Increase In Surface Dose Research Articles

Skin dose investigations on a 0.5 T parallel rotating biplanar linac-MR using Monte Carlo simulations and measurements.

The Alberta rotating biplanar linac-MR has a 0.5 T magnetic field parallel to the beamline. When developing a new linac-MR system, interactions of charged particles with the magnetic field necessitate careful consideration of skin dose and tissue interface effects. To investigate the effect of the magnetic field on skin dose using measurements and Monte Carlo (MC) simulations. We develop an MC model of our linac-MR, which we validate by comparison with ion chamber measurements in a water tank. Additionally, MC simulation results are compared with radiochromic film surface dose measurements on solid water. Variations in surface dose as a function of field size are measured using a parallel plate ion chamber in solid water. Using an anthropomorphic computational phantom with a 2mm-thick skin layer, we investigate dose distributions resulting from three beam arrangements. Magnetic field on and off scenarios are considered for all measurements and simulations. For a 20×20cm2 field size, (the minimum dose to the hottest contiguous 0.2 cc volume) for the top 2mm of a simple water phantom is 72% when the magnetic field is on, compared to 34% with magnetic field off (values are normalized to the central axis dose maximum). Parallel plate ion chamber measurements demonstrate that the relative increase in surface dose due to the magnetic field decreases with increasing field size. For the anthropomorphic phantom, (minimum skin dose in the hottest 1×1×1 cm3 cube) shows relative increases of 20%-28% when the magnetic field is on compared to when it is off. With magnetic field off, skin is 71%, 56%, and 21% for medial-lateral tangents, anterior-posterior beams, and a five-field arrangement, respectively. For magnetic field on, the corresponding skin values are 91%, 67%, and 25%. Using a validated MC model of our linac-MR, surface doses are calculated in various scenarios. MC-calculated skin dose varies depending on field sizes, obliquity, and the number of beams. In general, the parallel linac-MR arrangement results in skin dose enhancement due to charged particles spiraling along magnetic field lines, which impedes lateral motion away from the central axis. Nonetheless, considering the results presented herein, treatment plans can be designed to minimize skin dose by, for example, avoiding oblique beams and using a larger number of fields.

Investigation of the effect of bolus on skin dose in breast cancer treatment with tomotherapy and LINAC radiotherapy devices

In postmastectomy radiation therapy (PMRT), it is important that the chest wall skin is included in the target volume and receives an adequate dose. This study aims to investigate the effect of bolus on skin dose in breast cancer treatment with Tomotherapy and LINAC radiotherapy devices and to examine the accuracy of the surface dose calculated by treatment planning system (TPS) with thermoluminescence dosimetry (TLD). Female Alderson Rando Phantom's chest wall is virtually divided into 9 regions. Computed tomography (CT) images of the phantom were obtained with a section thickness of 3 mm. Two plans, with and without bolus, were created for each of the helical tomotherapy (HT), intensity-modulated radiotherapy (IMRT) and field-in-field (FiF) techniques. A bolus thickness of 0.5 cm was used for all bolus plans. Doses calculated from TPSs were obtained for 88 predetermined points on the chest wall. After irradiation, doses measured with TLDs were obtained. The effect of bolus use on the chest wall surface was examined. The increase in surface dose due to bolus use was 50.35%, 55.35% and 68.56% for HT, IMRT and FiF techniques in TPS, respectively. This increase in TLD measurements was 58.18%, 30.90% and 46.31% for HT, IMRT and FiF techniques, respectively. The best agreement between TPS and TLD doses for bolus and non-bolus plans was found in the HT technique. The difference between TPS and TLD doses decreased within the three treatment techniques due to bolus use. Since the chest wall skin cannot receive the required dose in IMRT and FiF techniques, bolus use is recommended until acute skin reactions occur. There is no need to use a bolus for the HT technique.

Post-operative complications following dose adaptation of intra-operative electron beam radiation therapy in locally advanced or recurrent rectal cancer.

