Advances in the determination of absorbed dose to water in clinical high-energy photon and electron beams using ionization chambers

During the last two decades, absorbed dose to water in clinical photon and electron beams was determined using dosimetry protocols and codes of practice based on radiation metrology standards of air kerma. It is now recommended that clinical reference dosimetry be based on standards of absorbed dose to water. Newer protocols for the dosimetry of radiotherapy beams, based on the use of an ionization chamber calibrated in terms of absorbed dose to water, ND,w, in a standards laboratory's reference quality beam, have been published by several national or regional scientific societies and international organizations. Since the publication of these protocols multiple theoretical and experimental dosimetry comparisons between the various ND,w based recommendations, and between the ND,w and the former air kerma (NK) based protocols, have been published. This paper provides a comprehensive review of the dosimetry protocols based on these standards and of the intercomparisons of the different protocols published in the literature, discussing the reasons for the observed discrepancies between them. A summary of the various types of standards of absorbed dose to water, together with an analysis of the uncertainties along the various steps of the dosimetry chain for the two types of formalism, is also included. It is emphasized that the NK–ND,air and ND,w formalisms have very similar uncertainty when the same criteria are used for both procedures. Arguments are provided in support of the recommendation for a change in reference dosimetry based on standards of absorbed dose to water.