INSTITUTE OF PHYSICS PUBLISHING PHYSICS IN MEDICINE AND BIOLOGY

Phys. Med. Biol. 48 (2003) 6371 PII: S0031-9155(03)37831-5

Refined gypsum effective attenuation coefficients for

Co-60, 6 MV, 10 MV and 18 MV x-rays
Glenn P Glasgow, Nesrin Dogan, Anil Sethi and Jerry Stanton
Department of Radiation Oncology, Loyola University Chicago Stritch School of Medicine,
2160 S 1st Avenue, Maywood, IL 60153, USA

E-mail: gglasgo@lumc.edu

Received 10 June 2002

Published 16 December 2002
Online at stacks.iop.org/PMB/48/63

Abstract
We report new effective linear attenuation coefficients (eff) for refined gypsum
for Co-60 and 18 MV x-rays. 6 MV and 10 MV eff agree with published
data. For a 100 cm2 field size (FS), tissue defect x = 1.35 cm, target depth
d = 1.65 cm beneath the tissue defect x, eff is 0.123 cm1 (Co-60) and
0.0934 cm1 (6 MV). For 100 cm2, x = 1.35 cm, and d = 5.65 cm beneath x,
eff is 0.072 cm1 (10 MV), and 0.0614 cm1 (18 MV). For d, eff decreases
about 10% from 25 to 400 cm2. For a given FS, eff decreases with d by
3%5% for Co-60, and 3% for 6 MV, 10 MV and 18 MV, but depends on
(d x). For d, when x is large (8 cm), depending on energy and FS, eff
is 2%4% less than when x is small (2 cm). These data were used in a
treatment-planning computer to design compensator filters for a step phantom.
Compensation was to within 10% in the compensation plane (CP). Above and
below CP, computer-calculated ratios of doses with and without filters were
0.751.13. Chamber dose ratios with and without filters were 0.751.12.

1. Introduction

Compensating filters were introduced by Ellis et al (1959), and subsequently developed

(Hall and Oliver 1961, Sundbom 1964, Hendee and Garciga 1967, Van de Geijn 1965) in
the 1960s. In the 1970s, Jackson (1970) and Boge et al (1974) described StyrofoamTM
(Dow Chemical Co., Midland, MI) moulds filled with wax as compensators. Compensators
are particularly useful for improving absorbed dose uniformity in head and neck treatments
(Clark and Evans 1988, Harari et al 1998). The dosimetry of compensating filters is complex
and several authors (Khan et al 1970, Dmytrow et al 1986, Robinson and Scrimger 1987,
1989) have explored their limitations. Boyer (1983) and Reinstein (1992) have provided
excellent reviews of the physics of compensators.
Refined gypsum mixtures for compensators used in x-ray beams were developed in
1988 by Weeks et al (1988), who reported field-size-dependent effective linear attenuation
0031-9155/03/010063+09$30.00 2003 IOP Publishing Ltd Printed in the UK 63
64 G P Glasgow et al

Gypsum Plates

Phantom

Figure 1. Schematic representation (not to scale) of the missing tissue compensator material
experiment. After baseline measurements with the complete phantom (left panel), polystyrene
plates are removed and gypsum attenuation plates inserted (right panel) to restore the charge
measured with the complete phantom.

coefficients (eff), measured in air, for refined gypsum, refined gypsum and steel and refined
gypsum and iron, for 6 MV and 15 MV photon beams. Arora and Weeks (1994) subsequently
reported eff coefficients, in tissue, for refined gypsum for 4 MV, 6 MV, 10 MV and 15 MV.
We extended the refined gypsum eff data to low and high energies by reporting new field-
size and depth-dependent eff for Co-60 and 18 MV x-rays, and 6 MV and 10 MV x-ray
eff coefficients that confirm previous work (Arora and Weeks 1994). We used these data to
implement the compensator filter module for a CMS (Computerized Medical Systems, Inc.,
St Louis, MO) FOCUS treatment-planning computer and confirmed the dosimetry for missing
tissue compensators. Additionally, the refined gypsum eff coefficients may be of use to those
desiring to deliver intensity-modulated radiotherapy (IMRT) using compensating filters.