The benefit of intra-operative radiotherapy (IORT) in the treatment of locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) lie in its ability to provide high-dose of radiation to limited at-risk volume, thereby eliminating microscopic disease and decreasing toxicity. A comparative study between high-dose-rate (HDR) brachytherapy, named intra-operative brachytherapy (IOBT), and intra-operative electron radiotherapy (IOERT) was performed showing favorable LRFS after IOBT, possibly due to a higher surface dose that is inherent in IOBT technique. The IOERT technique in Catharina Hospital Eindhoven was adapted to increase the surface dose, aiming to improve local control. Post-operative complications due to an increased radiation dose remain the matter of concern. This retrospective study was performed to compare complication rates before and after adapted IOERT dose. All patients undergoing surgery with IOERT for LARC or LRRC from September 2019 until July 2023, were considered. Patients selected until August 31, 2021 were included in control cohort (n = 108), and those chosen from September 1, 2021 onwards were included in intervention cohort (n = 92). Perioperative and (major) post-operative complications were classified retrospectively, during admission, at 30 days, and at 90 days. In LARC patients, a decrease in post-operative complications was observed (p = 0.009). 19% of LARC patients experienced major post-operative surgical complications, i.e., Clavien-Dindo grade 3b-5, regardless of treatment group. No difference in major 90-day complications was noted (p = 0.142). In LRRC patients, the use of induction chemotherapy decreased from 78% to 29% (p < 0.001), which complicated comparison. However, no difference in major post-operative complications was observed at 30 days (p = 0.222) or 90 days (p = 0.977) after surgery. Increased surface dose of IOERT does not seem to lead to an increase in post-operative complications. Further research is needed to evaluate the efficacy of dose adaptation in IOERT to improve local oncological control rates. Routine evaluation of CTCAE scores in follow-up will help uncover possible long-term radiation-induced toxicity.

Carbon-fiber alternative to the commercial gating surrogate for the Varian Truebeam™

Background In this study we present the Tracking Accessory 3 (TA3) as an alternative to the commercial gating block (GB) surrogate for the Varian Truebeam™ gating system (TGS). The TGS requires three visible reflectors to track the surrogate, presenting an opportunity for a surrogate to be made with less material and thus smaller dosimetric footprint than the commercial four reflector model. Materials and methods Relative dose and depth dose profiles below the TA3 and the GB were measured with radiosensitive film. Accuracy and reproducibility of the detected motion amplitude for three TA3s and one GB were determined using a respiratory phantom with surrogate to determine the camera’s tracking volume. Clinical performance was evaluated prospectively in 10 breast cancer patients treated with deep inspiration breath hold monitored with TA3 and compared to previously published results. Non-parametric statistics were applied to test for significance. Results and conclusions Surface doses were increased up to 94% and 187% for the TA3 and GB, respectively, compared to no surrogate. The surface area influenced by at least 25% increase in dose was 12 cm2 and 105 cm2 for the TA3 and GB, respectively. The water equivalent thickness of the surrogates was found to be 1 mm for the TA3 and 3 mm for GB. The difference in measured amplitude were <0.2 mm for TA3 compared to the GB. The TA3s and GB were detected at all extremes of the clinically relevant tracking volume of the TGS. Clinical performance showed no significant differences. The TA3 caused less surface dose increase compared to the commercial GB. In the tested range all surrogates measured motion amplitude within 0.2 mm of reference value, which is not a clinically relevant difference. The TA3 showed no significant differences in clinical performance to similarly positioned surrogates.

Effect of topical agents on skin surface dose in volumetric modulated arc therapy for head and neck cancer.

In volumetric modulated arc therapy (VMAT), the effect of an increase in skin surface dose due to topical agents might be negligible. We investigated the bolus effects of three types of topical agents in VMAT for head and neck cancer (HNC). Topical agents of different thicknesses (0.1, 0.5 and 2mm) were prepared. When each topical agent was set, the surface doses were measured for the anterior static field and VMAT, with and without a thermoplastic mask. No significant differences were observed among the three topical agents. For topical agent thicknesses of 0.1, 0.5 and 2mm, the increases in surface dose for the anterior static field without the thermoplastic mask were 7-9, 30-31 and 81-84%, respectively. With the thermoplastic mask, the corresponding increases were 5, 12-15 and 41-43%, respectively. The increases in surface dose for VMAT without the thermoplastic mask were 5-8, 16-19 and 36-39%, respectively, and those with the thermoplastic mask were 4, 7-10 and 15-19%, respectively. The rate of increase in surface dose with the thermoplastic mask was smaller than that without the thermoplastic mask. The increase in surface dose with topical agents of clinical standard thickness (0.02mm) was estimated to be 2% with the thermoplastic mask. The increase in surface dose with topical agents in dosimetric simulation, compared with control situation, is not significant in clinical conditions for HNC patients.

