The quality of high-energy X-ray beams

Characterization of the ZAP-X® Peripheral Dose Fall-Off

Various small-field radiation dose detectors were systematically compared and their impact on measured beam performance of the ZAP-X® dedicated stereotactic radiosurgery system (ZAP Surgical Systems, Inc., San Carlos, CA, USA) was determined. Three Physikalische Technische Werkstaetten (PTW) diodes, i.e., the microSilicon, the microDiamond, and the Stereotactic Radiosurgery (SRS) diode detectors of (PTW-Freiburg, Freiburg, Germany), as well as Gafchromic™ External Beam Therapy 3 (EBT) film (Ashland, Inc., Wilmington, DE, USA), were used and compared to arrive at a recommended standard for this critical component of small-field beam measurements. Beam profiles, including the dose fall-off region near the edge of the beam, were measured with the PTW diodes and EBT3 film and subsequently contrasted. The impact of detector physical and dosimetric characteristics on the results of the measurements was investigated and compared with film measurements. The beam penumbra was used to quantify the dose fall-off. The measurement acquired with the diodes and film showed the most significant differences in the fall-off region near the field edge. The film-based measurements clearly showed the steepest dose gradient verified by the penumbra value of 1.21 mm, followed by the SRS diode with 1.60 mm, the microSilicon diode with 1.67 mm, and the microDiamond diode with 1.83 mm. A clear correlation of each detector's sensitive area with the penumbra was found, with the microDiamond detector at 2.2 mm diameter sensitive area having the largest penumbra, followed by the microSilicon and SRS diodes. Beam measurements for the purposes of system characterization or treatment planning system beam data acquisition depend, to a large extent, on detector characteristics. This is especially true for small-field dosimetry performed during stereotactic radiosurgery beam measurements. Careful consideration should be practiced which allows for the measurements to represent true beam characteristics and minimize the impact of the detector on the measurements. We conclude that film should be considered the reference method for such measurements with the ZAP-X due to its smallest physical measurement resolution of 23.1 µm. Potential drawbacks to this methodology are the need to calibrate the film relative to the dose and possible problems with saturation and non-linear film response for very high and very low optical densities.

The Impact of Radiation Energy on Dose Homogeneity and Organ Dose in the Göttingen Minipig Total-Body Irradiation Model

Animal models of total-body irradiation (TBI) are used to elucidate normal tissue damage and evaluate the efficacy of medical countermeasures (MCM). The accuracy of these TBI models depends on the reproducibility of the radiation dose-response relationship for lethality, which in turn is highly dependent on robust radiation physics and dosimetry. However, the precise levels of radiation each organ absorbs can change dramatically when different photon beam qualities are used, due to the interplay between their penetration and the natural variation of animal sizes and geometries. In this study, we evaluate the effect of varying the radiation energy, namely cobalt-60 (Co-60); of similar penetration to a 4-MV polyenergetic beam), 6 MV and 15 MV, in the absorbed dose delivered by TBI to individual organs of eight Göttingen minipigs of varying weights (10.3-24.1 kg) and dimensions (17.5-25 cm width). The main organs, i.e. heart, lungs, esophagus, stomach, bowels, liver, kidneys and bladder, were contoured by an experienced radiation oncologist, and the volumetric radiation dose distribution was calculated using a commercial treatment planning system commissioned and validated for Co-60, 6-MV and 15-MV teletherapy units. The dose is normalized to the intended prescription at midline in the abdomen. For each animal and each energy, the body and organ dose volume histograms (DVHs) were computed. The results show that more penetrating photon energies produce dose distributions that are systematically and consistently more homogeneous and more uniform, both within individual organs and between different organs, across all animals. Thoracic organs (lungs, heart) received higher dose than prescribed while pelvic organs (bowel, bladder) received less dose than prescribed, due to smaller and wider separations, respectively. While these trends were slightly more pronounced in the smallest animals (10.3 kg, 19 cm abdominal width) and largest animals (>20 kg, ∼25 cm abdominal width), they were observed in all animals, including those in the 9-15 kg range typically used in MCM models. Some organs received an average absorbed dose representing <80% of prescribed dose when Co-60 was used, whereas all organs received average doses of >87% and >93% when 6 and 15 MV were used, respectively. Similarly, average dose to the thoracic organs reached as high as 125% of the intended dose with Co-60, compared to 115% for 15 MV. These results indicate that Co-60 consistently produces less uniform dose distributions in the Göttingen minipig compared to 6 and 15 MV. Moreover, heterogeneity of dose distributions for Co-60 is accentuated by anatomical and geometrical variations across various animals, leading to different absorbed dose delivered to organs for different animals. This difference in absorbed radiation organ doses, likely caused by the lower penetration of Co-60 and 6 MV compared to 15 MV, could potentially lead to different biological outcomes. While the link between the dose distribution and variation of biological outcome in the Göttingen minipig has never been explicitly studied, more pronounced dose heterogeneity within and between organs treated with Co-60 teletherapy units represents an additional confounding factor which can be easily mitigated by using a more penetrating energy.

