Dosimetry of 24-MV x rays from a linear accelerator

Dosimetric characteristics of a 24-MV photon beam produced by a Varian Clinac 2500 linear accelerator are presented. Particular attention is paid to measurements and applications relating to depth of maximum dose and scatter correction factors. New experimental methods were adopted to investigate scatter factors for field sizes ranging from 5 X 5 to 40 X 40 cm. For the largest field investigated, a 3% phantom scatter factor relative to a 10 X 10 cm field was determined. From the study, clinically useful scatter-phantom ratios were generated. The study also demonstrated that the estimated correction factors for scatter in a medium caused negligible changes (approximately equal to 0.1%) on the percent depth-dose values derived from the measured tissue-phantom ratio (TPR) data. The paper also quantitatively compares results obtained for dosimetric parameters like scatter output, tissue-phantom ratio, and percent depth-dose with those obtained from similar machines used for radiotherapy. Measured data relating to these parameters are expressed by taking a reference depth of 8 g/cm2 in a medium for normalization purposes and its importance discussed. Additional measurements presented in this work include beam quality and collimator effect on dose rate. Phantoms of various sizes and materials and a variety of detectors were used throughout the investigation.     

Monte Carlo Commissioning of Low Energy Electron Radiotherapy Beams using NXEGS Software

This work is a report on the commissioning of low energy electron beams of a medical linear accelerator for Monte Carlo dose calculation using NXEGS software (NXEGS version 1.0.10.0, NX Medical Software, LLC). A unique feature of NXEGS is automated commissioning, a process whereby a combination of analytic and Monte Carlo methods generates beam models from dosimetric data collected in a water phantom. This study uses NXEGS to commission 6, 9, and 12 MeV electron beams of a Varian Clinac 2100C using three applicators with standard inserts. Central axis depth-dose, primary axis and diagonal beam profiles, and output factors are the measurements necessary for commissioning of the code. We present a comparison of measured dose distributions with the distributions generated by NXEGS, using confidence limits on seven measures of error. We find that confidence limits are typically less than 3% or 3 mm, but increase with increasing source to surface distance (SSD) and depth at or beyond R(50). We also investigate the dependence of NXEGS' performance on the size and composition of data used to commission the program, finding a weak dependence on number of dose profiles in the data set, but finding also that commissioning data need be measured at only two SSDs.     

Comparative evaluation of Kodak EDR2 and XV2 films for verification of intensity modulated radiation therapy

Film dosimetry provides a convenient tool to determine dose distributions, especially for verification of IMRT plans. However, the film response to radiation shows a significant dependence on depth, energy and field size that compromise the accuracy of measurements. Kodak's XV2 film has a low saturation dose (approximately 100 cGy) and, consequently, a relatively short region of linear dose-response. The recently introduced Kodak extended range EDR2 film was reported to have a linear dose-response region extending to 500 cGy. This increased dose range may be particularly useful in the verification of IMRT plans. In this work, the dependence of Kodak EDR2 film's response on the depth, field size and energy was evaluated and compared with Kodak XV2 film. Co-60, 6 MV, 10 MV and 18 MV beams were used. Field sizes were 2 x 2, 6 x 6, 10 x 10, 14 x 14, 18 x 18 and 24 x 24 cm2. Doses for XV2 and EDR2 films were 80 cGy and 300 cGy, respectively. Optical density was converted to dose using depth-corrected sensitometric (Hurter and Driffield, or H&D) curves. For each field size, XV2 and EDR2 depth-dose curves were compared with ion chamber depth-dose curves. Both films demonstrated similar (within 1%) field size dependence. The deviation from the ion chamber for both films was small forthe fields ranging from 2 x 2 to 10 x 10 cm2: < or =2% for 6, 10 and 18 MV beams. No deviation was observed for the Co-60 beam. As the field size increased to 24 x 24 cm2, the deviation became significant for both films: approximately 7.5% for Co-60, approximately 5% for 6 MV and 10 MV, and approximately 6% for 18 MV. During the verification of IMRT plans, EDR2 film showed a better agreement with the calculated dose distributions than the XV2 film.     