Comparison of surface dose during whole breast radiation therapy on Halcyon and TrueBeam using Cherenkov imaging.

The emergence of the Halcyon linear accelerator has allowed for increased patient throughput and improved treatment times for common treatment sites in radiation oncology. However, it has been shown that this can lead to increased surface dose in sites like breast cancer compared with treatments on conventional machines with flattened radiation beams. Cherenkov imaging can be used to estimate surface dose by detection of Cherenkov photons emitted in proportion to energy deposition from high energy electrons in tissue. Phantom studies were performed with both square beams in reference conditions and with clinical treatments, and dosimeter readings and Cherenkov images report higher surface dose (25% for flat phantom entrance dose, 5.9% for breast phantom treatment) from Halcyon beam deliveries than for equivalent deliveries from a TrueBeam linac. Additionally, the first Cherenkov images of a patient treated with Halcyon were acquired, and superficial dose was estimated.

Double enhancement effect of a surface dose with tungsten rubber bolus in photon radiotherapy for keloids and superficial tumors.

To clarify the dosimetric characteristics of a real-time variable shape rubber-containing tungsten (STR) bolus in a clinical plan and investigate the efficacy of the STR bolus in photon radiotherapy for keloids and other superficial tumors.A 5 mm gel bolus or 1 mm STR bolus was placed on a solid water phantom. Tangential irradiation was performed using a TomoTherapy Radixact-X9 and 6 MV X-ray flattening-filter-free beam, and the surface dose was measured with radiochromic film. Clinical-like plans (TomoDirect; TD and TomoHelical; TH) were applied with the same geometry and the dose distributions were measured.The increase in surface dose by the build-up effect and backscatter was 37.7% and 8.0% for the gel bolus, and 40.5% and 26.4% for the STR bolus, respectively. In the TD and TH plans, the increase in surface dose was 27.4% and 48.3% for the gel bolus, and 39.0% and 63.2% for the STR bolus. Similary, changes in the sagittal plane dose were - 3.9% and 6.1% for the gel bolus, and - 6.3% and 6.9% for the STR bolus.The STR bolus effectively increased the surface dose by the build-up effect and backscatter in photon radiotherapy for keloids and other superficial tumors.

Effect of Diode-Based Transmission Detector Measurement on Dose Perturbation during Delivery of 6MV Photon

<h3>Purpose/Objective(s)</h3> Delivery dose quality assurance (QA) during treatment planning execution is the most direct and effective way to ensure that the prescribed dose is delivered accurately and the patient is irradiated safely. The purpose of this article is to evaluate the stability and sensitivity of the diode-based transmission detector (TD) installed on the beam path during radiotherapy, and analyze the effect of TD on the photon beam fluence and dose distribution. <h3>Materials/Methods</h3> The beam fluence with and without TD was measured for 6MV on a linear accelerator. The point doses at different depths (0.0cm∼15.0cm), different dose values (100MU∼500MU), different dose rates (100MU/min∼600MU/min) and different irradiation fields (3cm × 3cm∼20cm × 20cm) were measured by cylindrical three-dimensional water tank, and the transmission factors (TF) were calculated and analyzed. The percentage depth dose (PDD) and beam profile under different parameters were collected to analyze the effect of TD on ray quality and dose distribution. The effect of different irradiation fields on the γ passing rate was evaluated by a planar dosimeter. <h3>Results</h3> The diode-based TD has the high stability of 0.1% (1SD) and excellent position monitoring performance (≤0.2mm). The TF varies with the depth, dose, dose rate and irradiation fields. When the depth is 0cm, the TF has maximum value of 99.55%. For the depth of 0cm∼5cm, the TF increases with the increase of dose and dose rate (<i>R</i>=0.91, 0.75). For the depth of 5cm, the TF is least affected by dose and dose rate (1SD: 0.01%, 0.07%), and decreased with the increase of irradiation fields, 98.94% for 3cm × 3cm. When the depth is >5cm, it decreases with the dose increasing (<i>R</i>=−0.88∼−0.26), and increases with the dose rate increasing (<i>R</i>=0.78). The average TF under all the above conditions is 98.46%, that is, beam attenuation is 1.54%. The movement of the position of maximum dose depth is 0.124cm for 5cm × 5cm and 0.250cm for 3cm × 3cm to the surface of the water (0cm), otherwise ≤0.003cm. TD increases dose in build-up region, 1.49% for fields of 20cm × 20cm. TD effects ray quality (≤0.0028), beam symmetry and flatness (≤0.68%). The γ passing rate does not change under the commonly used indexes of 3%/3mm and 2%/2mm. <h3>Conclusion</h3> The diode-based TD has high stability and excellent monitoring performance. Although it has little effect on ray quality, beam symmetry, flatness and γ passing rate, it will cause beam attenuation and increase surface dose.

