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Investigating the Differences in Out-Of-Field Dose Between An Inherently Uniform Beam and a Flattening Filter Free Beam Made Uniform Through Inverse Modulation

J Gray

J Gray*, E Ekwelundu , W Yao , J Farr , St. Jude Children's Research Hospital, Memphis, TN


SU-E-T-218 Sunday 3:00PM - 6:00PM Room: Exhibit Hall

Purpose: To characterize with physical measurements the out-of-field dose for flattening filter free (FFF) and IMRT flattened FFF photon beams less than 10 MV from a Siemens Artiste LINAC, field size dependence, thereof, and comparison with the Pinnacle planning system calculation.

Methods: Single field plans were developed for 5x5cm^2 and 20x20cm^2 field sizes for 6MV and 7MV-FFF. An additional 7MV-FFF plan was developed for each field size with the purpose of delivering a uniform dose (7MV-FFF-Uniform), similar to 6MV, utilizing inverse modulation. The calculated and measured dose was normalized to achieve equivalence at 10cm depth in water. Out-of-field dose measurements were acquired with a farmer-type ionization chamber in solid water at incremental distances up to 90cm from the field edge at physical depths of 1.5cm and 5.0cm. The dose contribution from head leakage was determined by closing the jaws symmetrically and the MLC off-axis

Results: Data collected show that the out-of-field dose for 6MV is generally greater than 7MV-FFF and 7MV-FFF-Uniform. The 7MV-FFF-Uniform dose is less than 7MV-FFF for the small field size, but similar for the larger field and may be attributed to the small IMRT segments of the 5x5 field developing narrow beam geometry with reduced scatter. The out-of-field dose from 7MV-FFF-Uniform for the 20x20 field was greater than 6MV and 7MV-FFF beyond 50cm from the field edge. Head leakage from the 7MV-FFF-Uniform segmental MU modulation was greater than the un-modulated beams. The calculated out-of-field dose was consistently -200% different than measured for a subset of points considered.

Conclusion: The modulation required to deliver a uniform large field dose with 7MV-FFF will increase the peripheral dose to the patient in comparison to already physically flattened fields; however, the dose near the field edge will be reduced. If reliable out-of-field doses are needed physical measurements should be used.

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