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AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy

photon and electron beams


Peter R. Almond
Brown Cancer Center, Louisville, Kentucky 40202
Peter J. Biggs
Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114
B. M. Coursey
Ionizing Radiation Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899
W. F. Hanson
M.D. Anderson Cancer Center, University of Texas, Houston, Texas 77030
M. Saiful Huq
Kimmel Cancer Center of Jefferson Medical College, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107
Ravinder Nath
Yale University School of Medicine, New Haven, Connecticut 06510
D. W. O. Rogersa)
Ionizing Radiation Standards, National Research Council of Canada, Ottawa K1A OR6, Canada
共Received 17 September 1998; accepted for publication 4 June 1999兲
A protocol is prescribed for clinical reference dosimetry of external beam radiation therapy using
photon beams with nominal energies between 60Co and 50 MV and electron beams with nominal
energies between 4 and 50 MeV. The protocol was written by Task Group 51 共TG-51兲 of the
Radiation Therapy Committee of the American Association of Physicists in Medicine 共AAPM兲 and
has been formally approved by the AAPM for clinical use. The protocol uses ion chambers with
60Co
absorbed-dose-to-water calibration factors, N D,w , which are traceable to national primary stan-
60Co
dards, and the equation D w ⫽M k Q N D,w , where Q is the beam quality of the clinical beam, D wQ is
Q

the absorbed dose to water at the point of measurement of the ion chamber placed under reference
conditions, M is the fully corrected ion chamber reading, and k Q is the quality conversion factor
which converts the calibration factor for a 60Co beam to that for a beam of quality Q. Values of k Q
are presented as a function of Q for many ion chambers. The value of M is given by M
⫽ P ionP TPP elecP polM raw , where M raw is the raw, uncorrected ion chamber reading and P ion corrects
for ion recombination, P TP for temperature and pressure variations, P elec for inaccuracy of the
electrometer if calibrated separately, and P pol for chamber polarity effects. Beam quality, Q, is
specified 共i兲 for photon beams, by %dd(10) x , the photon component of the percentage depth dose
at 10 cm depth for a field size of 10⫻10 cm2 on the surface of a phantom at an SSD of 100 cm and
共ii兲 for electron beams, by R 50 , the depth at which the absorbed-dose falls to 50% of the maximum
dose in a beam with field size ⭓10⫻10 cm2 on the surface of the phantom (⭓20⫻20 cm2 for
R 50⬎8.5 cm兲 at an SSD of 100 cm. R 50 is determined directly from the measured value of I 50 , the
depth at which the ionization falls to 50% of its maximum value. All clinical reference dosimetry
is performed in a water phantom. The reference depth for calibration purposes is 10 cm for photon
beams and 0.6R 50⫺0.1 cm for electron beams. For photon beams clinical reference dosimetry is
performed in either an SSD or SAD setup with a 10⫻10 cm2 field size defined on the phantom
surface for an SSD setup or at the depth of the detector for an SAD setup. For electron beams
clinical reference dosimetry is performed with a field size of ⭓10⫻10 cm2 (⭓20⫻20 cm2 for
R 50⬎8.5 cm兲 at an SSD between 90 and 110 cm. This protocol represents a major simplification
compared to the AAPM’s TG-21 protocol in the sense that large tables of stopping-power ratios and
mass-energy absorption coefficients are not needed and the user does not need to calculate any
theoretical dosimetry factors. Worksheets for various situations are presented along with a list of
equipment required. © 1999 American Association of Physicists in Medicine.
关S0094-2405共99兲00209-6兴

1847 Med. Phys. 26 „9…, September 1999 0094-2405/99/26„9…/1847/24/$15.00 © 1999 Am. Assoc. Phys. Med. 1847
1848 Almond et al.: AAPM’s TG-51 protocol 1848

TABLE OF CONTENTS A. Reference conditions of depth, beam size, and


source-surface/axis distance. . . . . . . . . . . . . . . . . 1856
I. PREFACE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1848 B. Absorbed dose to water in clinical photon
II. NOTATION AND DEFINITIONS. . . . . . . . . . . . . . 1849 beams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1856
III. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . 1850 C. Absorbed dose at other depths in clinical
IV. GENERAL FORMALISM. . . . . . . . . . . . . . . . . . . 1851 photon beams. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1858
V. OBTAINING AN ABSORBED-DOSE TO X. ELECTRON BEAM DOSIMETRY. . . . . . . . . . . . . 1858
WATER CALIBRATION FACTOR. . . . . . . . . . . . 1852 A. Reference conditions of depth, beam size, and
A. Chamber waterproofing. . . . . . . . . . . . . . . . . . . . 1852 source-surface distance. . . . . . . . . . . . . . . . . . . . . 1859
VI. MEASUREMENT PHANTOMS. . . . . . . . . . . . . . 1852 B. Absorbed dose to water in clinical electron
VII. CHARGE MEASUREMENT. . . . . . . . . . . . . . . . 1852 beams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1859
A. Polarity corrections. . . . . . . . . . . . . . . . . . . . . . . . 1852 C. Use of plane-parallel chambers. . . . . . . . . . . . . . 1860
B. Electrometer correction factor. . . . . . . . . . . . . . . 1853 D. Absorbed dose at d max in clinical electron
C. Standard environmental conditions: beams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1860
Temperature, pressure, relative humidity. . . . . . 1853 XI. USING OTHER ION CHAMBERS. . . . . . . . . . . . 1860
D. Corrections for ion-chamber collection
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . 1860
inefficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1853
WORKSHEET A: PHOTON BEAMS . . . . . . . . . . . . 1861
1. General comments on P ion. . . . . . . . . . . . . . . 1853
WORKSHEET B: ELECTRON BEAMS—
2. Measuring P ion. . . . . . . . . . . . . . . . . . . . . . . . 1853
CYLINDRICAL CHAMBERS . . . . . . . . . . . . . . . . . . . 1863
VIII. BEAM QUALITY SPECIFICATION. . . . . . . . . 1854 60Co
A. Accounting for gradient and depth of WORKSHEET C: k ecalN D,w FOR
measurement effects. . . . . . . . . . . . . . . . . . . . . . . 1854 PLANE-PARALLEL CHAMBERS . . . . . . . . . . . . . . . 1865
B. Beam quality specification for photon beams... 1855 WORKSHEET D: ELECTRON BEAMS—
C. Beam quality specification for electron beams.. 1855 PLANE-PARALLEL CHAMBERS . . . . . . . . . . . . . . . 1867
IX. PHOTON BEAM DOSIMETRY. . . . . . . . . . . . . . 1856 APPENDIX: EQUIPMENT NEEDED. . . . . . . . . . . . . 1869

I. PREFACE phasis in primary standards laboratories has moved from


Advances in radiation dosimetry continue to improve the ac- standards for exposure or air kerma to those for absorbed
curacy of calibrating photon and electron beams for radiation dose to water since clinical reference dosimetry is directly
therapy. This document represents the third in a series of related to this quantity, and also because primary standards
protocols adopted by the AAPM and represents a radical for absorbed dose can be developed in accelerator beams,
departure from the two previous generations. The earlier pro- unlike exposure or air kerma standards. Standards for ab-
tocols were based on measurements using ion chambers with sorbed dose to water have an uncertainty 共1␴ ) of less than
dose being derived by applying Bragg–Gray or Spencer– 1% in 60Co and bremsstrahlung beams up to 25 MV 共see,
Attix cavity theory. In the first generation protocols, calibra- e.g., Refs. 6–9兲. It is appropriate to have a protocol that
tion laboratories provided exposure calibration factors for allows incorporation of this improved accuracy. These im-
ion chambers in 60Co beams and users needed to look up a provements are accomplished in this third generation proto-
simple table of dose conversion factors versus nominal en- col which is based on the use of ion chambers calibrated in
ergy for either an x-ray or an electron beam.1,2 The proce- terms of absorbed dose to water in a 60Co beam.10–13
dure was simple because there were no special consider- Clinical reference dosimetry based on 60Co absorbed-dose
ations in these factors for either the type of chamber used or calibration factors requires a quality conversion factor, de-
the actual quality of the beam. Omission of some of these noted k Q , and these factors have been calculated using
considerations led to errors in beam calibrations of up to 5%. Spencer–Attix cavity theory for the majority of cylindrical
In the second generation of protocols, e.g., the AAPM’s ionization chambers currently in clinical use for reference
TG-21 protocol published in 1983,3–5 many of these prob- dosimetry. Determination of k Q factors for electron beams is
lems were reduced at the expense of added complexity. The more complex than for photon beams since there is a change
accuracy of dose calibration was considerably better, but it in modality as well as energy, and some dependence on the
required complex calculations, especially for the chamber- gradient in the user’s beam. The protocol has been written in
dependent factors and their variation with beam quality. such a way as to allow future incorporation of measurements
These complexities themselves meant an increased potential with primary standards of absorbed dose in accelerator
for errors in the clinic. beams.
The protocol being introduced, TG-51, still uses ion An important point in this protocol is that clinical refer-
chambers as the basis for measurements, but requires ab- ence dosimetry must be performed in a water phantom. Ref-
sorbed dose to water calibration factors. As a result, it is erence dosimetry measurements in plastics, including water-
conceptually easier to understand and simpler to implement equivalent plastics, are not allowed. This is to ensure
than the earlier protocols. In the last decade, the major em- simplicity and accuracy in the protocol since the quantity of