Beam data modeling of linear accelerators (linacs) through machine learning and its potential applications in fast and robust linac commissioning and quality assurance

BACKGROUND AND PURPOSE

To propose a novel machine learning-based method for reliable and accurate modeling of linac beam data applicable to the processes of linac commissioning and QA.

MATERIALS AND METHODS

We hypothesize that the beam data is a function of inherent linac features and percentage depth doses (PDDs) and profiles of different field sizes are correlated with each other. The correlation is formulated as a multivariable regression problem using a machine learning framework. Varian TrueBeam beam data sets (n = 43) acquired from multiple institutions were used to evaluate the framework. The data sets included PDDs and profiles across different energies and field sizes. A multivariate regression model was trained for prediction of beam specific PDDs and profiles of different field sizes using a 10 × 10 cm² field as input.

RESULTS

Predictions of PDDs were achieved with a mean absolute percent relative error (%RE) of 0.19-0.35% across the different beam energies investigated. The maximum mean absolute %RE was 0.93%. For profile prediction, the mean absolute %RE was 0.66-0.93% with a maximum absolute %RE of 3.76%. The largest uncertainties in the PDD and profile predictions were found at the build-up region and at the field penumbra, respectively. The prediction accuracy increased with the number of training sets up to around 20 training sets.

CONCLUSIONS

Through this novel machine learning-based method we have shown accurate and reproducible generation of beam data for linac commissioning for routine radiation therapy. This method has the potential to simplify the linac commissioning procedure, save time and manpower while increasing the accuracy of the commissioning process.

Calculating Weighting Factors for Mixing Megavoltage Photon Beams to Achieve Desirable Dose Distribution in Radiotherapy

Background:

In radiotherapy, low-energy photon beams are better adapted to the treated volume, and the use of high-energy beams can reduce hot spots in the radiation therapy. Therefore, mixing low and high energies with different ratios can control the rate of hotspots, as well as the dose distribution of the target volume.

Material and Methods:

The percentage depth doses (PDDs) were calculated at various depths, by using a fitted double exponential equation. Then, using quality factor equation and PDD of a 10×10 cm2 field, the amount of energy equivalent to each PDD and the value of weighting factors of 6, 18 MV energies were calculated to produce different energies. To validate the mathematical model, dosimetry of 10 MV energy was used. For this purpose, PDDs and dose Profile of 10 MV obtained from the mix were compared with ones obtained from the measurement

Results:

The value of weighting factor of 6 MV energy required for the 10 ×10 cm² field to create dose distribution of 15 MV energy using 6 and 18 MV energies was obtained as equal to 0.57. Comparison of percentage depth dose curves and dose profile shows good agreement with the practical measurements of 10 MV for 10×10 cm² field using gamma index.

Conclusion:

The simultaneous use of high and low photon energies with different weighting factors to achieve desirable energy makes possible the treatment of tumors located at various depths without the need for different modes of energy in the accelerator leading to a decrease in the cost of the equipment and a safer treatment of the cancerous patients.

Characterization of a Novel 3 Megavolt Linear Accelerator for Dedicated Intracranial Stereotactic Radiosurgery

The purpose of this article is to investigate and characterize from a physics perspective the Zap-X (ZAP Surgical Systems, Inc., San Carlos, CA), a new, dedicated self-contained and self-shielded radiosurgery system, focusing on beam energy and performance, leakage, radiation safety, dose delivery accuracy, regulations, quality assurance, and treatment planning. This investigation is required to establish the mechanical and overall performance specifications of the system and to establish baseline parameters for future clinical usage. The applied methods include measurements of energy, focal spot size, beam performance, dosimetry, beam data, treatment planning system, leakage radiation, acceptance testing, and commissioning. The results of the characterization reveal a 3 megavolt (MV) linear accelerator (linac) with a focal spot size of 2 mm, a dose rate of 1,500 MU/min at the isocenter with a dose linearity of 3%, a beam penumbra of less than 3 mm, and beam symmetry of less than 2%. Beam performance, as well as dosimetry characteristics, are suitable for intracranial radiosurgery. It can be concluded that the system was found to meet safety, accuracy, and performance requirements widely accepted in the radiation oncology and radiosurgery industry. Furthermore, the system was shown to meet the practical, clinical needs of the radiosurgery community.