高能电子线放射治疗的剂量学参数测量与分析

目的：对高能电子线总输出因子、百分深度剂量、深度剂量分布的剂量学参数进行测量并分析讨论。方法：在Varian23EX直线加速器上,利用9606剂量测量仪和0．6cc指型电离室测量不同能量、不同限光筒及不同射野下的输出剂量并作归一,得到我们所要的剂量学参数,然后分析数据。结果：总输出因子在不同能量下与正方形射野边长的关系可满足等式：y=a·e^bx＋c·e^dx。水模体百分剂量分布中,6MeV电子线各限光筒的90％、85％等剂量深度基本不变,9MeV-15MeV下90％、85％等剂量深度随着限光筒尺寸增大而变深。对于水模体的深度剂量分布情况,6MeV和12MeV能量的10cmx10cm、15cmxl5cm限光筒均整区内对称点的最大相对剂量差分别都为0．04％、O．03％。结论：通过测量掌握实际照射中的剂量学特点．对于电子线剂量的准确计算以及临床计划制定具有很大的参考价值。     

Electron beam dose calculations

Electron beam dose distributions in the presence of inhomogeneous tissue are calculated by an algorithm that sums the dose distribution of individual pencil beams. The off-axis dependence of the pencil beam dose distribution is described by the Fermi-Eyges theory of thick-target multiple Coulomb scattering. Measured square-field depth-dose data serve as input for the calculations. Air gap corrections are incorporated and use data from'in-air' measurements in the penumbra of the beam. The effective depth, used to evaluate depth-dose, and the sigma of the off-axis Gaussian spread against depth are calculated by recursion relations from a CT data matrix for the material underlying individual pencil beams. The correlation of CT number with relative linear stopping power and relative linear scattering power for various tissues is shown. The results of calculations are verified by comparison with measurements in a 17 MeV electron beam from the Therac 20 linear accelerator. Calculated isodose lines agree nominally to within 2 mm of measurements in a water phantom. Similar agreement is observed in cork slabs simulating lung. Calculations beneath a bone substitute illustrate a weakness in the calculation. Finally a case of carcinoma in the maxillary antrum is studied. The theory suggests an alternative method for the calculation of depth-dose of rectangular fields.     

Dose discrepancies between Monte Carlo calculations and measurements in the buildup region for a high-energy photon beam

This study investigates a possible cause of reported significant dose discrepancies between Monte Carlo calculations and measurements in the buildup region for high-energy photon beams in large fields. A proposed hypothesis was that the discrepancy was caused by a source of electrons in the accelerator head that was not fully accounted for in the treatment head simulation. In this investigation, a lead foil is added just below the accelerator head in order to study this hypothesis. The lead foil effectively removes charged particles generated inside the accelerator head. The charged particles generated by the lead foil can be accounted for fully because the simple geometry can be simulated accurately. An 18 MV photon beam from a Varian Clinac-2100EX is measured using a WELLHOFER WP700 beam scanner with an IC-10 ionization chamber (cavity radius=3 mm). The BEAM Monte Carlo code is used in the incident beam simulations. Both EGS4/DOSXYZ and EGSnrc/DOSRZnrc are used in the dose calculations in a water phantom. The Monte Carlo calculated depth-dose curve is scaled so that it has the same values at 10 cm depth as the measured curve. It is found that the discrepancies between Monte Carlo calculations and measurements remain significant in the buildup region even after applying necessary corrections to the measured data. The discrepancies have only been modestly decreased with the lead foil in place compared to the 40 x 40 cm2 open field. At a depth of 1 cm, discrepancies of about 5% are still observed in the buildup region for the field with the lead foil. Therefore a new explanation for the unresolved discrepancy remains to be found.     

Investigation of photon beam output factors for conformal radiation therapy--Monte Carlo simulations and measurements

The purpose of this study was to investigate beam output factors (OFs) for conformal radiation therapy and to compare the OFs measured with different detectors with those simulated with Monte Carlo methods. Four different detectors (diode, diamond, pinpoint and ionization chamber) were used to measure photon beam OFs in a water phantom at a depth of 10 cm with a source-surface distance (SSD) of 100 cm. Square fields with widths ranging from 1 cm to 15 cm were observed; the OF for the different field sizes was normalized to that measured at a 5 cm x 5 cm field size at a depth of 10 cm. The BEAM/EGS4 program was used to simulate the exact geometry of a 6 MV photon beam generated by the linear accelerator, and the DOSXYZ-code was implemented to calculate the OFs for all field sizes. Two resolutions (0.1 cm and 0.5 cm voxel size) were chosen here. In addition, to model the detector four kinds of material, water, air, graphite or silicon, were placed in the corresponding voxels. Profiles and depth dose distributions resulting from the simulation show good agreement with the measurements. Deviations of less than 2% can be observed. The OF measured with different detectors in water vary by more than 35% for 1 cm x 1 cm fields. This result can also be found for the simulated OF with different voxel sizes and materials. For field sizes of at least 2 cm x 2 cm the deviations between all measurements and simulations are below 3%. This demonstrates that very small fields have a bad effect on dosimetric accuracy and precision. Finally, Monte Carlo methods can be significant in determining the OF for small fields.     