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1849 Almond et al.: AAPM’s TG-51 protocol 1849

interest is absorbed dose to water. This point does not pre- I 50 : the depth in an electron beam at which the gradient-
clude the use of plastic materials for more frequent quality corrected ionization curve falls to 50% of its maximum 共see
assurance checks, provided a transfer factor has been estab- Sec. VIII C兲. Unit: cm.
lished, but does require that in-water calibrations be per- k Q : the quality conversion factor, which accounts for the
formed at least annually. change in the absorbed-dose to water calibration factor be-
This protocol also differs in one other significant respect tween the beam quality of interest, Q, and the beam quality
from its predecessor. Whereas the TG-21 protocol combined for which the absorbed-dose calibration factor applies 共usu-
both the theory and practical application in the same docu- ally 60Co) 关see Eq. 共2兲兴. k Q is a function of the beam quality
ment, this protocol serves only as a ‘‘how to’’ document that Q 关specified by %dd(10) x or R 50] and is chamber depen-
will lead the medical physicist through all the steps neces- dent. For 60Co beams k Q ⫽1.000.
sary to perform clinical reference dosimetry for a given pho- k R 50: the component of k Q in an electron beam which is
ton or electron beam. There are separate worksheets for pho-
independent of the ionization gradient at the point of mea-
ton and electron beam dosimetry.
Under the assumption that TG-21 correctly predicts the surement 共i.e., k Q ⫽k R 50P gr
Q
, see Secs. IV and X B兲. k R 50 is
ratio of absorbed-dose to air-kerma calibration factors, it is a function of the electron beam quality specified by R 50 .
not expected that implementation of this protocol will k R⬘ , k ecal : the electron quality conversion factor and
50
change the results of clinical reference dosimetry in photon photon-electron conversion factor respectively. For electron
60Co
beams by more than roughly 1% compared to those assigned beams, k R 50⫽k R⬘ k ecal where k ecal is needed to convert N D,w
following TG-213 for measurements in water. Slightly larger 50
Q
ecal
into an electron beam absorbed-dose calibration factor N D,w
changes can be expected at d max in electron beams because
this protocol uses more accurate procedures regarding for a selected beam quality Q ecal and k R⬘ is needed to con-
50
Q
stopping-power ratios in realistic clinical electron beams and vert N D,wecal Q
into N D,w for any beam quality Q 共see Secs. IV
also takes into account the improvements provided by the and X B兲. k ecal is fixed for a given chamber model and k R⬘ is
50
TG-39 protocol for plane-parallel chambers.14 a function of the electron beam quality specified by R 50 .
M raw(d): uncorrected ion chamber reading with the point
II. NOTATION AND DEFINITIONS of measurement of the ion chamber at a depth d in water,
for a given number of monitor units 共or minutes for 60Co). If
All quantities shall be reported in SI units. no sign is indicated, the measurement is made collecting the
This protocol is based on the use of a set of physical data same charge as during calibration 共see Sec. VII A兲. If a sign
which is consistent with that used in US and Canadian pri- is indicated (⫹ or ⫺), it is the sign of the charge collected
mary standards laboratories. In particular, electron stopping
共see Sec. VII A兲. Unit: C 共coulomb兲 or rdg 共meter reading兲.
powers are based on those developed at NIST and recom-
M : fully corrected ion chamber reading 共see Sec. VII兲:
mended in ICRU Report 37.15
corrected to the standard environmental conditions of tem-
%dd(10) x : the photon component of the photon beam
perature and pressure for which the ion chamber calibration
percentage depth-dose at 10 cm depth in a 10⫻10 cm2 field
factor applies; and also corrected for polarity effects, lack of
on the surface of a water phantom at an SSD of 100 cm 共see
complete ion collection efficiency, and electrometer accu-
Sec. VIII B兲.
racy. Unit: C or rdg.
%dd(10): the measured photon beam percentage depth-
dose at 10 cm depth in a 10⫻10 cm2 field on the surface of MU: the number of monitor units 共or minutes for 60Co)
a water phantom at an SSD of 100 cm. %dd(10) includes for which a given irradiation is performed.
the effects of electron contamination in the beam, whereas N D,w : the absorbed-dose to water calibration factor for an
%dd(10) x does not. %dd(10) is measured in an open beam. ion chamber located under reference conditions in a radiation
%dd(10) Pb : same as %dd(10) except that a 1 mm lead beam. The absorbed dose measured is that at the chamber’s
foil is in place below the accelerator at about 50 cm from the point of measurement in the absence of the chamber. For a
phantom surface 共or 30 cm if 50 cm clearance is not avail- vented ion chamber the calibration factors from US and Ca-
able兲. nadian calibration laboratories apply for standard environ-
clinical reference dosimetry: determination of absorbed mental conditions of temperature, pressure, and relative hu-
dose to water per MU under reference conditions in the midity. Calibration factors apply assuming the chamber
clinic. reading corresponds to 100% charge collection efficiency
D wQ : the absorbed dose to water for a given number of 关see Eq. 共7兲兴. In contrast, calibration factors are usually for a
monitor units 共or minutes for 60Co) from a radiation beam of stated polarity and corrections are needed if there is a sig-
quality Q. Unit: gray, Gy. nificant polarity effect in the calibration beam 共see Sec.
d max : the depth at which the absorbed dose to water 共not VII A for how to handle this unusual case兲. Unit: Gy/C or
ionization兲 is a maximum for a given beam. In photon beams Gy/rdg.
Q
it may include effects of electron contamination in the inci- N D,w : the value of N D,w in a photon or electron beam of
dent beam. Unit: cm. quality specified by Q.
d ref : the reference depth for electron beams given as P: air pressure inside ion chamber. In a vented chamber it
d ref⫽0.6R 50⫺0.1, where R 50 is in cm. Unit: cm. is assumed to be the same as the local air pressure 共see Sec.

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1850 Almond et al.: AAPM’s TG-51 protocol 1850

VII C兲. Unit: kPa 共kilopascals, 1 atmosphere ⫽ 760 mm of size and SSD/SAD for which clinical reference dosimetry is
mercury ⫽ 101.33 kPa兲. performed 共see Secs. IX A and X A兲.
P elec : the electrometer correction factor. If the electrom- reference depth: the depth at which the point of mea-
eter is calibrated separately from the ion chamber, then P elec surement of the ion chamber is placed to measure the ab-
is the electrometer calibration factor which corrects the elec- sorbed dose.
trometer reading to true coulombs. P elec is considered 1.00 if SSD/SAD: source-to-surface distance for electron or pho-
the electrometer and ion chamber are calibrated as a unit. ton beams and source-to-axis distance for photon beams.
Unit: C/rdg or C/C. This is usually a nominal distance since the position of the
Q
P gr : the gradient correction factor is the component of k Q source is not well defined in many cases 共see Sec. IX A兲.
in an electron beam that is dependent on the ionization gra- Unit: cm.
dient at the point of measurement. For cylindrical cham- standard environmental conditions: conditions of tem-
bers P grQ
is a function of the radius of the cavity, r cav and the perature, pressure, and relative humidity for which ion cham-
local gradient. P gr Q
is unity for plane-parallel chambers 关see ber calibration factors apply. In the US and Canada these are
Secs. X B and IV and Eqs. 共21兲 and 共4兲兴. The equivalent temperature, T 0 ⫽22 °C, pressure, P 0 ⫽101.33 kPa, and rela-
factor in photon beams is accounted for within k Q since it is tive humidity of the air in the ion chamber between 20% and
the same for all beams of a given photon beam quality. 80% 共see Sec. VII C兲.
P ion : the recombination correction factor takes into ac- T: temperature of the air inside an ion chamber, taken as
the temperature of the surrounding water when in thermal
count the incomplete collection of charge from an ion cham-
equilibrium. Unit: °C 共degree Celsius兲.
ber 共see Sec. VII D兲. Unlike the TG-21 protocol, this factor
The new notation in this protocol may at first seem daunt-
does not appear explicitly in the dose equation but it is now
ing. The following general observations may be helpful.
taken into account when determining the corrected charge
Beam quality is denoted by a Q in the general case for
reading M .
both electron and photon beams. Two specific beam qualities
P pol : the polarity correction factor which takes into ac-
that are referred to often are 60Co and Q ecal . The beam qual-
count any polarity effect in the response of the ion chamber
ity specifiers used are %dd(10) x for photon beams and R 50
共see Sec. VII A兲.
for electron beams.
P TP : the temperature–pressure correction factor which
The various k quality conversion factors all transform an
makes the charge or measured current correspond to the stan-
absorbed-dose calibration factor from one quality to another
dard environmental conditions for which the calibration fac- as follows 共these relationships are formally introduced below
tor applies 共see Sec. VII C兲. and this summary is here only as an aide-memoire兲. Note
point of measurement: the point at which the absorbed that the quality conversion factor, k Q , is used to transform
dose is measured. For cylindrical ion chambers used for the 60Co absorbed-dose calibration factor to the correspond-
clinical reference dosimetry the point of measurement is ing factor in any beam quality Q for electrons or photons. In
on the central axis of the cavity at the center of the active contrast, the k R 50 factors apply only to electron beams and in
volume of the cavity and for plane-parallel chambers the
the general case require an additional gradient correction fac-
point of measurement is at the front 共upstream side兲 of the
tor, hence the different notation.
air cavity at the center of the collecting region. When used in
this specific sense, the phrase ‘‘point of measurement’’ is set Co
N D,w
60 Q
——→
k Q
N D,w 共photons
out in the text as point of measurement. or electrons兲
Q: The beam quality in the user’s photon or electron Co60 k Q 共electronsa兲
N D,w R 50
——→ N D,w
beam for which clinical reference dosimetry is to be per-
formed. For photon beams it is given in terms of %dd(10) x Co
N D,w
60
k
ecal Qecal R 50 k⬘ Q
N D,w 共electronsa,b兲
——→ N D,w ——→
共see Sec. VIII B兲 and for electron beams, in terms of R 50 共see
a Q
Sec. VIII C兲. also need P gr for cylindrical chambers.
b Q
also need P grecal for cylindrical chambers.
Q ecal : an arbitrary electron beam quality taken as R 50
⫽7.5 cm. It is introduced to simplify the factors needed in
Note that for electron beams k Q ⫽ P gr
Q
k R 50 and
electron beam dosimetry 共see Sec. IV兲.
k R 50⫽k R⬘ k ecal .
r cav : radius of the air cavity in a cylindrical ion chamber. 50

Unit, cm. See Secs. VIII A and X B.


