基于IAEA398号报告进行直线加速器输出量校准的实践与探索

目的:基于国际原子能机构(IAEA)398号报告,实践和探索基于水模体吸收剂量校准因子N_W的直线加速器输出量校准。方法:测量每档光子线和电子线辐射质,根据辐射质通过查找IAEA398号报告中的图表,计算出我科加速器各档光子线和电子线K_Q因子、校准深度,并测量校准深度处的PDD值。结果:按照IAEA398号报告,对于光子线6和10 MV,其射线质分别为0.681和0.732,其测量深度均为10 cm,K_Q分别为0.990和0.982,与对应的K_(Q,277)分别相差-0.81%和-0.81%。对于电子线,包括6、8、10、12、15、18 Me V,其射线质分别为2.481、3.225、3.964、4.747、5.959、7.234 cm,测量深度分别为1.39、1.84、2.28、2.75、3.48、4.24 cm,K_Q分别为0.937、0.928、0.920、0.914、0.904、0.897,与对应的K_(Q,277)分别相差0.60%、0.97%、0.43%、0.66%、0.11%、-0.45%。结论:相比IAEA277号报告,IAEA398号报告在实践过程中更直观,更易操作,两个报告剂量标定结果差异小于1%。     

IAEA TRS398与TRS277应用于加速器输出量校准的比较

目的:通过对IAEA TRS398和TRS277号报告推荐方法在加速器输出量校准中的使用比较,分析两者之间的区别和联系,正确指导临床外照射治疗源的校准。方法:用PTW公司UNIDOS E剂量仪和PTW30013指形电离室及NE2570A型剂量仪和2571型电离室,分别按照TRS398和TRS277号报告的要求对Varian 23EX线加速器两档光子线(6 MV,10 MV)吸收剂量进行测量,并对结果进行比较。结果:不同的剂量仪和不同的测量规程得到的结果基本相同。结论:采用TRS277号报告和TRS398号报告所有仪器测量结果偏差均小于1%,结合修正因子的不确定度,认为测量结果是一致的,采用两种规程得到测量结果均是正确的。398号报告应用比277号报告简单,且更接近用户现场测量实际情况。     

射波刀的吸收剂量校准

目的:介绍射波刀吸收剂量校准的计算及测量方法。方法:依据IAEA TRS-277、TRS-398及等AAPM TG-513个协议,利用Farmer 2670剂量仪配NE2571电离室测量校准射波刀加速器吸收剂量。结果:TG-51与TRS-398相比,剂量值基本没有差别,TRS-277则比TG-51及TRS-398约高0.4%;射波刀校准程序也给出相同的校准偏差。结论:三个协议得到的剂量值差别不大,而TG-51及TRS-398操作上更容易一些。     

医用直线加速器中心轴绝对剂量输出长期稳定性对比分析

目的:分析对比医用直线加速器中心轴光子绝对剂量输出的长期稳定性特点。方法:选取3台Varian加速器,以最新IAEA TRS-398报告中推荐的水中直接剂量法监测15个月内的剂量输出,用SPSS和Sigma Plot软件进行统计分析。结果:在390条数据中,超过±2%允差有7次(1.79%)。偏差主要分布在-0.2%~1.2%,最大+2.55%。同一加速器均整模式下不同能量输出稳定性差异显著(P0.05),但无临床意义(1 c Gy量级)。不同加速器的均整模式输出稳定性显著依赖于机龄(P0.05),与机型无关,而非均整模式(FFF)间差异不显著。结论:包括较新的True Beam FFF模式在内的Varian加速器中心轴绝对剂量输出的长期稳定性良好,错误率为1%~2%。放疗中心可以晨检仪和标准水箱测量相结合的方法,监测并及时纠正该偏差。     