Multichannel detectors for profile measurements in clinical proton fields

Two beam profile measurement detectors have been developed at Indiana University Cyclotron Facility to address the need for a tool to efficiently verify dose distributions created with active methods of clinical proton beam delivery. The multipad ionization chamber (MPIC) has 128 ionization chambers arranged in one plane and is designed to measure lateral profiles in fields up to 38 cm in diameter. The MPIC pads have a 5 mm pitch for fields up to 20 cm in diameter and a 7 mm pitch for larger fields, providing the accuracy of field size determination about 0.5 mm. The multilayer ionization chamber (MLIC) detector contains 122 small-volume ionization chambers stacked at a 1.82 mm step (water-equivalent) for depth-dose profile measurements. The MLIC detector can measure profiles up to 20 cm in depth, and determine the 80% distal dose fall-off with about 0.1 mm precision. Both detectors can be connected to the same set of electronics modules, which comprise the detectors' data acquisition system. The detectors have been tested in clinical proton fields produced with active methods of beam delivery such as uniform scanning and energy stacking. This article describes detector performance tests and discusses their results. The test results indicate that the MPIC and MLIC detectors can be used for dosimetric characterization of clinical proton fields. The detectors offer significant time savings during measurements in actively delivered beams compared with traditional measurements using a water phantom.     

Using a Monte Carlo model to predict dosimetric properties of small radiotherapy photon fields

Accurate characterization of small-field dosimetry requires measurements to be made with precisely aligned specialized detectors and is thus time consuming and error prone. This work explores measurement differences between detectors by using a Monte Carlo model matched to large-field data to predict properties of smaller fields. Measurements made with a variety of detectors have been compared with calculated results to assess their validity and explore reasons for differences. Unshielded diodes are expected to produce some of the most useful data, as their small sensitive cross sections give good resolution whilst their energy dependence is shown to vary little with depth in a 15 MV linac beam. Their response is shown to be constant with field size over the range 1-10 cm, with a correction of 3% needed for a field size of 0.5 cm. BEAMnrc has been used to create a 15 MV beam model, matched to dosimetric data for square fields larger than 3 cm, and producing small-field profiles and percentage depth doses (PDDs) that agree well with unshielded diode data for field sizes down to 0.5 cm. For fields sizes of 1.5 cm and above, little detector-to-detector variation exists in measured output factors, however for a 0.5 cm field a relative spread of 18% is seen between output factors measured with different detectors-values measured with the diamond and pinpoint detectors lying below that of the unshielded diode, with the shielded diode value being higher. Relative to the corrected unshielded diode measurement, the Monte Carlo modeled output factor is 4.5% low, a discrepancy that is probably due to the focal spot fluence profile and source occlusion modeling. The large-field Monte Carlo model can, therefore, currently be used to predict small-field profiles and PDDs measured with an unshielded diode. However, determination of output factors for the smallest fields requires a more detailed model of focal spot fluence and source occlusion.     

Analysis of various beamlet sizes for IMRT with 6 MV photons

Application of intensity modulated radiation therapy (IMRT) using multileaf collimation often requires the use of small beamlets to optimize the delivered radiation distribution. Small-beam dose distribution measurements were compared to dose distributions calculated using a commercial treatment planning system that models its data acquired using measurements from relatively large fields. We wanted to evaluate only the penumbra, percent depth-dose (PDD) and output model, so we avoided dose distribution features caused by rounded leaf ends and interleaf leakage by making measurements using the secondary collimators. We used a validated radiochromic film dosimetry system to measure high-resolution dose distributions of 6 MV photon beams. A commercial treatment planning system using the finite size pencil beam (FSPB) dose calculation algorithm was commissioned using measured central axis outputs from 4.0x4.0 to 40.0x40.0 cm2 beams and radiographic-film profile measurements of a 4.0x4.0 cm2 beam at twice the depth of maximum dose (dmax). Calculated dose distributions for square fields of 0.5x0.5 cm2, and 1.0x1.0 cm2, to 6.0x6.0 cm2, in 1.0x1.0 cm2, increments were compared against radiochromic film measurements taken with the film oriented parallel to the beam central axis in a water equivalent phantom. The PDD of the smaller field sizes exhibited behavior typical of small fields, namely a decrease in dmax with decreasing field size. The FSPB accurately modeled the depth-dose and central axis output for depths deeper than the nominal dmax of 1.5 cm plus 0.5 cm. The dose distribution in the build-up and penumbra regions was not accurately modeled for depths less than 2 cm, especially for the fields of 2.0x2.0 cm2 and smaller. Using the gamma function with 2 mm and 2% criteria, the dose model was shown to accurately predict the penumbra. While for single small beams the compared dose distributions passed the gamma function criteria, the clinical appropriateness of these criteria is not clear for a composite IMRT plan. Further investigation of the cumulative impact of the observed dose discrepancies is warranted. We speculate that the observed differences in the penumbra regions arise from some energy dependent artifact in the radiographic-film profiles used for commissioning. In the future, radiochromic film based commissioning might provide a more accurate data set for dose modeling.     

