad) photon spectrum, the
mass–energy absorption coefficient must be averaged
over the photon fluence.
There is a charged-particle analog of equation 5. Under
the restrictive conditions that (1) radiative photons escape
the volume of interest and (2) secondary electrons are
absorbed on the spot (or there is charged-particle equili-
brium of secondary electrons), the absorbed dose to med-
ium is given by the electron fluence multiplied by the
collisional stopping power.
Dose Equivalent
This quantity is useful where the effect produced by
the same absorbed dose is dependent on the particle
type ‘‘delivering’’ the dose. This is the case in biological
damage: the principal pathway for cell killing is a double-
strand break of the cell’s DNA, which is much more likely
for densely ionizing particles, such as protons, neutrons,
and a-particles, than it is for electrons or photons. A
radiation quality factor, w is therefore introduced to take
account of this and the dose equivalent is defined as the
absorbed dose multiplied by this quality factor. Values
of w vary from 1 for photons and electrons to 20 for
a-particles.
RADIATION DOSIMETRY FOR ONCOLOGY 467
PRIMARY METHODS OF DETERMINING ABSORBED DOSE
AND AIR KERMA
Due to the complexities of the measurements, the abso-
lute determination of radiation quantities is almost exclu-
sively the domain of national standards laboratories.
Two primary International System of Units (SI) quantities
are realised by national standards laboratories for radio-
therapy dosimetry: air kerma and absorbed dose. Air
kerma can only be measured using an air-filled ionization
chamber but absorbed dose can be determined in a variety
of ways.
The absolute measurement of absorbed dose has a
number of problems (some fundamental, others practical)
that limit the accuracy of the result and put constraints on
the experimental techniques that can be used.
1. Doses of interest are small. The definition of
absorbed is in terms of the energy absorbed in an
amount of material. Radiotherapy dose levels are
typically < 10 Gy (10 J
very small energy deposition. If one is trying to
determine this energy absolutely by measuring the
radiation-induced temperature rise (of the order of a
few mK) there is a significant challenge in achieving
uncertainties < 0.1%.
2. The quantity required is the dose in an undisturbed
phantom. In radiotherapy, the required end-point
is the dose to the tumor. However, since radiation
interactions are very material dependent a homoge-
neous phantom is the chosen medium for reference
dosimetry. This immediately presents a problem in
phantom and affect the measurement one wishes
to make.
3. The quantity required is the dose at a point in this
phantom. For radiotherapy dosimetry, one is not
interested in the average dose to the whole phantom
(although mean dose or integral dose is required for
radiation protection, when considering lifetime dose
to organs, etc.). Radiotherapy treatments using
photon and electron beams produce significant dose
variations within a phantom; otherwise, healthy tis-
sue could not be spared. It is therefore important to
be able to measure these dose variations, which by
implication requires a small detector. Such a detector
will generally have a larger uncertainty than a larger
detector. Care is required in designing a detector that
samples the dose at a point and does not give some
unwanted averaging.
4. Scattered radiation contributes a significant propor-
tion of the absorbed dose. In a typical radiotherapy
radiation field used for cancer treatment (e.g., a
6 MV photon beam), 15% of the dose at the point
of interest is due to scattered, rather than primary,
radiation. The experimental geometry is therefore
very important and care must be taken in designing
experiments, especially when comparing or calibrat-
ing dosimeters, so that scattered radiation is prop-
erly taken into account.
468 RADIATION DOSIMETRY FOR ONCOLOGY

5. Optimization of the measurement is difficult. One of Collecting electrode

the biggest practical constraints is that in the Guard of length L Guard
electrode electrode
measurement of absorbed dose one is not deter-
mining some fundamental constant or characteris-
tic of a material. The dose is the effect of a particular Defining
plane
radiation field at a point in a particular material and
it is therefore not possible to optimise all aspects of a Aperture
measurement. There are many ‘‘influence quanti- of area A
ties’’ (material, energy spectrum, geometry) so that
what may appear to be minor variations from the X-ray
real measurement problem (dose to a tumor) can beam
result in significant errors being introduced.

These issues also apply to the determination of air kerma.

Measurement
volume
Ionometry (defined by
aperture and
An ionization chamber measures the ionization produced collecting
by the incident radiation beam in a mass of air. Histori- electrode)
Guard bars
cally, the first quantity to be measured was Exposure Collecting HT electrode
volume
(symbol X) and is simply the charge, Q, liberated in a
volume of air mass mair. It is not a recommended SI unit
but is related to Air Kerma by Schematic diagram of the National Physics Laboratory (NPL)
primary standard free-air ionisation chamber
W l
Kair ¼ X (6)
e lg Figure 1. Diagram of a free-air chamber. (Courtesy NPL.)
where W/e is the average energy required to liberate an ion
pair and g has the same definition as in equation 4. The
Bragg–Gray cavity theory is then used to relate the dose
value of W/e has been measured by a large number of
in the air cavity to the dose to the medium. The conditions
experimenters of many years and there is an agreed value
for application of Bragg–Gray cavity theory are
of 33.97 eV/ion pair (3), which is constant over widely
varying conditions (air pressure, electron energy, etc.).
1. The cavity must be small when compared with the
For low energy beams produced by X-ray tubes
range of charged particles incident on it so that its
(< 400 kVp) exposure is measured using a free-air cham-
presence does not perturb the fluence of charged
ber. A typical chamber is shown in Fig. 1. By careful design
particles in the medium.
and precise manufacturing of the electrodes and entrance
aperture it is possible to accurately define the volume (and 2. The absorbed dose in the cavity is deposited solely by
thus mass) of air that is irradiated. The size of the free-air charged particles crossing it (i.e., photon interac-
chamber scales with the incident energy and for a 60Co tions in the cavity are assumed negligible and thus
beam a free-air chamber would be impractically large: ignored).
several meters in each dimension.
At energies of 137Cs (663 keV) and above, one must
therefore use a cavity chamber, where the volume of
the air cavity is small (typically a few cm3). One must
determine the mass of air in the cavity and various
designs been employed: spherical, cylindrical, and ‘‘pancake’’
(Fig. 2).
Until 1990, all absorbed dose measurements in the
radiotherapy clinic were based on air-kerma calibra-
tions using protocols as seen in Refs. 4 and 5. In recent
years, absorbed dose-based calibrations have become
available from national standards laboratories and asso-
ciated protocols produced (e.g., Refs. 6–8). However, air
kerma standards are still required for the dosimetry of
kilovolt X-ray beams, brachytherapy, and radiation
protection.
The dose to the air volume of a cavity chamber irra- Figure 2. Schematics of three graphite-walled cavity ion
diated by an X- or g-ray beam is given by chambers designed and operated at the National Research
Council (NRC) - cylindrical (3C), parallel-plate (Mark IV), and
Q W spherical (3S). The 3S utilizes an aluminum electrode, while the
Dair ¼ (7)
mair e other two chambers utilize graphite electrode.

