Comparison of skin dose between conventional radiotherapy and IMRT

The purpose of this study was to measure skin dose using radiochromic film for two step-and-shoot IMRT fields and compare the results to the skin dose for a conventional open field. All exposures were made using a 6 MV photon beam produced by a Varian 21EX linear accelerator (Varian Medical Systems, CA, USA) equipped with a Millennium 120 leaf MLC. Three different field configurations were used, these were an open field, a step-and-shoot IMRT field and a clinical IMRT field. The mean ratio of the skin dose to dose at d(max) for an open 10 x 10 cm2 field at 100 cm SSD was 0.178 +/- 0.003. The step-and-shoot IMRT field consisted of 1 cm wide strips of decreasing intensity that were delivered using a step-and-shoot technique across a 10 x 10 cm2 field. The ratio of skin dose to dose at d(max) ranged from 0.180 to 0.257, with the low intensity steps having a higher relative skin dose compared to the high intensity steps. A model was derived that attributed these variations to the electron contamination from both the adjacent and more distant high intensity steps. The clinical field consisted of a 25 segment 9.8 x 10.0 cm2 beam arrangement. The ratio of skin dose to dose at d(max) for the clinical IMRT field ranged from 0.093 to 0.284. The results indicated that an IMRT field produced only minor changes in the relative skin dose, with variations potentially attributable to fluctuations in the electron contamination produced by neighbouring regions of different intensity. The use of an individual IMRT field does not significantly increase the skin dose above that of a conventional photon field.