Enhancement of electron-beam surface dose with an electron multi-leaf collimator (eMLC): a feasibility study.

Use of a water-equivalent bolus in electron-beam radiotherapy is sometimes impractical and non-hygienic. Therefore, the feasibility of applying adjacent narrow beams for producing high surface dose electron beams without a bolus was investigated. Depth dose curves and profiles in water were calculated and measured for 6 and 9 MeV electron-beam segments (width 0.3-1.5 cm, length 10 cm) for source-to-surface distances (SSD) 102 and 105 cm. Segment shaping was performed with an add-on electron multi-leaf collimator prototype attached to the Varian 2100 C/D linac. Dose calculations were performed with the Voxel Monte Carlo++ algorithm. Resulting dose distributions in typical clinical cases were compared with the bolus technique. With a composite segmental field with 1.0 cm wide segments the surface dose was over 90% of the depth dose maximum for both energies. The build-up area practically disappeared with a 0.5 cm wide single beam. This led to decrease in the therapeutic range for composite fields with segment widths smaller than 1.0 cm. The new technique yielded similar surface doses as the bolus technique. The photon contamination was 4% with a 9 x 10 cm(2) field (1.0 cm wide segments) compared to 1% for the respective open field with 9 MeV with a bolus. The calculated dose agreed within 2 mm and 3% of the measured dose in 93.7% and 85.2% of the voxels. Adjacent narrow eMLC beams with a 1.0 cm width are suitable to produce electron fields with high surface dose. Despite a slight nonuniformity in the surface profiles in the lateral part of the field at SSD 102 cm, surface dose and target coverage are comparable with the bolus technique.