2. Materials and methods

The method of measurement was the classical compensation for the missing tissue
experiment, shown in figure 1. A polystyrene phantom, nominally 25 cm 25 cm 35 cm with
plates of 0.08, 0.16, 0.32, 0.64, 1.27, 2.54 and 5.08 cm thickness, was used for measurements.
A 0.99 scaling factor was used to correct the polystyrene thickness to water for Co-60 and
6 MV. A Capintec-192 (Capintec, Inc., Ramsey, NY) electrometer was used with a 0.6 cm3
PTW (Physikalisch-Technische Werkstatten-New York, New York, NY) Farmer-type chamber
for charge measurements. The chamber in the phantom was positioned at 100 cm source-
to-axis distance. Refined gypsum (sp gr 2.0) was chosen as the compensating material and
prepared following the recipe described by Weeks et al (1988) One hundred grams of gypsum
was thoroughly mixed with 20 ml of water. The refined gypsum mixture was poured into a
plate mould to form plates 20 cm 20 cm and nominally 0.635 cm thick. Each plate thickness
Gypsum effective attenuation coefficients 65

x
d

d-x
A1 A2 A3
Compensation Plane

B1 B2 B3 B4 B5

Figure 2. Schematic representation of the phantom for measuring the degree of compensation
provided by the gypsum missing tissue filters. The compensation plane, in which film
measurements were made, is at the top of the bottom slab of the phantom. One set of chamber
measurement points (A1A3) are 3.5 cm above the plane of compensation and the other set
of measurement points (B1B5) are 1.5 cm below the plane of compensation. All chamber
measurement points lie on the midline of the phantom.

was measured with callipers and the exact plate thicknesses were used in data analysis. For
square field sizes (25, 64, 144, 225 and 400 cm2) and numerous depths (from 1.65 cm to 14 cm),
measurements were first made with all polystyrene plates present. As polystyrene plates were
removed the gypsum plates were placed in the beam to restore the charge to a value less than
that measured for the full phantom. The plates were placed on a solid 0.635 cm Plexiglas
plate in the block tray slot at 65 cm on the Co-60 unit and each linear accelerator. The exact
thickness of gypsum required to restore the measured charge to that measured for the full
phantom was determined by interpolation. Values for eff were obtained using the tissueair
ratio methodology (Boyer 1983), modified to tissue-maximum ratios
exp(eff t) = [TMR(A, d)/TMR(A, d x)]. (1)
Here eff is the effective linear attenuation coefficient per centimetre, t is the thickness of
gypsum in centimetres, TMR is the tissue-maximum ratio, A is the field size, d is the depth of
the plane of compensation beneath the high point and x is the missing tissue defect. Linear
least-squares fits were performed on eff as a function of field size area and eff extracted
for the intermediate square field sizes of 36, 49, 81, 100, 121, 169, 196, 256, 289, 324 and
361 cm2. Because of space limitations the results of only the even field sizes are presented
in tables 14. Complete tables for all 16 field sizes are available from the author on
request.
To confirm the accuracy of the measured gypsum effective attenuation coefficients
confirmation measurements were performed. A test phantom (figure 2) was designed using
the same polystyrene phantom described. The plane of compensation was selected at a depth
of 12 cm below the high point of the phantom. On the central axis the tissue defect was 3 cm
and the target depth was 9 cm. The phantom was irradiated with an 8 cm 17 cm field at
66 G P Glasgow et al

Table 1. Effective attenuation coefficient (per cm)refined gypsumcobalt-60.