Condition (2) implies that all electrons depositing the
dose inside the cavity are produced outside the cavity and
completely cross the cavity. Therefore, no secondary elec-
trons are produced inside the cavity and no electrons stop
within the cavity. The dose to the medium is obtained using
a ratio of stopping powers:
 
Q W S
Dmed ¼ (8)
mair e r med,air
where (S/r)med,air is the mass stopping power ratio for the
medium divided by that for air. The Bragg–Gray cavity
theory does not take into account the creation of secondary
(delta) electrons generated as a result of the slowing down
of the primary electrons in the sensitive volume of the
dosimeter. The Spencer–Attix cavity theory is a more
general formulation that accounts for the creation of these
electrons that have sufficient energy to produce further
ionization on their own account.
Equation 8, in principle, gives a possible route to the
absolute absorbed dose, if the stopping power ratio is
known. The Bureau International des Poids et Mesures
(BIPM) maintains such an ionometric standard for
absorbed dose to graphite. This is a graphite walled ion-
ization chamber, whose volume has been determined by
mechanical means, and is described in detail by Boutillon
and Peroche (9). Strictly speaking, however, this is not a
primary device, as the value for the product of W/e and the
stopping power ratio is taken from calorimeter measure-
ments. Although there are independent measurements of
W/e, there is a lack of measured stopping power data (see
below) to provide a true measurement of absorbed dose
absolutely.
As noted above, one of the difficulties in realising a
primary standard cavity ion chamber is defining the effec-
tive volume of the chamber. This problem can be overcome
to a certain extent by the use of an extrapolation, or
gradient, chamber. In such a chamber, the absolute volume
of the cavity is not known, but can be changed by a known
amount, usually by changing the electrode spacing. Assum-
ing that the chamber does not perturb the medium then the
dose is given by
 
DQ W S 1
Dmed ¼ ð9Þ
Dx e r med,air A rair
where DQ is the change in the measured ionization
charge for a change in the electrode spacing of Dx, A
is the area of the electrode and rair is the air density.
The dose measurement becomes a relatively simple
charge measurement and the problem of the determina-
tion of volume is reduced to that of determining the
area of the collecting electrode. Klevenhagen (10) car-
ried out some of the first work on gradient chambers for
the determination of dose in megavoltage photon and
electron beams and Zankowski and Podgorsak (11)
describe a chamber where the entire device is manu-
factured from a plastic with similar radiation properties
to water (see Fig. 3). It is a parallel plate chamber with
a fixed radius and the plate separation is varied by way
of a precision micrometer. The charge gradient DQ/Dx
can be determined at the 0.2% level and the effective
RADIATION DOSIMETRY FOR ONCOLOGY 469
Solid water entrance window
2.0 cm ∆r
Variable air-gap Polarizing electrode
Guard electrode
3.5 cm
Measuring electrode
10 cm
Solid water phantom
Solid water
High voltage supply mobile piston
Electrometer Piston housing
Micrometer head
Travel indicator
1 mm
0.0
Figure 3. Extrapolation chamber design (11).
area of the collecting electrode (determined by a capa-
citance measurement) has an uncertainty of 0.1%. The
limiting factor for this type of device is the uncertainty
in W/e and the stopping power ratio at energies other
than 60Co.
An extrapolation chamber is also the device of choice for
b-ray brachytherapy sources (such sources are used for the
treatment of ophthalmic cancers) and one can derive
absorbed dose using the Bragg–Gray principle (12).
Calorimetry
A calorimeter directly measures the absorbed dose as it is
defined above. Although care must be taken in the design
of a calorimeter, in terms of geometry and material com-
position, no primary conversion factor (e.g., W/e, G-value)
is required. However, the basic operating principle of
calorimetry is that all the energy deposited by the radia-
tion is expressed as heat. If this is not the case, then there
is said to be a heat defect. The heat defect can be due to
crystal dislocations, radiation-driven chemical reactions
or some other mechanism and is strongly material depen-
dent. It follows from equation 3 that if there is no heat
defect then
Di ¼ cp DT (10)
where cp is the specific heat at constant pressure and DT
is the temperature rise in the material (absorber). The
size of the > element > that defines the measured dose
will depend on the specific application as well as the
design of the calorimeter and the material used. A mate-
rial with a high thermal conductivity will require
mechanically defined components (e.g., some small absor-
ber thermally isolated from the rest of the material), while
it is much easier to measure a point dose in a material
with a low thermal conductivity. Inhomogeneities in the
phantom will affect the scattering of the radiation beam,
and therefore change the absorbed dose measured. A
correction will be required to give the dose in a homo-
geneous medium.
470 RADIATION DOSIMETRY FOR ONCOLOGY
The three challenges in calorimetry are therefore
to (1) measure the radiation induced temperature; (2)
measure a material of known specific heat capacity, and
(3) make sure that what is measured is relevant to the
particular application of the radiation beam. These pro-
blems have been addressed in a number of (often novel)
ways over many years, but currently there are basically
two types of calorimeter: graphite (e.g., see Refs. 13
and 14) and water (e.g., see Ref. 15). Graphite has some
obvious advantages: it is solid and a graphite calorimeter
can be made smaller and more robust than a water
device. For example, McEwen and Duane (16) demon-
strate a calorimeter designed to be taken routinely into
radiotherapy clinics. There is no heat defect or convec-
tion to consider for graphite and the temperature rise
pure unit absorbed dose is much larger than that of
water due to the low specific heat capacity (cp,graphite
 700 cp,water  4200 J
kg1
8C1). However, the high
thermal conductivity is an issue and the quantity rea-
lized is absorbed dose to graphite so a conversion is
required to obtain absorbed dose to water (see below).
Since water is the standard reference material for radia-
tion dosimetry the majority of standards laboratories are
moving over to water calorimeters as the primary stan-
dard and the device operated at the National Research
Council in Canada is shown in Fig. 4. The major pro-
blems in developing a water calorimeter are controlling
convection and obtaining a stable (ideally zero) heat
defect for the sample of water irradiated. The present
state-of-the-art in calorimetry yields an uncertainty in
absorbed dose to water of  0.3% and for recent reviews
of calorimetric development see Ross and Klassen (17),
Williams and Rosser (19), and Seuntjens and DuSautoy (20).
Chemical Dosimetry
In chemical dosimetry, the absorbed dose is determined
from some chemical change in an appropriate material and
Thermistor
Wooden cable (to AC bridge)
enclosure Platinum resistance
thermometer
Air Heat exchanger
(for air)
Beam
Styrofoam
Lucite
s1
Glass Heat exchanger
vessel (for water)
Stirrer
Figure 4. Overview of the NRC sealed water calorimeter. The
outer box, which provides thermal insulation, is  80 cm on a side,
while the water phantom is  30 cm on a side. The inner-glass
vessel provides a stable volume, where the purity of the water can be
rigorously maintained (to control the heat defect). The radiation-
induced temperature rise (typically a few mK) is measured using
thermistor probes and the outer sys- tem controls the temperature
at 48C to minimize convection effects.
any well-characterized chemical reaction where the reac-
tion product(s) can be measured with good precision may
serve as the basis for the dosimeter. Chemical dosimeter
systems were developed as early as 1927 and a wide range
of systems have been studied. Although, in principle a
chemical dosimeter is a secondary device, in that it does
not directly measure the absorbed energy, it can be
regarded as a primary device if the relation between
absorbed energy and chemical change can be determined
absolutely. This relationship is termed the radiation che-
mical yield and is expressed as the number of molecules or
ions of product X liberated per unit absorbed energy,
designated G(X). Assuming that the G-value is known
and is constant with dose then the absorbed dose is
given by
DM
D¼ (11)
GðXÞr
where DM is the volume concentration of molecules pro-
duced by the radiation absorbed and r is the density of the
medium.
To act as a primary dosimeter, a chemical dosimeter
should be dose, dose-rate, and LET independent. Aqueous
systems are preferred as they are basically water equiva-
lent, although this introduces a containment vessel whose
effect must be taken into account.
The ferrous sulfate (21) dosimeter is the most widely
used and longest established dosimetry system. It demon-
strates the advantages and problems of chemical dosi-
meters. The reaction mechanism is the oxidation of
ferrous to ferric ions, in aerated sulfuric acid. The oxidation
proceeds via a number of reactions involving hydroxyl
radicals, hydroperoxy (HO2) radicals, and hydrogen per-
oxide. The ferric ion formation is directly proportional to
energy absorbed as long as some oxygen remains in the
solution, hence the requirement for aeration. All the reac-
tions are fast (< 1 min), therefore there is no aftereffect
under usual g- or electron irradiations. However, great
care must be taken in the preparation of the solutions,
particularly with regard to water purity as organic impu-
rities can have a significant effect. Spontaneous oxidation
of the ferrous ions occurs that can be corrected for by the
use of an unirradiated sample as a control.
The concentration of ferric ions may be determined by
titration, but absorption spectroscopy is generally a more
convenient technique, using ultraviolet (UV) wavelengths
of 304 or 224 nm. The Fricke dosimeter is dose-rate inde-
pendent for 60Co radiation in the range 0.1–40 Gy
(a range that covers both radiotherapy and industrial
dosimetry applications) and for linac irradiations, G(Fe3þ)
production is linear up to a maximum dose-per-pulse of
2 Gy (significantly greater than radiotherapy linacs). The
normal dose range is 5–350 Gy, although this can be
extended by suitable modifications of the composition of
the system, or of its analysis. With care, Fricke dosimetry
is capable of 0.1% precision, but for absolute dosimetry
one requires an accurate determination of the G-value. As
with ionometry, this factor can be determined from calori-
metry, but preferably one would like an independent
measurement. Such a measurement is possible if one

