Discussion 4

Explain the difference between TMR, TPR, TAR, and PDD geometries. What does
your site use for MU calculations and why?

Each of these methods are used to obtain absorbed dose within a patient as depth
changes. PDD depends on SSD. This makes it useful for SSD technique/treatments and
calculations and useless for isocentric/SAD treatments and calculations. The other
methods (TMR, TPR, TAR) do not depend on SSD and are therefore used for isocentric
techniques. TMR, TPR, TAR account for change in dose depending on field size, energy
and depth. All of these methods are used as modifying factors within MU calculations.
TAR is not used as often as the others.

PDD is the percent of absorbed dose at any depth to that of the dose of the
reference depth on the CAX.1 Essentially it determines how much dose can be delivered
to a depth relative to dmax.1 It depends on energy, field size, SSD, medium, and depth.1
The minimum SSD recommended is 80cm.1

TAR is the ratio of dose at a given point within the phantom to the dose in free
space at the same point.1 The distance from the source does not affect TAR.

TPR is the ratio of dose rate at a given depth in the phantom to the dose rate at the
same source distance but at a reference depth.1

TMR is just like TPR except dmax is the reference depth in this case.
TMR is the ratio of dose rate at a given depth in the phantom to the dose rate at the same
source distance but at a reference depth of dmax.1

The ratios are below:

PDD: dose at depth/dose at dmax

TMR: dose at depth/dose at dmax
TPR: dose at point B/dose at point A
TAR: dose at A/dose at Bfree space (BSF is TAR with dose at A being dmax)

At my clinical site we use TPR and PDD for MU calculations. The machines are
calibrated at 100SSD plus dmax. (See below). They are calibrated per AAPM Task
Group 51 protocol. Our data books are accessible online with MU calc examples for our
machines and data tables. We use these methods because there is no standard
measurement for isocenter, other than the physical location that varies between patients.

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 Here are also examples of calculation formulas using PDD and TPR:

Reference

Gibbons, J. Khan’s the Physics of Radiation Therapy. Wolter Kluwer. 2020.

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