直线加速器均整和非均整模式下射线质和射野输出因子的蒙特卡罗模拟与实测值比较

目的:利用蒙特卡罗方法分别模拟True Beam直线加速器6 MV均整和非均整(Flattening Filter-Free,FFF)模式,计算其射线质和射野输出因子,并比较上述参数与实际测量结果的差异。方法:利用Beamnrc和Dosxyznrc程序建立加速器机头模型并计算两档能量在参考条件下不同射野的剂量学数据。输出上述数据,计算各个射野射线质与实际测量值的相对偏差,对其绝对值做统计分析;利用各个射野中心轴上水下10 cm处的剂量值获取射野输出因子,并计算与测量值的相对偏差,绝对化后做统计分析。结果:6 MV和6FFF两档能量射线质相对偏差绝对值分别为(0.459±0.462)%和(0.486±0.300)%,射野输出因子相对偏差绝对值分别为(1.315±1.868)%和(0.904±1.214)%。结论:该模型的射线质和输出因子与测量结果相对偏差较小,基本可用于临床剂量学研究。     

均整与非均整模式下TrueBeam加速器治疗床对放疗剂量的影响

目的:探讨均整(FF)与非均整(FFF)模式下瓦里安TrueBeam加速器全碳纤维治疗床对模体中心和表面剂量的影响。方法:将30 cm×30 cm×20 cm的固体水模分别放置于治疗床薄、中、厚段上,模体的中心与加速器等中心重合,德国IBA FC65-G电离室测量等中心的剂量;选取6/10 MV光子束FF/FFF模式4档能量,10 cm×10 cm标准射野,等中心照射,以机架转角0°～80°(间隔10°采样)为参考,计算100°～180°范围与对应角度参考剂量的比值得到对应角度的穿透因子;将EBT3胶片分别置于上述模体表面和底部,对应机架角度为0°和180°,分析相应的百分深度剂量。结果:4档光子束能量下治疗床薄、中、厚段位置穿透因子范围分别为0.956 6～1.000 0、0.955 4～1.000 0和0.954 8～1.000 0,薄中段在6 MV-FFF120°时最小,厚段在6 MV-FFF 130°时最小。与0°照射相比,180°照射6 MV-FFF、6 MV、10 MV-FFF和10 MV X射线表面剂量从30.6%、24.1%、18.3%和14.1%分别增加到95.4%、93%、83%和79.6%。结论:治疗床的存在减少肿瘤剂量、增加表面剂量,FFF模式较FF影响更大,在治疗计划系统中加入虚拟床减小了治疗床引起的剂量学影响。     

高能光子水吸收剂量辐射质转换因子的实验测量

目的:简要介绍中国计量科学院(NIM)水吸收剂量国际比对结果,基于此实验给出9种常见指形电离室的辐射质转换因子。方法:在NIM~(60)Coγ基准实验室测量9种型号指形电离室的基于~(60)Coγ辐射场的校准因子,在NIM的高能光子水吸收剂量基准实验室测量这9种型号指形电离室的基于6、10 MV高能光子辐射场的校准因子,依据这两种校准因子,计算得到这9种指形电离室的辐射质转换因子。并与IAEA TRS 398报告中提供的数据相比较。结果:NIM水吸收剂量国家基准实验室已经具备水吸收剂量的量传和溯源能力,在此基础上,所测指形电离室的辐射质转换因子均与398报告符合较好,但普遍偏小,相对偏差不超过0.9%。这是由于NIM~(60)Coγ基准实验室给出的校准因子比国际原子能机构给出的值偏大,而高能光子水吸收剂量基准实验室给出的校准因子比国际计量局给出的值偏小所致。结论:NIM的水吸收剂量国家基准实验室可以精确给出用户指形电离室的辐射质转换因子。     

医用加速器输出剂量长期稳定性分析

目的:分析医用加速器输出剂量长期稳定性及其影响因素。方法:按照IAEA TRS 277技术报告,对武警四川省总队医院医用加速器进行吸收剂量测量,统计分析2012年5月～2017年12月共计240组输出剂量数据,分析医用加速器输出剂量长期稳定性及其影响因素,为加速器剂量质量保证提供方法与措施。结果:6 MV-X输出剂量3组数据K-S检验双尾渐进概率P值分别为0.101、0.269、0.549,均大于显著性水平0.05,符合标准正态分布,且P值逐渐增大,符合程度越来越好;剂量误差≤1%符合率达到91.94%,剂量误差≤2%符合率达到97.92%。结论:武警四川省总队医院医用加速器输出剂量具有很好的正态性和长期稳定性,完全能够满足临床放疗需求;影响加速器输出剂量稳定性的主要因素有加速器硬件自身稳定性、剂量仪电离室稳定性、剂量测量方法准确性、摆位误差等;物理师应按照科室实际情况,制定个体化的加速器剂量质量保证程序,并按照规定频次校准输出剂量,监测输出剂量的稳定性,为精准放疗提供有力保障。     

