Electron and photon spread contributions to the radiological penumbra for small monoenergetic x-ray beam (≤2 MeV)

Our team has previously published that submegavoltage photons could significantly improve the radiological penumbra for small size radiation fields. The present work uses Monte Carlo simulation to evaluate the contributions of secondary electrons and photon scatter to the penumbra region for various field sizes (5, 10, 20, and 40 mm in diameters) and for various monoenergetic photon beams (200, 400, 600, 800, 1000, and 2000 keV, and a standard 6 MV beam), minimizing geometrical and transmission penumbra. For field sizes less than 2 cm in diameter, photon scatter is negligible such that the secondary electrons are the main contributor to the radiological penumbra. Reducing the photon beam energy to the submegavoltage range reduces the range of secondary electrons and eventually improves the beam boundary sharpness. Provided that the geometrical penumbra and patient immobilization system are optimized, submegavoltage photon beams with effective photon energies in the 300 to 600 keV range, present significant advantages for multiple beam stereotactic irradiations of tumors less than 2 cm in diameter.