Part I: Out-of-field dose mapping for 6X and 6X-Flattening-Filter-Free beams on the TrueBeam for extended distances.

PurposeWith increasing cancer treatment success rates, many patients go on to live long, productive lives following recovery. Therefore, minimizing potential side effects due to dose outside the treated field is becoming a significant consideration in radiation therapy. With many potential treatment configurations available, it is important to quantify how out-of-field dose varies with common variables such as distance from isocenter, couch angle, jaw size, and flattening-filter setting. The accurate quantification of out-of-field dose at extended distances could also benefit researchers and detector developers. While data exist for out-of-field dose from older linear accelerator (Linac) models, the phenomenon has not been described for the latest generation of machines, such as the Varian TrueBeam. The purpose of this study was to comprehensively quantify out-of-field dose for the Varian TrueBeam Linac low energy photons in a wide range of positions and treatment geometries. Method and MaterialsOut-of-field doses were measured using two phantom setups: (a) A large volume ion chamber with a buildup sleeve to quantify head leakage and collimator scatter background dose; and (b) A farmer ion chamber in solid water to incorporate phantom scatter in addition to collimator scatter, and head leakage background dose. In both cases, the ion chamber was positioned with its length along the slowly varying transverse direction (perpendicular to the radial from isocenter). Doses were measured for four symmetric jaw settings (2x2cm(2), 4x4cm(2), 10x10cm(2), and 20x20cm(2)) for a range of distances from the isocenter (0-100cm). The angular dependence of the out-of-field dose was measured using four different angles: 0 degrees, 45 degrees, 90 degrees, and 135 degrees with respect to the in-plane direction. All measurements were performed for both 6X and 6X-flattening-filter-free (FFF) beams. ResultsThe lowest out-of-field doses were observed at 60cm away from isocenter in both in-plane and cross-plane directions for fields smaller than 10x10cm(2). Out-of-field dose decreased with decreasing jaw size (a factor of 4.7 for 6X-FFF and a factor of 3.1 for 6X going from 20x20cm(2) to 2x2cm(2) at 60cm from isocenter in the in-plane direction). The 6X-FFF beam produced out-of-field doses as low as 64% of the 6X beam. ConclusionThis study presents a comprehensive description of 6X and 6X-FFF out-of-field doses on a Varian TrueBeam Linac including measurements at a range of positions, angles, and jaw settings and with and without phantom scatter.