Characterization of brass mesh bolus for electron beam therapy

Purpose. Bolus is often required for targets close to or on skin surface, however, standard bolus on complex surfaces can result in air gaps that compromise dosimetry. Brass mesh boluses (RPD, Inc., Albertville, MN) are designed to conform to the patient's surface and reduce air gaps. While they have been well characterized for their use with photons, minimal characterization exists in literature for their use with electrons.Methods and materials.Dosimetric characteristics of brass mesh bolus was investigated for use with 6, 9 and 12 MeV electrons using a 10 × 10 cm²applicator on standard multi-energy LINAC. Measurements for bolus equivalence and percentage depth doses (PDDs) under brass mesh, as well as surface dose measurements were performed on solid water and a 3D printed resin breast phantom (Anycubic Photon MonoX, Shenzhen, China) using Markus^®parallel-plate ionization chamber (Model 34045, PTW Freiburg, Germany), thermoluminescent detectors (TLD) and EBRT film. After obtaining surface dose measurements, these were compared to dose calculated on the Pinnacle3 treatment planning system (TPS, 16.2, Koninklijke Philips N.V.).Results. Measurements of surface dose under brass mesh showed consistently higher dose than without bolus, confirming that brass mesh can increase the PDD at surface up to ∼ 94% of dose at d_max, depending on incident electron energy. This increase is equivalent to using ∼ 7.2 mm water equivalent bolus for 6 MeV, ∼ 3.6 mm for 9 MeV and ∼ 2.2 mm bolus for 12 MeV electrons. TPS results showed close agreement within-vivomeasurements, confirming the potential for brass mesh as bolus for electron irradiation, provided blousing effect is correctly modelled.Conclusions. To increase electron surface dose, a brass mesh can be used with equivalent effect of water-density bolus varying with electron energy. Proper implementation could allow for ease of treatment, as well as increase bolus conformality in electron-only plans.