Centre News and Events
Tin Foil Noses
30th Mar 2009
Tin foil bolus used with electron fields enables a much more conformal dose to be delivered to superficial cancers of the nose and other sites compared to techniques using conventional tissue equivalent bolus. The tin foil technique allows the treatment to be planned to avoid normal tissue structures, such as the septum, and provide a superior cosmetic outcome to surgery. Each treatment plan is dependent on the patient because the shape of the treatment site, in particular for a nose, varies quite considerably between individuals and some experience is required to ensure appropriate dose coverage.
The suggestion to use tin foil bolus was made by Lambert et al. in 1999. Following on from this publication Perth Radiation Oncology developed the tin foil technique in Western Australia using the Pinnacle3 computerised treatment planning system with Elekta Precise linear accelerators. During the course of developing the tin foil technique it was found that the dose delivered to the entire surface of the treatment site is uniformly the prescribed dose. This is superior to the conventional tissue equivalent bolus techniques that have been historically used where the doses to the surface of sites such as the nose are not uniform. The tin foil technique was used clinically for the first time in October 2001. Five year follow up of patients at PRO shows very good cosmetic outcomes, no adverse reactions and excellent control.
The introduction of tin foil modified electron beams to a radiation oncology practice using Pinnacle3 with the Elekta Precise linear accelerators provides better target volume coverage of complex superficial structures compared to using conventional tissue equivalent bolus. There is a large amount of medical physics work required to implement this modality and it is possible that other treatment planning systems, other models of linear accelerators and other metals used in the foil could provide similar results.
Lambert GD et al. “The use of high density metal foils to increase surface dose in low-energy clinical electron beams”, Radiotherapy and Oncology 1999; 53: 161-166
Geoghegan DS et al., “Using tin foil to replace bolus for electron beams”, Australasian Physical and Engineering Sciences in Medicine 2001; 24: 230-231.
Geoghegan DS et al., “Tin foil modified electron beams”, Australasian Physical and Engineering Sciences in Medicine 2007; 30: 360-361.
Arancini WD and Brackenridge SA, “Tin foil modified electron radiation of the skin of the nose”, The Radiographer 2008; 55: 7–11
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