Surface dose in intracavitary orthovoltage radiotherapy

Radiotherapy with orthovoltage techniques is often the prime treatment for localized superficial malignancies. Surface doses and depth doses measured with cylindrical and end-window Farmer chambers are presented for various orthovoltage x-ray beams in the range from 80 to 300 kVp, both for open beams and beams collimated with commercial intracavitary leaded-glass cones. For radiation fields collimated by a diaphragm positioned at a distance from the patient surface (open beams) there is a small skin-sparing effect. On the other hand, the surface doses with commercial leaded-glass intracavitary cones can exhibit a fivefold increase compared to the open-beam dose maxima. Beyond a depth of approximately 0.2 mm in a tissue-equivalent phantom, the doses measured for open beams and beams collimated with intracavitary cones are essentially identical. The increase in the surface dose observed with intracavitary cones is attributed to photoelectrons and recoil electrons produced in the cones. The high surface doses are measured by thin-wall parallel-plate ionization chambers but cannot be measured with cylindrical Farmer chambers since these chambers have wall thicknesses too large for the transmission of electrons produced in the cone. Since cylindrical Farmer chambers are typically used for calibration of radiation output, the high surface doses produced by the intracavitary cones may be overlooked; they can, however, be reduced to open-beam values by simple modifications to the cones.