This topical review provides an up-to-date overview of the theoretical and practical aspects of therapeutic kilovoltage x-ray beam dosimetry. Kilovoltage x-ray beams have the property that the maximum dose occurs very close to the surface and thus, they are predominantly used in the treatment of skin cancers but also have applications for the treatment of other cancers. In addition, kilovoltage x-ray beams are used in intra operative units, within animal irradiators and in on-board imagers on linear accelerators and kilovoltage dosimetry is important in these applications as well. This review covers both reference and relative dosimetry of kilovoltage x-ray beams and provides recommendations for clinical measurements based on the literature to date. In particular, practical aspects for the selection of dosimeter and phantom material are reviewed to provide suitable advice for medical physicists. An overview is also presented of dosimeters other than ionization chambers which can be used for both relative and in vivo dosimetry. Finally, issues related to the treatment planning and the use of Monte Carlo codes for solving radiation transport problems in kilovoltage x-ray beams are presented.

In this work, the authors have evaluated ten different ionization chambers for the relative dosimetry of kilovoltage x-ray beams in the energy range of 50-280 kVp. Percentage depth doses in water and relative detector response (in Solid Water and in air) were measured for each of the x-ray beams studied using a number of chambers. Measured depth dose data were compared with Monte Carlo calculated depth doses using the EGSnrc Monte Carlo package and the BEAMnrc user code. The accuracy of the phase space files generated by BEAMnrc was verified by calculating the half-value layer and comparing with the measured half-value layer of each x-ray beam. The results indicate that the Advanced Markus, Markus, NACP, and Roos parallel plate ionization chambers were suitable for the measurement of depth dose data in this beam quality range with an uncertainty of less than 3%, including in the regions close to the water surface. While the relative detector response of the Farmer and scanning thimble chambers exhibited a better energy response, they were not suitable for depth dose measurements in the first 5 mm below the water surface with differences of up to 12% in the surface dose measurement for the 50 kVp x-ray beam. These differences were due to dose artifacts generated by the chamber size and the dose gradient. However, at depths greater than 5 mm, the Farmer and thimble scanning chambers gave uncertainties of less than 3% for the depth dose measurements for all beam energies. The PTW PinPoint 31006 chamber was found to give varying dose differences of up to 8% depending on the x-ray beam energy; this was attributed to the steel central electrode. The authors recommend that one of the parallel plate ionization chambers investigated be used to determine depth dose data for kilovoltage x-ray beams in the energy range studied and give correct dose information close to the surface and at depth in the water phantom.

Solid phantoms are widely used in radiation therapy for both relative and reference dosimetry. Two water equivalent phantoms, RMI-457 Solid Water and Plastic Water, were evaluated for use in kilovoltage x-ray dosimetry in the energy range from 75 to 300 kVp. Relative and reference dosimetry measurements were performed in the solid phantoms and compared with water. The results indicate that RMI-457 Solid Water could be used for output factor determination for all energies tested and the measurement of percentage depth doses for the 300 kVp x-ray beam, with data agreeing to within 1%, compared to the same measurements in water. For the same criteria, Plastic Water could only be used for output factor determination of the 300 kVp x-ray beam. The superior agreement of the calculated mass-energy absorption coefficients for Solid Water and water, as compared to Plastic Water and water was consistent with the experimental results. Reference dosimetry is not recommended with the solid phantoms for the energies studied due to the lack of published correction factors. It is recommended that any solid phantom be tested by comparison with water in the same manner before being used for the dosimetry of kilovoltage x-ray beams.