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Comparison of Percent Depth Doses for Various Linear

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Article · January 2005

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Krzysztof Ślosarek Agata Rembielak

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Pol J Med Phys Eng 2005;11(1):39-50.
PL ISSN 1425-4689

1 1, 2
Krzysztof Ślosarek , Agata Rembielak

Comparison of Percent Depth Doses for Various

Linear Accelerators

1
Treatment Planning Unit, Centre of Oncology–Institute,
Gliwice Branch, Poland
2
Radiotherapy Department, Toronto – Sunnybrook Regional Cancer Center,
Toronto, Canada
e-mail: slosarek@io.gliwice.pl

Purpose: The aim of this study was to present the method of comparing Percent Depth Dose
values (PDDs) for various electron energy beams produced by a linear accelerator in one mode of
obtaining an electron beam as well as for electron beams generated in different modes.
Materials and Methods: Four linear accelerators: Neptun 10p, Saturne II+, Philips SL20, Clinac
2300 C/D were employed. Normalization procedures were established as an appropriate method of
comparing several PDD obtained in each accelerator.
Results and Conclusion: The normalization procedure when the dose is normalized to the depth
selected by a physicist makes it possible to compare dose distributions for various energies obtained
in linear accelerators both in the scattering and scanning modes. It is a convenient way to compare
dose distributions as permits checking and controlling of the beam energy generated by a linear
accelerator (during routine measurements).
Key words: Percent Depth Dose (PDD), linear accelerator, electron mode, dose normalization.

Introduction
Linear accelerators have become standard treatment machines in radiotherapy centres.
They may produce either X-rays, electron beams or both, depending on a model. In
medical accelerators, the electrons are ejected with an initial energy of about 50 keV into
the accelerator structure and accelerated by electromagnetic waves in the range of
40 Krzysztof Ślosarek et al.

microwave frequencies. The high-energy electrons that exit the accelerator structure are
in a form of a pencil beam of about 2 to 3 mm in diameter. In a beam subsystem for
X-rays, electrons pass through an X-ray target and a flattening filter to make X-rays beam
intensity uniform across the irradiated field. The direct electron irradiation is possible by
removing the X-ray target and the flattening filter from the electrons' path. The electron
beam is narrow so it must be broaden by an electron scattering-foil (so called scattering
electron mode). The choice of material for the scatterers and their location affect both
the flatness and the energy of the beam. The alternative method used in some medical
accelerators is a scanning electron beam across the patient's skin (which employs
various magnetic fields) to reduce energy degradation and bremsstralung, appearing
when a scattering-foil is used (so called scanning electron mode). The way of generating
the electron beam influences its energy spectrum.
Electrons lose energy as they travel in a medium until their energy is reduced to
essentially “zero”, it means that they have a specific maximum depth of penetration,
depending on their energy spectrum and the medium. The absorbed dose delivered at a
particular point in an irradiated area is referred to as a depth dose. The ratio of the depth
dose to the dose at a reference depth (usually the depth of the maximum dose) along the
central axis, is referred to as the central axis Depth Dose (DD) and when multiplied by
100% — as the central axis Percent Depth Dose (PDD) [1].
The measured PDD for the same medium depends on both energy and energy
spectrum. To present a PDD diagram for electron beams several terms are used, for
example: d100 as a build-up depth, d90 as the 90% maximum dose depth, and dmax as the
maximum range of electrons in a medium (phantom). The depth values on the X-axis
are different and depend on beam energy, so a direct comparative analysis of various
energies produced by a linear accelerator is difficult [2]. The comparison is even more
complicated when accelerators generate electron beams using different electron modes.
It is known that for low energies the dose decrease is bigger than for higher energies as a
relation to the depth. For the same energies it depends also on the field size.
The aim of this study was to present a method of comparing PDDs for various
electron energy beams produced by a linear accelerator in a selected electron mode as
well as for electron beams generated in different modes.
Comparison of Doses… 41

Materials
Dosimetric data obtained in the following linear accelerators were utilized in this paper:
– Neptun 10p (ZDAJ, Poland)
– Saturne II+ (GE, France)
– Philips SL20 (Philips, The Netherlands)
– Clinac 2300 C/D (Varian, USA)
Although construction of the above-mentioned machines differ considerably, the
principles of operation are the same (see Table 1).

A scattering-foil system is used in three linear accelerators: Neptun 10p, Philips

SL20 [3] and Clinac 2300. In Saturne II+ the electron beam field is accomplished by
electromagnetic scanning of the electron pencil beam over the irradiated area [4].
The measuring equipment consisted of a water phantom, radiation dosimeters and a
computer program [5, 6]. Semiconductors and a Therados program were used in
measurements with Neptune 10p and Saturne II+ and ionization chambers controlled
by a Mephisto PTW Freiburg computer program were employed in measurements with
Philips SL20 and Clinac 2300 C/D [7, 8, 9].

