Assessment of skin doses in small field radiotherapy for 6 MV photons and beam spectral analysis at skin surface: an EGSnrc based Monte Carlo study

This study aims at the estimation of skin doses during small field radiotherapy with 6 MV photons and analysis of beam spectra at skin surface. The EGSnrc Monte Carlo code was used for spectral analysis and dose scoring in a water phantom. Percent skin dose (PSD) was calculated at a depth of 70 µm (relative to 10 cm depth), and the effects of field size, collimation, source-to-surface distance, and tissue inhomogeneity (bone/air) below the skin were evaluated. Low-energy photons and contaminant electrons from the machine head or back-scattered from underlying tissue were found to be the major contributors to skin dose. As the field size was reduced, the beam hardened, while the photon and electron fluences at the skin decreased compared to those at the reference depth of 10 cm. This resulted in a PSD reduction for fields smaller than the reference field size. Multi leaf collimators increased the PSD (up to 4%) while variation in source-to-skin dose showed a negligible effect. A substantial increase in PSD has been observed (up to 6%) when high Z material like bone was placed below the skin. In contrast, air as underlying material decreased the skin dose. The skin dose varied considerably with various clinical and geometric parameters. It is concluded that, although the skin doses were low for small fields compared to those for the reference field, skin doses may become substantial when escalated target doses are delivered with multi leaf collimators. Moreover, the presence of high Z materials such as bones or metallic implants below the skin can result in significant enhancement of the skin dose.