水模体吸收剂量校准因子的比较

目的:美国医学物理学家协会(AAPM)TG-51协议和国际原子能结构(IAEA)TRS-398报告分别提出基于水模本吸收剂量校准因子,(N40CoD、W)及(ND、W、Q0)的吸收剂量测定规程,而我国至今没有相应的测定规程.计算三种常用进口指形电离室的(N40CoD、W)/NX和(ND、W、Q0)/NX值,分别为Capintec PR-06C、NE2571及PTW30001,以便用国家计量实验室给出的照射量校准因子NX获得(N40CoD、W)及(ND、W、Q0)方法:根据TG-21和TG-51号协议推导出(N40CoD、W)/NX;根据IAEA TRS-277及398号报告推导出(ND、W、Q0)/NX.结果:Capintec PR-06C的(N40CoD、W)/NX和(N40CoD、W)/NX及值分别为0.949和0.960,单位10-2Gy/R;NE2571,0.956和0.957;PTW 30001,0.954和0.956.结论:(ND、W、Q0)的理论值有可能比(N40CoD、W)的更准确;不同指形电离室的(N40CoD、W)和(ND、W、Q0)的理论值变化并不显著.     

磁共振加速器Unity的输出量测量

目的:建立磁共振加速器Unity绝对剂量校准方法和输出量日检流程,并评价Unity输出量长期稳定性。方法:使用防水型指型电离室（PTW 30013）和特制的靴型水箱（Boot Phantom）进行绝对剂量校准,利用电子射野影像装置（EPID）图像确保模体摆位的准确性,选择适当的磁场修正因子修正磁场条件下电离室的响应。为节省时间,建立EPID图像特定像素点的累积灰度值与输出量的校准曲线,实现输出量日检。分析国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科新装的Unity从2019年10月22日至2020年5月9日的输出量日检结果,评估其输出量长期稳定性。结果:标准测量条件（SAD=143.5 cm,射野大小为10 cm×10 cm,机架角0°）下,水下10 cm处100 MU绝对剂量校准为0.87 Gy。在输出量变化±5%范围内,EPID像素点的累积灰度值与输出量高度线性相关（R2=0.999 9）。在116次Unity输出量日检中,输出量偏移基准值大于1%的仅有2次,并被标准测量方法证实。基于EPID的输出量日检方法相比标准输出量测量方法更方便快捷。结论:与常规加速器相比,Unity的绝对剂量校准更为复杂,需谨慎选择测量工具、摆位方式、测量条件和修正因子。初步结果显示,Unity具有较好的输出量长期稳定性;但真实临床工作负荷条件下,输出量长期稳定性还有待进一步观察。     

Comparison of the IAEA TRS-398 and AAPM TG-51 absorbed dose to water protocols in the dosimetry of high-energy photon and electron beams.

The International Atomic Energy Agency (IAEA TRS-398) and the American Association of Physicists in Medicine (AAPM TG-51) have published new protocols for the calibration of radiotherapy beams. These protocols are based on the use of an ionization chamber calibrated in terms of absorbed dose to water in a standards laboratory's reference quality beam. This paper compares the recommendations of the two protocols in two ways: (i) by analysing in detail the differences in the basic data included in the two protocols for photon and electron beam dosimetry and (ii) by performing measurements in clinical photon and electron beams and determining the absorbed dose to water following the recommendations of the two protocols. Measurements were made with two Farmer-type ionization chambers and three plane-parallel ionization chamber types in 6, 18 and 25 MV photon beams and 6, 8, 10, 12, 15 and 18 MeV electron beams. The Farmer-type chambers used were NE 2571 and PTW 30001, and the plane-parallel chambers were a Scanditronix-Wellh?fer NACP and Roos, and a PTW Markus chamber. For photon beams, the measured ratios TG-51/TRS-398 of absorbed dose to water Dw ranged between 0.997 and 1.001, with a mean value of 0.999. The ratios for the beam quality correction factors kQ were found to agree to within about +/-0.2% despite significant differences in the method of beam quality specification for photon beams and in the basic data entering into kQ. For electron beams, dose measurements were made using direct N(D,w) calibrations of cylindrical and plane-parallel chambers in a 60Co gamma-ray beam, as well as cross-calibrations of plane-parallel chambers in a high-energy electron beam. For the direct N(D,w) calibrations the ratios TG-51/TRS-398 of absorbed dose to water Dw were found to lie between 0.994 and 1.018 depending upon the chamber and electron beam energy used, with mean values of 0.996, 1.006, and 1.017, respectively, for the cylindrical, well-guarded and not well-guarded plane-parallel chambers. The Dw ratios measured for the cross-calibration procedures varied between 0.993 and 0.997. The largest discrepancies for electron beams between the two protocols arise from the use of different data for the perturbation correction factors p(wall) and p(dis) of cylindrical and plane-parallel chambers, all in 60Co. A detailed analysis of the reasons for the discrepancies is made which includes comparing the formalisms, correction factors and the quantities in the two protocols.     