Skin Dose Modeling and Measurement in a High Field In-Line MRI-Linac System

The Australian MRI-Linac prototype radiotherapy system has been shown to generate significant entry skin or surface dose increases. This arises from electron contamination focusing toward the isocenter caused by the 1 T MRI field being in-line with the x-ray beam. The aim of this study is to present accurate Monte Carlo modeling of these skin dose changes and to compare them with previous experimental measurements. Accurate skin dose modeling will improve confidence in the pathway forward to treatment planning for clinical trials. A COMSOL Multiphysics model of the Australian MRI-Linac system was used to generate a 3D magnetic field map to be used in corresponding Geant4 Monte Carlo simulations. The Geant4 simulations included the x-ray source (6 MV Linac), multileaf collimators (MLCs), and a 30 cm × 30 cm × 30 cm water phantom located with its front surface at the beam isocenter. Simulations were performed with a source to surface distance (SSD) of 1,819 mm for nominal field sizes 2 cm × 2 cm, 6 cm × 6 cm, and 10 cm × 10 cm. Central axis percentage depth dose (PDD) and surface (or skin) doses at 70 μm depth were calculated by using high-resolution scoring voxels of 10 μm thickness. The results were compared with corresponding experimental data collected using MOSkin™ on the Australian MRI-Linac prototype system. The accurate modeling provides great detail into how the electron contamination is heavily confined and focused toward the beam central axis due to the presence of in-line magnetic field. This concentration significantly increases the skin dose up to 320% for the field size of 10 cm × 10 cm. For 2 cm × 2 cm and 6 cm × 6 cm, the surface skin dose is 128% and 217%, respectively, as compared to the skin dose in the absence of the magnetic field. The simulation results are in generally good agreement, ±10%, with previously collected experimental data for the same nominal field sizes. For the first time, detailed Geant4 Monte Carlo simulations of the electron contamination in the Australian MRI-Linac system have been performed and confirmed to be sufficiently accurate. These simulations will provide a solid framework for estimating the skin dose changes in more clinically relevant treatment plan scenarios that are envisaged in the near future.

Effect of variation of silicone rubber RTV 52 and bluesil catalyst 60 R composition on bolus material for electron beam radiotherapy application

A bolus is a material equivalent to soft tissue and is directly placed on the skin surface during radiotherapy. It is commonly used to increase the dose on the skin surface in electron beam radiation. A typical material for a bolus is silicone rubber (SR). We made a bolus with dimensions of 17 × 17 × 1 cm3 by varying silicone rubber (SR) RTV 52 and hardening material (bluesil catalyst 60 R) using a simple molded method. We characterized it using a CT scan to find the relative electron density (RED) and examined it using the electron beam of a linear accelerator (LINAC) at energies of 5 and 7 MeV to investigate the percentage of surface dose (PSD). The PSD value is relative to the dose at maximum doses (dmax). The RED value of the bolus was from 1.168 ± 0.021 to 1.176 ± 0.019, higher than the soft tissue (muscle) value of 1.043. The percentage of surface dose (PSD) test at 5 and 7 MeV LINAC energy showed that the highest PSD without using a bolus were 84.79 0.06% and 86.03 0.07%, respectively. With a bolus, the PSD values were 112.52 0.16% and 111.14 0.03%, respectively. The results indicate that bolus fabrication using SR RTV 52 and bluesil 60R is very effective for radiotherapy in the treatment of skin cancer due to an increase in surface dose.

Evaluation of Surface Dose and Commissioning of Compensator-Based Total Body Irradiation.