knows the total energy in the radiation beam. Roos and
Hohlfeld (22) describe the system developed at the PTB
(Physikalisch Technische Bundesanstalt) in Germany
based on a microtron accelerator with a very well deter-
mined electron energy and beam current. With such a
system an uncertainty in the G-value (the effective
response of the Fricke is actually derived in this measure-
ment) of < 0.4% is achievable and the overall uncertainty
in measuring absorbed dose to water is  0.5%. Other
chemical dosimeter systems include ceric sulfate, oxalic
acid, potassium dichromate, and alanine, which cover
higher dose ranges than Fricke. However, G-values for
these systems are either unknown, or have a much larger
uncertainty, and therefore cannot be regarded as primary
dosemeters.
Conversion of Dose Between Materials
Since dose is material dependent, the primary device
one uses to measure absorbed dose may not yield the
quantity required. A conversion procedure is therefore
needed. If the uncertainty on this conversion is suffi-
ciently large then the usefulness of the primary device
is called into question. The majority of effort in this area
has concentrated on water and graphite since graphite
is commonly used for primary standard calorimeters
and water is the material of interest for radiotherapy
dosimetry.
For electron beams, the conversion factor is a product
of two factors: a ratio of stopping powers and a fluence
correction (the latter takes account the differences in
scattering power between the two materials). The most
accurate values for stopping powers are those given in
Ref. 23, but these are based on calculation alone and a
quoted uncertainty of  1% for each material is given.
There have been a number of attempts to measure stop-
ping powers (e.g., Ref. 24), but these did not have the
accuracy to validate the calculations. One of the problems
in measuring stopping powers is that it is only possible to
measure relatively small energy losses and this signifi-
cantly increases the precision required if the achieved
overall uncertainty is to be < 1%. Faddegon et al. (25)
presented a new technique using a large sodium iodide
detector to directly measure elemental stopping powers
and McPherson (26) reports the results of such mea-
surements. The standard uncertainty on these measure-
ments (0.4–0.7%) is significantly lower than the previous
attempts and is at a level where the calculated values
in Ref. 23 can be tested. Fluence corrections are deter-
mined either through direct measurement in phantoms
of different materials or using Monte Carlo simulations
(see below).
For megavoltage photon beams, there is more than one
method available for converting dose from one material to
another. Burns and Dale (27) describe two methods: the
first making use of the photon fluence scaling theorem
(28) and the second based on cavity ionization theory.
Nutbrown et al. (29) repeated the experimental work of
Burns and Dale and applied a third method based on
extensive Monte Carlo simulations. Fricke dosimeters
RADIATION DOSIMETRY FOR ONCOLOGY 471
can also be used to transfer the dose between materials
as it can be assumed that the G-value is independent of
the phantom material (27).
Monte Carlo: A Primary Technique for the Future?
There has been a rapid development of Monte Carlo tech-
niques for radiation dosimetry in the last 10–15 years. A
Monte Carlo calculation is based on radiation transport
physics and tracks individual particles as they interact
with the detector and phantom. By averaging over a large
number of particles (typically > 10 million), statistical
fluctuations can be reduced to an acceptable level. The
big advantages of a Monte Carlo simulation are (1) there is
no reliance on a physical artifact, such as a ion chamber or
calorimeter, and (2) you are not constrained by many of the
problems of physical measurement as outlined above and
can derive the exact quantity you require. Calculations
initially focused on determining correction factors, such as
the ion chamber wall effect for air kerma standards and the
effect of inhomogeneities in a medium. More recent Monte
Carlo codes have included the accurate simulation of the
radiation source (e.g., BEAM (30)) and the detector (e.g.,
EGSnrc (31)). The sophistication has reached the level
where they may be considered as viable alternatives to
measurements.
In considering the idea of Monte Carlo as a primary
technique one can clearly not escape some absolute mea-
surement for the primary realization of absorbed dose. For
example, the absolute beam current produced by a linear
accelerator or the total activity of a radioactive source
would be required as an input to the simulation, but the
dose itself would be calculated. If this measurement can
be determined with high accuracy and the absolute uncer-
tainties in the Monte Carlo can be reduced, then this
offers a potential alternative to the present primary
standards. The major limitation is the accuracy of input
data for the physics models: interaction cross-sections,
stopping powers, and so on are not known accurately
enough. The high accuracy obtained in the determination
of correction factors in dosimetry is because in those
situations one does not rely in such a direct way on
absolute interaction coefficients, but on differences (or
ratios) in interaction coefficients, where one benefits from
the cancellation of correlated uncertainties. To date, the
majority of the effort has been in developing the Monte
Carlo codes (improving efficiency and refining the physics
modeled), but there are still significant gaps in the input
data so it is not clear whether the potential for the
absolute application of Monte Carlo techniques can be
fulfilled.
REFERENCE OR SECONDARY DOSIMETERS
