For a megavoltage X-ray beam, the surface absorbed dose is below the subsurface maximum. Photons generate energetic secondary electrons, mainly through Compton scattering; the downstream electron fluence initially builds up until approximate charged-particle equilibrium is established. Beyond this buildup region, decreasing primary photon fluence, scattering and geometric spreading make the depth-dose curve fall gradually. A penetrating photon beam has a substantial exit dose.
A nearly monoenergetic proton beam deposits a moderate entrance dose, then a sharp Bragg peak near the end of its range. As nonrelativistic protons slow, their electronic stopping power rises approximately as 1/v2 over the relevant part of the track. Once the protons stop, the dose falls steeply. Range straggling and energy spread broaden the peak; nuclear interactions add a smaller nonideal tail, so an exact hard cutoff is an idealization. Superposing appropriate incident energies produces a spread-out Bragg peak covering an extended target.[ref]
Proton depth-dose proposal (1946). pp. 487–489, increasing specific ionization near the end of range
The label MV for an X-ray treatment beam specifies the nominal accelerating potential of the electron accelerator. Its bremsstrahlung beam is a broad photon energy spectrum with an endpoint of order eV, not a monoenergetic beam whose individual photons all carry the quoted numerical energy. Proton therapy beam energies can instead be specified directly in MeV per incident proton.
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