Protocols for the dosimetry of high-energy photon and electron beams: a comparison of the IAEA TRS-398 and previous international codes of practice. International Atomic Energy Agency

A new international Code of Practice for radiotherapy dosimetry co-sponsored by several international organizations has been published by the IAEA, TRS-398. It is based on standards of absorbed dose to water, whereas previous protocols (TRS-381 and TRS-277) were based on air kerma standards. To estimate the changes in beam calibration caused by the introduction of TRS-398, a detailed experimental comparison of the dose determination in reference conditions in high-energy photon and electron beams has been made using the different IAEA protocols. A summary of the formulation and reference conditions in the various Codes of Practice, as well as of their basic data, is presented first. Accurate measurements have been made in 25 photon and electron beams from 10 clinical accelerators using 12 different cylindrical and plane-parallel chambers, and dose ratios under different conditions of TRS-398 to the other protocols determined. A strict step-by-step checklist was followed by the two participating clinical institutions to ascertain that the resulting calculations agreed within tenths of a per cent. The maximum differences found between TRS-398 and the previous Codes of Practice TRS-277 (2nd edn) and TRS-381 are of the order of 1.5-2.0%. TRS-398 yields absorbed doses larger than the previous protocols, around 1.0% for photons (TRS-277) and for electrons (TRS-381 and TRS-277) when plane-parallel chambers are cross-calibrated. For the Markus chamber, results show a very large variation, although a fortuitous cancellation of the old stopping powers with the ND,w/NK ratios makes the overall discrepancy between TRS-398 and TRS-277 in this case smaller than for well-guarded plane-parallel chambers. Chambers of the Roos-type with a 60Co ND,w calibration yield the maximum discrepancy in absorbed dose, which varies between 1.0% and 1.5% for TRS-381 and between 1.5% and 2.0% for TRS-277. Photon beam calibrations using directly measured or calculated TPR20,10 from a percentage dose data at SSD = 100 cm were found to be indistinguishable. Considering that approximately 0.8% of the differences between TRS-398 and the NK-based protocols are caused by the change to the new type of standards, the remaining difference in absolute dose is due either to a close similarity in basic data or to a fortuitous cancellation of the discrepancies in data and type of chamber calibration. 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.     

The advantages of absorbed-dose calibration factors.

A formalism for clinical external beam dosimetry based on use of ion chamber absorbed-dose calibration factors is outlined in the context and notation of the AAPM TG-21 protocol. It is shown that basing clinical dosimetry on absorbed-dose calibration factors ND leads to considerable simplification and reduced uncertainty in dose measurement. In keeping with a protocol which is used in Germany, a quantity kQ is defined which relates an absorbed-dose calibration factor in a beam of quality Q0 to that in a beam of quality Q. For 38 cylindrical ion chambers, two sets of values are presented for ND/NX and Ngas/ND and for kQ for photon beams with beam quality specified by the TPR20(10) ratio. One set is based on TG-21's protocol to allow the new formalism to be used while maintaining equivalence to the TG-21 protocol. To demonstrate the magnitude of the overall error in the TG-21 protocol, the other set uses corrected versions of the TG-21 equations and the more consistent physical data of the IAEA Code of Practice. Comparisons are made to procedures based on air-kerma or exposure calibration factors and it is shown that accuracy and simplicity are gained by avoiding the determination of Ngas from NX. It is also shown that the kQ approach simplifies the use of plastic phantoms in photon beams since kQ values change by less than 0.6% compared to those in water although an overall correction factor of 0.973 is needed to go from absorbed dose in water calibration factors to those in PMMA or polystyrene. Values of kQ calculated using the IAEA Code of Practice are presented but are shown to be anomalous because of the way the effective point of measurement changes for 60Co beams. In photon beams the major difference between the IAEA Code of Practice and the corrected AAPM TG-21 protocol is shown to be the Prepl correction factor. Calculated kQ curves and three parameter equations for them are presented for each wall material and are shown to represent accurately the kQ curve for all ion chambers in this study with a wall of that specified material and a thickness less than 0.25 g/cm2. Values of kQ can be measured using the primary standards for absorbed dose in photon beams.     