Table 1. Selected physical parameters of electron linear accelerators.

Clinac 2300
Neptun 10p Saturne II+ Philips SL20
C/D

SAD [cm] 100 100 100 100

Electron beam scattered scanned scattered scattered

Collimator variable variable constant constant

Max. electron energy

10 25 20 22
[MeV]

Energy 6, 9, 12, 15, 4, 6, 8, 10, 6, 9, 12, 15,

6, 8, 10
[MeV] 21, 25 12, 15, 18, 20 18, 22

6 × 6, 6 × 6,
Field size min. 3 × 3, min. 3 × 3, 10 × 10, 10 × 10,
[cm × cm] max. 35 × 35 max. 35 × 35 14 × 14, 15 × 15,
20 × 20 20 × 20
42 Krzysztof Ślosarek et al.

Methods and Results

The first step of the study was to introduce a normalization procedure, the second step
was to determine if normalization is an appropriate method of comparing PDD for
various accelerators.

The same accelerator and the same field size but various
electron energies
Figure 1 shows the central axis depth dose for several electron energies achieved in
Philips SL20. These doses are expressed as a percentage of the maximum dose on the
beam axis. The shapes of the depth-dose curves and dose distributions depend on a
specific linac as well as on the beam energy and field size. For a given machine the depth
of the maximum dose changes with beam energy and field size. As the energy increases,
the maximum dose depth also increases.
To compare depth dose curves obtained with one accelerator but for various
energies or field sizes as well as for the same field size and energy but obtained in
different accelerators a normalization procedure is introduced. The normalization depth

Figure 1. PDD plotted as a function of depth in water for Philips SL20 for various energies;
field size 10 × 10 cm.
Comparison of Doses… 43

(Nd) is chosen to be 50% of the maximum dose for each energy at the same depth (1,0)
according to the formula:
d
Nd =
d 50
where:
d is the depth for a specified depth dose, and
d50 is the depth of the 50% of maximum dose

The normalization dose (ND) is defined as the ratio of the dose at a specified depth to
the dose in the build-up region:
D
ND =
Dbuild − up
where:
D is the dose at the specified depth;
Dbuild-up is the dose in the build-up region.
The result of depth normalization procedures performed — by way of example — for
electron energies of 4 MeV and 20 MeV are presented in Table 2.

Table 2. PDD as a function of depth and normalization depth for energy 4 MeV and 20 MeV,
Philips SL20, field size 10 × 10 cm, SSD = 100 cm.

Depth 4 MeV Normalization 20 MeV Depth

[cm] Depth Dose Depth Depth Dose [cm]

0.20 0.85 0.10 0.99 0.80

0.50 0.96 0.30 1.00 2.30

0.80 1.00 0.50 0.99 3.80

1.10 0.96 0.70 0.93 5.30

1.50 0.66 0.90 0.69 6.80

1.55 0.50 1.00 0.50 7.60

1.80 0.32 1.10 0.33 8.30

2.10 0.11 1.30 0.09 9.90

2.30 0.05 1.40 0.05 10.60

2.60 0.01 1.60 0.01 12.10

44 Krzysztof Ślosarek et al.

Figure 2. Normalization doses as a function of normalization depth for Philips SL20.

Figure 2 shows data presented in Figure 1 after normalization. The normalization

dose is plotted as a function of the normalization depth for 5 different energies produced
by the linear accelerator Philips SL20.
However the differences among the energies analyzed are significant for the
normalization depth lower than Dmax, normalization dose decrease (gradient) being
independent of energy.

The same accelerator and the same energy but various field sizes
The following figures (Fig. 3 and Fig. 4) represent the normalization dose as a function
of the normalization depth for the same accelerator (Philips SL20 and Saturne II+,
respectively) but various square field sizes.
The differences of the normalization doses obtained for various field sizes but for the
same accelerator and energy do not exceed the measuring error. It means that PDD
presentation, as a function of the normalization depth is an appropriate method of
comparing PDD for various energies and field sizes, but for the same linear accelerator.
However both accelerators, Philips SL20 and Saturne II+, are equipped with a different
electron beams mode. So the next step is to analyze the differences in PDD for two
accelerators, both using a scattering achieving mode as well as for two accelerators
Comparison of Doses… 45

Figure 3. Normalization doses as a function of normalization depth in water for Philips

SL20 for various field sizes but the same energy. Measuring error 3%.

Figure 4. Normalization doses as a function of normalization depth in water for Saturne II+
for various field sizes but the same energy. Measuring error 3%.

producing electron beam, one with a scanning mode, and the other with a scattering foil,
but for the same electron energy and field size.
46 Krzysztof Ślosarek et al.

