title: Clinical use of carbon-loaded thermoluminescent dosimeters for skin dose determination.
abstract: OBJECTIVE
  Carbon-loaded thermoluminescent dosimeters (TLDs) are designed for surface/skin dose measurements. Following 4 years in clinical use at the Mater Hospital, the accuracy and clinical usefulness of the carbon-loaded TLDs was assessed.
  
  
  METHODS
  Teflon-based carbon-loaded lithium fluoride (LiF) disks with a diameter of 13 mm were used in the present study. The TLDs were compared with ion chamber readings and TLD extrapolation to determine the effective depth of the TLD measurement. In vivo measurements were made on patients receiving open-field treatments to the chest, abdomen, and groin. Skin entry dose or entry and exit dose were assessed in comparison with doses estimated from phantom measurements.
  
  
  RESULTS
  The effective depth of measurement in a 6 MV therapeutic x-ray beam was found to be about 0.10 mm using TLD extrapolation as a comparison. Entrance surface dose measurements made on a solid water phantom agreed well with ion chamber and TLD extrapolation measurements, and black TLDs provide a more accurate exit dose than the other methods. Under clinical conditions, the black TLDs have an accuracy of +/- 5% (+/- 2 SD). The dose predicted from black TLD readings correlate with observed skin reactions as assessed with reflectance spectroscopy.
  
  
  CONCLUSIONS
  In vivo dosimetry with carbon-loaded TLDs proved to be a useful tool in assessing the dose delivered to the basal cell layer in the skin of patients undergoing radiotherapy.
authors.affiliation: Department of Radiation Oncology, Newcastle Mater Misericordiae Hospital, Waratah, NSW, Australia.
authors.forename: P M
authors.initials: PM
authors.lastname: Ostwald
authors.forename: T
authors.initials: T
authors.lastname: Kron
authors.forename: C S
authors.initials: CS
authors.lastname: Hamilton
authors.forename: J W
authors.initials: JW
authors.lastname: Denham
mesh_terms: D002244:Carbon; D006801:Humans; D011829:Radiation Dosage; D012867:Skin; D013819:Thermoluminescent Dosimetry / Q000295:instrumentation / Q000379:methods*
chemical_list: D002244:Carbon