Purpose:The aim of the current study is to commission compensator-based total body irradiation (TBI) and to compare surface dose using percentage depth dose (PDD) while varying the distance between beam spoiler and phantom surface.Materials and Methods:TBI commissioning was performed on Elekta Synergy® Platform linear accelerator for bilateral extended source to surface distance treatment technique. The PDD was measured by varying the distance (10 cm, 20 cm, 30 cm, and 40 cm) between the beam spoiler and the phantom surface. Beam profile and half-value layer (HVL) measurement were carried out using the FC65 ion-chamber. Quality assurance (QA) was performed using an in-house rice-flour phantom (RFP). In-vivo diodes (IVD) were placed on the RFP at various regions to measure the delivered dose, and it was compared to the calculated dose.Results:An increase in Dmax and surface dose was observed when beam spoiler was moved away from the phantom surface. The flatness and symmetry of the beam profile were calculated. The HVL of Perspex and aluminum is 17 cm and 8 cm, respectively. The calculated dose of each region was compared to the measured dose on the RFP with IVD, and the findings showed that the variation was <4.7% for both Perspex and Aluminum compensators.Conclusion:The commissioning of the compensator-based TBI technique was performed and its QA measurements were carried out. The Mayneord factor corrected PDD and measured PDD values were compared. The results are well within the clinical tolerance limit. This study concludes that 10 cm −20 cm is the optimal distance from the beam spoiler to phantom surface to achieve prescribed dose to the skin.

Narrowing the difference in dose delivery for IOERT and IOBT for locally advanced and locally recurrent rectal cancer

PurposeIntra-operative radiotherapy (IORT) has been used as a tool to provide a high-dose radiation boost to a limited volume of patients with fixed tumors with a likelihood of microscopically involved resection margins, in order to improve local control. Two main techniques to deliver IORT include high-dose-rate (HDR) brachytherapy, termed ‘intra-operative brachytherapy’ (IOBT), and electrons, termed ‘intra-operative electron radiotherapy’ (IOERT), both having very different dose distributions. A recent paper described an improved local recurrence-free survival favoring IOBT over IOERT for patients with locally advanced or recurrent rectal cancer and microscopically irradical resections. Although several factors may have contributed to this result, an important difference between the two techniques was the higher surface dose delivered by IOBT. This article described an adaptation of IOERT technique to achieve a comparable surface dose as dose delivered by IOBT.Material and methodsTwo steps were taken to increase the surface dose for IOERT: 1. Introducing a bolus to achieve a maximum dose on the surface, and 2. Re-normalizing to allow for the same prescribed dose at reference depth.ConclusionsWe describe and propose an adaptation of IOERT technique to increase surface dose, decreasing the differences between these two techniques, with the aim of further improving local control. In addition, an alternative method of dose prescription is suggested, to consider improved comparison with other techniques in the future.

Does Thermoplastic Mask Alleivates Skin Sparing Effect of Photons in Head and Neck Cancer Patients: A Pilot study

Introduction: Head and Neck tumors are mainly treated with concurrent chemoradiation. Treatment delivery with Megavoltage beam has the advantage of skin sparing effect but still skin reactions have been a major side effect since 2D era. Initially these reactions were due to the delivery with bilateral opposed portals but with advent of IMRT/ VMAT, it has been possible to escalate the tumor dose with the need of strict immobilization with thermoplastic mask. This thermoplastic mask may have a bolus effect and can result in increase in surface dose resulting in skin reactions. The aim of this study was to evaluate if any bolus effect of thermoplastic mask exists. Materials and Methods: A total of 15 patients of histologically proven carcinoma oropharynx and hypopharynx were taken. Patients were scanned for planning CT with thermoplastic mask. Another scan was taken in the same position but without thermoplastic mask. Same contouring and planning were done on both the scans. Plans were made and ascertained that all OAR’s and target volumes should get similar doses. Skin contoured on both the scans was evaluated for the dose received. Results: Mean dose received by skin in patients with thermoplastic mask was 48.15 GY while Mean dose received by skin in patients without thermoplastic mask was 43.18 GY. A paired t-test was applied on the dataset which revealed a statistically significant difference between the skin doses with and without mask with a p value of &lt; 0.05. Conclusion: Increase in skin dose can be attributed of the bolus effect of thermoplastic mask. This bolus effect should be considered once high dose to skin is observed during planning or patient develops skin reaction.