Two linear accelerators using a scattering-foil, the same energy and the
same field size
Both Philips SL20 and Clinac 2300C/D accomplish electron beam broadening with the
use of a scattering-foil. The differences in the normalization dose as a function of the
normalization depth do not exceed the measuring error (Fig. 5).

Figure 5. Normalization doses as a function of normalization depth in water for two linear
accelerators using scattering-foil.

Two linear accelerators with a different electron achieving mode, the

same energy and the same field size
In Saturne II+ electron beam is obtained by scanning across the irradiated field, in
Clinac 2300C/D scattered with a scattering-foil. The diagram of the normalization dose
taken for both accelerators is presented in Fig. 6.
As shown in Fig. 6 the measured relative error for a scattered beam and a scanned
beam exceeds the measuring error. The difference is more significant at a smaller
normalization depth.
Comparison of Doses… 47

Figure 6. Normalization doses as a function of normalization depth in water for linear

accelerator using scattering-foil and scanning beam.

Figure 7 shows the normalization dose as a function of the normalization depth for
all four linear accelerators under discussion. A bigger the decrease in the normalization
dose was found for the scanning electron beam over the irradiated area (Saturne II+).
Discussion
The goal of treatment planning is to produce an appropriate isodose plan for the
irradiated area. This plan is usually calculated with the use of treatment planning
computers from the data obtained by the physicist.
The percentage Depth Dose (PDD) is a well known notion used in radiotherapy.
Normalization involves the selection of one of the values, the so called basic value, and
then after normalization all other values are presented as percent of the basic value. The
comparison of normalized PDDs is easier than the comparison of absolute values.
In the clinical practice, various electron linear accelerators are used. They differ in
beam energy, construction, e.g. in electron achieving modes. Thus PDD diagrams
obtained for medium irradiation differ, depending on the type of the medium, electron
beam energy spectrum, and the field size. The comparison of various PDDs is possible
due to the dose normalization procedure. In this paper, the dose is normalized to a 50%
isodose line, this means that 50% of the maximum dose rate (d50) is at the same depth for
48 Krzysztof Ślosarek et al.

Figure 7. Normalization doses as a function of normalization depth in water for all utilized
linear accelerators. Measuring error 3%.

all the energies analyzed. (d50) is being precisely defined for each energy and irradiated
field size. Another value, for example the maximum range (dmax) could also be taken into
consideration, however it is not so precise as (d50). The normalization makes PDD
independent of beam energy.
To check if normalization is an appropriate method for PDD comparison the authors
have compared normalized PDDs for various electron energies but the same field size as
well as for various fields' sizes but the same energy for the same electron achieving
mode. In both cases, PDD diagrams plotted after normalization do not exceed the
measuring error, thus dose normalization is an appropriate method of comparing PDDs
for various energies and field sizes but for the same accelerator. Normalized PDDs for
different achieving modes were also analyzed; however in this case the measuring error
exceeded 3%.
The data indicate that there is no difference in PDDs obtained in accelerators
(Neptun 10p, Philips SL20 and Clinac 2300C/D) which enlarge the electron beam with
the use of a scattering-foil (the same electron scattering mode). However the differences
in PDDs are significant for accelerators using scattered and scanned beams. The gradient
of the dose decrease with depth is higher for accelerators with a scanning mode than for
Comparison of Doses… 49

accelerators with a scattered mode, and it is related to a lower brehmsstralung on the

scattering-foil. Larger differences for lower energies confirm this conclusion. Thus in
clinical practice there is a need for dose calculations whenever irradiation of the patient
follows the same treatment plan but a different accelerator.
Except for comparing of dose distributions for various combinations of energy, field
size and accelerator, the normalization procedure is convenient way as a part of
accelerator check-up [10]. Changing of energy or energetic spectrum in accelerator
could cause each change in PDD shape. Those parameters are very important for
planning, because they constitute the base for computer calculations. They must be
verified routinely. Dose normalization enables in easy and fast way checking the
accelerator standard parameters loaded into treatment planning systems.
Summarizing, the normalization procedure when dose is normalized to the depth
selected by physicist gives us advantages as follows:
– it provides the possibility of comparing the dose distributions for various energies
achieved in linear accelerators both in scattering and scanning mode
– it is convenient way of comparison for dose distributions
– it enables to check and control beam energy generated by linear accelerator (during
routine measurements)

Conclusions
Based on the presented study in linear accelerator based radiotherapy the following can
be concluded:
1. Dose normalization procedure allows comparing the depth dose for various field
sizes and electron beam energies as well as for different electron achieving modes and it
is a convenient tool for medical physicist.
2. Depth dose characteristic depends on electron achieving mode. Higher decrease of
normalization dose is for accelerators scanning electron beam over the irradiated area.

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