Toward a Skin Dose-Area Metric Predictive of Moist Desquamation Using In Vivo Skin Dosimetry and Skin Assessments

Malhotra, A.; Carpentier, Emilie E.; Grahame, Sheri; Chan, Elisa K.; Nichol, Alan; Duzenli, Cheryl

doi:10.1016/j.adro.2023.101318

Cited by 1 publication

(2 citation statements)

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“…In a previous study,our group proposed skin dose constraints to reduce the incidence of moist desquamation in breast radiotherapy. 15 This study demonstrated a separation of 10% in prescribed dose in DVH curves of patients who developed moist desquamation and those that did not. To implement the dose constraints developed in this study, a TPS agreement with film of ± 5% would be required.…”

Section: Discussionmentioning

confidence: 60%

“…EBT3 film has a 2.8 × 10 −3 cm thick sensitive layer sandwiched between two 1.25 × 10 −2 cm thick polyester layers. 14 As described in a previous study, 15 the films were cut using a stencil to create a reproducible 170 cm 2 region to place on the breast cradle against the skin in the lateral and inferior portion of the breast (see Figure 1a). Film measurements under the device are at an effective depth of 0.1 g/cm 2 , which is highly relevant and is consistent with the resolution of the TPS.…”

Section: Film Measurementsmentioning

confidence: 99%

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Recommendations for using analytical anisotropic algorithm and AcurosXB for epidermal dose calculations in breast radiotherapy from an in vivo Gafchromic film study

Malhotra,

Carpentier,

Duzenli

2024

J Applied Clin Med Phys

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Background and purposeThis study recommends clinical epidermal dose calculation methods based on in‐vivo film measurements and registered skin dose distributions with the Eclipse (Varian Medical Systems) treatment planning system's Analytical Anisotropic Algorithm (AAA) and Acuros XB (AXB) dose calculation algorithms.Materials and methodsEighteen AAA V13.6 breast plans were recalculated using AXB (dose to medium) V13.5 with the same beam parameters and monitor units as in the original plans. These are compared against in‐vivo Gafchromic film measurements from the lateral and inferior breast regions. Three skin structures in the treatment planning system are evaluated: a surface layer of voxels of the body contour, a 0.2 cm internal skin rind, and a 0.5 cm internal skin rind.ResultsSystematic shifts are demonstrated between the film measurements of skin dose and the Eclipse dose calculations. On average, the dose to the surface layer of pixels is underestimated by AAA by 8% and overestimated by AXB by 3%. A 5 mm skin rind extended into the body can increase epidermal dose calculations on average by 8% for AAA and 4% for AXB.ConclusionThis is the first study to register in‐vivo skin dose distributions in the breast to the treatment planning system for comparison. Based on the results from this study it is recommended that epidermal dose is calculated with a 0.5 cm skin rind for the AAA algorithm and with rind thickness up to 0.2 cm for the AXB algorithm.

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Section: Discussionmentioning

confidence: 60%

Section: Film Measurementsmentioning

confidence: 99%