Dosimetric determination of tissue maximum ratios in small fields

Aims

This exploration is intended to measure tissue maximum ratios (TMRs) in smaller fields through CC01 detector and to compare CC01 measured TMRs with Pinnacle treatment planning software (TPS) calculated TMRs.

Materials and methods

CC01 compact chamber detector was used to measure TMR in water phantom for 6 and 18 MV beam delivered from Varian linear accelerator. Pinnacle TPS was employed in this study to calculate TMR from the measured percentage depth doses data. CC01 measured TMR data was compared with the calculated TMR data at depths from 5 to 20 cm for field sizes varying from 1 to 10 cm2.

Results

For the smallest given field size of 1 cm2, CCO1 measured 13·95% higher TMR value for 18 MV beam than that for 6 MV beam. At 20 cm depth for 1 cm2 field size, TMR due to 18 MV beam was 52·4% higher than the TMR due to 6 MV beam. For 6 MV beam, the maximum difference appeared between the measured TMR and pinnacle calculated TMR was 2·8% and for 18 MV beam, the maximum difference was 4%.

Conclusion

For both 6 and 18 MV beam, there was good agreement between CC01 measured and Pinnacle calculated TMRs for the field sizes ranging from 1 to 10 cm2. This exploration can be extended to the determination of other dosimetric parameters like TARs, TPRs in small fields.

Monte Carlo simulation of photon buildup factors for shielding materials in radiotherapy x-ray facilities

PURPOSE

This paper presents the results of a series of calculations to determine buildup factors for ordinary concrete, baryte concrete, lead, steel, and iron in broad beam geometry for photons energies from 0.125 to 25.125 MeV at 0.250 MeV intervals.

METHODS

Monte Carlo N-particle radiation transport computer code has been used to determine the buildup factors for the studied shielding materials.

RESULTS

The computation of the primary broad beams using buildup factors data was done for nine published megavoltage photon beam spectra ranging from 4 to 25 MV in nominal energies, representing linacs made by the three major manufacturers. The first tenth value layer and the equilibrium tenth value layer are calculated from the broad beam transmission for these nine primary megavoltage photon beam spectra.

CONCLUSIONS

The results, compared with published data, show the ability of these buildup factor data to predict shielding transmission curves for the primary radiation beam. Therefore, the buildup factor data can be combined with primary, scatter, and leakage x-ray spectra to perform computation of broad beam transmission for barriers in radiotherapy shielding x-ray facilities.

Energy dependence of EBT-1 radiochromic film response for photon (10 kvp-15 MVp) and electron beams (6-18 MeV) readout by a flatbed scanner

PURPOSE

The aim of this article is to investigate the energy dependence of the radiochromic film type, Gafchromic EBT-1, when scanned with a flatbed scanner for film readout.

METHODS

Dose response curves were determined for 12 different beam qualities ranging from a 10 kVp x-ray beam to a 15 MVp x-ray beam and include also two high energy electron beam qualities (6 and 18 MeV). The dose responses measured as net optical density (netOD) for the different beam qualities were normalized to the response of a reference beam quality (6 MVp).

RESULTS

A strong systematic energy dependence of the film response was found. The lower the effective beam energy, the less sensitive the EBT-1 films get. The maximum decrease in dose for the same film response between the 25 kVp and 6 MVp beam qualities was 44%. Additionally, a difference in energy dependence for different doses was discovered, meaning that higher doses show a smaller dependency on energy than lower doses. The maximum decrease in the normalized netOD was found to be 25% for a dose of 0.5 Gy relative to the normalized netOD for 10 Gy. Moreover, a scaling procedure is introduced, allowing the correction of the energy dependence for the investigated beam qualities and also for comparable x-ray beam qualities within the energy range studied.

CONCLUSIONS

A strong energy dependence for EBT-1 radiochromic films was found. The films were readout with a flatbed scanner. If the effective beam energy is known, the energy dependence can be corrected with the introduced scaling procedure. Further investigation of the influence of the spectral band of the readout device on energy dependence is needed to understand the reason for the different energy dependences found in this and previous works.

