Verification of surface dose on patients undergoing low to medium energy X-ray therapy

About 5% of patients still undergo cancer treatment with superficial (peak energy < or = 120 kVp) X-ray radiation. Dosimetry of these beams is difficult since the maximum dose is delivered at the surface and backscatter contributes significantly to the dose. This is particularly a problem in the difficult geometries encountered in superficial treatments in the head and neck area. It has recently been shown that surface dose measurements in mega-voltage X-ray beams can be performed using TLD (Thermoluminescence Dosimetry) extrapolation. In this technique, LiF TLD chips with a surface area of 3.15 x 3.15 cm2 and three different thicknesses (0.230, 0.099, and 0.038 g/cm2) are used together in the same radiation beam which allows the extrapolation of the measured dose back to the true surface. The energy response curve of the three thicknesses of LiF chips was measured for the energy range of 60kVp, HVL 1.6 mm Al to 300kVp, 4 mm Cu. LiF was found to over respond by a factor of 1.7 at 60kVp HVL 1.6 mm Al with respect to a 6MV photon beam. A feasibility study was carried out on three patients undergoing treatment at 120kVp. Because of the small field sizes involved it was necessary to limit irradiation to one or two chips at a time. The dose fall off in the first millimetre of tissue could be clearly detected. TLD extrapolation, in low to medium energy beams, was found to be useful to assess the dose of patients undergoing treatment for superficial lesions.