Photon energy is transferred to matter in a two-step process. First, energy is transferred to charged particles in the medium through various photon interactions (e.g. photoelectric effect, Compton scattering, pair production, and photodisintegration). Next, these secondary charged particles transfer their energy to the medium through atomic excitation and ionizations.
For low-energy photons, kerma is numerically approximately the same as absorbed dose. For higher-energy photons, kerma is larger than absorbed dose because some highly energetic secondary electrons and X-rays escape the region of interest before depositing their energy. The escaping energy is counted in kerma, but not in absorbed dose. For low-energy X-rays, this is usually a negligible distinction. This can be understood when one looks at the components of kerma.
There are two independent contributions to the total kerma, collision kerma  and radiative kerma  – thus, . Collision kerma results in the production of electrons that dissipate their energy as ionization and excitation due to the interaction between the charged particle and the atomic electrons. Radiative kerma results in the production of radiative photons due to the interaction between the charged particle and atomic nuclei (mostly via Bremsstrahlung  radiation), but can also include photons produced by annihilation of positrons in flight.
Frequently, the quantity  is of interest, and is usually expressed as
where g is the average fraction of energy transferred to electrons that is lost through bremsstrahlung.