Measurements of dose from secondary radiation outside a treatment field

Radiation dose to organs outside the radiotherapy treatment field can be significant and therefore is of clinical interest. Measurements of dose have been made 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