Are neutrons responsible for the dose discrepancies between Monte Carlo calculations and measurements in the build-up region for a high-energy photon beam?

This study presents measured neutron dose using a neutron dosimeter in a water phantom and investigates a hypothesis that neutrons in a high-energy photon beam may be responsible for the reported significant dose discrepancies between Monte Carlo calculations and measurements at the build-up region in large fields. Borated polyethylene slabs were inserted between the accelerator head and the phantom in order to remove neutrons generated in the accelerator head. The thickness of the slab ranged from 2.5 cm to 10 cm. A lead slab of 3 mm thickness was also used in the study. The superheated drop neutron dosimeter was used to measure the depth-dose curve of neutrons in a high-energy photon beam and to verify the effectiveness of the slab to remove these neutrons. Total dose measurements were performed in water using a WELLHOFER WP700 beam scanner with an IC-10 ionization chamber. The Monte Carlo code BEAM was used to simulate an 18 MV photon beam from a Varian Clinac-2100EX accelerator. Both EGS4/DOSXYZ and EGSnrc/DOSRZnrc were used in the dose calculations. Measured neutron dose equivalents as a function of depth per unit total dose in water were presented for 10 x 10 and 40 x 40 cm2 fields. The measured results have shown that a 5-10 cm thick borated polyethylene slab can reduce the neutron dose by a factor of 2 when inserted between the accelerator head and the detector. In all cases the measured neutron dose equivalent was less than 0.5% of the photon dose. In order to study if the ion chamber was highly sensitive to the neutron dose, we have investigated the disagreement between the Monte Carlo calculated and measured central-axis depth-dose curves in the build-up region when different shielding materials were used. The result indicated that the IC-10 chamber was not highly sensitive to the neutron dose. Therefore, neutrons present in a high-energy photon beam were unlikely to be responsible for the reported discrepancies in the build-up region for large fields.     

Peripheral dose measurements for 6 and 18 MV photon beams on a linear accelerator with multileaf collimator

Peripheral dose (PD) to critical structures outside treatment volume is of clinical importance. The aim of the current study was to estimate PD on a linear accelerator equipped with multileaf collimator (MLC). Dose measurements were carried out using an ionization chamber embedded in a water phantom for 6 and 18 MV photon beams. PD values were acquired for field sizes from 5 x 5 to 20 x 20 cm2 in increments of 5 cm at distances up to 24 cm from the field edge. Dose data were obtained at two collimator orientations where the measurement points are shielded by MLC and jaws. The variation of PD with the source to skin distance (SSD), depth, and lateral displacement of the measurement point was evaluated. To examine the dependence of PD upon the tissue thickness at the entrance point of the beam, scattered dose was measured using thermoluminescent dosemeters placed on three anthropomorphic phantoms simulating 5- and 10-year-old children and an average adult patient. PD from 6 MV photons varied from 0.13% to 6.75% of the central-axis maximum dose depending upon the collimator orientation, extent of irradiated area, and distance from the treatment field. The corresponding dose range from 18 MV x rays was 0.09% to 5.61%. The variation of PD with depth and with lateral displacements up to 80% of the field dimension was very small. The scattered dose from both photon beams increased with the increase of SSD or tissue thickness along beam axis. The presented dosimetric data set allows the estimation of scattered dose outside the primary beam.     