An MCNP-based model of a medical linear accelerator x-ray photon beam

The major components in the x-ray photon beam path of the treatment head of the VARIAN Clinac 2300 EX medical linear accelerator were modeled and simulated using the Monte Carlo N-Particle radiation transport computer code (MCNP). Simulated components include x-ray target, primary conical collimator, x-ray beam flattening filter and secondary collimators. X-ray photon energy spectra and angular distributions were calculated using the model. The x-ray beam emerging from the secondary collimators were scored by considering the total x-ray spectra from the target as the source of x-rays at the target position. The depth dose distribution and dose profiles at different depths and field sizes have been calculated at a nominal operating potential of 6 MV and found to be within acceptable limits. It is concluded that accurate specification of the component dimensions, composition and nominal accelerating potential gives a good assessment of the x-ray energy spectra.

[Improvement of the accuracy of the Laplace transform method for the determination of radiotherapy spectra of clinical linear accelerators]

The present study focused on the reconstruction of the bremsstrahlung spectrum of a clinical linear accelerator from the measured transmission curve, with the aim of improving the accuracy of this method. The essence of the method was the analytic inverse Laplace transform of a parameter function fitted to the measured transmission curve. We tested known fitting functions, however they resulted in considerable fitting inaccuracy, leading to inaccuracies of the bremsstrahlung spectrum. In order to minimise the fitting errors, we employed a linear combination of n equations with 2n-1 parameters. The fitting errors are now considerably smaller. The measurement of the transmission function requires that the energy-dependent detector response is taken into account. We analysed the underlying physical context and developed a function that corrects for the energy-dependent detector response. The factors of this function were experimentally determined or calculated from tabulated values.

On the beam quality specification of high-energy photons for radiotherapy dosimetry

An overview of common photon beam quality specifiers used in radiotherapy dosimetry introduces a reasoned discussion on the advantages and disadvantages of TPR20,10 and PDD(10)x. It is shown that some of the potential advantages of PDD(10)x are also present in other well known beam quality specifiers such as d80. However, all PDD-based beam quality indices, including PDD(10)x, are subject to electron contamination and their determination is affected by practical limitations. The proposed filtration of contaminant electrons by Kosunen and Rogers [Med. Phys. 20, 1181-1188 (1993)] and by Li and Rogers [Med. Phys. 21, 791-798 (1994)] is questioned, not only with regard to the adequacy of using lead as an electron filter, but also in relation to its efficiency (if there were no contamination, restrictions for beam calibrations at dmax would be removed) and practical measurement. It is argued that (i) there is no unique beam quality specifier that works satisfactorily in all possible conditions, for the entire energy range of photon energies used in radiotherapy and all possible accelerators used in hospitals and in standards laboratories, and (ii) TPR20,10 remains to be the most appropriate specifier for clinical photon beams as it has less practical drawbacks than PDD-based quality indices. The final impact on clinical photon beam dosimetry resulting from the use of different photon beam quality specifiers, is that they are not expected to yield a significant change (i.e., more than 0.5% and in most cases well within 0.2%) in the absorbed dose to water in reference conditions for most clinical beams.

An MCNP-based model of a linear accelerator x-ray beam

The Monte Carlo N-Particle radiation transport computer code (MCNP) has been employed on a personal computer to develop a simple model simulating the major components within the beam path of a linear accelerator radiation head, namely the electron target, primary conical collimator, beam flattening filter, wedge filter and the secondary collimators. The model was initially used to calculate the energy spectra and angular distributions of the x-ray beam for the Philips SL 75/5 linear accelerator, in a plane immediately beneath the flattening filter. These data were subsequently used as a 'source' of x-rays at the target position, to assess the emergent beam from the secondary collimators. The depth dose distributions and dose profiles at constant depth for various field sizes have been calculated for a nominal operating potential of 4 MV and found to be within acceptable limits. It is concluded that the technique may be used to calculate the energy spectra of any linear accelerator upon specification of the component dimensions, materials and nominal accelerating potential. It is anticipated that this work will serve as the basis of a quality control tool for linear accelerators and treatment planning systems.

