Dose behind various immobilization and beam-modifying devices.

PURPOSE: To quantify the degradation of skin sparing associated with using beam modifiers such as compensators, immobilization devices, and custom blocks for high energy photon beams. METHODS AND MATERIALS: The degradation of skin sparing was quantified by measuring dose build-up curves with an extrapolation chamber for 6 and 15 MV photon beams. Uniform thickness compensators made of gypsum and lead, thermoplastic mask material, immobilization cradle foam, and cerrobend custom blocks were placed in geometries that mimic relevant clinical situations.
RESULTS: Compensators, whether made of gypsum or lead, placed in the linear accelerator's wedge slot did not significantly effect the depth dose curve's build-up region. Immobilization devices such as cradle foam or thermoplastic placed in contact with the patient degrade the skin sparing expected from high energy photon beams proportional to their thickness and density. Measurements behind custom blocks show that surface and near surface doses for a blocked field are best described by build-up curves for an equivalent size open field.
CONCLUSIONS: These results allow explanation and possibly prediction of skin reactions on patients in which compensators, foam immobilization cradles, thermoplastic masks, or custom blocks are used. These results also provide a baseline by which substitute materials can be evaluated.