This work aims to generate a simple analytical model that allows estimation of peripheral photon equivalent dose to organs of individual patients, valid for any isocentric technique. Photon radiation scattered in the LINAC head has been simulated as a virtual source of radiation emitting isotropically so that, before reaching a point inside the patient, it decreases with the square law and with attenuation due to air and tissue. Leakage has been simulated as a constant background dose along the patient. Firstly, a dose-to-points basic model was proposed and parameterized by fitting it to absorbed doses measured with TLD-700 in a humanoid phantom. Secondly, this model was generalized to any other situation involving intensity-modulated beams of any size and shape. Validation of this general model, usable beyond 10 cm from the field edge, was carried out by comparing estimation with TLD-100 doses for VMAT and IMRT treatments as well as with experimental data and models existing in the bibliography. Finally, an equivalent dose-to-organs model has been proposed by rescaling individual anatomical dimensions onto a mathematical phantom in order to make an estimation of organ length for dose calculation. The parameterized extended model, accounting for intensity-modulated beams of any shape, predicts measurements with a maximum relative uncertainty of ±25%. This general model, easy to apply in a clinical routine thanks to the ready availability of input parameters, has been proposed and validated for estimation of photon equivalent doses to peripheral organs. Finally, as a first step, it has been implemented into a piece of software termed PERIPHOCAL (PERIpheral PHOton CALculation), which is easily transferred to a commercial treatment planning system (TPS).

The results obtained indicate that direct evaluation of equivalent dose estimation in organs, both in phantom and patients, is perfectly feasible with this new detector. This will open the door to an easy implementation of specific peripheral neutron dose models for any type of treatment and facility.

There is a growing interest in the combined use of Stereotactic Body Radiation Therapy (SBRT) with Flattening Filter Free (FFF) due to the high local control rates and reduced treatment times, compared to conventionally fractionated treatments. It has been suggested that they may also provide a better radiation protection to radiotherapy patients as a consequence of the expected decrease in peripheral doses. This work aims to determine this reduction in unattended out-of-field regions, where no CT information is available but an important percentage of second primary cancers occur. For that purpose, ten different cases suitable for SBRT were chosen. Thus, 142 different treatment plans including SBRT, as well as 3D‐CRT, IMRT and VMAT (with standard fractionation) in low and high energies for Varian (FF and FFF), Siemens and Elekta machines were created. Then, photon and neutron peripheral dose in 14 organs were assessed and compared using two analytical models. For the prostate case, uncomplicated and cancer free control probability estimation was also carried out. As a general behavior, SBRT plans led to the lowest peripheral doses followed by 3D-CRT, VMAT and IMRT, in this order. Unflattened beams proved to be the most effective in reducing peripheral doses, especially for 10 MV. The obtained results suggest that FFF beams for SBRT with 10 MV represent the best compromise between dose delivery efficiency and peripheral dose reduction.

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The aim of this work was to estimate peripheral neutron and photon doses associated with the conventional 3D conformal radiotherapy techniques in comparison to modern ones such as Intensity modulated radiation therapy and volumetric modulated arc therapy. Assessment in terms of second cancer incidence ought to peripheral doses was also considered. For that, a dosimetric methodology proposed by the authors has been applied beyond the region where there is no CT information and, thus, treatment planning systems do not calculate and where, nonetheless, about one third of second primary cancers occurs.