Target
depth Total depth Field size (cm cm)
Tissue below high point to
defect (cm) defect (cm) target (cm) 6 6 88 10 10 12 12 14 14 16 16 18 18 20 20
36 64 100 144 196 256 324 400
1.35 1.65 3 0.1249 0.1239 0.1227 0.1211 0.1193 0.1171 0.1147 0.1120
2 1 3 0.1236 0.1227 0.1216 0.1202 0.1186 0.1167 0.1146 0.1123
2.6 3.4 6 0.1210 0.1204 0.1196 0.1187 0.1176 0.1163 0.1149 0.1134
2.6 6.4 9 0.1223 0.1215 0.1204 0.1192 0.1177 0.1159 0.1140 0.1119
2.6 11.4 14 0.1204 0.1196 0.1185 0.1172 0.1157 0.1140 0.1122 0.1099
3.95 2.05 6 0.1216 0.1208 0.1198 0.1186 0.1172 0.1155 0.1137 0.1116
5.1 0.9 6 0.1212 0.1204 0.1199 0.1183 0.1169 0.1152 0.1135 0.1115
5.2 3.8 9 0.1211 0.1203 0.1194 0.1181 0.1167 0.1151 0.1133 0.1113
5.2 8.8 14 0.1202 0.1194 0.1184 0.1171 0.1156 0.1139 0.1120 0.1097
6.55 2.45 9 0.1215 0.1206 0.1195 0.1181 0.1165 0.1146 0.1126 0.1102
8 1 9 0.1207 0.1198 0.1188 0.1174 0.1158 0.1140 0.1121 0.1098
8 6 14 0.1194 0.1186 0.1176 0.1164 0.1149 0.1134 0.1115 0.1094
10.4 3.6 14 0.1202 0.1193 0.1183 0.1170 0.1154 0.1139 0.1120 0.1098

Table 2. Effective attenuation coefficient (per cm)refined gypsum6 MV.

Target
depth Total depth Field size (cm cm)
Tissue below high point to
defect (cm) defect (cm) target (cm) 6 6 88 10 10 12 12 14 14 16 16 18 18 20 20
36 64 100 144 196 256 324 400
1.35 1.65 3 0.0945 0.0940 0.0934 0.0926 0.0917 0.0906 0.0894 0.0881
2.6 3.4 6 0.0946 0.0940 0.0932 0.0923 0.0912 0.0900 0.0885 0.0869
2.6 6.4 9 0.0944 0.0937 0.0928 0.0916 0.0903 0.0888 0.0870 0.0850
2.6 11.4 14 0.9125 0.0908 0.0902 0.0894 0.0896 0.0892 0.0864 0.0851
3.95 2.05 6 0.0950 0.0944 0.0936 0.0926 0.0915 0.0902 0.0889 0.0873
5.2 3.8 9 0.0935 0.0928 0.0922 0.0910 0.0899 0.0885 0.0875 0.0853
5.2 8.8 14 0.0934 0.0920 0.0918 0.0900 0.0887 0.0873 0.0862 0.0837
6.55 2.45 9 0.0938 0.0931 0.0922 0.0911 0.0898 0.0883 0.0866 0.0847
7.8 6.2 14 0.0910 0.0905 0.0898 0.0890 0.0881 0.0870 0.0857 0.0843
10.4 3.6 14 0.0926 0.0915 0.0907 0.0897 0.0885 0.0871 0.0856 0.0838

100 cm SAD, nominally at the lower chamber measurement plane in figure 2. Kodak (Eastman
Kodak Co., Rochester, NY) XV-2 film was placed in the plane of compensation to measure
compensation in that plane. The test phantom design allowed the 0.6 cm3 chamber to be
placed at eight locations in the phantom so that the degree of compensation could be measured
at points 3.5 cm above and 1.5 cm below the plane of compensation. Compensator filters for
the test phantom for each energy were designed using the FOCUS (Computerized Medical
Systems, Inc 1998) compensating filter module, using the Clarkson algorithm to compensate
for irregular dose pattern produced when a radiation beam was incident perpendicular to the
irregular surface of this phantom. The software uses the same mathematical model previously
described, but solved for eff. Specifically
eff = ln[TMR(A, d)/TMR(A, d x)]/t. (2)
Gypsum effective attenuation coefficients 67

Table 3. Effective attenuation coefficient (per cm)refined gypsum10 MV.