Absorbed dose beam quality correction factors kappaQ for the NE2571 chamber in a 5 MV and a 10 MV photon beam

Dose to water (Dw) determination in clinical high-energy photon beams with ionization chambers calibrated in terms of absorbed dose to water has been proposed as an alternative to ionization chamber dosimetry based on air kerma calibrations. Dw in the clinical beam is derived using a kappaQ factor that scales the absorbed dose calibration factor in the reference beam to the absorbed dose calibration factor in the user beam. In the present study kappaQ values were determined for the NE2571 chamber in a 5 MV and a 10 MV high-energy photon beam generated at the 15 MeV high-intensity electron linac of the University of Gent. A set of three NE2571 chambers was calibrated relative to the Gent sealed water calorimeter both in 60Co and in the linac beam at a depth of 5 cm and a source to detector distance of 100 cm. Two high-purity chemical water systems were used in the detection vessel of the calorimeter, H2-saturated and Ar-saturated pure water, which are both supposed to give a zero heat defect. TPR20(10) and %dd(10) have been evaluated as beam quality specifiers. Simulations using the BEAM/DOSXYZ Monte Carlo system were performed to evaluate potential corrections on the measured beam qualities. The average kappaQ values measured for the three NE2571 chambers in the 5 MV and 10 MV photon beams are 0.995 +/- 0.005 and 0.979 +/- 0.005 respectively. For the three chambers used, the maximum deviation of individual kappaQ values is 0.2%. The measured beam quality specifiers %dd(10) and TPR20(10) are 67.0 and 0.705 for the 5 MV beam and 75.0 and 0.759 for the 10 MV beam. Although our beam design is very different from those used by other investigators for the measurement of kappaQ values, the agreement with their results is satisfactory showing a slightly better agreement when %dd(10) is used as the beam quality specifier.

Photon beam quality specification by narrow-beam transmission measurements

Radiation quality specifications in megavoltage photon beams are usually based on depth-dose measurements performed under reference conditions. Stopping-power ratios and various correction factors are then related to parameters such as TPR(10)20, which are extracted from depth-dose measurements. Stopping-power ratio determinations based on this concept were shown to be in error by more than 2% at high energies. Furthermore, electrons generated in the treatment head can, at high energies, contribute to the dose at a depth of 10 cm and thus significantly affect the TPR(10)20 ratio. This method was further shown to be inadequate when the dose in other parts of the field than the reference point was to be measured with ionization chamber dosimetry. A new standardized device for determining photon beam quality based on half value layer (HVL) measurements in water was developed and thoroughly investigated in both a low-energy, (4 MV) and a high-energy beam. A relation between HVL and stopping-power ratios water-to-air was determined by comparative measurements with air ionization chambers and liquid-filled ionization chambers together with Fricke dosimetry. Furthermore, different radiation quality gradients in the photon fields for different types of field-flattening systems, and field-compensating methods were discussed.

Monte Carlo simulations of the differential beam hardening effect of a flattening filter on a therapeutic x-ray beam

A quantitative study of the differential beam hardening effect of the flattening filter on the 6-MV beam of Clinac 2100C has been conducted with Monte Carlo simulations using EGS4 code. The fluence-weighted photon energy of the unfiltered beam decreases from 1.35 MeV at central axis (CAX) to 1.22 MeV at an off-axis distance (OAD) of 20.0 cm. Compared to the unfiltered beam, the fluence-weighted photon energy of the filtered beam increases to 1.93 MeV at CAX and to 1.36 MeV at an OAD f 20.0 cm, respectively. The beam hardening effect was found to be 2.1 times higher at CAX than at an OAD of 20.0 cm. With the differential filtration of the flattening filter, the photon energy fluence reduced to 44% and 78% at CAX and an OAD of 20.0 cm respectively, resulting in the energy fluence of the filtered beam being flat from CAX to an OAD of 20.0 cm. The differential transmission ratios between the high energy and low energy photons decrease as the OAD increases. The percentage depth doses (PDDs) at field size of 10.0 cm x 10.0 cm for both the filtered and unfiltered 6-MV beams at CAX and at an OAD of 15.0 cm were calculated with a Monte Carlo technique based on the simulated spectra and fluence. The calculated PDDs were found to be consistent with the measured data for the filtered beam at CAX and an OAD of 15.0 cm. The beam quality (BQ) of the filtered beam at CAX is also higher than that of the same beam at an OAD of 15.0 cm. All the above results quantitatively demonstrate the differential beam hardening effects of a flattening filter on a therapeutic x-ray beam.

