title: Quantification of the skin sparing effect achievable with high-energy photon beams when carbon fiber tables are used.
abstract: OBJECTIVE
  To quantify the skin doses resulting from the use of carbon fiber couches (CFCs) for patient support.
  
  
  METHODS
  BrainLab's CFC was evaluated for five prostate patients and five lung patients. For each patient PTV, organs at risk (OARs), and a 0.3cm thick skin contour on the patient's posterior surface were outlined. Two sets of IMRT plans, each consisting of 4, 5, 7, and 9 beams, were generated per patient. The sets were identical with the exception that in the first set only 6MV energy was used, while in the second set (mixed energy) the photon energy of the beams traversing the CFC was 18MV. The plans for each patient were normalized to deliver the same dose to 95% of the PTV. The CFC skin dose was evaluated by the maximum dose received by 1% (D(1%)) of the skin volume. Paired one-tailed t-tests were used to establish the statistical significance.
  
  
  RESULTS
  The mixed energy plans resulted in D(1%) increase from 18% to more than 23% as the number of beams in the plan was decreased from 9 to 4.
  
  
  CONCLUSIONS
  Skin doses as high as approximately 70% of the prescription dose were found even in 9-beam mixed energy plans. Therefore mixed energy plans may be more beneficial for patients treated with higher fractional doses.
authors.affiliation: Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. ibmihaylov@uams.edu
authors.forename: Ivaylo B
authors.initials: IB
authors.lastname: Mihaylov
authors.forename: Jose
authors.initials: J
authors.lastname: Penagaricano
authors.forename: Eduardo G
authors.initials: EG
authors.lastname: Moros
mesh_terms: D002244:Carbon; D000077482:Carbon Fiber; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D017785:Photons / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012867:Skin / Q000528:radiation effects*
chemical_list: D000077482:Carbon Fiber; D002244:Carbon