Target
depth Total depth Field size (cm cm)
Tissue below high point to
defect (cm) defect (cm) target (cm) 6 6 88 10 10 12 12 14 14 16 16 18 18 20 20
36 64 100 144 196 256 324 400
1.35 5.65 7 0.0728 0.0725 0.0720 0.0714 0.0707 0.0699 0.0690 0.0679
1.35 8.35 9.7 0.0739 0.0734 0.0730 0.0720 0.0711 0.0701 0.0689 0.0676
1.35 11.1 12.4 0.0727 0.0722 0.0716 0.0709 0.0700 0.0691 0.0680 0.0668
1.35 13.9 15.2 0.0708 0.0706 0.0702 0.0698 0.0693 0.0688 0.0682 0.0675
2.6 4.4 7 0.0740 0.0735 0.0730 0.0723 0.0715 0.0705 0.0695 0.0683
2.6 7.1 9.7 0.0732 0.0727 0.0721 0.0714 0.0705 0.0696 0.0684 0.0672
2.6 9.8 12.4 0.0722 0.0717 0.0710 0.0703 0.0693 0.0682 0.0670 0.0657
2.6 12.6 15.2 0.0711 0.0708 0.0703 0.0698 0.0692 0.0685 0.0677 0.0667
5.2 4.5 9.7 0.0731 0.0726 0.0719 0.0711 0.0702 0.0691 0.0679 0.0665
5.2 7.2 12.4 0.0725 0.0720 0.0714 0.0707 0.0698 0.0688 0.0676 0.0664
5.2 10 15.2 0.0713 0.0798 0.0703 0.0697 0.0689 0.0680 0.0670 0.0659
7.8 4.6 12.4 0.0718 0.0714 0.0708 0.0700 0.0692 0.0682 0.0671 0.0659
7.8 7.4 15.2 0.0712 0.0708 0.0702 0.0695 0.0686 0.0676 0.0665 0.0653
10.4 4.8 15.2 0.0718 0.0713 0.0706 0.0699 0.0689 0.0679 0.0667 0.0653

Table 4. Effective attenuation coefficient (per cm)refined gypsum18 MV.

Target
depth Total depth
Field size (cm cm)
Tissue below high point to
defect (cm) defect (cm) target (cm) 6 6 88 10 10 12 12 14 14 16 16 18 18 20 20
36 64 100 144 196 256 324 400
1.35 5.65 7 0.0627 0.0621 0.0614 0.0605 0.0594 0.0581 0.0567 0.0551
1.35 8.35 9.7 0.0606 0.0602 0.0598 0.0593 0.0586 0.0579 0.0571 0.0562
1.35 11.1 12.4 0.0603 0.0599 0.0593 0.0586 0.0577 0.0567 0.0556 0.0543
1.35 13.9 15.2 0.0596 0.0593 0.0589 0.0584 0.0578 0.0570 0.0562 0.0553
2.6 4.4 7 0.0634 0.0629 0.0623 0.0615 0.0605 0.0595 0.0582 0.0569
2.6 7.1 9.7 0.0609 0.0604 0.0598 0.0591 0.0582 0.0572 0.0561 0.0549
2.6 9.8 12.4 0.0600 0.0596 0.0591 0.0585 0.0577 0.0569 0.0559 0.0549
2.6 12.6 15.2 0.0611 0.0606 0.0599 0.0590 0.0580 0.0569 0.0555 0.0541
5.2 4.5 9.7 0.0617 0.0612 0.0606 0.0598 0.0589 0.0578 0.0566 0.0553
5.2 7.2 12.4 0.0604 0.0597 0.0590 0.0587 0.0578 0.0569 0.0558 0.0546
5.2 10 15.2 0.0594 0.0590 0.0584 0.0577 0.0569 0.0560 0.0550 0.0538
7.8 4.6 12.4 0.0609 0.0604 0.0598 0.0590 0.0581 0.0570 0.0558 0.0544
7.8 7.4 15.2 0.0597 0.0593 0.0587 0.0580 0.0572 0.0563 0.0552 0.0540
10.4 4.8 15.2 0.0605 0.0600 0.0594 0.0587 0.0578 0.0568 0.0556 0.0543

This module requires the use of a eff that is a function of field size and the depth of the
selected plane of compensation beneath the highest point in the treatment field.
The dosimetrist performs an initial isodose computation with a field size and an
approximate value of eff. This yields the depth of the plane of compensation beneath the
high point, and, on the central axis, the missing tissue defect and the target depth below
the missing tissue defect. Using these parameters and tables 14, the dosimetrist selects an
appropriate eff and repeats the computation. For the confirmation dosimetry, the eff values
were 0.1193, 0.0906, 0.0716 and 0.0599 for Co-60, 6, 10 and 18 MV, respectively.
68 G P Glasgow et al

Table 5. Confirmation ion-chamber dosimetry. Table entries are ratios of the measured absorbed
dose in water to the FOCUS calculated absorbed dose in water without (w/o) and with the filter
present.