R 50 : the depth in water in a 10⫻10 cm2 or larger beam of III. INTRODUCTION
electrons at an SSD of 100 cm at which the absorbed dose This protocol prescribes a methodology for clinical refer-
falls to 50% of the dose maximum 共see Sec. VIII C兲. For ence dosimetry. It applies to photon beams with nominal
beams with R 50⬎ 8.5 cm 共i.e., with energy greater than energies between 60Co and 50 MV and electron beams with
roughly 20 MeV兲, a 20⫻20 cm2 or greater field size is nominal energies between 4 and 50 MeV.
needed. Unit: cm. The protocol uses ion chambers calibrated in terms of
rdg: the meter reading of an ion chamber in whatever absorbed dose to water in a 60Co beam.
units are on the scale. The primary purpose of this dosimetry protocol is to en-
reference conditions: defined conditions of depth, beam sure uniformity of reference dosimetry in external beam ra-

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1851 Almond et al.: AAPM’s TG-51 protocol 1851

diation therapy with high-energy photons and electrons. To In general, for electron beams the quality conversion fac-
achieve this goal requires a common starting point and this is tor k Q contains two components, i.e.,
accomplished by starting with an ion chamber calibration
k Q ⫽ P gr
Q
k R 50 , 共4兲
factor which is directly traceable to national standards of
absorbed dose to water maintained by Primary Standards
Laboratories 共National Institute of Standards and Technol- where k R 50 is a chamber-specific factor which depends on the
ogy, NIST, in the US, the National Research Council of quality for which the absorbed-dose calibration factor was
Canada, NRCC, in Canada兲. Direct traceability is also obtained and the user’s beam quality, Q, as specified by R 50
achieved via calibration factors obtained from an Accredited 共see Sec. VIII C兲, and P grQ
is necessary only for cylindrical
Dosimetry Calibration Laboratory 共ADCL兲. chambers, to correct for gradient effects at the reference
Q
depth. The value of P gr depends on the radius of the chamber
cavity and the ionization gradient at the point of measure-
IV. GENERAL FORMALISM ment in the user’s beam and must be measured by the user.
Q
This protocol provides a procedure for measuring P gr in the
Many of the data used in this protocol apply only under
user’s electron beam 共as described in Sec. X B兲.
certain well-defined reference conditions. These conditions
The factor k R 50 is written as the product of two factors,
are specified below for photon and electron beams, and in-
clude such factors as the depth of measurement, field size, viz.
and source-to-surface distance, SSD. Also, throughout this k R 50⫽k R⬘ k ecal . 共5兲
50
protocol doses and charges are ‘‘for a given number of moni-
tor units 共or minutes for 60Co),’’ although this cumbersome The photon-electron conversion factor, k ecal , is fixed for a
phrase will not usually be included. given chamber model and is just k R 50 for an electron beam of
Q
Given N D,w 共in Gy/C or Gy/rdg兲, the absorbed-dose to Co
quality Q ecal , i.e., the value needed to convert N D,w
60
into
water calibration factor for an ion chamber located in a beam Q ecal
N D,w , the absorbed-dose calibration factor in an electron
of quality Q, then, under reference conditions:
beam of quality Q ecal . The electron beam quality conversion
factor, k R⬘ , is beam quality dependent and converts N D,w
Q ecal
D wQ⫽M N D,w
Q
共 Gy兲 , 共1兲
50
Q
where D wQ is the absorbed dose to water 共in Gy兲 at the point into N D,w . Thus, in an electron beam, the dose is given by
of measurement of the ion chamber when it is absent 共i.e., at 60
D wQ ⫽M P gr
Q
k R⬘ k ecal N D,w
Co
共 Gy兲 . 共6兲
the reference depth兲; M is the fully corrected electrometer 50

reading in coulombs 共C兲 or meter units 共rdg兲 which has been The introduction of the photon-electron conversion factor,
corrected for ion recombination, polarity and electrometer k ecal , appears quite arbitrary, but it is very useful since 共i兲 it
calibration effects and corrected to standard environmental means the chamber-to-chamber variation of k R⬘ is much less
conditions of temperature and pressure 共see Sec. VII兲; and 50
than that of k R 50; 共ii兲 it is a directly measurable quantity once
the same or equivalent waterproofing sleeve is used as was
primary standards for absorbed dose in electron beams are
used during the calibration 共if needed兲. If an absorbed-dose
available; and 共iii兲 it plays a very natural role when cross-
calibration factor has been obtained for the beam quality of
calibrating plane-parallel chambers against calibrated cylin-
interest, this equation can be used directly and the next step
drical chambers 共see Sec. X C兲.
in this protocol, to determine k Q 共see below兲, can be by-
Although the protocol allows and provides data to carry
passed.
through the above approach using plane-parallel chambers,
More usually, it is expected that absorbed-dose calibration
there is evidence that minor construction details significantly
factors will be obtained for reference conditions in a 60Co
60Co affect the response of these detectors in 60Co beams16 and
beam, viz. N D,w . In this case, define the quality conversion this makes measurements or calculations of k ecal more uncer-
factor, k Q , such that tain. Therefore, the preferred choice is to cross calibrate
60
Q
N D,w ⫽k Q N D,w
Co
共Gy/C or Gy/rdg兲, 共2兲 them in high-energy electron beams against calibrated cylin-
drical chambers as recommended by TG-3914 共see Sec. X C兲.
i.e., k Q converts the absorbed-dose to water calibration factor The reference depth for electron-beam dosimetry is at
for a 60Co beam into the calibration factor for an arbitrary d ref⫽0.6R 50⫺0.1 cm, which is essentially at the depth of
beam of quality Q which can be for photon or electron dose maximum for beams with energies below 10 MeV but
beams in general. The quality conversion factor k Q is cham- is deeper for higher-energy beams.17 By going to this depth
ber specific. Using k Q , gives10,12,13 the protocol can make use of stopping-power ratios which
60 account for the realistic nature of electron beams rather than
D wQ ⫽M k Q N D,w
Co
共 Gy兲 . 共3兲
assume they are mono-energetic and at the same time no
For photon beams, this protocol provides values of k Q for longer requires stopping-power ratios tabulated as a function
most chambers used for reference dosimetry 共Sec. IX B兲. of depth and R 50 共or mean energy at the phantom surface兲.
Note that plane-parallel chambers are not included because To utilize this formalism one starts by obtaining an
there is insufficient information about wall correction factors absorbed-dose to water calibration factor for an ion chamber
in photon beams other than 60Co beams. in a 60Co beam as described in the next section and then

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1852 Almond et al.: AAPM’s TG-51 protocol 1852

determines the quality conversion factor, k Q , for the cham- terproofing by using the chamber in a water tank immedi-
ber being used. This first requires that one determine the ately prior to sending it for calibration. For nonwaterproof
beam quality, Q. chambers the calibration laboratories will use their own thin-
walled waterproofing sleeves to calibrate Farmer-like cylin-
drical chambers or they will use the clients waterproofing
V. OBTAINING AN ABSORBED-DOSE TO WATER sleeve if it meets the criteria below. It is the responsibility of
CALIBRATION FACTOR the clinical physicist to use a waterproofing sleeve which
The first step in applying this protocol is to obtain an minimizes air gaps near the chamber wall (⭐0.2 mm兲 and it
absorbed-dose to water calibration factor for the user’s ion should be made of polymethylmethacrylate 共PMMA兲 ⭐1
chamber when placed in a 60Co beam under reference con- mm thick. Another allowed option is to use a latex condom
ditions 共specified in Sec. IX A兲. The absorbed-dose calibra- but users are urged to make sure talcum powder is not used
tion factor is defined such that in this case since the talcum can lead to problems with the
60 ion chamber. Other materials are not recommended since
60Co D w Co discrepancies have been observed.19–21 For other chamber
N D,w ⫽ 共Gy/C or Gy/rdg兲, 共7兲
M types, the user should communicate with the calibration
60Co
where D w is the absorbed dose to water 共in Gy兲 in the laboratory to ensure that the waterproofing sleeves used in
calibration laboratory’s 60Co beam at the point of measure- the calibration laboratory, and in the user’s beam, are similar
ment of the ion chamber in the absence of the chamber. The and meet the criteria above. If the user’s waterproofing
calibration factor applies under standard environmental con- sleeve meets the above criteria, then the effect of the sleeves
ditions of temperature, pressure, and relative humidity of the in both the calibration lab and the clinic are negligible, as are
air in the ion chamber, viz. 22 °C, 101.33 kPa, and relative any differences between them.
humidity between 20% and 80%, respectively 共in the US and
Canada兲. This calibration factor must be traceable to the us- VI. MEASUREMENT PHANTOMS
er’s national primary standard for absorbed dose to water. In Clinical reference dosimetry must be performed in a water
practice, for most members of the AAPM, this means the phantom with dimensions of at least 30⫻30⫻30 cm3 . If the
calibration factor must be obtained from an ADCL in the US beam enters through the plastic wall of the water phantom
共traceable to NIST兲 or NRCC in Canada. and the wall is greater than 0.2 cm thick, all depths should be
It is the responsibility of the clinical physicist to ensure scaled to water-equivalent depths by measuring from the out-
that there are adequate, independent, and redundant checks side face of the wall with the phantom full of water and
in place to ensure that any problems with the ion chamber accounting for the wall density. For a PMMA wall, in photon
will be detected prior to the routine calibration.18 Checks are or electron beams the effective wall thickness is given by the
achieved by use of check sources, by regular measurements measured thickness in cm times 1.12.3,22
in a 60Co beam, or by use of multiple independent dosimetry
systems. With adequate and redundant checks in place, it is VII. CHARGE MEASUREMENT
necessary to have the ion chamber calibrated when first pur- The fully corrected charge reading from an ion chamber,
chased, when repaired, when the redundant checks suggest a M , is given by
need, or once every two years. The clinical physicist must
M ⫽ P ionP TPP elecP polM raw 共C or rdg兲, 共8兲
perform at least two independent checks prior to sending a
chamber for calibration and repeat the same checks when the where M raw is the raw ion chamber reading in coulombs, C,
chamber is returned to ensure that the chamber characteris- or the instrument’s reading units 共rdg兲; P TP is the
tics have not changed during transit and the calibration factor temperature–pressure correction which corrects the reading
obtained applies to the chamber. to the standard environmental conditions for which the ion
The ion chamber and the electrometer with which it is to chamber’s calibration factor applies; P ion corrects for incom-
be used should both be calibrated, possibly as a single unit. plete ion collection efficiency; P pol corrects for any polarity
All ranges of the electrometer that are routinely used for effects; and P elec takes into account the electrometer’s cali-
clinical reference dosimetry should be calibrated. bration factor if the electrometer and ion chamber are cali-
brated separately. In addition, any shutter timing error must
A. Chamber waterproofing
be accounted for if needed 共see, e.g., Ref. 23, p. 358, or
To follow this protocol a chamber is calibrated in water as TG-6124兲.
well as used clinically in water. As a result, 60Co buildup
A. Polarity corrections
caps are not needed. However, equivalent waterproofing
techniques must be used for measurements in the user’s Polarity effects25–27 vary with beam quality and other
beam and in the calibration laboratory. An inherently water- conditions such as cable position. Therefore, it is necessary
proof chamber avoids the complications of extra waterproof- to correct for these effects by making measurements each
ing sleeves and possible air gaps. time clinical reference dosimetry is performed.
Chambers that are inherently waterproof will be cali- To correct an ion chamber’s raw reading for polarity ef-
brated in water without any extra waterproofing. It is the fects one takes readings with both polarities applied and de-
user’s responsibility to ensure the integrity of inherent wa- duces P pol from

