Variations in skin dose associated with linac bed material at 6 MV x-ray energy

Treatment with radiotherapy x-rays at 6 MV energy produces a build-up effect whereby a smaller dose is delivered to the patient's skin compared to the tumour dose. With anterior fields, no material is normally placed over the patient's skin, thus providing the maximum skin sparing possible with the beam configuration used. A posterior beam normally passes through the treatment couch top and increases the dose delivered to the patient's skin. Both the Mylar sheeting and the support ribbing material produce a significant increase in skin dose. Measurements at 6 MV have shown that the basal cell layer dose can be increased by up to 51% of maximum dose with a carbon fibre/Mylar couch and by 28% for a tennis string/Mylar couch when compared to anterior beams. These values are associated with the position of the carbon fibre or tennis string ribbing. Dermal layer doses are increased by up to 30 and 24% of maximum dose for carbon fibre and tennis string, respectively. These values include a combination of dose due to the support ribbing and the Mylar sheeting. Due to the variability in patient positioning on the couch top, these increases would be spread out over the skin surface producing an average increase per unit area at the basal layer of up to 32 and 20% of the maximum, respectively, for carbon fibre and tennis string couch tops and 21 and 12% at the dermal layer compared to dose at D_max.