Composite depth dose measurement for total skin electron (TSE) treatments using radiochromic film

Total skin electron (TSE) radiotherapy is routinely used to treat cutaneous T-cell lymphomas and can be implemented using a modified Stanford technique. In our centre, the composite depth dose for this technique is achieved by a combination of two patient positions per day over a three-day cycle, and two gantry angles per patient position. Due to patient morphology, underdosed regions typically occur and have historically been measured using multiple thermoluminescent dosimeters (TLDs). We show that radiochromic film can be used as a two-dimensional relative dosimeter to measure the percent depth dose in TSE radiotherapy. Composite depth dose curves were measured in a cylindrical, polystyrene phantom and compared with TLD data. Both multiple films (1 film per day) and a single film were used in order to reproduce a realistic clinical scenario. First, three individual films were used to measure the depth dose, one per treatment day, and then compared with TLD data; this comparison showed a reasonable agreement. Secondly, a single film was used to measure the dose delivered over three daily treatments and then compared with TLD data; this comparison showed good agreement throughout the depth dose, which includes doses well below 1 Gy. It will be shown that one piece of radiochromic film is sufficient to measure the composite percent depth dose for a TSE beam, hence making radiochromic film a suitable candidate for monitoring underdosed patient regions.