Comparison of high-energy photon and electron dosimetry for various dosimetry protocols

The American Association of Physicists in Medicine Task Group 51 (TG-51) and the International Atomic Energy Agency (IAEA) published a new high-energy photon and electron dosimetry protocol, in 1999 and 2000, respectively. These protocols are based on the use of an ion chamber having an absorbed-dose to water calibration factor with a 60Co beam. These are different from the predecessors, the TG-21 and IAEA TRS-277 protocols, which require a 60Co exposure or air-kerma calibration factor. The purpose of this work is to present the dose comparison between various dosimetry protocols and the AAPM TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. The absorbed-dose to water calculated according to the Japanese Association of Radiological Physics (JARP), International Atomic Energy Agency Technical Report Series No. 277 (IAEA TRS-277) and No. 398 (IAEA TRS-398) protocols is compared to that calculated using the TG-51 protocol. For various Farmer-type chambers in photon beams, TG-51 is found to predict 0.6-2.1% higher dose than JARP. Similarly, TG-51 is found to be higher by 0.7-1.7% than TRS-277. For electron beams TG-51 is higher than JARP by 1.5-3.8% and TRS-277 by 0.2-1.9%. The reasons for these differences are presented in terms of the cavity-gas calibration factor, Ngas, and a dose conversion factor, Fw, which converts the absorbed-dose to air in the chamber to the absorbed-dose to water. The ratio of cavity-gas calibration factors based on absorbed-dose to water calibration factors, N60Co(D,w), in TG-51 and cavity-gas calibration factors which are equivalent to absorbed-dose to air chamber factors, N(D,air), based on the IAEA TRS-381 protocol is 1.008 on average. However, the estimated uncertainty of the ratio between the two cavity-gas calibration factors is 0.9% (1 s.d.) and consequently, the observed difference of 0.8% is not significant. The absorbed-dose to water and exposure or air-kerma calibration factors are based on standards traceable to the National Institute of Standards and Technology (NIST). In contrast, the absorbed-dose to water determined with TRS-398 is in good agreement with TG-51 within about 0.5% for photon and electron beams.     

A small-body portable graphite calorimeter for dosimetry in low-energy clinical proton beams

Calorimetry has been recommended and performed in proton beams for some time, but never has graphite calorimetry been used as a reference dosimeter in clinical proton beams. Furthermore, only a few calorimetry measurements have been reported in ocular proton beams. In this paper we describe the construction and performance of a small-body portable graphite calorimeter for clinical low-energy proton beams. Perturbation correction factors for the gap effect, volume averaging effect, heat transfer phenomena and impurity effect are calculated and applied in a comparison with ionization chamber dosimetry following IAEA TRS-398. The ratio of absorbed dose to water obtained from the calorimeter measurements and from the ionization measurements varied between 0.983 and 1.019, depending on the beam type and the ionization chamber calibration modality. Standard uncertainties on these values varied between 1.9% and 2.5% including a substantial contribution from the kQ values in IAEA TRS-398. The (Wair/e)p values inferred from these measurements varied between 33.6 J C(-1) and 34.9 J C(-1) with similar standard uncertainties. A number of improvements for the small-body portable graphite calorimeter and the experimental set-up are suggested for potential reduction of the uncertainties.     

