An analytic approach to optimized retracted missing tissue compensators.

The introduction of an attenuating medium into a photon beam serves both to reduce the intensity of the primary beam and to create secondary radiation due to scatter. When retracted missing tissue compensators are employed to compensate for irregular surface contour or internal inhomogeneities, they are often fabricated without regard to the scattered radiation that they introduce into the system. The study of a mathematically describable conical geometry has clearly demonstrated the need for improved compensator design. Experimental results obtained with this geometry can be reproduced with good agreement, using theoretical calculations based on primary and first order scattered radiation. This method of analysis may be extended to predict the shape of a compensator which will produce an optimized dose distribution at a given depth in a phantom, equivalent to that which would be obtained when an irregular surface is filled with unit density material (bolus), producing a flat surface. An optimized compensator was constructed based on these theoretical considerations and excellent agreement was observed between theory and experiment. Dramatic improvement in the restoration of bolus dose is obtained with this optimized compensator. Finally, an anthropomorphic phantom of the neck region has been constructed and the performance of a compensator designed according to current clinical methods for this geometry has been evaluated. The performance of an optimized compensator specific to this geometry is presented and good agreement between theoretical predictions and experimental results is observed. Dramatic improvement in bolus dose restoration over that obtained with the clinically designed compensator is realized.