J Korean Soc Ther Radiol Oncol.  2008 Sep;26(3):189-194. 10.3857/jkstro.2008.26.3.189.

Evaluation of a Water-based Bolus Device for Radiotherapy to the Extremities in Kaposi's Sarcoma Patients

  • 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Medical School, Seoul, Korea. jjhmd@yuhs.ac
  • 2Institute of Physics and Applied Physics, Yonsei University, Seoul, Korea.
  • 3Department of Rehabilitation Medicine, Rehabililtaion Hospital, Yonsei University Medical School, Seoul, Korea.


PURPOSE: We designed a water-based bolus device for radiation therapy in Kaposi's sarcoma. This study evaluated the usefulness of this new device and compared it with the currently used rice-based bolus.
We fashioned a polystyrene box and cut a hole in order to insert patient's extremities while the patient was in the supine position. We used a vacuum-vinyl based polymer to reduce water leakage. Next, we eliminated air using a vacuum pump and a vacuum valve to reduce the air gap between the water and extremities in the vacuum-vinyl box. We performed CT scans to evaluate the density difference of the fabricated water-based bolus device when the device in which the rice-based bolus was placed directly, the rice-based bolus with polymer-vinyl packed rice, and the water were all put in. We analyzed the density change with the air gap volume using a planning system. In addition, we measured the homogeneity and dose in the low-extremities phantom, attached to six TLD, and wrapped film exposed in parallel-opposite fields with the LINAC under the same conditions as the set-up of the CT-simulator.
The density value of the rice-based bolus with the rice put in directly was 14% lower than that of the water-based bolus. Moreover, the value of the other experiments in the rice-based bolus with the polymer-vinyl packed rice showed an 18% reduction in density. The analysis of the EDR2 film revealed that the water-based bolus shows a more homogeneous dose plan, which was superior by 4.0~4.4% to the rice-base bolus. The mean TLD readings of the rice-based bolus, with the rice put directly into the polystyrene box had a 3.4% higher density value. Moreover, the density value in the case of the rice-based bolus with polymer-vinyl packed rice had a 4.3% higher reading compared to the water-based bolus.
Our custom-made water-based bolus device increases the accuracy of the set-up by confirming the treatment field. It also improves the accuracy of the therapy owing to the reduction of the air gap using a vacuum pump and a vacuum valve. This set-up represents a promising alternative device for delivering a homogenous dose to the target volume.


Kaposi's sarcoma; Water-based bolus; Rice-based bolus
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