Review of backscatter measurement in kilovoltage radiotherapy using novel detectors and reduction from lack of underlying scattering material.

Lack of underlying material can lead to dose reduction in kilovoltage radiotherapy treatments because of backscatter reduction. Conversely, the use of lead shielding can lead to large dose enhancement close to the lead interface. GAFCHROMIC film has been shown to be of use in verification of local backscatter factors compared to reference data in codes of practice, but careful handling and multiple readings are required to reduce systematic uncertainties to between 3% and 4%. Monte Carlo modeling of the specific treatment unit should be performed in cases which are found to differ from reference values before alternative values are adopted clinically, but these cases are expected to be few. GAFCHROMIC film may also be used to estimate backscatter reduction more readily than customized ionization chambers, for a range of beam qualities, applicator sizes and depth, with and without lead shielding. Differences were found between different studies, and it is not clear to what extent these are due to variation in equipment and/or technique. However, a layer of wax around lead shielding of 1 mm thickness should be sufficient to eliminate lead enhancement effects for all kilovoltage energies from 40 kV to 300 kV.