Electron bolus design for radiotherapy treatment planning: bolus design algorithms.

Computer algorithms to design bolus for electron beam radiotherapy treatment planning were investigated. Because of the significant electron multiple scatter, there is no unique solution to the problem of bolus design. However, using a sequence of operators, a bolus can be designed that attempts to meet three important criteria: adequate dose delivery to the target volume, avoidance of critical structures, and dose homogeneity within the target volume. Initial calculation of bolus shape was based upon creation operators forcing either the physical or the effective depths of the distal surface of the target volume to a specified value. Modification operators were then applied to the bolus to alter the shape to better meet the design criteria. Because the operators each address a single dosimetric issue, they can often adversely affect some other attribute of the dose distribution. In addition, an extension operator is used to design the bolus thickness outside the target volume. Application of these operators is therefore carried out in certain sequences and each may be used more than once in the design of a particular bolus. The effects of these operators on both the bolus and the resulting dose distribution are investigated for test geometries and patient geometries in the nose, parotid, and paraspinal region.