title: A surface energy spectral study on the bone heterogeneity and beam obliquity using the flattened and unflattened photon beams.
abstract: OBJECTIVE
  Using flattened and unflattened photon beams, this study investigated the spectral variations of surface photon energy and energy fluence in the bone heterogeneity and beam obliquity.
  
  
  BACKGROUND
  Surface dose enhancement is a dosimetric concern when using unflattened photon beam in radiotherapy. It is because the unflattened photon beam contains more low-energy photons which are removed by the flattening filter of the flattened photon beam.
  
  
  METHODS
  We used a water and bone heterogeneity phantom to study the distributions of energy, energy fluence and mean energy of the 6 MV flattened and unflattened photon beams (field size = 10 cm × 10 cm) produced by a Varian TrueBEAM linear accelerator. These elements were calculated at the phantom surfaces using Monte Carlo simulations. The photon energy and energy fluence calculations were repeated with the beam angle turned from 0° to 15°, 30° and 45° in the water and bone phantom.
  
  
  RESULTS
  Spectral results at the phantom surfaces showed that the unflattened photon beams contained more photons concentrated mainly in the low-energy range (0-2 MeV) than the flattened beams associated with a flattening filter. With a bone layer of 1 cm under the phantom surface and within the build-up region of the 6 MV photon beam, it is found that both the flattened and unflattened beams had slightly less photons in the energy range <0.4 MeV compared to the water phantom. This shows that the presence of the bone decreased the low-energy photon backscatters to the phantom surface. When both the flattened and unflattened photon beams were rotated from 0° to 45°, the number of photon and mean photon energy increased. This indicates that both photon beams became more hardened or penetrate when the beam angle increased. In the presence of bone, the mean energies of both photon beams increased. This is due to the absorption of low-energy photons by the bone, resulting in more beam hardening.
  
  
  CONCLUSIONS
  This study explores the spectral relationships of surface photon energy and energy fluence with bone heterogeneity and beam obliquity for the flattened and unflattened photon beams. The photon spectral information is important in studies on the patient's surface dose enhancement using unflattened photon beams in radiotherapy.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, ON M5G 2M9, Canada; Radiation Medicine Program, Princess Margaret Caner Center, University Health Network, Toronto, ON M5G 2M9, Canada.
authors.forename: James C L
authors.initials: JC
authors.lastname: Chow
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, ON M5G 2M9, Canada; Department of Medical Physics, Sunnybrook Health Sciences Center, Toronto ON M4N 3M5, Canada.
authors.forename: Amir M
authors.initials: AM
authors.lastname: Owrangi
keywords: Beam obliquity; Bone heterogeneity; Energy fluence spectrum; Monte Carlo simulation; Surface dosimetry; Unflattened photon beam