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1853 Almond et al.: AAPM’s TG-51 protocol 1853

P pol⫽ 冏 ⫹
共 M raw
2M raw

⫺M raw


, 共9兲
Chambers require time to reach thermal equilibrium with
their surroundings. After inserting the ion chamber into the
water tank it is necessary to ensure that this equilibrium is

where M raw is the reading when positive charge is collected, reached by waiting for changes in chamber output to become

M raw is the reading when negative charge is collected, and negligible. At this point, usually after 5 to 10 min,28 one can
⫹ ⫺
M raw 共one of M raw or M raw ) is the reading corresponding to assume that the temperature inside the ion chamber has
the charge collected for the reference dosimetry measure- reached the temperature of the water near the chamber in the
ments in the clinic and which should be the same as for the phantom.
chamber calibration. In both cases, the sign of M raw must be It is assumed that the relative humidity is always in the
⫹ ⫺
used and usually M raw and M raw have opposite signs unless range of 20% to 80%. In this range, the error introduced by
the background is large. Adequate time must be left after ignoring variations in relative humidity is ⫾0.15%.29
changing the sign of the voltage so that the ion chamber’s Humid air may cause condensation inside the ion chamber
reading has reached equilibrium. volume and this can affect chamber response, especially for
In the unlikely event that the polarity correction is more nylon-wall chambers30 which therefore should not be used.
than 0.3% different from unity in a photon beam of 6 MV or
lower energy, then one must establish what the value of P pol
is in the calibration laboratory’s beam. This can be requested D. Corrections for ion-chamber collection inefficiency
from the calibration laboratory or established by the clinical
physicist using a 60Co source. Since calibration laboratories 1. General comments on P ion
traditionally report the calibration factor for one polarity, if In this protocol, ion chamber readings in the user’s beam
there is a significant polarity correction in the calibration must be corrected for lack of complete collection efficiency.
60Co 60
beam, the user must use N D,w / P polCo everywhere in this pro- This recombination correction factor is denoted P ion and the
60Co
tocol instead of N D,w . experimental methods for measuring it are discussed below.
It must be emphasized that P ion is a function of the dose per
pulse in accelerator beams and thus will change if either the
B. Electrometer correction factor pulse rate for a fixed dose rate, or the dose rate is changed.
It is common practice in the US to calibrate ion chambers The correction must be measured in each set of experimental
and electrometers separately. This is not essential and it is conditions for which clinical reference dosimetry is being
common practice in Canada to calibrate them as a unit. If the performed.
electrometer is calibrated separately from the ion chamber, This protocol is based on the definition of the calibration
the electrometer correction factor, P elec , is just the electrom- factor given in Eq. 共7兲, which means that it applies when
eter calibration factor which corrects the electrometer read- 100% of the ions created are collected. The correction to
ing to true coulombs. The electrometer calibration factor is 100% ion collection at the time of chamber calibration is
obtained from an Accredited Dosimetry Calibration Labora- done at the calibration laboratory. The user must, however,
tory. P elec is the electrometer correction factor which is ap- explicitly include in Eq. 共8兲, the recombination correction,
plicable to the range being used on the electrometer. P elec is P ion , which applies in each of the user’s beams.
considered 1.00 if the electrometer and ion chamber are cali- The recombination corrections are well enough
brated as a unit. It is also taken as 1.00 for cross-calibrated understood31 that for small corrections they can be made
plane-parallel chambers since it cancels out of the final equa- accurately. However, if an ion chamber exhibits a correction
tions 共see Sec. X C兲. factor, P ion , greater than 1.05, the uncertainty in this correc-
tion becomes unacceptably large and another ion chamber
with a smaller recombination effect should be used. Voltages
C. Standard environmental conditions: Temperature,
should not be increased above normal operating voltages just
pressure, and relative humidity
to reduce P ion since there are indications in the literature that
Since calibration factors are given for standard environ- the assumptions in the standard theories break down at
mental conditions of temperature at T 0 ⫽22 °C and pressure higher voltages.32–36 In fact, the evidence suggests that lower
at P 0 ⫽101.33 kPa 共1 atmosphere兲, one corrects charge or voltages should be used as long as P ion values are acceptable.
meter readings to standard environmental conditions using Despite these issues, the procedure recommended below is
very similar to the TG-21 procedure since the above effects
273.2⫹T 101.33
P TP⫽ ⫻ , 共10兲 are believed to cause less than 0.5% errors at normal oper-
273.2⫹22.0 P ating voltages of 300 V or less.
where T is the temperature in degrees Celsius in the water
near the ion chamber and P is the pressure in kilopascals
2. Measuring P ion
共not corrected to sea level and including temperature and
latitude corrections for a mercury barometer兲. Standard envi- The standard two-voltage techniques for determining the
ronmental conditions are different in some countries outside P ion correction should be used. This involves measuring the
the US and Canada and the corresponding changes in Eq. charge produced by the ion chamber in the beam of interest
共10兲 are necessary. when two different bias voltages are applied to the detector.

Medical Physics, Vol. 26, No. 9, September 1999


1854 Almond et al.: AAPM’s TG-51 protocol 1854

After changing the voltage it is necessary to wait for the


chamber readings to come to equilibrium 共usually several
minutes, at least兲.
Let V H be the normal operating voltage for the detector
共always the higher of the two voltages in these measure-
H
ments兲 and M raw be the raw chamber reading with bias V H .
H
After measuring M raw reduce the bias voltage by at least a
L
factor of 2 to V L and measure M raw once the chamber read-
ings have reached equilibrium.
For continuous 共i.e., 60Co) beams, the two voltage for-
mula gives37,38
FIG. 1. Effect of shifting depth-ionization data measured with cylindrical
1.⫺ 共 V H /V L 兲 2 chambers upstream by 0.6 r cav for photon beams 关panel 共a兲兴 and 0.5 r cav for
P ion共 V H 兲 ⫽ . 共11兲 electron beams 关panel 共b兲兴 共with r cav ⫽ 1.0 cm兲. The raw data are shown by
H
M raw L
/M raw ⫺ 共 V H /V L 兲 2 curve I 共long dashes兲 in both cases and the shifted data, which are taken as
the depth-ionization curve, are shown by curve II 共solid line兲. The value of
Equation 共11兲 extracts an estimate of the general recombina- the % ionization at point A 共10 cm depth兲 in the photon beam gives
tion in the continuous beam although initial recombination %dd(10) and the depth at point B 共solid curve, 50% ionization兲 in the
electron beam gives I 50 from which R 50 can be determined 共see Sec. VIII C兲.
may dominate. For the photon beams, curve II is effectively the percentage depth-dose
For pulsed or pulsed-swept beams with P ion⬍1.05, i.e., curve. For the electron beams, curve II must be further corrected 共see Sec.
where the linear form of the saturation curve holds, X D兲 to obtain the percentage depth-dose curve shown 共short dashes—but
this is not needed for application of the protocol兲.
1.⫺ V H /V L
P ion共 V H 兲 ⫽ . 共12兲
H L
M raw /M raw ⫺ V H /V L at the reference depth when measuring dose at an individual
Although the exact equations for pulsed or pulsed-swept point 共as opposed to a depth-dose curve兲. Nonetheless, the
beams are nonlinear,38 Eq. 共12兲 gives the same result as solv- effective point of measurement is upstream of the point of
ing the nonlinear equations to within 0.2% and 0.4%, respec- measurement 共i.e., closer to the radiation source兲 due to the
tively, for a voltage ratio of 2 and 0.3% and 0.6% for a predominantly forward direction of the secondary electrons
voltage ratio of 3 and is most inaccurate at the limiting value 共since the primary beam enters the chamber at various dis-
of P ion⫽1.05. For larger values of the voltage ratio or values tances upstream兲. This has an impact on the measurement of
of P ion near 1.05 one may use the published programs or fits depth-ionization 共and therefore depth-dose兲 curves and on
for the nonlinear equations.5,38 the calculation of absolute dose from ionization measure-
ments at the reference depth.
When measuring central-axis depth-dose data with a cy-
VIII. BEAM QUALITY SPECIFICATION
lindrical chamber, the effective point of measurement is
For both photon and electron beams from accelerators, the made use of as follows. First, depth-ionization data are mea-
beam quality must be specified in order to determine the sured with the point of measurement identified as the as-
correct value of the quality conversion factor, k Q or the elec- sumed depth, as shown by curve I in Figs. 1共a兲 and 1共b兲.
tron quality conversion factor, k R⬘ . For a 60Co beam the The entire curve is then shifted to shallower depths by a
50
factor k Q ⫽1.000 by definition and hence there is no need for distance proportional to r cav , the radius of the ionization
further beam quality specification. Beam quality must be chamber cavity, as shown by curves II in Figs. 1共a兲 and 1共b兲.
measured each time clinical reference dosimetry is per- For cylindrical and spherical chambers the shift is taken
formed for accelerator beams. To do this, one needs to mea- as 0.6r cav for photon beams35 and 0.5r cav for electron
sure a parameter related to the central-axis depth-dose curves beams.22,39,40 The shifted curves are taken as the depth-
for the beam in question. Careful measurement of depth-dose ionization curves for cylindrical chambers. It is these depth-
curves is quite complex because various factors needed for ionization curves that are used to determine the beam quality
converting depth-ionization curves to depth-dose curves for both photons and electrons. Using these measurements as
change as a function of depth. Although this protocol is quite depth-ionization curves ignores any variations in P ion and
flexible about the SSD used when establishing the absorbed P pol with depth41 and for electron beams it also ignores
dose at the reference depth, nonetheless it is essential to use variations in the electron fluence correction factor. Since
SSD⫽100 cm when establishing the beam quality for photon well-guarded plane-parallel chambers minimize these varia-
and electron beams. This is because %dd(10) and R 50 are tions with depth, they are preferred for measuring electron
functions of SSD whereas absorbed-dose calibration factors beam depth-ionization curves.
are not 共for 10⫻10 cm2 fields兲. For photon beams the variation in stopping-power ratio is
negligible past d max (⬍0.1%42兲 and thus the depth-ionization
A. Accounting for gradient and depth of measurement curve is treated as a depth-dose curve 共these same techniques
effects
should be used to determine any clinical photon beam depth-
The point of measurement for a cylindrical chamber is dose curve兲. In order to determine depth-dose curves for
on the central axis of the chamber and this is always placed electron beams, the depth-ionization curve must be further