Improving the imaging performance of the 1.5 T MR-linac using a flexible, 32-channel, on-body receive array

High impedance coils (HICs) are suitable as a building block of receive arrays for MRI-guided radiotherapy (MRIgRT) as HICs do not require radiation-attenuating capacitors and dense support materials. Recently, we proved the feasibility of using HICs to create a radiation transparent (i.e. radiolucent) window. In this work, we constructed a fully functional 32-channel array based on this design. The anterior element is flexible and follows the shape of the subject, while the posterior element is rigid to support the subject. Both elements feature a 2 × 8 channel layout. Here, we discuss the construction process and characterize the array’s radiolucency and imaging performance. The dosimetric impact of the array was quantified by assessing the surface dose increase and attenuation of a single beam. The imaging performance of the prototype was compared to the clinical array in terms of visual appearance, signal-to-noise ratio (SNR), and acceleration performance, both in phantom and in-vivo measurements. Dosimetry measurements showed that on-body placement changed the anterior and posterior surface dose by +3% and −16% of the dose maximum. Attenuation under the anterior support materials and conductors was 0.3% and ≤1.5%, respectively. Phantom and in-vivo imaging with this array demonstrated an improvement of the SNR at the surface and the image quality in general. Simultaneous irradiation did not affect the SNR. G-factors were reduced considerably and clinically used sequences could be accelerated by up to 45%, which would greatly reduce pre-beam imaging times. Finally, the maximally achievable temporal resolution of abdominal 3D cine imaging was improved to 1.1 s, which was > 5 × faster than could be achieved with the clinical array. This constitutes a big step towards the ability to resolve respiratory motion in 3D. In conclusion, the proposed 32-channel array is compatible with MRIgRT and can significantly reduce scan times and/or improve the image quality of all on-line scans.

Impact of a parallel magnetic field on radiation dose beneath thin copper and aluminum foils

Purpose: The RF coils for magnetic resonance image guided radiotherapy (MRIgRT) may be constructed using thin and/or low-density conductors, along with thinner enclosure materials. This work measures the surface dose increases for lightweight conductors and enclosure materials in a magnetic field parallel to a 6 MV photon beam. Methods: Aluminum and copper foils (9–127 μm thick), as well as samples of polyimide (17 μm) and polyester (127 μm) films are positioned atop a polystyrene phantom. A parallel plate ion chamber embedded into the top of the phantom measures the surface dose in 6 MV photon beam. Measurements (% of dose at the depth of maximum dose) are performed with and without a parallel magnetic field (0.22T at magnet center). Results: In the presence of a magnetic field, the unobstructed surface dose is higher (31.9%Dmax versus 22.2%Dmax). The surface dose is found to increase linearly with thickness for thin (<25 μm) copper (0.339%Dmaxμm−1) and aluminum (0.116%Dmaxμm−1) foils. In the presence of a magnetic field the slope is lower (copper: 0.16%Dmaxμm−1, aluminum: 0.06%Dmaxμm−1). The effect of in-beam foils is reduced due to partial shielding of the surface from contaminant electrons. Copper causes a surface dose increase ≈3 times higher than aluminum of the same thickness, consistent with their relative electron density. Polyester film (127μm) increases the surface dose (to 35% Dmax with field) about as much as a gown (36% Dmax with field), while the increase with polyimide film (17μm) is less than 1% above the open field dose. Conclusions: Thin copper and aluminum conductors increase surface dose by an amount comparable to a hospital gown. Similarly, enclosure materials made of thin polyester or polyimide film increase surface dose by only a few %Dmax in excess of an unobstructed beam. Based on measurements in this study, in-beam, surface RF coils are feasible for MRIgRT systems.

Monte Carlo study of a free flattening filter to increase surface dose on 12 MV photon beam

Monte Carlo study of a free flattening filter to increase surface dose on 12 MV photon beam

Comparison of Dosimetry Characteristics from Some Bolus Materials for 6 and 10 MV Photons Beam Radiation Therapy

In radiation therapy, bolus material is often used for increased surface dose, compensate for surface irregularities and internal heterogeneities. Bolus has properties equivalent to water and soft tissue. In this study, the mixture of Silicone Rubber (SR) and Bismuth was used for bolus fabrication and then compared to commercial boluses such as Paraffin, Play-Doh, and Paraffin Wax. The study aims to evaluate the comparison of relative electron density (RED), effective mass attenuation coefficient, transmission factor, percentage of surface dose (PSD), and Percentage Depth Dose (PDD) for all boluses. The bolus was made with the size 11 × 11 × 0.5 cm3. Physical density of the synthesized bolus was assessed by computerized tomography (CT) Scanning. The results of the RED analysis for the mixture of Silicone Rubber (SR) and Bismuth, Paraffin, Play-Doh, and Paraffin Wax were 0.954; 0.743; 0.933; and 0.878, respectively. The values of RED for all boluses has a similar to water and soft tissue. These results prove that the bolus is equivalent to soft tissue density such as fat, breast, lungs, and liver. Furthermore, for other dosimetry tests such as transmission factors and attenuation coefficients using Linear Accelerator (LINAC) with photon energy sources 6 and 10 MV. In general, Percentage of surface dose at 6 MV is higher than 10 MV. The highest percentage of the surface dose was achieved by paraffin wax at 6 MV energy by 85%. For effective mass attenuation coefficient result, the highest is the mixture of silicone rubber and bismuth at -0.0030 cm2/g for 6 MV and Play-Doh at -0.0114 cm2/g for 10 MV.

