Evaluation of the dosimetric characteristics of 10 MV flattened and unflattened photon beams in a heterogeneous phantom

Background: The free flattening filter (FFF) beam can affect the characteristics of the linac output such as the maximum dose depth, surface dose, dose in the fall-off area, and doses outside the field because the beam hardening effect does not occur in the FFF linac head. Therefore, the present study aimed to investigate the influence of the FFF beam on the dose distribution in an inhomogeneous phantom using the EGSnrc/DOSXYZnrc Monte Carlo package. Materials and Methods: In the present study, an Elekta Infinity 10 MV photon beam equipped with a multileaf collimator Agility linear accelerator was used. Two types of virtual inhomogeneous phantoms were built for percent depth doses (PDDs) and dose profiles measurement. The first phantom comprised four layers: water (4 cm thickness), bone (2 cm thickness), lung tissue (5 cm thickness), and water (19 cm thickness). The second phantom had a half-lung tissue slab and a half-bone slab (10 cm thickness) on the left side of the water. Results: The PDD curves in the inhomogeneous phantom considerably decreased in the lung area for small exposure fields because the charged particle equilibrium was not achieved. The dose in the lung was higher than the dose in the water when the charged particle equilibrium was reached. Meanwhile, the dose in the bone is always lower than the dose in the water. Conclusions: The dose distribution of flattening filter (FF) and FFF beams in the inhomogeneous phantom was the same in the small field of exposure. However, differences in dose distribution are increasingly apparent for larger field sizes.