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1855 Almond et al.: AAPM’s TG-51 protocol 1855

corrected for the significant change in the stopping-power when the foil is not needed, an ion chamber should be used
ratio with depth. This conversion is not needed in this pro- to generate the central-axis percentage depth-ionization
tocol except to transfer the dose from d ref to d max if neces- curve measured in water 关i.e., curve I in Fig. 1共a兲兴 using a
sary 共Sec. X D兲. field size of 10⫻10 cm2 at the phantom surface and an SSD
For plane-parallel chambers, the center of the front 共up- of 100 cm. For cylindrical or spherical chambers, the mea-
stream兲 face of the chamber air cavity is the point of mea- sured depth-ionization data should be shifted upstream by
surement. This is traditionally taken as the effective point 0.6r cav to give curve II, the depth-ionization curve. For
of measurement.3,39 Therefore there is no shift in the depth- plane-parallel chambers no shift is needed, i.e., curves I and
ionization curves for plane-parallel chambers and curves I II are coincident. The percentage depth-ionization curve can
and II are coincident and give the depth-ionization curve for be treated as the percentage depth-dose curve.
the purposes of beam quality specification. Next, locate point A at 10 cm depth on the percentage
In contrast to the above, for measurements of absolute depth-dose curve 关i.e., curve II in Fig. 1共a兲兴. This value is
dose at the reference depth in both electron and photon %dd(10) or %dd(10) Pb , the measured percentage depth-
beams, a cylindrical chamber’s point of measurement dose at 10 cm depth.
共center of the chamber, Sec. II兲 is placed at the reference For beams with energies less than 10 MV, this value of
depth 共10 cm for photons and d ref for electrons兲. The gradient %dd(10) measured in the open beam is the beam quality,
effects are included implicitly in the beam quality conversion %dd(10) x . For beam energies of 10 MV and above, the
Q
factor k Q for photons and explicitly by the term P gr for elec- value of %dd(10) x for the open beam is obtained from the
trons. That is, the formalism of this protocol yields absorbed value of %dd(10) Pb measured with the foil in the beam at
dose to water at the point occupied by the point of mea- 50 ⫾5 cm from the phantom surface by43
surement after the chamber has been removed from the
%dd 共 10兲 x⫽ 关 0.8905⫹0.00150%dd 共 10兲 Pb兴 %dd 共 10兲 Pb
water.
关foil at 50 cm, %dd 共 10兲 Pb⭓73%兴, 共13兲
B. Beam-quality specification for photon beams and, if the foil is placed at 30 ⫾1 cm from the phantom
surface, by
For the purposes of reference beam dosimetry, beam qual-
ity in accelerator photon beams is specified by %dd(10) x , %dd 共 10兲 x⫽ 关 0.8116⫹0.00264%dd 共 10兲 Pb兴 %dd 共 10兲 Pb
the percentage depth dose at 10 cm depth in a water phantom
关foil at 30 cm, %dd 共 10兲 Pb⭓71%兴. 共14兲
due to photons only 共i.e., excluding electron contamination兲.
The value of %dd(10) x is defined for a field size of 10 If %dd(10) Pb is less than the respective thresholds given
⫻10 cm2 at the phantom surface at an SSD of 100 cm. For above in the equations, then %dd(10) x⫽%dd(10) Pb .
60
Co beams %dd(10) x is not required since k Q ⫽1.000 by The foil is only used when determining the beam quality
definition. specifier, %dd(10) x and must be removed after the beam
At higher energies 共about 10 MV and above兲, the elec- quality is determined.
trons from the accelerator head may significantly affect the There is also a general formula available to correct for
dose at d max and hence reduce the measured value of electron contamination which can be used as an interim mea-
%dd(10). This electron contamination varies with machine sure for machines with 45 cm or more clearance between the
type. However, it has been shown that placing a 1 mm thick jaws and the phantom surface. For low-energy beams, i.e.,
lead foil just below the accelerator head reduces the effects for energies below 10 MV with %dd(10)⭐75%,
of the electrons from the accelerator to a negligible level and %dd(10) x⫽%dd(10). For higher-energy beams the follow-
calculations have been done which take into account the ef- ing applies up to %dd(10)⫽89%:
fect of the known electron contamination from the lead %dd 共 10兲 x⫽1.267%dd 共 10兲 ⫺20.0
foil.43,44 Thus the first step in specifying the photon beam
quality for beams with energies of 10 MV or above is to 关for 75%⬍%dd 共 10兲 ⭐89%兴, 共15兲
measure the value of %dd(10) Pb with a 1 mm lead foil
where %dd(10) is measured as described above for an open
positioned to intercept the beam completely 共but remove it
beam. This formula is based on a global fit45 to data in Fig. 7
for the measurement of absorbed dose at the reference posi-
of Ref. 46. For high-energy beams this global fit may cause
tion兲. For beam energies below 10 MV the lead foil is not
errors in assigning %dd(10) x of up to 2% in extreme
needed and one measures %dd(10) in the open beam.
cases,46 which would lead to an error in k Q , and hence the
If a 1 mm lead foil is being used, it should be placed
absorbed dose, of 0.4%.
about 50 cm from the phantom surface (⫾5 cm兲 in an oth-
erwise open beam. Only if the accelerator construction does
C. Beam quality specification for electron beams
not permit a position near 50 cm 共e.g., because of tertiary
collimators兲, then the lead foil may be placed 30⫾1 cm from For the purposes of reference beam dosimetry, beam qual-
the phantom surface. The exact thickness of the lead foil is ity in electron beams is specified by R 50 , the depth in water
not critical and a tolerance of ⫾20% is acceptable.43 共in cm兲 at which the absorbed dose falls to 50% of the maxi-
To measure %dd(10) Pb , with the lead foil in place 共for mum dose for a beam, which has a field size on the phantom
10 MV and above兲, or %dd(10) for lower-energy beams surface ⭓10⫻10 cm2 (⭓20⫻20 cm2 for R 50⬎ 8.5 cm, i.e.,

Medical Physics, Vol. 26, No. 9, September 1999


1856 Almond et al.: AAPM’s TG-51 protocol 1856

FIG. 3. Schematic of the SSD or SAD setups which may be used for photon
beam reference dosimetry. In both cases the ion chamber is at a water
equivalent depth of 10 cm in the water phantom. The actual value of SSD or
SAD is that most useful in the clinic 共expected to be about 100 cm兲.

60
FIG. 2. Here R 50 is defined as the depth, in cm, at which the absorbed dose
D wQ⫽M k Q N D,w
Co
共 Gy兲 .
falls to 50% of its maximum value in a ⭓10⫻10 cm2 (⭓20⫻20 cm2 for
R 50⬎ 8.5 cm兲 electron beam at an SSD of 100 cm. The depth for clinical
A. Reference conditions of depth, beam size, and
reference dosimetry is d ref⫽0.6R 50⫺0.1 cm, in the same sized beam at an source-surface/axis distance
SSD between 90 and 110 cm. Note that for low-energy beams, d ref is usually
Clinical reference dosimetry for photon beams is per-
at d max .
formed in an open beam 共i.e., without trays, wedges, lead
filters, or blocks兲 with the point of measurement of the
E⬎20 MeV兲 at an SSD of 100 cm. Figure 2 shows R 50 on a cylindrical ion chamber placed at the reference depth which
typical electron beam percentage depth-dose curve. is at a water-equivalent depth of 10 cm in a water phantom
To determine R 50 one must first measure a central-axis 共see Sec. VI for corrections if there is a wall in the path of
depth-ionization curve in a water phantom at an SSD of 100 the beam兲. Either an SSD or an SAD setup can be used 共at
cm 关curve I in Fig. 1共b兲兴. For cylindrical chambers, correct the normal clinical distance, see Fig. 3兲. The field size is
for gradient effects by shifting the curve upstream by 0.5 r cav 10⫻10 cm2 . When using an SSD setup, the field size is
to give curve II.22,39,40 For plane-parallel chambers no shift is defined at the surface of the phantom. When an SAD setup is
needed. Curve II is taken as the depth-ionization curve. being used, the field size is defined at the detector position
Next, locate point B at the level of 50% of the maximum which is placed at 10 cm depth at the isocenter of the ma-
ionization on the depth-ionization curve corrected for gradi- chine.
ent effects 关i.e., curve II in Fig. 1共b兲兴. The depth of point B In calibration laboratories, the traditional reference depth
gives I 50 . The beam quality specifier for the electron beam, for 60Co beams is 5 g/cm2 . The difference between an ion
R 50 , is determined from the measured value of I 50 using47,48 chamber’s calibration factor determined at this depth versus
one determined at a depth of 10 g/cm2 is negligible,42 and
R 50⫽1.029I 50⫺0.06 共cm兲 共for 2 ⭐I 50⭐10 cm兲 共16兲 hence the calibration factor for a depth of 5 g/cm2 can be
or used.
Note that although the reference conditions for measure-
R 50⫽1.059I 50⫺0.37 共cm兲 共for I 50⬎10 cm兲. 共17兲 ment of the dose are quite flexible, those for the specification
A second alternative is to determine the percentage depth- of beam quality are not and must be at SSD⫽100 cm 共see
dose curve using a good-quality diode detector which re- Sec. VIII兲.
sponds as a dose-detector in an electron beam,22,49 although
one must establish that this condition is fulfilled.50 A third B. Absorbed dose to water in clinical photon beams
alternative is to convert the depth-ionization curve for an ion
To use Eq. 共3兲 one needs a value of k Q . For 60Co beams
chamber to a percentage depth-dose curve 共see Sec. X D兲.
k Q ⫽1.000. Figure 4 presents calculated values of k Q in ac-
celerator beams as a function of %dd(10) x for cylindrical
ion chambers commonly used for reference dosimetry. Alter-
IX. PHOTON BEAM DOSIMETRY
natively, values for specific chambers can be selected from
In photon beams Eq. 共3兲 gives the absorbed dose to water Table I which contains values for the same cylindrical cham-
under reference conditions, for the same number of monitor bers, calculated as described by Rogers45 with a minor
units as used to measure the charge M, at the point of mea- update.51 Note that plane-parallel chambers are not included
surement of the ion chamber in the user’s photon beam of because there is insufficient information about wall correc-
quality Q, specified by %dd(10) x , i.e., tion factors in photon beams other than 60Co.

