title: Dose to the skin in helical tomotherapy: results of in vivo measurements with radiochromic films.
abstract: OBJECTIVE
  The aim of this study is to report results of measurements of dose to the skin in vivo with radiochromic EBT films in treatments with helical tomotherapy.
  
  
  METHODS
  In vivo measurements were performed by applying pieces of radiochromic films to the skin or to the inner side of thermoplastic mask before the treatment. The sites of treatment included scalp, brain, head and neck, cranio-spinal axis and lower limbs. Skin dosimetry was performed in a patient who experienced grade 3-4 acute side effects to the skin shortly after the first treatment sessions. For each patient we measured the setup errors using the daily MVCT acquired for image guidance of the treatment. EBT films were read with a flatbed Epson Expression scanner and images were processed with an in-house written routine.
  
  
  RESULTS
  A total of 96 measurements of dose to the skin performed on 14 patients. The mean difference and standard error of the mean difference between measured and TPS-calculated dose was -9.2% ± 2.6% for all treatments, -6.6% ± 2.6% for head and neck treatments. These differences were statistically significant at the 0.05 significance level (t-Student test). Planned dose and dose range in the region of measurements were not correlated with dose discrepancy.
  
  
  CONCLUSIONS
  Radiochromic EBT films are suitable detectors for surface dose measurements in tomotherapy treatments. Results show that TPS overestimates dose to the skin measured with EBT radiochromic films. In vivo skin measurements with EBT films are a useful tool for quality assurance of tomotherapy treatments, as the treatment planning system may not give accurate dose values at the surface.
authors.affiliation: Department of Medical Physics, IRCSS Centro di Riferimento Oncologico, via Franco Gallini 2, 33081 Aviano (PN), Italy. mavanzo@cro.it
authors.forename: Michele
authors.initials: M
authors.lastname: Avanzo
authors.forename: Annalisa
authors.initials: A
authors.lastname: Drigo
authors.forename: Stefano
authors.initials: S
authors.lastname: Ren Kaiser
authors.forename: Antonella
authors.initials: A
authors.lastname: Roggio
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sartor
authors.forename: Paola
authors.initials: P
authors.lastname: Chiovati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franchin
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mascarin
authors.forename: Elvira
authors.initials: E
authors.lastname: Capra
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D005373:Film Dosimetry / Q000379:methods*; D006801:Humans; D009928:Organ Specificity; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012879:Skin Physiological Phenomena / Q000528:radiation effects*