title: Ultrasound transmission gel as a bolus device for skin irradiation of irregular surfaces: technical note.
abstract: OBJECTIVE
  This paper describes an uncommon radiation treatment of the external ear, with ultrasound (US) transmission gel used as bolus device to compensate for the irregularity of the target surface.
  
  
  METHODS
  Postoperative radiotherapy for cutaneous carcinoma was performed with a single high-energy electron beam directed over the ear auricle. Due to the irregular surface of the target, a "missing tissue" compensator was employed. Daily, after patient positioning, the concha was filled and flattened with US gel, and a dose of 54 Gy in 27 fractions was delivered.
  
  
  RESULTS
  Water equivalence of the gel was verified by comparing the gel's computed tomography (CT) number [Hounsfield units (HU)] and density with the corresponding values for water and another commercial bolus device. Whereas ultrasound gel and water had comparable values (HU: 0; density 1 g/cm(3) for both), the corresponding values for the commercial device were slightly higher (HU: 80; density 1.02 g/cm(3)).
  
  
  CONCLUSIONS
  Ultrasound gel proved to be an easy, fast and cheap compensating tool. Its water equivalence allows it to be used as an alternative to water, though easier to position and with lower risk of displacement. Thus, it is recommendable as a practical tool for most irregular sites. Further investigations are warranted to validate this solution in more complex irradiation techniques.
authors.affiliation: Unit of Radiotherapy, MultiMedica Clinical Institute, Viale Piemonte 70, 21053 Castellanza, Italy. gianpiero.catalano@multimedica.it
authors.forename: G
authors.initials: G
authors.lastname: Catalano
authors.forename: P
authors.initials: P
authors.lastname: Canino
authors.forename: M
authors.initials: M
authors.lastname: Cassinotti
authors.forename: S
authors.initials: S
authors.lastname: Pagella
authors.forename: V
authors.initials: V
authors.lastname: Piazzi
authors.forename: S
authors.initials: S
authors.lastname: Re
authors.forename: G
authors.initials: G
authors.lastname: Wizemann
authors.forename: E
authors.initials: E
authors.lastname: Bucci
mesh_terms: D002277:Carcinoma / Q000532:radiotherapy*; D054644:Ear Auricle / Q000528:radiation effects*; D005782:Gels; D006801:Humans; D056888:Patient Positioning; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012878:Skin Neoplasms / Q000532:radiotherapy*; D016896:Treatment Outcome; D014465:Ultrasonics
chemical_list: D005782:Gels