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1857 Almond et al.: AAPM’s TG-51 protocol 1857

FIG. 4. Values of k Q at 10 cm depth in accelerator photon beams as a function of %dd(10) x for cylindrical ion chambers commonly used for clinical reference
dosimetry. When values were the same within 0.1%, only one curve is shown. Explicit values are given in Table I, as is a list of equivalent chambers. For 60Co
beams, k Q ⫽1.000.

TABLE I. Values of k Q for accelerator photon beams as a function of %dd(10) x for cylindrical ion chambers commonly used for clinical reference dosimetry.
Values calculated as described in Refs. 45 and 51. The tabulated values can be interpolated linearly in %dd(10) x . The ion chamber specifications used in
these calculations are found in Table III. Figure 4 presents the same data within 0.1%. For 60Co beams, k Q ⫽1.000 by definition.

kQ
%dd(10) x
Ion chamber 58.0 63.0 66.0 71.0 81.0 93.0
Capintec PR-05/PR-05P 0.999 0.997 0.995 0.990 0.972 0.948
Capintec PR-06C/G 0.6cc Farmer 1.000 0.998 0.994 0.987 0.968 0.944
Exradin A1 Shonkaa 0.999 0.998 0.996 0.990 0.972 0.948
Exradin A12 Farmer 1.000 0.999 0.996 0.990 0.972 0.948
NE2505/3,3A 0.6cc Farmer 1.000 0.998 0.995 0.988 0.972 0.951
NE2561 0.3cc NPL Sec. Stdb 1.000 0.998 0.995 0.989 0.974 0.953
NE2571 0.6cc Farmer 1.000 0.998 0.995 0.988 0.972 0.951
NE2577 0.2cc 1.000 0.998 0.995 0.988 0.972 0.951
NE2581 0.6cc robust Farmer 1.000 0.994 0.988 0.979 0.960 0.937
PTW N30001 0.6cc Farmerc 1.000 0.996 0.992 0.984 0.967 0.945
PTW N30002 0.6cc all Graphite 1.000 0.997 0.994 0.987 0.970 0.948
PTW N30004 0.6cc Graphite 1.000 0.998 0.995 0.988 0.973 0.952
PTW 31003 0.3cc waterproofd 1.000 0.996 0.992 0.984 0.967 0.946
Wellhofer IC-10/IC-5 1.000 0.999 0.996 0.989 0.971 0.946
a
The cavity radius of the A1 here is 2 mm although in the past Exradin has designated chambers with another radius as A1.
b
The NE2611 has replaced the equivalent NE2561.
c
PTW N30001 is equivalent to the PTW N23333 it replaced.
d
PTW N31003 is equivalent to the PTW N233641 it replaced.

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1858 Almond et al.: AAPM’s TG-51 protocol 1858

TABLE II. Values of the photon-electron conversion factor, k ecal , for plane-
parallel chambers, calculated as described in Ref. 52 and adopting a beam
quality Q ecal of R 50⫽7.5 cm. Section X C recommends using a cross cali-
60Co
bration technique, if possible, to obtain k ecalN D,w . However, if not possible,
these values of k ecal may be used in Eq. 共6兲 along with a 60Co calibration
60Co
factor, N D,w .

Chamber k ecal
Attix 0.883
Capintec 0.921
PTB/Roos 0.901
Exradin 0.888
Holt 0.900
Markus 0.905
NACP 0.888

C. Absorbed dose at other depths in clinical photon


beams
FIG. 5. Calculated values of k ⬘R 50 at d ref as a function of R 50 for several
Clinical reference dosimetry determines the absorbed common cylindrical ion chambers. These values can be used with Eq. 共6兲
dose to water at 10 cm depth. If this is not the reference 共with a measured value of P gr
Q
and a k ecal value from Table III兲 to determine
the absorbed dose to water at the reference depth of d ref⫽0.6R 50⫺0.1 cm.
depth used for clinical dosimetry calculations, one deter-
mines the corresponding dose at the appropriate depth using
one of two methods. For SSD setups the clinical percentage
depth-dose curves are used. For SAD setups the clinical X. ELECTRON BEAM DOSIMETRY
tissue-phantom ratio 共TPR兲 curves are used unless one wants
the dose at d max. In such situations the clinical tissue- Equation 共6兲 gives the absorbed dose to water under ref-
maximum ratio 共TMR兲 curves are used. erence conditions for the same number of monitor units as

TABLE III. Values of the photon-electron conversion factor, k ecal , for commercial cylindrical chambers, calcu-
lated as described in Ref. 52 and adopting a beam quality Q ecal of R 50⫽7.5 cm.

Wall
Al electrode
Thickness Cavity radius diameter
Chamber k ecal Material g/cm2 r cav 共cm兲 共mm兲

Farmer-like
Exradin A12 0.906 C-552 0.088 0.305
NE2505/3,3A 0.903 Graphite 0.065 0.315 1.0
NE2561a 0.904 Graphite 0.090 0.370e 1.0
NE2571 0.903 Graphite 0.065 0.315 1.0
NE2577 0.903 Graphite 0.065 0.315 1.0
NE2581 0.885 A-150 0.041 0.315
Capintec PR-06C/G 0.900 C-552 0.050 0.320
PTW N23331 0.896 Graphite 0.012 0.395e 1.0
PMMA 0.048
PTW N30001b 0.897 Graphite 0.012 0.305 1.0
PMMA 0.033
PTW N30002 0.900 Graphite 0.079 0.305
PTW N30004 0.905 Graphite 0.079 0.305 1.0
PTW N31003c 0.898 Graphite 0.012 0.275 1.0f
PMMA 0.066
Other cylindrical
Exradin A1d 0.915 C-552 0.176 0.200
Capintec PR-05/PR-05P 0.916 C-552 0.210 0.200
Wellhofer IC-10/IC-5 0.904 C-552 0.070 0.300
a
The NE2611 has replaced the equivalent NE2561.
b
PTW N30001 is equivalent to the PTW N23333 it replaced.
c
PTW N31003 is equivalent to the PTW N233641 it replaced.
d
The cavity radius of the A1 here is 2 mm although in the past Exradin has designated chambers with another
radius as A1.
e
In electron beams there is only data for cavity radii up to 0.35 cm and so 0.35 cm is used rather than the real
cavity radius shown here.
f
Electrode diameter is actually 1.5 mm, but only data for 1.0 mm is available.

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1859 Almond et al.: AAPM’s TG-51 protocol 1859

FIG. 6. Calculated values of k ⬘R 50 at d ref as a function of R 50 for several FIG. 8. Calculated values of k ⬘R 50 at d ref for high-energy electron beams, as a
common plane-parallel chambers. Note that the values for the five well- function of R 50 for plane-parallel chambers. Note that the values for the five
guarded chambers lie on the same line in the figure. These values can be well-guarded chambers lie on the same line in the figure. These values can
used with Eq. 共6兲 共with P gr
Q
⫽1.0) to determine the absorbed dose to water at be used with Eq. 共6兲 共with P gr Q
⫽1.0 and a k ecal value from Table II兲 to
the reference depth of d ref⫽0.6R 50⫺0.1 cm. determine the absorbed dose to water at the reference depth of
d ref⫽0.6R 50⫺0.1 cm.

A. Reference conditions of depth, beam size, and


used to measure the charge M , at the point of measure- source-surface distance
ment of the ion chamber, in an electron beam of quality Q,
Clinical reference dosimetry for electron beams is per-
specified by R 50 , i.e.,
formed in an open beam at the reference depth which is at a
60 water-equivalent depth of17
D wQ ⫽M P gr
Q
k R⬘ k ecal N D,w
Co
共 Gy兲 .
50
d ref⫽0.6R 50⫺0.1 共 cm兲 . 共18兲
For electron beams with R 50⭐4.3 cm 共incident energies of See Sec. VI for corrections to the depth to take into account
10 MeV or less兲, well-guarded plane-parallel chambers are tank walls which may be in the path of the beam. The point
preferred and they may be used at higher energies. Plane- of measurement of the ion chamber is placed at d ref 共i.e.,
parallel chambers must be used for beams with R 50⭐2.6 cm the central axis of cylindrical chambers or the front face of
共incident energies of 6 MeV or less兲. the air cavity for plane-parallel chambers兲. For beams with
R 50⭐8.5 cm 共E ⭐20 MeV兲, the field size is ⭓10⫻10 cm2 at
the phantom surface and for higher-energy beams it is ⭓20
⫻20 cm2 .
Clinical reference dosimetry may be performed with an
SSD from 90 to 110 cm. The underlying Monte Carlo calcu-
lations of stopping-power ratios were done for SSD⫽100
cm, but changes of up to 10 cm from this SSD do not affect
the parameters used in the protocol.

