DOI QR코드

DOI QR Code

Development and Evaluation of a Thimble-Like Head Bolus Shield for Hemi-Body Electron Beam Irradiation Technique

  • Shin, Wook-Geun (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Lee, Sung Young (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Jin, Hyeongmin (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Kim, Jeongho (Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kang, Seonghee (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Kim, Jung-in (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Jung, Seongmoon (Department of Radiation Oncology, Seoul National University Hospital)
  • Received : 2022.01.20
  • Accepted : 2022.04.21
  • Published : 2022.09.30

Abstract

Background: The hemi-body electron beam irradiation (HBIe-) technique has been proposed for the treatment of mycosis fungoides. It spares healthy skin using an electron shield. However, shielding electrons is complicated owing to electron scattering effects. In this study, we developed a thimble-like head bolus shield that surrounds the patient's entire head to prevent irradiation of the head during HBIe-. Materials and Methods: The feasibility of a thimble-like head bolus shield was evaluated using a simplified Geant4 Monte Carlo (MC) simulation. Subsequently, the head bolus was manufactured using a three-dimensional (3D) printed mold and Ecoflex 00-30 silicone. The fabricated head bolus was experimentally validated by measuring the dose to the Rando phantom using a metal-oxide-semiconductor field-effect transistor (MOSFET) detector with clinical configuration of HBIe-. Results and Discussion: The thimble-like head bolus reduced the electron fluence by 2% compared with that without a shield in the MC simulations. In addition, an improvement in fluence degradation outside the head shield was observed. In the experimental validation using the inhouse-developed bolus shield, this head bolus reduced the electron dose to approximately 2.5% of the prescribed dose. Conclusion: A thimble-like head bolus shield for the HBIe- technique was developed and validated in this study. This bolus effectively spares healthy skin without underdosage in the region of the target skin in HBIe-.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean government (No. NRF-2020R1F1A1073430).

References

  1. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768-3785. https://doi.org/10.1182/blood-2004-09-3502
  2. Vonderheid EC, Van Scott EJ, Johnson WC, Grekin DA, Asbell SO. Topical chemotherapy and immunotherapy of mycosis fungoides: intermediate-term results. Arch Dermatol. 1977;113(4):454-462. https://doi.org/10.1001/archderm.1977.01640040062009
  3. Rosen ST, Foss FM. Chemotherapy for mycosis fungoides and the Sezary syndrome. Hematol Oncol Clin North Am. 1995;9(5):1109-1116. https://doi.org/10.1016/S0889-8588(18)30061-3
  4. Parida DK, Verma KK, Chander S, Joshi RC, Rath GK. Total skin electron irradiation therapy in mycosis fungoides using highdose rate mode: a preliminary experience. Int J Dermatol. 2005;44(10):828-830. https://doi.org/10.1111/j.1365-4632.2005.02217.x
  5. Navi D, Riaz N, Levin YS, Sullivan NC, Kim YH, Hoppe RT. The Stanford University experience with conventional-dose, total skin electron-beam therapy in the treatment of generalized patch or plaque (T2) and tumor (T3) mycosis fungoides. Arch Dermatol. 2011;147(5):561-567. https://doi.org/10.1001/archdermatol.2011.98
  6. Pepek JM, Paulino AC, Briones MA, Marcus RB Jr, Esiashvili N. Role of total skin electron beam therapy for leukemia cutis in pediatric patients. Pediatr Blood Cancer. 2008;50(5):1054-1055. https://doi.org/10.1002/pbc.21390
  7. Delinikolas P, Patatoukas G, Kouloulias V, Dilvoi M, Plousi A, Efstathopoulos E, et al. A novel Hemi-Body Irradiation technique using electron beams (HBIe-). Phys Med. 2018;46:16-24. https://doi.org/10.1016/j.ejmp.2017.12.022
  8. Karzmark CJ. Total skin electron therapy: technique and dosimetry (AAPM Report No. 23). New York, NY: American Association of Physicists in Medicine; 1987.
  9. Tadros AA, Tepperman BS, Hryniuk WM, Peters VG, Rosenthal D, Roberts JT, et al. Total skin electron irradiation for mycosis fungoides: failure analysis and prognostic factors. Int J Radiat Oncol Biol Phys. 1983;9(9):1279-1287. https://doi.org/10.1016/0360-3016(83)90258-4
  10. Muller-Sievers K, Ertan E, Kober B. Dosimetry of rotational partial-skin electron irradiation. Radiother Oncol. 2001;58(2):187-192. https://doi.org/10.1016/S0167-8140(00)00329-7
  11. Rivers CI, AlDahlawi I, Wang IZ, Singh AK, Podgorsak MB. The dose penumbra of a custom-made shield used in hemibody skin electron irradiation. J Appl Clin Med Phys. 2016;17(6):276-282. https://doi.org/10.1120/jacmp.v17i6.6367
  12. Earley L, Moeller J, O'Rear J, Leavitt DD. A method for total skin electron treatment for infants. Med Dosim. 1995;20(4):243-248. https://doi.org/10.1016/0958-3947(95)02010-1
  13. Agostinelli S, Allison J, Amako KA, Apostolakis J, Araujo H, Arce P, et al. GEANT4: a simulation toolkit. Nucl Instrum Methods Phys Res A. 2003;506(3):250-303. https://doi.org/10.1016/S0168-9002(03)01368-8
  14. Kwon O, Jin H, Son J, Choi CH, Park JM, Kim JI, et al. Dose calculation of 3D printing lead shield covered by biocompatible silicone for electron beam therapy. Phys Eng Sci Med. 2021;44(4):1061-1069. https://doi.org/10.1007/s13246-021-01041-y
  15. Karzmark CJ, Loevinger R, Steele RE, Weissbluth M. A technique for large-field, superficial electron therapy. Radiology. 1960;74:633-644. https://doi.org/10.1148/74.4.633
  16. Chen Z, Agostinelli AG, Wilson LD, Nath R. Matching the dosimetry characteristics of a dual-field Stanford technique to a customized single-field Stanford technique for total skin electron therapy. Int J Radiat Oncol Biol Phys. 2004;59(3):872-885. https://doi.org/10.1016/j.ijrobp.2004.02.046
  17. Park SY, Ahn BS, Park JM, Ye SJ, Kim IH, Kim JI. Dosimetric comparison of 4 MeV and 6 MeV electron beams for total skin irradiation. Radiat Oncol. 2014;9:197. https://doi.org/10.1186/1748-717X-9-197