A multiple source model for 6 MV photon beam dose calculations using Monte Carlo

A multiple source model (MSM) for the 6 MV beam of a Varian Clinac 2300 C/D was developed by simulating radiation transport through the accelerator head for a set of square fields using the GEANT Monte Carlo (MC) code. The corresponding phase space (PS) data enabled the characterization of 12 sources representing the main components of the beam defining system. By parametrizing the source characteristics and by evaluating the dependence of the parameters on field size, it was possible to extend the validity of the model to arbitrary rectangular fields which include the central 3 x 3 cm2 field without additional precalculated PS data. Finally, a sampling procedure was developed in order to reproduce the PS data. To validate the MSM, the fluence, energy fluence and mean energy distributions determined from the original and the reproduced PS data were compared and showed very good agreement. In addition, the MC calculated primary energy spectrum was verified by an energy spectrum derived from transmission measurements. Comparisons of MC calculated depth dose curves and profiles, using original and PS data reproduced by the MSM, agree within 1% and 1 mm. Deviations from measured dose distributions are within 1.5% and 1 mm. However, the real beam leads to some larger deviations outside the geometrical beam area for large fields. Calculated output factors in 10 cm water depth agree within 1.5% with experimentally determined data. In conclusion, the MSM produces accurate PS data for MC photon dose calculations for the rectangular fields specified.     

Dosimetric effect of collimating jaws for small multileaf collimated fields

The dosimetric effects from the jaw positioned close to the small field (0.5 x 0.5, 1 x 1, and 2 x 2 cm2) side-edge generated by a single-focused multileaf collimator (MLC) were measured and studied. The measurement is important in intensity modulated radiotherapy (IMRT) because generally the jaw cannot perfectly cover all the leaf-ends in a segment of irregular field. This leads to additional dose contributed by (1) the end surface of the jaw, (2) the leaf-end, and (3) the inter- and intraleaf leakage/transmissions during the dosimetric measurement. Moreover, most of the conventional treatment planning systems ignore these effects in the dose calculation. In this study, measurements were made using a Varian 21 EX linear accelerator with 6 MV photon beam through a MLC containing 120 leaves. Percentage depth dose, beam profile, and output for small fields were measured by varying the jaw at different positions away from the leaf-ends in the field side-edge. Moving the jaw away from the leaf-ends increases the output and penumbra width for the small fields. Such increase is particularly significant when the field size is small (0.5 x 0.5 cm2) and the degree of increase changes quickly when the jaw-end is at about 1-2 cm from the leaf-end. It is suggested that measurements should be carried out in the IMRT commissioning to provide information to physicists in reviewing the treatment planning system's accuracy regarding leaf leakage/transmission and jaw effects.     

Dosimetry of therapeutic photon beams using an extended dose range film

For intensity modulated radiation therapy (IMRT) dose distribution verification, multidimensional measurements are required to quantify the steep dose-gradient regions. High resolution, two-dimensional dose distributions can be measured using radiographic film. However, the photon energy response of film is known to be a function of depth, field size, and photon beam energy, potentially reducing the accuracy of dose distribution measurements. The dosimetric properties of the recently developed Kodak EDR2 film were investigated and compared to those of Kodak XV film. The dose responses of both film types to 6 MV and 18 MV photon beams were investigated for depths of 5 cm, 10 cm, and 15 cm and field sizes of 4x4 cm2 and 15x15 cm2. This analysis involved the determination of sensitometric curves for XV and EDR2 films, the determination of dose profiles from exposed XV and EDR2 films, and comparison of the film-generated dose profiles to ionization chamber measurements. For the combinations of photon beam energy, depth, and field size investigated here, our results indicate that the sensitometric curves are nearly independent of field size and depth of calibration. For a field size of 4x4 cm2, a single sensitometric curve for either EDR2 and XV film can be used for the determination of relative dose profiles. For the larger field size, the sensitometric curve for EDR2 film is superior to XV film in regions where the dose falls below 20% of the central axis dose, due to the effects that the increased low energy scattered photon contributions have on film response. The limited field size and depth dependence of sensitometric data measured using EDR2 film, along with the inherently wide linear dose-response range of EDR2 film, makes it better suited to the verification of IMRT dose distributions.     

Dosimetric characteristics of a double-focused miniature multileaf collimator.

The dosimetric characteristics of a double-focused miniature multileaf collimator (mMLC) attached to a Philips SL75/5 linear accelerator (linac) have been investigated. Output factors, percentage depth-dose, penumbra, leaf transmission, and leakage between the leaves were measured for the 6 MV x-ray beam on this accelerator. Because leakage both through and between the leaves is minimal, the linac jaws can be kept fixed while the mMLC leaf configuration is modified for different aperture shapes. This allows for accurate output prediction using the equivalent square formalism. Percent depth-dose measured for fields defined by the mMLC show little deviation from the percent depth-dose measured for fields defined by the machine jaws or Lipowitz metal blocks. Because the mMLC matches beam divergence in both directions, allows minimal beam transmission, and has a large source-to-collimator distance, the penumbra is sharper for fields defined by the mMLC than for fields defined by the linac jaws or Lipowitz metal blocks. Based on these data, dose calculations for mMLC-defined fields can be applied with no change in procedures from those used for fields defined using conventional methods.     