As with primary devices, there are number of different
types of secondary dosimeter that are used in radiotherapy.
Secondary dosimeters require calibration against a pri-
mary standard and are then used to realise absorbed dose
on a more routine basis.
472 RADIATION DOSIMETRY FOR ONCOLOGY
Figure 5. Radiograph of a NE2571 Farmer-type chamber. One
can see the graphite outer wall of the cavity, aluminum central
electrode, and internal construction of the stem.
Ion Chambers
Ionization chambers (particularly air-filled chambers) are
the most widely used instruments in radiotherapy dosime-
try. They offer a number of characteristics which are
particularly suited to the measurement of therapy radia-
tion beams - sensitivity, long-term stability, and ease-of-
use. The most widely used chamber is the Farmer-type
(33), an example of which is shown in Fig. 5. Chambers of
this type show excellent stability (figures of  0.3% over
25 years are not uncommon) with the only disadvantage
being a lack of waterproofing. A waterproof sleeve is there-
fore required for measurements in water. Such a sleeve
should be thin (< 1 mm), close fitting (no air gaps), and
made from some low Z material to minimize any additional
perturbation effect [PMMA-poly(methyl-methacrylate) is
commonly used].
Parallel-plate chambers, which are usually waterproof,
are recommended for the dosimetry of electron beams.
The NACP design (34) is one of the most widely used
(Fig. 6).
Ionization chambers are usually vented to the atmo-
sphere and therefore an air density correction, fTP, is
required to normalise for variations in air temperature
and pressure (Tair and Pair, respectively):
273:15 þ Tair Pref
f TP ¼
(12)
273:15 þ Tref Pair
Pref is taken to be 101.325 kPa, but there is no agreed value
for Tref. In Europe a value of 20 8C is used, while in North
America the reference temperature is 22 8C. Care must
therefore be taken when comparing results from different
laboratories.
A correction for the humidity of the air in the chamber is
not generally applied. The presence of water vapor affects
the value of W/e (36), as well as stopping power and
Mylar film
Silicon tubing
10 mm
30 mm
Ventilation
Graphite
Rexolite
Figure 6. Schematic of the NACP parallel-plate chamber (taken
from Ref. 35). Design features include waterproof construction, low
Z materials to minimize the perturbation correction, and large
guard ring to minimize in-scatter.
mass-energy absorption coefficients. However, for relative
humidities between 10 and 90% (when comparing to a
standard humidity of 50%) the effect is a maximum of
0.1%.
A correction is required to account for the incomplete
collection of charge due to ion recombination in the
chamber volume. The correction for ion recombination
is the sum of two components: initial recombination
and general or volume recombination. General recombi-
nation takes place when oppositely charged ions from
different ionization tracks (i.e., created by different inci-
dent ionizing particles) recombine while they drift under
the influence of the electric field toward their respective
electrodes. Initial recombination takes place when oppo-
sitely charged ions from the same ionization track recom-
bine; as the name suggests, this process takes place
before the electric field is able to pull the track structure
apart and therefore precedes general recombination.
Initial recombination is independent of dose rate but
general recombination depends on the ion density in
the cavity. This ion density depends on the dose rate
for continuous radiation and on the dose per pulse for
pulsed beams. Initial recombination is typically small
( 0.1–0.2% for the usual cylindrical and parallel-plate
chambers employed in radiotherapy). General recombi-
nation is typically a small effect for continuous radiation
(e.g., kilovoltage X-ray beams or 60Co g-ray beams) but
for pulsed beams it can often be significant, especially so
for modern linear accelerators that employ large dose-
per-pulse values (recombination corrections of up to 5%
have been reported).
The theoretical aspects of ion recombination for pulsed
and continuous radiation have been well discussed in the
literature (37–39). However, in recent years a number of
authors (40–42) have presented recombination data that
do not agree with the standard theory. A number of
possible mechanisms have been proposed, including ion
multiplication, air volume change, and direct collection of
primary electrons, but at present there is no consensus
as to which, if any, of these is the reason for these
anomalous results. Dosimetry protocols recommend that
a full 1/I against 1/V plot be measured where I is the
measured Ionization current and V is the polarizing voltage
to establish the range of linearity where the standard theory
holds and the chamber then operated at voltages to remain
within that range (Fig. 7).
Ion chamber measurements must also be corrected for
the effects of polarity. The polarity effect is the difference
in readings obtained in the same irradiation conditions,
but taken with positive and negative polarizing voltages.
Boag (43) identified a number of components of the polar-
ity effect including secondary electron emission (due to
the Compton effect) that produces a negative current
independent of polarity; uneven distribution of the space
charge due to a difference in the drift velocity of negative
and positive ions; variation of the active volume due to
space charge distortions; stopping of fast electrons in the
collecting electrode not balanced by the ejection of recoil
electrons; and collection of current outside the chamber
volume due to leakage in solid insulators. In practice, it is
difficult to identify the mechanisms acting in a particular
 RADIATION DOSIMETRY FOR ONCOLOGY 473

