Variations in 6MV x-ray radiotherapy build-up dose with treatment distance

Dose in the build up region for high energy x-rays produced by a medical linear accelerator is affected by the x-ray source to patient surface distance (SSD). The use of isocentric treatments whereby the tumour is positions 100 cm from the source means that depending of the depth of the tumour and the size of the patient, the SSD can vary from distances of 80 cm to 100 cm. To achieve larger field sizes, the SSD can also be extended out to 120 cm at times. Results have shown that open fields are not significantly affected by SSD changes with deviations in percentage dose being less than 4% of maximum dose for SSD's from 80 cm to 120 cm SSD. With the introduction of beam modifying devices such as Perspex blocking trays, the effects are significant with a deviation of up to 22% measured at 6MV energy with a 6 mm Perspex tray for SSD's from 80 cm to 120 cm. These variations are largest at the skin surface and reduce with depth. The use of a multi leaf collimator for blocking removes extra skin dose caused by the Perspex block trays with decreasing SSD.