Ratios of dose with filter to dose without filter

Distance from
beam (B) or Depth Co-60 6 MV 10 MV 18 MV
phantom (P) beneath
Point edge (cm) surface (cm) Cc Meas Cc Meas Cc Meas Cc Meas
3.5 cm above compensation plane
A1 5.1B 6.7 1.130 1.119 1.089 1.076 1.076 1.067 1.052 1.043
A2 6.6P 3.9 0.999 1.000 1.000 0.992 1.000 0.993 0.999 0.990
A3 3.7P 1.3 0.894 0.897 0.913 0.906 0.931 0.919 0.948 0.937
1.5 cm below compensation plane
B1 3.7B 11.8 1.123 1.121 1.082 1.078 1.074 1.071 1.050 1.050
B2 6.7B 11.8 1.064 1.022 1.045 1.023 1.058 1.025 1.028 1.014
B3 12.3B 9.2 0.999 0.975 1.000 0.990 0.999 0.992 0.999 0.990
B4 9.2B 6.6 0.893 0.890 0.912 0.907 0.929 0.920 0.943 0.936
B5 6.3B 1.5 0.750 0.749 0.827 0.820 0.866 0.950 0.928 0.906
Note: Cc: Computer calculated, Meas: Measured.

The FOCUS compensator data files were transferred electronically to a Par Scientific
DIGIMILLTM (S & S Par Scientific, Inc., Brooklyn, NY) automated milling machine, where
the moulds for the compensator filters were milled. The mould material machined was regular
density (sp gr 0.0337) StyrofoamTM blocks 8

8

2.165

thick. The milling machine has
a milling accuracy of 1 mm. Quality assurance depth measurements were performed on the
milled moulds and confirmed that the accuracy of the milled depths was within 1 mm.

3. Results

Tables 14 present even-field size results of the experiments. For a 10 cm 10 cm field, a

tissue defect of 1.35 cm, and a target depth of 1.65 cm beneath the tissue defect (the most
shallow depth measured), eff measured 0.123 cm1 (Co-60) and 0.0934 cm1 (6 MV). For
the same field size and tissue defect, and a target depth of 5.65 cm beneath the tissue defect,
eff measured 0.070 cm1 (10 MV), and 0.0614 cm1 (18 MV). Generally, a 10% decrease
in eff with field size increases from 25400 cm2 is observed for all energies. For a given
field size, eff decreased with the target depth by 3%5%, depending on energy, but the depth
dependence is complex. Table 5 shows the position of the eight points and their distances
from the closest beam field edge or the edge of the phantom and their depth in the phantom.
For measurements filters were designed to produce dose uniformity in an arbitrarily selected
compensation plane in the step phantom. Table 5 lists the computer-calculated ratios of dose
in water with filter, to the calculated dose in water without the compensator filter. Also listed
are the measured ratios of dose in water with filter to the dose in water without the filter.
Computer-calculated ratios of doses with filters to doses without filters ranged from 0.75 to
1.13. Chamber dosimetry of doses with filters to doses without filters ranged from 0.75 to 1.12.
For 32 measurements (four energies, eight points), without filters, the computer-calculated
absorbed dose to measured absorbed dose average ratio was 1.01 0.04; with the filters
present, the average ratio was 1.02 0.04, confirming the computer calculations.
Figure 3 compares, for 6 MV, in the plane of compensation, the coronal isodose scans
obtained without and with the compensator. Similar results, not shown, were obtained at the
Gypsum effective attenuation coefficients 69

Figure 3. 6 MV coronal per cent isodose scans in the compensation plane of the test phantom.
Without compensation (left panel) and with compensation (right panel). Per cent isodose curves
are normalized to the maximum absorbed dose in each scan.

Table 6. Comparison of 100 cm2 effective linear attenuation for gypsum.