1.020 liquid ion chambers have a role to play in reference

dosimetry.
1.015

Fricke
1.010
The Fricke dosimeter was described in detail in the section
above on primary dosimeters. As a secondary dosimeter it
Is /I

1.005 is used in exactly the same way, except that the G-value is
effectively measured for each batch of solution by compar-
1.000 ison with a calorimeter (48). The big disadvantages of
Fricke are (1) the care needed to produce ‘good’ solutions,
0.995
and (2) the perturbation correction required for the vessel
holding the Fricke solution (usually glass or quartz) is
generally large. The NRC in Canada has used Fricke to
0.990
transfer the dose from water calorimeter to ionization
0.000 0.005 0.010 0.015 0.020 0.025 0.030
chambers (49).
1/V (V -1)

Figure 7. Plot from Burns and McEwen (41) showing the TLD
deviation from theory (straight line) of the recombination
behavior for a NACP chamber. Without extensive measure- Another class of systems is thermoluminescent dosi-
ments errors of up to 1% are possible. meters (TLDs). One of the obvious advantages of such
dosimeters is that they can be made very small, and are
therefore ideal for plotting dose distributions. The TLD
situation, but measurements show that the polarity effect material can be used as a powder or can be formed in
will vary with chamber type, beam energy and modality, various shapes (chips, rods, pellets, etc.). These materials
measurement depth and can vary with other factors, such have a wide dose range, from a few tens of mGy to  1 kGy.
as field size. The readout (measurement of the glow curve) is destruc-
The polarity correction is given by tive, but the dosimeters can be reused. The equipment
required is readily available and the production and read-
jMþ j þ jM j out of dosimeters is relatively simple, particularly com-
fpol ¼ (13)
2jMj pared to Fricke or alanine (Fig. 8).
Lithium fluoride is the most widely used system for
where the superscripts þ or  indicate the reading (M)
radiotherapy applications as it has a mean atomic number
with collecting voltage positive and negative, respectively,
close to that of tissue (Zeff ¼ 8.2, compared to 7.4 for
and M in the denominator is the reading taken with the
tissue). It has a fairly flat response with energy (especially
normal polarity used during measurements. Table 1 sum-
in the megavoltage region) and is therefore not particularly
marizes typical polarity corrections for chambers in differ-
sensitive to variations in beam quality. Both CaF2 and
ent beams.
CaSO4 are useful in that they have sensitivities 10–100
A variation on the air-filled ionization chamber is the
times greater than LiF but, because of their high Z values,
liquid ion chamber. In this design, the air is replaced by a
they show a very rapid change in energy response at low
liquid, which offers two major advantages: a flat energy
energies. Lithium borate has a better tissue similarity
response and an increased carrier concentration (and
(Zeff ¼ 7.4) but has a sensitivity of only one tenth of that
therefore increased spatial resolution). Liquid ion cham-
of LiF. As for the other systems based on some chemical
bers have been developed over many years, but their use
change, TLD materials require calibration against a pri-
as secondary dosimeters has been severely hampered by
mary dosimeter. It is not possible to determine any thermo-
the volatility of the liquid (usually a short-chain hydro-
luminescent equivalent of a G-value as the dose response
carbon) resulting in loss of signal. However, recent results
depends on the annealing process and tends to be batch
(47) show impressive stability and may indicate that
dependent. Typical reproducibility at the 1% level is possible
routinely with an overall uncertainty of 2–3% (one standard
deviation). However, Marre et al. (50) obtained a reprodu-
Table 1. Typical Polarity Corrections cibility of better than  0.5% and an overall standard
uncertainty in measuring absorbed dose to water of
Beam Cylindrical Chambers Parallel-Plate Chambers
 1.6%. These values are approaching those of ion chambers
Megavoltage < 0.2% beyond dmax, Generally < 0.3%, although the delay between irradiation and readout and the
photons more variable in but can show care required to achieve this level of precision limit the
build-up region variable behavior. applications for this dosimeter.
Megavoltage Up to 1% at lower < 0.2% for well-designed TLD is an attractive dosimeter for the dosimetry of low
electrons end of recommended chambers (45). doserate brachytherapy sources. The source strength is
energy range (44) Can be significant normally too low for small ionization chambers, and large
for other chamber
volume chambers have poor spatial resolution. However,
types (46)
for 125I, one of the commonly used isotopes in prostate
474 RADIATION DOSIMETRY FOR ONCOLOGY
TL signal
0 50 100 150 200 250
Channel
Figure 8. Glow curves from two different TLD materials. The
temperature is slowly ramped to a maximum (in this case 240 8C) and
the thermoluminescent intensity measured using a photomultiplier.
The shape of the glow curve depends both on the material and the
thermal pre-treatment (annealing).
treatment, the mean photon energy in only 27 keV and
therefore the energy dependence of TLD needs to be known
accurately (Fig. 9).
Since LiF is nontoxic, TLD can be used as an In vivo
dosimeter, placed directly on the patient, to verify treat-
ment delivery. It is a less invasive technique compared to
diodes or MOSFET detectors (see below), as there are no
trailing wires or associated equipment.
Alanine
Over recent years, alanine has become more widely
accepted as a chemical dosimeter for radiotherapy dosime-
try. It has a very wide dose range, showing a linear
response from 10 Gy to 70 kGy. It is a solid dosimeter,
with a density and atomic number close to that of water
(close to zero perturbation) and the dosimeters are small:
typically disks are 5 mm in diameter and 3 mm thick, but
can be made as thin as 0.5 mm for measuring low electron
energies. The energy dependence is very small. Zeng et al.
(52) showed that any variation in the sensitivity of alanine
Relative response per unit air
1.50
1.40
1.30
1.20
kerma
1.10
1.00
0.90
0.80
0.70
10 100
Photon energy (keV)
Figure 9. Energy dependence of two types of LiF TLD dosimeters
(from Ref. 5). Triangles - TLD-100, diamonds - TLD-100H.
LiF:Mg,Ti (TLD-100) has been a widely used dosimeter since
the 1960s, LiF:Mg,Cu,P (TLD-100H) was developed in 1976,
with 20–30 times greater sensitivity.
is not more than  0.5% over the energy range from 60Co
to 25 MV X rays. The dosimeter is read out nondestruc-
tively using ESR (electron spin resonance) spectroscopy.
This nondestructive read-out, together with the long-term
stability of the radiation-induced signal means that ala-
nine has a potential role as a dose record. The National
Physical Laboratory in the United Kingdom offers a
mailed dosimetry service for radiotherapy using alanine
dosimeters.
Summary
300 350 400 450 For reference dosimetry in radiotherapy clinics the sys-
tem of choice is the ion chamber. Ion chambers are simple
to use, offer high precision and accuracy and give an
immediate reading. Integrating dosimeters (Fricke, ala-
nine, and TLD) tend to be used as QA checks, either
internally or within a wider framework of national or
international comparisons (e.g., TLD is used for both
the IAEA international mailed reference dosimetry ser-
vice (53) and the RPC audit scheme in North America
(54)). Generally, ion chambers are calibrated against
primary standards and then used to calibrate other dosi-
metry systems within the clinic.
CALIBRATION OF SECONDARY DOSIMETERS
Basic Formalism
An ideal secondary dosimeter will have a zero energy
dependence. Calibration against a primary standard
(calorimeter) would then only need to be carried out at
one beam quality (e.g., 60Co). Energy independence also
implies that the calibration coefficient is the same in
photon and electron beams since the dose in a photon beam
is dependent on the secondary electron spectrum generated
in-phantom. In practice, the majority of secondary dosi-
meters commonly in use have some energy dependence.
Ionization chambers, for example, show a variation of > 3%
over the energy range from 60Co to 25 MV photons, with
even larger variations at low X-ray energies.
The obvious method to calibrate an ion chamber in
terms of absorbed dose is to compare a chamber with a
primary device. However, although accelerators were
being used from the 1950s for radiotherapy, there were
no absorbed dose standards for megavoltage photon or
electron beams until the 1970s. Absorbed dose measure-
ments using ion chambers were therefore based on air-
kerma calibrations derived at lower photon energies
(either 60Co or 2 MV X rays). Protocols were developed
to enable users to obtain a measurement of the absorbed
dose delivered by a linac in the clinic. Only in recent years
have absorbed dose-based calibrations become available
from national standards laboratories and associated pro-
1000 tocols produced (e.g., Refs. 6–8). For the purpose of the
following discussion, we will only deal with absorbed dose
calibrations in megavoltage photon and electron beams,
but the principles are basically the same for other situa-
tions (kV X rays, protons, etc.).
The basic formalism for the calibration of an ion cham-
ber is simple. The chamber is compared against the

