Phantom dosimetric study of nondivergent aluminum tissue compensator using ion chamber, TLD, and gafchromic film

Anatomic contour irregularity and tissue inhomogeneity in head-and-neck radiotherapy can lead to significant dose inhomogeneity due to the presence of hot and cold spots across the treatment volumes. Missing tissue compensators (TCs) can overcome this dose inhomogeneity. The current study examines the capacity of 2-dimensional (2D) custom aluminum TCs fabricated at our hospital to improve the dose homogeneity across the treatment volume. The dosimetry of the 2D custom TCs was carried out in a specially designed head-and-neck phantom for anterior-posterior (AP) and posterior-anterior (PA) fields with an ion chamber, thermoluminscence dosimeters (TLDs), and film. The results were compared for compensated and uncompensated plans generated from the Eclipse treatment planning system. On average, open-field plans contained peak doses of 117%, optimally wedged-plans contained peak doses of 113%, and custom-compensated plans contained peak doses of 105%. The dose variation between prescribed and measured dose at midplane of the phantom was observed as high as 17%, which was reduced to 3.2% for the customized TC during ionometric measurements. It was further confirmed with TLDs, in a sagittal plane, that the high-dose region of 13.3% was reduced to 2.3%. The measurements carried out with the ion chamber, TLDs, and film were found in good agreement with each other and with Eclipse. Thus, a custom-made 2D TC is capable of reducing hot spots to improve overall dose homogeneity across the treatment volume.