Assessing the deviation from the inverse square law for orthovoltage beams with closed-ended applicators

In this report, we quantify the divergence from the inverse square law (ISL) of the beam output as a function of distance (standoff) from closed-ended applicators for a modern clinical orthovoltage unit. The divergence is clinically significant exceeding 3% at a 1.2 cm distance for 4 × 4 and 10 × 10 cm2 closed-ended applicators. For all investigated cases, the measured dose falloff is more rapid than that predicted by the ISL and, therefore, causes a systematic underdose when using the ISL for dose calculations at extended SSD. The observed divergence from the ISL in closed-ended applicators can be explained by the end-plate scattering contribution not accounted for in the ISL calculation. The standoff measurements were also compared to the predictions from a home-built kV dose computation algorithm, kVDoseCalc. The kVDoseCalc computation predicted a more rapid falloff with distance than observed experimentally. The computation and measurements agree to within 1.1% for standoff distances of 3 cm or less for 4 × 4 cm2 and 10 × 10 cm2 field sizes. The overall agreement is within 2.3% for all field sizes and standoff distances measured. No significant deviation from the ISL was observed for open-ended applicators for standoff distances up to 10 cm.