B. Absorbed dose to water in clinical electron beams


In electron beams, Eq. 共6兲 is used to establish the ab-
sorbed dose to water. To use this equation one needs the
Q
values of the factors P gr , k R⬘ , and k ecal . The values of k ecal
50
for a number of ion chambers are given in Tables II and III.52
The selection of the beam quality Q ecal are arbitrary and has
been taken as R 50⫽7.5 cm for the purposes of this protocol.
Figure 5 presents calculated values for k R⬘ for cylindrical
50
ion chambers used for clinical reference dosimetry in elec-
FIG. 7. Calculated values of k ⬘R 50 at d ref for high-energy electron beams, as a tron beams with energies up to about 21 MeV and Fig. 6
function of R 50 for cylindrical ion chambers. These values can be used with presents k R⬘ values for plane-parallel chambers.52 For
Eq. 共6兲 共with a measured value of P gr Q
and a k ecal value from Table III兲 to 50
determine the absorbed dose to water at the reference depth of higher-energy electron beams, the corresponding data are
d ref⫽0.6R 50⫺0.1 cm. presented in Figs. 7 and 8. For Farmer-like cylindrical cham-

Medical Physics, Vol. 26, No. 9, September 1999


1860 Almond et al.: AAPM’s TG-51 protocol 1860

bers the following expression can be used for 2⭐R 50⭐9 cm D. Absorbed dose at d max in clinical electron beams
with a maximum error of 0.2%:52
This protocol provides the reference dose at a depth of
k R⬘ 共 cyl兲 ⫽0.9905⫹0.0710e (⫺R 50 /3.67) . 共19兲 d ref which, for higher-energy beams, will not be at d max
50
where clinical normalization most often takes place. To es-
For well-guarded plane-parallel chambers, the following ex- tablish the dose at d max one should use the clinical percent-
pression is an analytic representation of the curve shown in age depth-dose data for a given beam and determine the dose
Figs. 6 and 8, i.e., for 2⭐R 50⭐20 cm: at d max from that at d ref . Methods for measuring electron-
k R⬘ 共 pp兲 ⫽1.2239⫺0.145共 R 50兲 0.214. 共20兲 beam percentage depth-dose curves are given in TG-25.22
50
These procedures require stopping-power ratios when ion
The correction for gradient effects 共i.e., P gr
Q
) is not neces- chambers are used and in TG-25 these are presented for
sary for plane-parallel chambers and is close to unity for mono-energetic electron beams. In TG-51, stopping-power
cylindrical chambers when the reference depth is at d max , ratios for realistic electron beams have been used and these
which is usually the case for electron beams below about 10 differ from the mono-energetic stopping-power ratios. To ex-
Q
MeV. For cylindrical chambers P gr is determined as22,39 tract the dose maximum in a completely consistent manner,
the expression presented by Burns et al.17 for stopping-
M raw共 d ref⫹0.5r cav兲
Q
P gr ⫽ 共for cylindrical chambers兲, 共21兲 power ratios in realistic electron beams as a function of
M raw共 d ref兲 R 50 and depth should be used to determine the clinical
depth-dose data since they are consistent with the
where r cav is the radius of the chamber’s cavity in cm and values used here 共a FORTRAN routine is available at
M raw(d ref⫹0.5r cav)/M raw(d ref) is the ratio of the integrated http: // www.irs.inms.nrc.ca / inms / irs / papers / SPRR50 /
charges or ionization currents with the central axis of the node12.html兲. Measuring depth-dose curves for electron
chamber at d ref⫹0.5r cav and d ref . This procedure is equiva- beams also requires corrections for variations in P repl accord-
lent to making the measurement at the ‘‘effective point of ing to TG-25.22 This variation can be significant for cylindri-
measurement,’’22,39 but the present formalism is adopted to cal chambers although there is no variation for well-guarded
facilitate future utilization of primary standards of absorbed plane-parallel chambers.
Q
dose to water in electron beams. Note that P gr is less than 1
for d ref⬎(d max⫹0.5r cav). XI. USING OTHER ION CHAMBERS
This protocol provides k Q data for the vast majority of
chambers used in clinical reference dosimetry in North
C. Use of plane-parallel chambers America as evidenced by the data on ADCL calibrations.
For electron beam dosimetry this protocol allows for the However, other cylindrical chambers can be used by finding
use of plane-parallel chambers which have been calibrated in the closest matching chamber for which data are given. The
a 60Co beam. However, since the 60Co calibration factors of critical features are, in order, the wall material, the radius of
at least some plane-parallel chambers appear to be very sen- the air cavity, the presence of an aluminum electrode, and
sitive to small features of their construction,16 it is recom- the wall thickness. As long as the wall material is matched
mended that, when possible, plane-parallel chambers be cali- and the chamber is ‘‘normal,’’ these matching data should be
brated against calibrated cylindrical chambers in a high- accurate to within 0.5%. It is the responsibility of the user to
energy electron beam, as recommended in TG-213 and confirm this by comparing the results to those of a calibrated
TG-39.14 cylindrical chamber for which data are given in the protocol.
After determining the beam quality and the reference
depth in the high-energy electron beam to be used, measure- ACKNOWLEDGMENTS
ments are made, in sequence, with the point of measure- The members of the task group would like to thank the
ment of both the calibrated cylindrical chamber and the members of the RTC over the years in which this protocol
plane-parallel chamber at d ref . While measuring with the was developed for their helpful comments and suggestions
Q
cylindrical chamber, P gr is measured as described above 关see and, in particular, the 1998 members for their very helpful
60Co
Eq. 共21兲兴. From these measurements the product of k ecalN D,w reviews. We also thank Alan Nahum of the Royal Marsden
is determined for the plane-parallel chamber as Hospital in Sutton, UK, and David Burns of the BIPM in
Paris for detailed external reviews on behalf of the RTC and
60 共 D w 兲 cyl
兲 ⫽
Co pp
共 k ecal N D,w Jan Seuntjens of NRC Canada for helpful comments on
共 M k R⬘ 50兲 pp many versions of the protocol. We also wish to acknowledge
60 the contributions of Herb Attix who was involved with the
Q
共 M P gr k R⬘ k ecal N D,w
Co cyl
兲 early development of this protocol and the anonymous jour-
50
⫽ 共 Gy/C兲 . 共22兲 nal referee who provided thoughtful comments. Finally, we
共 M k R⬘ 50兲 pp
thank the members of the ADCL Subcommittee of the RTC
This product is then used in Eq. 共6兲, thereby avoiding the for their substantial efforts to put in place a system for
need for obtaining the 60Co absorbed-dose calibration factor absorbed-dose calibrations and their helpful inputs to the
for the plane-parallel chamber. protocol.

