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Purpose: Certain dosimetric characteristics continue to make proton beam therapy an appealing modality for cancer treatment. The proton Bragg peak allows for conformal radiation dose delivery to the target while reducing dose to normal tissue and organs. As field sizes become very small the benefit of the Bragg peak is diminished due to loss of transverse equilibrium along the central beam axis. Furthermore, aperture scattering contributes additional dose along the central axis. These factors warrant the need for accurate small field dosimetry. In this study small field dosimetry was performed using two different methods. Methods: Small field dosimetry measurements were performed using a PTW microdiamond detector and Gafchromic EBT2 film for aperture sizes ranging from 0.5cm to 10cm and a proton range in water of 10cm to 27cm. The measurements were analyzed and then compared to each other and to reference dosimetry data acquired with a Markus chamber. Results: A decrease in normalized output is observed at small field sizes and at larger ranges in water using both measurement methods. Also, a large variation is observed between the output measurements by microdiamond and film at very small field sizes. At the smallest aperture, normalized output ranged from 0.16 to 0.72 and the percent difference between both measurement methods ranged from 36% to 70% depending on proton range. At field sizes above 5cm the film and microdiamond agree within 3%. Conclusion: Although both measurement methods exhibit a general decrease in output factor at small field sizes, dosimetric measurements for small fields using these two methods can vary significantly. Dosimetry under standard conditions is not sufficient to correctly model the dose distributions and outputs factors for small field sizes, additional small field measurements should be performed.

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