primary device and a calibration coefficient (ND,sec) for that
beam is derived
Dstd
ND,sec ¼
Msec
The parameter Dstd is the dose measured by the primary
device and Msec the chamber reading corrected for influ-
ence quantities. This calibration coefficient will be a func-
tion of the energy of the photon or electron beam and is
given in terms of a beam quality specifier, Qref. The user
then derives the calibration coefficient for the user beam
quality, ND,ref (Quser). Some primary laboratories only
supply calibration coefficients for 60Co and thus correction
factors are required, which are given in dosimetry protocols
(e.g., Ref. 7). An alternative approach, as used in the
United Kingdom’s Code of Practice (6) is to obtain absorbed
dose calibration coefficients in linac photon beams. In this
case there is no need for the calculated conversion factors
and an ion chamber is calibrated in a beam similar to what
it will be used to measure.
A measurement is then made in the user’s radiation
beam to measure the absorbed dose, Duser:
Duser ¼ ND,sec ðQuser ÞMuser
where Muser is the chamber reading.
Implied in equations 14 and 15 is the reference depth at
which the measurement is carried out. The concept of the
reference depth for a calibration is much more important
for electrons than photons. In a phantom irradiated by a
megavoltage photon beam the secondary electron spectrum
(which determines the dose) varies only slowly with depth
(for depths greater than the range of incident primary
electrons). By contrast, in the situation of a primary elec-
tron beam, the electron spectrum seen by the detector
constantly changes from the surface to the practical range.
The choice of reference depth should be both clinically
relevant and reliable in terms of transferring the dose
from the primary laboratory to the user’s beam. For photon
1.0
0.8
Dose (normalized)
0.6
0.4
0.2
0.0
0 5 10
d (cm)
RADIATION DOSIMETRY FOR ONCOLOGY 475
beams there may be only one or two reference depths
defined for all energies while for electron beam dosimetry
all modern protocols define the reference depth as a func-
(14) tion of energy.
Potential Problems with Beam Quality Specifiers
A typical radiotherapy linac accelerates electrons to ener-
gies in the range 4–22 MeV and can also produce brems-
strahlung X-ray beams over a similar energy range. In both
cases, the detector calibration coefficient will be some
function of this spectrum. Since it is not generally possible
to measure the energy spectrum directly a beam quality
specifier (Q) is used. This is obtained by measuring some
property of the radiation beam (e.g., the penetration
through a material). A ‘‘good’’ beam quality specifier is
one such that a value of Q relates uniquely to the effect of a
particular spectrum. A problem arises if Q is not a good
beam quality specifier, that is, there is some ambiguity in
the relation between Q and the effect of the incident
spectrum.
Beam Quality Specifiers for Photon Beams. Typical
photon depth–dose curves from a clinical linac are shown
in Fig. 10 (it should be noted that MeV tends to be used as a
(15)
label for electron beams and MV for photon beams). Over
the years, a number of beam quality specifiers have been
proposed for megavoltage photon beams, but all relate in
some way to the penetration of the photons through some
material.
The most widely used parameter has been TPR20,10
(tissue phantom ratio), which is defined as the ratio
of ionization currents at measurement depths of 20 and
10 cm in water with a fixed-field size and source to
chamber distance. The 10 and 20 cm points in Fig. 10
are on the downward portion of the curves, and therefore
TPR is related to a measurement of the attenuation of
the beam.
There has been much debate in recent years over
the sufficiency of TPR20,10 as a beam quality specifier for
6 MV
10 MV
25 MV
15 20
Figure 10. Depth dose curve for three photon beams.
476 RADIATION DOSIMETRY FOR ONCOLOGY
the purpose of ion chamber calibration in terms of
absorbed dose to water. Rosser et al. (55) found that an
error of up to 0.6% could be introduced by the incorrect
application of calibration coefficients using TPR. A num-
ber of other beam quality specifiers have been put forward
as alternatives to TPR including: d80 (the depth at which
the dose is 80% of the peak dose); the HVL of water and
the percentage depth dose at a depth of 10 cm, %dd(10)X
(where a 1 mm lead filter is used to correct for electron
contamination). There is no consensus on this problem
at the moment: the new IAEA Code of Practice (8) uses
TPR20,10 while the AAPM absorbed dose protocol (7) uses
%dd(10)X. However, in practice there is no real contro-
versy: Kalach and Rogers (56) showed that although
%dd(10)X gave better agreement for a wide range of
accelerators, for the heavily filtered beams produced by
modern clinical linacs, TPR20,10 was an adequate beam
quality specifier.
Beam Quality Specifiers for Electron Beams. It is poten-
tially simpler to measure the electron spectrum from a
Linac than a photon spectrum. The most accurate method
is to use a calibrated magnetic spectrometer (57,58), but
this technique tends to be rather time consuming and
the necessary equipment is not always available. The
mean energy of the electron beam can be determined
via activation analysis (59,60) or the determination of
the total charge and energy using a Faraday cup. How-
ever, all these systems tend to be rather complex so the
actual electron spectrum (or even mean electron energy)
is rarely measured.
As with photons, parameters derived from the pene-
tration of electrons in a medium are used as a measure of
electron energy. A typical electron depth–dose curve in
water is shown in Fig. 11. The two most important para-
meters obtained from such a curve are R50, defined as
the depth at 50% of the peak dose; and Rp (the practical
range), defined as the point where the extrapolation from
the point of maximum gradient on the downward part of
the curve meets the extrapolation of the bremsstrahlung
background.
100
Absorbed dose (%)
50
dmax R50 Rp
Depth in water (z)
Figure 11. An electron beam depth–dose distribution in water
showing the various range parameters. (From Ref. 61).
Considerable work has been done to relate these para-
meters to beam energy (see Ref. 2), and it is generally
understood that R50 and Rp described different aspects
of the incident electron spectrum. The parameter R50
relates to the mean electron energy, while Rp is directly
related to the most probable energy. For a symmetrical,
single-peaked spectrum the mean and most probable
energies will be the same but, as shown by Klevenhagen
(62), the spectrum incident on a phantom will be skewed
towards lower energies due to scattering in air. Reference
2 shows depth–dose data for two spectra where the most
probable energy is the same but with different mean
energies (and different energy spreads). In this case,
the two curves give the same value for the practical range,
but different values for R50. However, Burns et al. (63)
collated a large amount of depth–dose data from a wide
variety of linacs and showed that there was a direct
relation between R50 and Rp, indicating that the majority
of linacs in use today either generate symmetrical or very
similar spectra.
RELATIVE DOSIMETRY AND QUALITY/VERIFICATION
For relative dosimetry or for quality (QA) measurements
there are a wide range of dosimetry systems to choose
from (including many discussed above as secondary dosi-
meters). The choice will depend on a number of factors
including application (simple external beam therapy, inten-
sity modulated radiotherapy (IMRT), brachytherapy); pre-
cision; spatial resolution and/or detector size; type of
measurement (i.e., relative, QA, etc.); and immediacy
(instant readout required?). However, one of the primary
drivers will be practical issues such as cost, availability,
complexity and setup time. With so many detectors to choose
from it is difficult to give anything other than a very brief
overview here.
Solid-State Detectors (1D)
Diodes. Semiconductor diodes offer increased sensitiv-
ity over air-filled ionization chambers due to the higher
density of charge carriers. This means that the sensitive
volume can be made  100–1000 times smaller, giving excel-
lent spatial resolution. The stopping power ratio silicon/
water varies much less with energy than the air/water
ratio, and therefore diodes are ideally suited for measuring
dose distributions. The biggest problem with diodes is that
the sensitivity is dose dependent and diodes need recali-
brating approximately every few hundred gray. Dose
diodes are available in two types: electron and photon.
Photon diodes employ shielding around the sensitive
volume to correct for the effects of scattered radiation in
a photon beam. Uncorrected, an unshielded diode over-
estimates the dose at depth by as much as 15% for a 6 MV
beam and Yin et al. (64) present a method to correct for the
response of diodes in photon beams. Due to the potential for
confusion as to the construction of a diode, dosimetry
protocols usually recommend that diode measurements
are validated using an ion chamber.
 RADIATION DOSIMETRY FOR ONCOLOGY 477

