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A single plan solution to chest wall radiotherapy with bolus?

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A brass mesh bolus offers a simpler radiotherapy approach for post-mastectomy chest wall treatments. This alternative bolus allows for a single treatment plan, reducing complexity and planning time while effectively managing skin dose.

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Area of Science:

  • Medical Physics
  • Radiation Oncology

Background:

  • Radiotherapy for post-mastectomy chest walls requires precise dose delivery near the skin surface.
  • Current techniques often involve thick boluses, necessitating plan changes mid-treatment, increasing complexity and time.

Purpose of the Study:

  • To evaluate the efficacy of a brass mesh bolus as a single-plan alternative for chest wall radiotherapy.
  • To compare dosimetric properties and skin dose delivery of a brass mesh bolus against traditional boluses.

Main Methods:

  • Dosimetric measurements were performed using solid water and anthropomorphic phantoms.
  • Ionization chambers and thermoluminescent dosemeters assessed photon depth-dose curves (DDCs) and skin doses.
  • Compared a 10-mm Vaseline bolus, brass mesh, and 3-mm Superflab bolus at 6 and 15 MV.

Main Results:

  • Brass mesh demonstrated minimal impact on DDCs (<0.7% change beyond dmax) and superior skin conformity.
  • Compared to the current protocol, the brass mesh resulted in an increased skin dose.
  • The 5-mm Superflab bolus was rejected from further analysis.

Conclusions:

  • Brass mesh effectively increases surface dose with minimal effect on DDCs, offering a viable single-plan radiotherapy solution.
  • This bolus can be removed at any treatment fraction based on clinical judgment, eliminating the need for re-planning.
  • Utilizing a single treatment plan significantly streamlines radiotherapy workflow and reduces planning time.