title: Surface applicator calibration and commissioning of an electronic brachytherapy system for nonmelanoma skin cancer treatment.
abstract: OBJECTIVE
  The Xoft Axxent x-ray source has been used for treating nonmelanoma skin cancer since the surface applicators became clinically available in 2009. The authors report comprehensive calibration procedures for the electronic brachytherapy (eBx) system with the surface applicators.
  
  
  METHODS
  The Xoft miniature tube (model S700) generates 50 kVp low-energy x rays. The new surface applicators are available in four sizes of 10, 20, 35, and 50 mm in diameter. The authors' tests include measurements of dose rate, air-gap factor, output stability, depth dose verification, beam flatness and symmetry, and treatment planning with patient specific cutout factors. The TG-61 in-air method was used as a guideline for acquiring nominal dose-rate output at the skin surface. A soft x-ray parallel-plate chamber (PTW T34013) and electrometer was used for the output commissioning. GafChromic EBT films were used for testing the properties of the treatment fields with the skin applicators. Solid water slabs were used to verify the depth dose and cutout factors. Patients with basal cell or squamous cell carcinoma were treated with eBx using a calibrated Xoft system with the low-energy x-ray source and the skin applicators.
  
  
  RESULTS
  The average nominal dose-rate output at the skin surface for the 35 mm applicator is 1.35 Gy/min with +/- 5% variation for 16 sources. The dose-rate output and stability (within +/- 5% variation) were also measured for the remaining three applicators. For the same source, the output variation is within 2%. The effective source-surface distance was calculated based on the air-gap measurements for four applicator sizes. The field flatness and symmetry are well within 5%. Percentage depth dose in water was provided by factory measurements and can be verified using solid water slabs. Treatment duration was calculated based on the nominal dose rate, the prescription fraction size, the depth dose percentage, and the cutout factor. The output factor needs to be measured for each case with varying shapes of cutouts.
  
  
  CONCLUSIONS
  Together with TG-61, the authors' methodology provides comprehensive calibration procedures for medical physicists for using the Xoft eBx system and skin applicators for nonmelanoma skin cancer treatments.
authors.affiliation: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA. rong@humonc.wisc.edu
authors.forename: Yi
authors.initials: Y
authors.lastname: Rong
authors.forename: James S
authors.initials: JS
authors.lastname: Welsh
mesh_terms: D055592:Biophysical Phenomena; D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D002280:Basal Cell Carcinoma / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D006282:Health Personnel; D006801:Humans; D016273:Occupational Exposure; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012449:Safety; D012878:Skin Neoplasms / Q000532:radiotherapy*