Diamond. Diamond detectors have been investigated 100.0

for over 20 years (65,66). The spatial resolution of diamond

men/r ratio, film emulsion to water

detectors (1–6 mm3) is comparable to that of commonly
used silicon diode detectors with the added advantage of
showing high resistance to radiation damage (0.05%
k
Gy1, > 100 times lower than typical diode values). As
expected for a solid-state dosimeter, diamond detectors
have a high sensitivity, but also a good long-term stability
and low temperature dependence. Diamond has a reason-
able tissue equivalence for both photon and electron beams.
The majority of recent work with diamond detectors has
focused on their use for small field IMRT and brachyther-
apy, where the high sensitivity and small size are highly
advantageous. Mack et al. (67) compared a number of
techniques for the dosimetry of small radiosurgery beams
and found that a diamond detector gave very good results
down to field sizes of 4
4 mm. However, a significant
disadvantage of diamond detectors at present is the very
high cost compared to other solid-state detectors. This is
because at present natural diamonds are used and have to
be carefully selected, since the dose linearity and polariza-
tion effects are very sensitive to impurities and defects in the
crystal. However, the more recent availability of low cost,
polycrystalline diamond specimens produced using chemi-
cal vapor deposition (CVD) offers the potential for improved
diamond detectors with selectable size and impurities.
MOSFETs. The MOSFET dosimeter (68) is a more recent
development. The dosimeter operates by measuring the
threshold voltage of a MOSFET field effect transistor, which
is permanently changed by the absorption of radiation
(radiation damage). As an integrating detector it therefore
has similar applications to TLD or alanine and the small
detector area (only 0.2
0.2 mm) offers very high spatial
resolution. The reproducibility is typically  2%.
Two-Dimensional Detectors
Radiographic Film. Film dosimetry has long been
viewed as an attractive alternative to ionometric and ther-
moluminescent methods as an entire two-dimensional (2D)
chart may be extracted from a single film exposure. In
addition, film has the highest spatial resolution of any
practical dosimeter and is easily set up and exposed.
However, radiographic film dosimetry is not without pro-
blems - daily film calibrations are essential to obtain
absolute dose results and care must be taken with film
handling and processing not to introduce artifacts. A more
10.0
1.0
0.1
0.01 0.1 1.0 10.0
E (MeV)
Figure 12. Energy dependence of radiographic film relative to
that of water.
the optical density (measured using a scanner or densit-
ometer) and ideally this should show a linear increase with
dose (Fig. 13).
Although there are obvious problems with radiographic
film, alternatives for 2D dose verification have their own
limitations and therefore it is likely that film will continue
to play a role in dosimetry. Radiochromic film is considered
tissue equivalent and energy independent, but is expensive,
limited in size, and prone to large dose response nonunifor-
mities due to the manufacturing process. Commercially
available 2D ion chamber and diode arrays provide a fast
and accurate evaluation, but are still limited in resolution,
and therefore better used to dose verification rather than
commissioning IMRT. Electronic portal imagers have the
advantage of being available in many modern therapy
centres but by design, they measure fluence patterns,
not dose distributions in phantoms, and therefore inter-
pretations of delivery errors could be difficult.
Radiochromic Film. A radiation-induced color change is
one of the simplest dosimeters one can think of and a number
of systems were developed in the early 1900s. Although
widely used in the radiation processing industry, where
2
6 MV, 360 MU, n=315
1.6
Net optical density