Dosimetric analysis and clinical implementation of 6 MV X-ray radiosurgery beam

The dosimetric data on tissue maximum ratios (TMR), output factors, off axis ratios and beam profiles are presented for small circular fields of diameters ranging from 12.5 to 40 mm for 6 MV radiosurgery beam. It is noticed that dmax increases as the collimator field size increases. Comparison of our data with the published TMR and output factors of similar small circular fields shows that our values are higher than those data. Similarities in trend are noticed with the published isodose volumes for 1-5 and 10 arcs. Not much variation is seen beyond two arcs for 80% isodose volumes for all the field sizes. The variation is small in 20% isodose volumes beyond three arcs. Variations are noticed in 5% isodose volumes for 12.5 mm diameter collimated beam. Our experience has been exclusively with malignant neoplasms. An ideal target volume is covered by 80% isodose volume with 3-4 arcs and a single isocenter. Sixteen patients have been treated to date at our institution, including one patient with brain metastases, two patients with meningiomas, one patient with lymphoma and 12 patients with astrocytomas. The majority of tumors have been treated with single isocenter but some as large as 7 cm have been treated safely with two isocenters.

Linear accelerator photon beam quality at off-axis points

Transmitted intensity through water was measured in a narrow-beam geometry for different energy x-ray beams from commercial accelerators. In order to accurately obtain the attenuation coefficient of the incident beam using transmission data, a novel formula was developed based on consideration of beam hardening in phantom. The value of the attenuation coefficient obtained by fitting transmission data to this formula was found to be independent of the absorber thickness used in experiments, whereas the attenuation coefficient obtained from the traditional formula, I(x) = I0 exp(-mux), changed by up to 7% with absorber thickness for a given beam. The beam hardening coefficient obtained from our formula indicates that the attenuation coefficient in water changes by about 0.33% per cm near the surface for the high-energy photon beams studied. Variations in beam quality with off-axis distance were subsequently investigated using the new formula. Results show that the attenuation coefficient at the water surface increased by about 15% for 15 and 18 MV beams, and by 11%-13% for 6 MV beams, when the off-axis distance at 100 cm from the source was changed from 0 to 18 cm. Consideration of the physics of bremsstrahlung production suggests that these variations should be mainly determined by the shape of the flattening filter, i.e., by the path length of rays traversing the filter in different directions. This expectation was confirmed by observing that the attenuation coefficient at the phantom surface can be related to the ray path of the beam in the flattening filter using the new transmission formula.

The influence of the IAEA standard holder on dose evaluated from TLD samples

The EROPAQ quality assurance project started in 1994 with TLD postal dose intercomparisons for photon beams used in 47 radiotherapy centres in the middle and eastern European countries. The photon dose intercomparisons include beam output checks and beam quality checks. Since an acceptance limit of +/- 3% was chosen for the EROPAQ intercomparisons, any systematic error in dose evaluation by the measuring centre should be minimized. The standard IAEA TLD holder is used in the intercomparisons. In this work the magnitude of the holder attenuation is evaluated and holder corrections derived both for output and photon beam quality checks for beam qualities ranging from Co-60 up to 18 MV. The correction of the dose at the depth of reference does not exceed 1% and decreases with increasing beam energy. A correction of the beam quality ratio of the order of 1% and that is independent of the photon energy has been determined by both calculation and measurements. These corrections are consistent with the preliminary data published by the IAEA and EC QA network.

The status of high-energy photon and electron beam dosimetry five years after the implementation of the IAEA Code of Practice in the Nordic countries

The status of the dosimetry of high-energy photon and electron beams is analysed, taking into account the main developments in the field since the implementation of the IAEA Code of Practice in the Nordic countries. In electron beam dosimetry, energy-range relationships are discussed; Monte-Carlo results with different codes are compared with the experimentally derived empirical expression used in most protocols. Updated calculations of water-to-air stopping-power ratios following the changes in the Monte-Carlo code used to compute actual Sw,air values are compared with the data included in most dosimetry protocols. The validity of the commonly used procedure to select stopping-power ratios for a clinical beam from the mean energy at the phantom surface and the depth of measurement, is analysed for 'realistic' electron beams. In photon beam dosimetry, calculated correction factors including the effect of the wall plus waterproofing sleeve and existing data on the shift of the effective point of measurement of an ionization chamber, are discussed. New calculations of medium-to-air stopping-power ratios and their correlation with the quality of the beam obtained from the convolution of Monte-Carlo kernels are presented together with their possible practical implications in dosimetry. Trends in Primary Standard Dosimetry Laboratories towards implementing calibrations in terms of absorbed dose to water are presented, emphasizing controversial proposals for the specification of photon beam qualities. Plane-parallel ionization chambers are discussed regarding aspects that affect determinations of absorbed dose, either through the different methods used for the calibration of these chambers or by means of correction factors. Recent studies on the effect of the central electrode in Farmer-type cylindrical chambers are described.