Kilovoltage x-ray dosimetry--an experimental comparison between different dosimetry protocols.

Kilovoltage dosimetry protocols by the IAEA (TRS-277 and TRS-398), DIN (6809), IPEMB (with addendum), AAPM (TG-61) and NCS (report 10) were compared experimentally in four clinical beams. The beams had acceleration potentials of 30, 80, 120 and 200 kV, with half-value layers ranging from 0.6 mm Al to 1 mm Cu. Dosimetric measurements were performed and data were collected under reference conditions as stipulated within each separate protocol under investigation. The Monte Carlo method was used to derive backscatter factors for the actual x-ray machine. In general, the agreement of the dosimetric data at the surface of a full-scatter water phantom obtained using the guidelines of the various protocols was fairly good, i.e. within 1-2%. However, the in-air calibration method using the IPEMB and AAPM TG-61 protocols yielded an absorbed dose about 7% lower than the IAEA TRS-398 protocol in the 120 kV beam. By replacing the backscatter factors given in the protocols with Monte Carlo calculated backscatter factors, the convergence between the protocols improved (within 4%). The internal consistency obtained for protocols supporting more than one geometry for dosimetry under reference conditions was better than 0.2% for the DIN protocol (120 kV beam), 2-3% for the AAPM TG-61 (120 and 200 kV beams) and about 2% for the IPEMB protocol (200 kV beam). The present study shows that the current-supported dosimetry protocols in the kilovoltage range were in fairly good agreement, and there were only a few exceptions of clinical significance.