fundamental problem is that the high atomic number of

the silver halide film emulsion means that dose response 1.2
relative to water varies significantly in the low energy
photon range (< 200 keV), as can be seen in Fig. 12. This 0.8
is also an issue for measurements in megavoltage photon
beams where the scatter-to-primary ratio can change
0.4
(e.g. off-axis). Having said this, radiographic film dosime-
try is experiencing a renaissance in the radiation therapy
0
community, driven by the need to verify the absorbed dose
0 100 200 300 400
delivered with IMRT, where both detector resolution and (b) Dose (cGy)
2D data acquisition are advantages.
As with any other secondary dosimeter, a calibration Figure 13. Dose linearity curve for Kodak EDR2 film (from Ref. 69).
curve must be derived. The quantity measured using film is The response is very repeatable and linear for doses above 150 cGy.
478 RADIATION DOSIMETRY FOR ONCOLOGY

the large doses can induce easy-to-detect color changes, Three-Dimensional Detectors
radiochromic films have only recently begun to be used once
The adoption of conformal radiotherapy techniques and, in
again for radiotherapy dosimetry. The most promising to
particular, IMRT, where verification of the delivered 3D
date is the GafChromic material. One of the main advantages
dose distribution is very important, has been a major
of radiochromic films over radiographic is that they are
driving force in the development of 3D detection systems.
essentially tissue equivalent so the energy response relative
Presently, there are basically three options: TLD (either as
to water only changes very slowly with energy (Fig. 14).
individual pellets or in powder form), film stacks (radio-
As with any dosimeter there are problems in obtaining
graphic or radiochromic), and gel dosimeters.
high accuracy dosimetric information. Klassen et al. (71)
carried out a detailed investigation and showed that the
Gel Dosimetry. Although the use of radiation sensitive
precision was affected by the readout method, the readout
gels for dosimetry measurements was suggested as early as
temperature and wavelength as well as the polarization of the
the 1950s, the use and development of this type of dosimeter
light source. However, with care, dosimetry with a relative
has only grown significantly in the last decade. Gel dosimeters
uncertainty of < 1% is possible for doses of the order of 6 Gy.
offer a number of advantages over other 3D techniques, such
as TLD or film stacks, including resolution, number of data
EPIDs. Electronic portal imaging devices (EPIDs) have
points, energy dependence, and water equivalence (Fig. 15).
been gradually replacing conventional radiographic film
There are currently two main types of gel dosimeter: (1)
for geometric verification in radiation therapy. The obvious
Fricke gel – ferrous sulfate solution is incorporated into
advantage of using an EPID for dosimetry is that they are
aqueous gel matrices of gelatin, agarose or poly (vinyl alcohol)
now standard equipment on most modern linacs. Early
(PVA). As for the Fricke dosimeter, there is a conversion of
generations, employing liquid ion-chambers or camera-
Fe2þ ions to Fe3þ and this change in concentration is readout
based fluoroscopy, generally produced poorer images com-
via magnetic resonance imaging (MRI) or optical tomogra-
pared to film, but it was shown that EPIDs could be used for
phy. One of the main drawbacks of Fricke gels is that there is
IMRT quality assurance (e.g., leaf position verification for
a rapid diffusion of the ferric ions centers within the matrix,
Multi- Leaf Collimators, or MLCs). The most recent class of
which tends to smooth out the dose distribution. (2) Polymer
EPID uses flat-panel photodiode arrays and with improved
gels: This system is based on the polymerisation of certain
spatial resolution and higher detector efficiency are espe-
materials. Initial work focused on the materials acryla-
cially well suited for IMRT applications. However, to use
mide (AA) and N,N-methylene-bis(acrylamide) (BIS)
any EPID for dosimetric IMRT requires calibration coeffi-
with readout again via MRI. One of the main problems
cients to relate pixel intensity to either fluence or dose.
with these systems is that they are sensitive to atmo-
Calibration of the EPID is more involved than simple cross-
spheric oxygen contamination. A newer formulation
calibration of pixel response with dose measurements
named methacrylic and ascorbic acid in gelatin initiated
made with an ion chamber in a homogeneous water phan-
by copper (MAGIC) is less sensitive to the presence of
tom, but the ability to verify treatment ‘‘as it happens’’ is a
oxygen and looks promising as a gel dosimeter. Perhaps
significant advantage over other methods. Warkentin et al.
the biggest problem with gel systems is that they require
(72) describe the use of a flatpanel detector for accurate
pretreatment dosimetric verification of IMRT treatment
fields.

50 Gy
GafChromic MD 55
2.0 2.0
GafChromic MD 55

30
1.5 1.5
Absorbance (A)

∆A (675 nm)

20

1.0 1.0

10

0.5 5 0.5
3

21 0
0 0
550 600 650 700 0 10 20 30 40 50
Wavelength nm Absorbed dose in water, Gy
(a) (b)

Figure 14. Performance of GafChromic MD-55 film. (From Ref.

70 reprinted with permission from Elsevier.) (a) Absorption Figure 15. Dose distribution for a high dose rate 192Ir brachythe-
spectra as a function of dose. (b) Dose response curve measured rapy source measured in a flask of polymer gel dosimeter. (From
at the absorption band peak. Ref. 73.)

a containment vessel, which can both perturb the dose
measurement and introduce imaging artefacts.
There is a very active gel dosimetry community world-
wide and development continues both on gel formulations
(e.g., reduce diffusion or sensitivity to impurities) and
readout (e.g., CT and ultrasound have been suggested
as alternative readout methods to MRI). For a recent review
of the subject see Baldock (74).
CONCLUSION
This article has outlined the basic theory of radiation
dosimetry and the problems involved in measuring
absorbed dose. A number of primary and secondary mea-
surement techniques have been described together with
the formalism for calibrating dosimeters. Since whole text-
books have been written on this subject, this can be no more
than a brief introduction to the field. Readers are referred
to the extensive bibliography for further detail.
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