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APPENDIX: EQUIPMENT NEEDED Perroche, ‘‘A comparison of absorbed dose standards for high energy
x-rays,’’ Phys. Med. Biol. 38, 1937–1955 共1993兲.
To implement this protocol the following minimal set of 9
D. W. O. Rogers, C. K. Ross, K. R. Shortt, N. V. Klassen, and A. F.
dosimetric equipment is needed. Bielajew, ‘‘Towards a Dosimetry System Based on Absorbed-Dose Stan-
dards,’’ IAEA-SM-330/9 in Proceedings of Symposium on Measurement
共i兲 A secondary-standard ion chamber, associated elec- Assurance in Dosimetry 共IAEA, Vienna, 1994兲, pp. 565–580.
trometer 共and cables兲, all of high-quality. These are
10
K. Hohlfeld, ‘‘The standard DIN 6800: Procedures for absorbed dose
determination in radiology by the ionization method,’’ in Proceedings of
calibrated when first purchased, after repairs, when- 1987 Symposium on Dosimetry in Radiotherapy 共IAEA, Vienna, 1988兲,
ever internal checks suggest problems and at least ev- Vol. 1, pp. 13–24.
ery two years. Calibrations must be traceable to the 11
ICRU, ‘‘ICRU Report Committee Activities,’’ in ICRU News 共ICRU,
appropriate national primary standard for absorbed Bethesda, MD兲, June 20, 1990.
12
D. W. O. Rogers, ‘‘The advantages of absorbed-dose calibration factors,’’
dose to water 共Sec. V兲. For photon beams the chamber Med. Phys. 19, 1227–1239 共1992兲.
must be cylindrical 共Secs. IV and IX B兲. For electron 13
P. Andreo, ‘‘Absorbed dose beam quality factors for the dosimetry of
beams with energies of 6 MeV or less, plane-parallel high-energy photon beams,’’ Phys. Med. Biol. 37, 2189–2211 共1992兲.
14
chambers are mandatory, preferred for beams of 10 P. R. Almond, F. H. Attix, S. Goetsch, L. J. Humphries, H. Kubo, R.
Nath, and D. W. O. Rogers, ‘‘The calibration and use of plane-parallel
MeV or less and can be used for any energy 共Sec. X兲. ionization chambers for dosimetry of electron beams: An extension of the
共ii兲 Equipment to allow for two independent checks of the 1983 AAPM protocol, Report of AAPM Radiation Therapy Committee
secondary-standard ion chamber 共check sources, inde- Task Group 39,’’ Med. Phys. 21, 1251–1260 共1994兲.
15
pendent dosimetry systems, a 60Co unit, Sec. V兲. ICRU, ‘‘Stopping powers for electrons and positrons,’’ ICRU Report 37
共ICRU, Washington, DC, 1984兲.
共iii兲 A system which allows the voltage applied to the ion 16
A. Kosunen, H. Järvinen, and P. Sipilä, ‘‘Optimum calibration of NACP
chamber to be set to at least two different voltages type plane-parallel ionization chambers for absorbed dose determinations
differing by a factor of 2 or more and which allows in low energy electron beams,’’ IAEA-SM-330/cw419 in Proceedings of
for reversing the applied polarity 共Sec. VII兲. Symposium on Measuremnet Assurance in Dosimetry 共IAEA, Vienna,
1994兲, pp. 505–513.
共iv兲 If the ion chamber is not inherently waterproof, a 17
D. T. Burns, G. X. Ding, and D. W. O. Rogers, ‘‘R50 as a beam quality
PMMA waterproofing sleeve of ⬍1 mm thickness or ecifier for selecting stopping-power ratios and reference depths for elec-
other approved waterproofing methods 共Sec. V A兲. tron dosimetry,’’ Med. Phys. 23, 383–388 共1996兲.
18
共v兲 A water phantom 共dimensions at least 30 cm on each G. J. Kutcher, L. Coia, M. Gillen, W. F. Hanson, S. Leibel, R. J. Morton,
J. R. Palta, J. A. Purdy, L. Reinstein, G. K. Svensson, M. Weller, and L.
side兲 which allows for the measurement of depth-dose Wingfield, ‘‘Comprehensive QA for radiation oncology: Report of
curves 共preferably with a scanning system兲 and allows AAPM Radiation Therapy Committee Task Group 40,’’ Med. Phys. 21,
for accurate placement of the ion chamber at a speci- 581–618 共1994兲.
19
fied depth 共Sec. VI兲. C. K. Ross and K. R. Shortt, ‘‘The effect of waterproofing sleeves on
ionization chamber response,’’ Phys. Med. Biol. 37, 1403–1411 共1992兲.
共vi兲 If calibrating a beam of 10 MV or greater, a lead foil 20
W. F. Hanson and J. A. D. Tinoco, ‘‘Effects of plastic protective caps on
with area adequate to intercept the entire beam, with a the calibration of therapy beams in water,’’ Med. Phys. 12, 243–248
thickness within 20% of 1 mm 共Sec. VIII B兲. 共1985兲.
21
共vii兲 A high-quality system for measuring the local air M. T. Gillin, R. W. Kline, A. Niroomand-Rad, and D. F. Grimm, ‘‘The
effect of thickness of the waterproofing sheath on the calibration of pho-
pressure in the room where the measurements are be- ton and electron beams,’’ Med. Phys. 12, 234–236 共1985兲.
ing made 共Sec. VII C兲. 22
F. M. Khan, K. P. Doppke, K. R. Hogstrom, G. J. Kutcher, R. Nath, S. C.
共viii兲 A high-quality system for measuring the temperature Prasad, J. A. Purdy, M. Rozenfeld, and B. L. Werner, ‘‘Clinical electron-
beam dosimetry: Report of AAPM Radiation Therapy Committee Task
of the water near the ion chamber when doing refer-
Group 25,’’ Med. Phys. 18, 73–109 共1991兲.
ence dosimetry 共Sec. VII C兲. 23
F. H. Attix, Introduction to Radiological Physics and Radiation Dosime-
try 共Wiley, New York, 1986兲.
a兲 24
Electronic mail: dave@irs.phy.nrc.ca C. M. Ma, C. W. Coffey, L. A. DeWerd, C. Liu, R. Nath, S. M. Seltzer,
1
SCRAD, ‘‘Protocol for the dosimetry of x- and gamma-ray beams with and J. Seuntjens, ‘‘AAPM protocol for 40–300 kV x-ray beam dosimetry
maximum energies between 0.6 and 50 MeV,’’ Phys. Med. Biol. 16, in radiotherapy and radiobiology: Report of Task Group 61,’’ Med. Phys.
379–396 共1971兲. 共in preparation兲.
2 25
ICRU, ‘‘Radiation Dosimetry: X-Rays and Gamma-Rays with Maximum J. V. Dyk and J. C. F. MacDonald, ‘‘Penetration of high energy electrons
Photon Energies Between 0.6 and 50 MeV,’’ ICRU Report 14, ICRU, in water,’’ Phys. Med. Biol. 17, 52–65 共1972兲.
Washington D.C. 共1969兲. 26
S. C. Klevenhagen, Physics and Dosimetry of Therapy Electron Beams
3
AAPM TG-21, ‘‘A protocol for the determination of absorbed dose from 共Medical Physics Publishing, Madison, WI, 1993兲.
27
high-energy photon and electron beams,’’ Med. Phys. 10, 741–771 H. Aget and J. C. Rosenwald, ‘‘Polarity effect for various ionization
共1983兲. chambers with multiple irradiation conditions in electron beams,’’ Med.
4
AAPM TG-21, ‘‘Erratum: A protocol for the determination of absorbed Phys. 18, 67–72 共1991兲.
28
dose from high-energy photon and electron beams,’’ Med. Phys. 11, 213 R. C. Tailor, C. Chu, D. Followill, and W. F. Hanson, ‘‘Equilibration of
共1984兲. air temperature inside the thimble of a farmer-type ion chamber,’’ Med.
5
R. J. Schulz, P. R. Almond, G. Kutcher, R. Loevinger, R. Nath, D. W. O. Phys. 25, 496–502 共1998兲.
29
Rogers, N. Suntharalingham, K. A. Wright, and F. Khan, ‘‘Clarification D. W. O. Rogers and C. K. Ross, ‘‘The role of humidity and other cor-
of the AAPM Task Group 21 Protocol,’’ Med. Phys. 13, 755–759 共1986兲. rection factors in the AAPM TG-21 dosimetry protocol’’ Med. Phys. 15,
6
S. R. Domen, ‘‘A sealed water calorimeter for measuring absorbed 40–48 共1988兲.
dose,’’ J. Res. NIST 99, 121–141 共1994兲. 30
B. J. Mijnheer, ‘‘Variations in response to radiation of a nylon-walled
7
M. Boutillon, B. M. Coursey, K. Hohlfeld, B. Owen, and D. W. O. Rog- ionization chamber induced by humidity changes,’’ Med. Phys. 12, 625–
ers, ‘‘Comparison of primary water absorbed dose standards,’’ IAEA- 626 共1985兲.
31
SM-330/48 in Proceedings of Symposium on Measurement Assurance in J. W. Boag, ‘‘Ionization Chambers,’’ in The Dosimetry of Ionizing Ra-
Dosimetry 共IAEA, Vienna, 1994兲, pp. 95–111. diation, edited by K. R. Kase, B. E. Bjärngard, and F. H. Attix 共Aca-
8
K. R. Shortt, C. K. Ross, M. Schneider, K. Hohlfeld, M. Roos, and A. M. demic, New York, 1987兲, Vol II, pp. 169–244.

Medical Physics, Vol. 26, No. 9, September 1999


1870 Almond et al.: AAPM’s TG-51 protocol 1870

32 42
J. E. Burns and D. T. Burns, ‘‘Comments on ‘Ion recombination correc- A. Booth and D. W. O. Rogers, ‘‘Monte Carlo study of effects of phan-
tions for plane-parallel and thimble chambers in electron and photon ra- tom size, radial position, and depth on photon beam calibration,’’ NRC
diation,’ ’’ Phys. Med. Biol. 38, 1986–1988 共1993兲. Report PIRS–507 共NRC Canada, Ottawa, 1995兲.
33 43
K. Derikum and M. Roos, ‘‘Measurement of saturation correction factors D. W. O. Rogers, ‘‘Correcting for electron contamination at dose maxi-
of thimble-type ionization chambers in pulsed photon beams,’’ Phys. mum in photon beams,’’ Med. Phys. 26, 533–537 共1999兲.
44
Med. Biol. 38, 755–763 共1993兲. X. A. Li and D. W. O. Rogers, ‘‘Reducing electron contamination for
34
C. Zankowski and E. B. Podgorsak, ‘‘Determination of saturation charge photon-beam-quality specification,’’ Med. Phys. 21, 791–798 共1994兲.
45
and collection efficiency for ionization chambers in continuous beams,’’ D. W. O. Rogers, ‘‘Fundamentals of Dosimetry Based on Absorbed-Dose
Med. Phys. 25, 908–915 共1998兲. Standards,’’ in Teletherapy Physics, Present and Future, edited by J. R.
35
IAEA, The Use of Plane Parallel Ionization Chambers in High Energy Palta and T. R. Mackie 共AAPM, Washington, DC, 1996兲, pp. 319–356.
46
Electron and Photon Beams: An International Code of Practice for Do- A. Kosunen and D. W. O. Rogers, ‘‘Beam quality specification for photon
beam dosimetry,’’ Med. Phys. 20, 1181–1188 共1993兲.
simetry, Technical Report Series, Vol. 381 共 IAEA, Vienna, 1997兲. 47
36 G. X. Ding, D. W. O. Rogers, and T. R. Mackie, ‘‘Calculation of
J. W. Boag, E. Hochhäuser, and O. A. Balk, ‘‘The effect of free-electron
stopping-power ratios using realistic clinical electron beams,’’ Med.
collection on the recombination correction to ionization measurements of
Phys. 22, 489–501 共1995兲.
pulsed radiation,’’ Phys. Med. Biol. 41, 885–897 共1996兲. 48
M. S. Huq, N. Yue, and N. Suntharalingam, ‘‘Experimental determination
37
P. R. Almond, ‘‘Use of a Victoreen 500 electrometer to determine ion- of fluence correction factors at depths beyond d max for a farmer type
ization chamber collection efficiencies,’’ Med. Phys. 8, 901–904 共1981兲. cylindrical ionization chamber in clinical electron beams,’’ Med. Phys.
38
M. S. Weinhous and J. A. Meli, ‘‘Determining P ion , the correction factor 24, 1609–1613 共1997兲.
for recombination losses in an ionization chamber,’’ Med. Phys. 11, 846– 49
G. Rikner, ‘‘Characteristics of a p-Si detector in high energy electron
849 共1984兲. fields,’’ Acta Radiol.: Oncol. 24, 71–74 共1985兲.
39
IAEA, Absorbed Dose Determination in Photon and Electron Beams; An 50
K. Derikum and M. Roos, ‘‘Determination of radiation quality parameters
International Code of Practice, Technical Report Series, Vol. 277 共IAEA, for high energy photons and electrons using different types of detectors,’’
Vienna, 1987兲. IAEA-SM-330/46, in Proceedings of Symposium on Measurement Assur-
40
F. M. Khan, ‘‘Replacement correction ( P repl) for ion chamber dosime- ance in Dosimetry 共IAEA, Vienna, 1994兲, pp. 323–331.
try,’’ Med. Phys. 18, 1244–1246 共1991兲. 51
D. W. O. Rogers and C. L. Yang, ‘‘Corrected relationship between
41
A. Nisbet and D. I. Thwaites, ‘‘Polarity and ion recombination correction %dd(10) x and stopping-power ratios,’’ Med. Phys. 26, 538–540 共1999兲.
52
factors for ionization chambers employed in electron beam dosimetry,’’ D. W. O. Rogers, ‘‘A new approach to electron beam reference dosime-
Phys. Med. Biol. 43, 435–443 共1998兲. try,’’ Med. Phys. 25, 310–320 共1998兲.

Medical Physics, Vol. 26, No. 9, September 1999