The local enhancement of radiation dose from photons of MeV energies obtained by introducing materials of high atomic number into the treatment region.

With the advent of therapeutic radiation treatment machines with photon end point energies of several MeV, a new channel is available to transfer the photon energy to biological material, namely, pair production. This process has a photon threshold energy of 1.02 MeV. The probability of pair production, which depends on the square of the atomic number (Z) of the interacting material, increases markedly as the photon energy is further increased. As the goal of treatment planning in radiation therapy is to locally maximize the absorbed dose in abnormal cells and minimize the dose in surrounding normal cells, in this study the authors measured the dose enhancement which could be expected if a high-Z material such as gold was present adjacent to tumor sites during irradiation. The authors used photon beams produced by electron accelerators with energies ranging from 6 to 25 MV. They chose either gold or lead foils as high-Z materials, the measurements being repeated using the same geometry but replacing the high-Z materials with a low-Z material (aluminum). The comparison of the experimental results using low- and high-Z materials verified the theoretical prediction of the expected dose enhancement. The effect of finite range of the electron-positron pairs was also studied by varying the spacing between two foils placed parallel or orthogonal to the incident photon beam. Using an 18 MV photon beam, the authors observed a maximum dose enhancement of 44%. They intend therefore to proceed from these phantom studies to animal measurements.