Reference Dosimetry according to the New German Protocol DIN 6800-2 and Comparison with IAEA TRS 398 and AAPM TG 51

The preceding DIN 6800-2 (1997) protocol has been revised by a German task group and its latest version was published in March 2008 as the national standard dosimetry protocol DIN 6800-2 (2008 March). Since then, in Germany the determination of absorbed dose to water for high-energy photon and electron beams has to be performed according to this new German dosimetry protocol. The IAEA Code of Practice TRS 398 (2000) and the AAPM TG-51 are the two main protocols applied internationally. The new German version has widely adapted the methodology and dosimetric data of TRS-398. This paper investigates systematically the DIN 6800-2 protocol and compares it with the procedures and results obtained by using the international protocols. The investigation was performed with 6 MV and 18 MV photon beams as well as with electron beams from 5 MeV to 21 MeV. While only cylindrical chambers were used for photon beams, the measurements of electron beams were performed by using cylindrical and plane-parallel chambers. It was found that the discrepancies in the determination of absorbed dose to water among the three protocols were 0.23% for photon beams and 1.2% for electron beams. The determination of water absorbed dose was also checked by a national audit procedure using TLDs. The comparison between the measurements following the DIN 6800-2 protocol and the TLD audit-procedure confirmed a difference of less than 2%. The advantage of the new German protocol DIN 6800-2 lies in the renouncement on the cross calibration procedure as well as its clear presentation of formulas and parameters. In the past, the different protocols evoluted differently from time to time. Fortunately today, a good convergence has been obtained in concepts and methods.     

Monte-Carlo-based perturbation and beam quality correction factors for thimble ionization chambers in high-energy photon beams

This paper presents a detailed investigation into the calculation of perturbation and beam quality correction factors for ionization chambers in high-energy photon beams with the use of Monte Carlo simulations. For a model of the NE2571 Farmer-type chamber, all separate perturbation factors as found in the current dosimetry protocols were calculated in a fixed order and compared to the currently available data. Furthermore, the NE2571 Farmer-type and a model of the PTW31010 thimble chamber were used to calculate the beam quality correction factor kQ. The calculations of kQ showed good agreement with the published values in the current dosimetry protocols AAPM TG-51 and IAEA TRS-398 and a large set of published measurements. Still, some of the single calculated perturbation factors deviate from the commonly used ones; especially prepl deviates more than 0.5%. The influence of various sources of uncertainties in the simulations is investigated for the NE2571 model. The influence of constructive details of the chamber stem shows a negligible dependence on calculated values. A comparison between a full linear accelerator source and a simple collimated point source with linear accelerator photon spectra yields comparable results. As expected, the calculation of the overall beam quality correction factor is sensitive to the mean ionization energy of graphite used. The measurement setup (source-surface distance versus source-axis distance) had no influence on the calculated values.     

Varian Edge加速器射野外辐射剂量水平与铅防护用品的防护效果

目的:研究Varian Edge加速器不同工作状态下射野外辐射剂量水平以及铅防护用品的防护效果。方法:利用实验测量的方法，研究加速器在不同工作能量、不同线束均整状态、使用不同防护用品，测量距射野边缘不同距离及不同深度下辐射剂量水平的变化情况。结果:射野外辐射剂量随距射野边缘距离增加（5~40 cm）近似呈指数规律下降，距射野边缘20 cm范围内低能量射束（6 MV、6 MV FFF）的辐射剂量低于高能射束（10 MV、10 MV FFF）的辐射剂量，且随测量深度增加（1~2 cm）而降低。非均整模式下射野外剂量测量结果低于均整模式射束。在相同能量条件下，铅防护用品的防护效果与线束的均整状态无关。对高能射束的防护效果要优于低能射束且随深度增加防护效果迅速下降。深度为1 cm，射束能量10 MV FFF，距射野边缘5~30 cm条件下，防护效果最强，射野外辐射剂量水平降低50%以上。测量深度为2 cm，射束能量为6 MV FFF，距离射野边缘5~30 cm的条件下，防护效果最差，仅能降低10%以下。结论:在实现临床目标的前提下，治疗过程中若无铅防护用品进行保护，推荐采用低能非均整模式进行计划设计；若使用铅防护用品进行保护，可以采用高能非均整模式射束，此时铅防护用品效果最佳，射野外浅层器官所受剂量最低，可有效降低二次肿瘤发生几率。