Field size (cm cm)

Energy Study 66 10 10 20 20
Co-60 This study 0.1249 0.1227 0.1220
4 MV Arora and Weeks 0.1012 0.0998 0.0932
6 MV Arora and Weeks 0.0912 0.0908 0.0890
6 MV This study 0.0945 0.0934 0.0881
10 MV Arora and Weeks 0.0725 0.0719 0.0690
10 MV This study 0.0728 0.070 0.0679
15 MV Arora and Weeks 0.0651 0.0646 0.0625
18 MV This study 0.0627 0.0614 0.0551

other energies. Figure 3, for 6 MV, shows in the plane of compensation, the per cent isodose
curves normalized to the maximum dose in the compensation plane. A dose uniformity of
about 10% is achieved in the plane of compensation. A similar degree of dose uniformity was
obtained in the plane of compensation for the other three energies. Numerous factors could
contribute to the observed non-uniformity. Further careful studies will be required to identify
these factors and their relative contributions to the non-uniformity in dose.
Table 6 compares coefficients from this study to that reported by Arora and Weeks (1994).
The new coefficients for Co-60 and 18 MV x-rays have values expected for these energies.
The eff of 0.1227 cm1 (Co-60) is greater than the eff of 0.0998 cm1 (4 MV); the eff of
70 G P Glasgow et al

0.0614 cm1 (18 MV) is less than the 0.063 cm1 eff (15 MV). For 6 MV and 10 MV the
coefficients agree to within 1% to about 3%. This study included measurements for five square
field sizes (25, 64, 144, 225, 400 cm2); Arora and Weeks (1994) studied four square field sizes
(25, 100, 400 and 625 cm2). For the two energies (6 MV, 10 MV) this study shows a somewhat
stronger decrease in eff with increases in field size than the previous study (Arora and Weeks
1994). They also noted a weak decrease in eff as depth increased. The depth dependence
is a complex function, and depends on the tissue defect, or filter thickness, as noted later.
For example, for a 100 cm2 field, for 6 MV, for a target depth 6.4 cm below a 2.6 cm tissue
defect, eff is 0.0928 cm1; for essentially the same depth 6.2 cm below a 7.8 cm tissue defect,
eff is 0.0898 cm1, about 3% less. For the same field size, for 10 MV, for a target depth of
8.35 cm beneath a 1.35 cm tissue defect, eff is 0.0730 cm1; for a similar target depth of
7.4 cm beneath a 7.8 cm tissue defect, eff is 0.0702 cm1, about 4% less. For a given target
depth below the defect, when the tissue defect is large (about 8 cm), depending on energy and
field size, eff is 2%4% less than the corresponding eff when the tissue defect is small (about
2 cm). Arora and Weeks (1994) noted this dependence with tissue defect as a dependence
associated with the thickness of the attenuating filter. For a 100 cm2 field, to 10 cm depth,
for a 7.9 cm attenuator, Arora and Weeks (1994) reported a 1.7% decrease in eff (4 MV) and
0.6% decrease in eff (15 MV). In this study, the corresponding decreases in eff for a tissue
defect of 10.4 cm were 3.6% (Co-60), 2.9% (6 MV), 2.0% (10 MV), and 3.2% (18 MV).
Multiple factors contribute to the effect. For the same depth below different tissue defects,
beam geometry and scatter is different. Moreover, a thicker filterrequired for a greater tissue
deficitprobably hardens the beam more than a thinner filter. Consequently, the eff for the
slightly higher energy beam is less than the eff for a thinner filter in the same nominal energy
beam.

4. Conclusions

For a 100 cm2 field size, the new refined gypsum eff of 0.1227 cm1 (Co-60) and the eff
of 0.0614 cm1 (18 MV) are values expected for these energies. Other eff coefficients
(6 MV, 10 MV) agree to within 1% to about 3% with published data. For all energies, for a
given depth, eff coefficients decrease by about 10% for field sizes from 5 cm 5 cm to 20 cm
20 cm. For a given field size, eff generally decreases with target depth from 3% to 5% for
Co-60, and 3% for 6, 10 and 18 MV, but the depth dependence is complex and a function
of the tissue defect. Compensator filters constructed using these data and a compensator
filter-planning module produced ratios of doses with filters to doses without filters that were
confirmed to within 1% by chamber measurements. In a test phantom designed to test
compensation using film, compensation to within about 10% was achieved across the plane of
compensation.

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