Dose measurements and calculations of small radiation fields for 9-MV x rays

Measurements of dose distribution for square fields with sizes ranging from 1 X 1 to 30 X 30 cm for a 9-MV x-ray beam from a Neptune 10 linear accelerator, manufactured by CGR, are reported. Special attention was paid to field sizes smaller than 4 X 4 cm, used in radiosurgery techniques. To express the dose-monitor units relationship, total, collimator, and phantom scatter correction factors were obtained by experimental measurements. A strong dependence of these factors on the smallest field sizes (less than 4 X 4 cm) was shown. Measurements of the maximum depth dose dmax, plotted as a function of field size, showed a maximum at about 5 X 5 cm, in good agreement with previous results. dmax was also measured for the smallest fields, demonstrating that the contaminating electron component of the x-ray beam was not responsible for the dmax shift. Analysis of the penumbra width of cross dose distributions, as a function of field sizes, allowed us to postulate that the dmax shift could be due to the phantom scattered photons, which in turn were generated by the collimator scattered photons. Newly derived tissue-maximum ratio and scatter-maximum ratio data were used for dose profile calculations of 2 X 2, 4 X 4, and 10 X 10 cm field sizes. The agreement between experimental and calculated data was found to be +/- 2% within the geometrical edges of the fields and +/- 6% outside of them. A dose profile from the isocenter of a 2 X 2 cm square field moving through a 360 degree rotation arc was obtained and compared with that from the center of a 125I shielded source, as measured by Ling. Advantages and problems relating to the use of x-ray beams from linear accelerators in radiosurgery are discussed.     

A semianalytical method for the design of a linac x-ray beam flattening filter

The purpose of this study was to design an improved flattening filter for a Therac 20 medical linear accelerator. Profiles of the 18-MV x-ray beam produced by this accelerator measured along the diagonal of a 40 X 40 cm field at a depth of 5 cm were measured, and it was found that there were regions near the corners of the field where the dose was 109% of the central axis dose. An iterative algorithm for designing flattening filters was developed which required, as input, precise measurements of the following data: the unflattened primary beam profile, the fraction of the beam due to contamination radiation arising from interactions of primary photons with the flattening filter and the collimator assemblies, and the attenuation of the primary photons in water and lead as a function of angle from the central axis of the beam. A new flattening filter was designed and profiles of the beam were measured at a number of depths. These measurements showed that the beam was flattened to within +/- 1% out to 24 cm along the diagonal of a 40 X 40 cm field at a depth of 5 cm.     

Dosimetry characteristics of degraded electron beams investigated by Monte Carlo calculations in a setup for intraoperative radiation therapy

Degraded electron beams, as used for intraoperative radiation therapy (IORT) or similar complicated dosimetric situations, have different characteristics compared to conventional electron therapy beams. If international dosimetry protocols are applied in a direct manner to such degraded beams, uncertainties will be introduced in the absorbed dose determination. The Monte Carlo method has been used to verify experimentally determined relative absorbed dose distributions and output factors in an IORT geometry. Monte Carlo generated dose distributions are mostly within +/-2% or +/-2 mm of measured data. The simulated output variation between the IORT cones (relative output factors) are mostly within 2% of measured values. By comparing IORT and conventional electron beam characteristics (e.g. energy spectra, angular distributions and the contributions of different system components to these quantities) limitations and uncertainties of commonly used dosimetric techniques in IORT electron fields are quantified. The intraoperative treatment field contains a larger amount of scattered electrons, which leads to a broader energy spectrum as well as a wider angular distribution of electrons at the phantom surface. The dose from the scattered electrons can contribute up to 40% of the total dose at a depth of dose maximum, compared to approximately 10% for standard beams. A study of the energy spectra at the reference depth reveals that an uncertainty of the order of 1% can be introduced if ionization chamber based dosimetry is used to determine output factors for the investigated IORT system. We recommend that relative absorbed dose distributions and output factors in IORT electron beams and for similar complicated dosimetric situations should be determined with detectors having a small energy and angular dependence (e.g. diamond detectors or p-Si diodes).