Overview of the forthcoming AAPM TG-158 Report, 'Measurements and calculations of doses outside the treatment volume from External Beam Radiation Therapy' - Paper 85

The evolution of techniques and technology in radiotherapy has greatly improved our ability to deliver higher tumor doses while minimizing the dose to the adjacent organs at risk. However, this improved conformality has not removed the problem of doses to normal tissues outside the target volume. Whether these out-of-field doses arise from photons, electrons, protons or neutrons, there are unique challenges that many medical physicists may have limited knowledge about or experience with. With modern treatment planning systems, high dose regions and areas within the primary beam path are typically well described. However, their accuracy beyond a few centimeters outside the treatment field edge are usually poor. In these cases, alternate methods are required to assess the out-of-field dose. Such assessments require additional care to avoid potentially large errors associated with a variety of unique complications in performing dosimetry outside the treatment field. Furthermore, physicists will not always have an a priori estimate of the expected dose, and, as a result, large dosimetric errors are more easily missed. Low radiation doses outside the treatment volume are a concern because they can cause deleterious effects to the patient. The risk of late effects from the secondary radiation may be more evident today because of the success of cancer screening and modern therapies that have increased the number of cancer patients who survive and live long enough for the adverse radiation effects on healthy tissues to manifest. Simultaneously, radiotherapy procedures have become more complex, making the estimation of low out-of-field doses even more challenging. Over the past 30 years, numerous studies have been published detailing non-target doses from various radiotherapy treatments (for a detailed review see Xu et al. However, dosimetry data were obtained using a variety of measurement or computational techniques. An overview of dosimetry techniques for measuring low-level non-target doses is not available. Improved, or at least valid, dosimetry is important for several reasons. In clinical care (e.g. fetal dose estimates), large dose errors can lead to inappropriate or unnecessary treatment decisions, with potentially serious consequences to the patient. In a broader sense of somatic effects, more accurate dosimetry will improve patient risk assessment, understanding of dose responses, treatment planning, and design of the radiation delivery machines. Once reliable dosimetry data are available, it is then the clinician's responsibility to assess the risk vs. benefit of the radiotherapy treatment to make a sound and informed assessment of all possible treatment outcomes. (author)