Flattening filter-free (FFF) beams generated by linear accelerators have been widely adopted in many hospitals recently for radiation therapy. FFF technology can provide higher dose rates so that shortening of the treatment time and less intra-fraction motion error are expected.In Japan, the current way of determining absorbed dose to water for FFF beams is to follow the Standard Dosimetry 12 protocol which was developed for flattened beams. Since it has been reported that the flattened beams and FFF beams have different beam properties, it is necessary to evaluate the usefulness of Standard Dosimetry 12 protocol for FFF beam dosimetry.This report reviews physical and dosimetric properties of FFF beams especially in terms of the effect on absorbed dose to water dosimetry using an ionization chamber. From the review, it became evident that the absorbed dose to water is underestimated by volume averaging effect of the ionization chamber. On the other hand, the absorbed dose to water is overestimated by using the beam-quality specifier TPR20,10 to predict the restricted mass collision stopping power ratio for FFF beams. Therefore, an alternative method was proposed for absorbed dose to water dosimetry of FFF beams based on Standard Dosimetry 12.
Keywords: flattening filter-free; ionization chamber; radiation therapy; reference dosimetry.