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Radiation dose to organs outside the radiotherapy treatment field can be significant and therefore is of clinical interest. We have made measurements of dose at distances up to 70 cm from the central axes of 5 X 5, 15 X 15 and 25 X 25 cm radiation fields of 300 kVp, 4 MV and 8 MV X rays, and 60Co gamma rays, at the surface and at depths in water of 5 and 10 cm. Contributions to the total secondary radiation dose from water scatter, machine (collimator) scatter and leakage radiation have been separated. We have found that the component of dose from water scatter can be described by a simple exponential function of distance from the central axis of the radiation field for all energies and field sizes. Machine scatter contributes 20 to 40% of the total secondary dose depending on machine, field size and distance from the field. Leakage radiation contributes very little dose, but becomes the dominant component at distances beyond 60 cm from the central axis. Estimates of the risk of second tumors in long term survivors indicate a small incremental increase above the natural incidence rate based on information from the 1980 BEIR Committee report.

A "gradient correction factor" and an "electron fluence correction factor" are used in the AAPM Task Group 21 dosimetry protocol, the product of the two being the "replacement correction factor." The separation of two physical processes, implied by the concepts, is theoretically unfounded. The proof of this statement rests on Fano's theorem, the conditions for which constitute a case without variations in fluence or its directional and energy distributions. Deviations from these conditions represent gradients in the radiation field, affect the response of a measurement cavity, and do so by perturbing the fluence of electrons that deposit energy in the cavity. Thus, in beams of both electrons and photons, corrections are required when fluence variations exist in the vicinity of the cavity. The rationale for an electron fluence correction based on "in-scattering" and "obliquity" is weak, since the effects only occur when gradients are present. The choice of values for the two correction factors at the depth of maximum dose are particularly inconsistent with the actual characteristics of the radiation field.

A 300 kVp orthovoltage therapy machine has been installed in an operating room for intraoperative radiation therapy (IORT). A description is presented of the physical aspects of the treatment system including applicator design, radiation field data, dosimetry, and radiation shielding of the operating room.

Traditionally, measurements have been made in heterogeneous phantoms to determine the factors which should be applied to dose calculations, when calculating a dose to a heterogeneous medium. Almost all measurements have relied on relatively thin-walled ion chambers, with no attempt to match ion chamber wall material to the measuring medium. The recent AAPM dosimetry protocol has established that a mismatch between ion chamber wall and phantom material can have an effect on dose measurement. To investigate the affect of this mismatch of ion chamber wall material to phantom material, two parallel-plate ion chambers were constructed. One ion chamber from solid water, for measurements in a solid water phantom and the other from plastic lung material, for measurements in a plastic lung material phantom. Correction factors measured by matching ion chamber to media were compared to correction factors measured by using a thin-walled cavity ion chamber with no regard for matching wall and media for cobalt-60, 6-, 10- and 20-MV photon beams. The results demonstrated that the matching of ion chamber to measuring media can be ignored, provided that a small, approximately tissue-equivalent, thin-walled ion chamber is used for measuring the correction factors.

Radiation dose outside the radiotherapy treatment field can be significant and therefore is of clinical interest in estimating organ doses. In a previous paper we reported the results of measurements made using unmodified radiation fields. We have extended this study to include the effects of wedge filters and blocks. For a given dose on the central axis of a radiation field, wedges can cause a factor of 2 to 4 increase in dose at any point outside the field compared with the dose when no wedge is used. Adding blocks to a treatment field can cause an increase in dose at points outside the field, but the effect is much smaller than the effect of a wedge, and generally less than a factor of 2. From the results of these measurements, doses to selected organs outside the field for specified treatment geometries were estimated, and the potential for reducing these organ doses by additional shielding was assessed.