Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy

Purpose: Cone beam computed tomography (CBCT) is fast becoming standard on modern linear accelerators. CBCT increases the dose to regions within and outside the treatment field, potentially increasing secondary cancer induction and toxicity. This study quantified megavoltage (MV) CBCT skin dose and compared it to skin dose delivered during standard tangential breast radiotherapy. Method: Dosimetry was performed both in- and out-of-field using thermoluminescent dosimeters (TLDs) and a metal-oxide-semiconductor-field-effect-transistor (MOSFET) detector specifically designed for skin dosimetry; these were placed superficially on a female anthropomorphic phantom. Results: The skin dose from a single treatment fraction ranged from 0.5 to 1.4 Gy on the ipsilateral breast, 0.031–0.18 Gy on the contralateral breast, and 0–0.02 Gy in the head and pelvic region. An 8 MU MV CBCT delivered a skin dose that ranged from 0.02 to 0.05 Gy in the chest region and was less than 0.01 Gy in the head and pelvis regions. One MV CBCT per fraction was found to increase the outof- field skin dose from both the CBCT and the treatment fields by approximately 20%. The imaging dose as a percentage of treatment doses in the ipsilateral breast region was 3% for both dosimeters. Conclusion: Imaging increases the skin dose to regions outside the treatment field particularly regions immediately adjacent the target volume. This small extra dose to the breasts should be considered when developing clinical protocols and assessing dose for clinical trials.