Breast Radiation Therapy Using a Breast Cup: Moving the Target, Not the Patient

PurposeTo compare whole-breast radiation therapy dose distributions with and without the use of breast cups to reposition the breast itself. Methods and MaterialsA fitted plastic breast cup repositions the breast on the anterior chest wall, reducing the lateral fall and ptosis of the breast. Eighteen patients requiring breast cups were identified on an initial simulation computed tomography scan (without breast cup); subsequently, a second scan with the breast cup fitted was performed. An optimal treatment plan was then created on both scans with the differences in radiation dose to underlying organs compared. In vivo measurements were performed to assess any possible bolusing effect on skin dose owing to the breast cup. ResultsBreast cups significantly reduce dose to both lung and heart for all left-sided cases. All lung dose metrics decreased for all right-sided cases. Right-sided heart dose metrics did not significantly decrease with the use of breast cups; however, heart mean dose for these cases was all under 100 cGy. A 16% increase in skin surface dose was observed in an anthropomorphic phantom when using a breast cup. ConclusionsUse of the breast cup in breast radiation therapy decreases dose to underlying organs at risk and is cost-effective. It can be easily integrated with deep inspiration breath hold, intensity modulated radiation therapy, and volumetric-modulated arc therapy techniques. With use of the device, a supine patient position can be maintained, meaning nodal regions can be treated mono-isocentrically.

Relation between body mass index and position of chest examination as a function of entrance surface dose

X-ray is ionic radiation which is now a necessity in the health sector as a tool in establishing diagnosis. Calculation of exposure doses in patients generally only considers gender and age, but from a theoretical point of view, energy absorption will be greater with increasing thickness of material. The thickness of the material in terms of chest examination using X-rays is indicated by position of the examination where the lateral examination makes the material exposed to radiation thicker than the posterioranterior or anteriorposterior examination position, as well as the patient's body mass index. Therefore, the relationship between the position of examination and body mass index to the entrance surface dose is the topic of this study. Analysis of chest examination data in several patients with various examination positions and different body mass indices showed an increase in entrance surface dose with increasing body mass index and examination position. The highest entrance surface dose was observed in patients with lateral examination positions, as well as in patients with large body mass indexes.

Investigation of AAA dose calculation algorithm accuracy in surface and buildup region for 6MV photon beam using markus parallel-plate ion chamber.

In radiotherapy, dose distributions are obtained by using dose calculation algorithms that are implanted in treatment planning systems (TPS). This study aims to compare the surface doses of separate field sizes calculated by different version of The Analytical Anisotropic Algorithm (AAA) and measured by the parallel-plate ion chamber that is admitted as the most reliable dosimetry system for the surface region dose measurements. In order to measure the near surface dose, water equivalent solid phantom was used and measurements were made for 6MV photon beam at 100 cm source-detector distance for 5×5, 10×10, and 20×20 cm2 field sizes. AAA 8.9 and AAA 15.1 versions of the Varian Eclipse TPS were used for surface dose calculations by generating beams with separate field sizes. The doses were read by considering the effective buildup thickness of Markus parallel-plate ion chamber. The surface doses using 6 MV photon beams for 10×10 cm2 field size at 0.07 mm were found to be 11.04%, 26.25%, and 19.69% for AAA v8.9, AAA v15.1 and Markus chamber, respectively. It was seen that for both of the AAA versions and Markus parallel-plate ion chamber, increasing field sizes also increase surface dose. For all field sizes, surface dose was lowest by using AAA v8.9 at 0.07 mm. The different versions of the same TPS algorithms may calculate the surface doses distinctively. After upgrading of TPS algorithms, surface doses should be calculated and compared by measurements with different dosimetry systems to better understand their calculation behaviors in the near surface region.