Development of advanced skin dose evaluation technique using a tetrahedral-mesh phantom in external beam radiotherapy: a Monte Carlo simulation study.

Incorrect prediction of skin dose in external beam radiotherapy (EBR) can have normal tissue complication such as acute skin desquamation and skin necrosis. The absorbed dose of skin should be evaluated within basal layer, placed between the epidermis and dermis layers. However, current treatment planning systems (TPS) cannot correctly define the skin layer because of the limitation of voxel resolution in computed tomography (CT). Recently, a new tetrahedral-mesh (TM) phantom was developed to evaluate radiation dose realistically. This study aims to develop a technique to evaluate realistic skin dose using the TM phantom in EBR. The TM phantom was modeled with thin skin layers, including the epidermis, basal layer, and dermis from CT images. Using the Geant4 toolkit, the simulation was performed to evaluate the skin dose according to the radiation treatment conditions. The skin dose was evaluated at a surface depth of 50 µm and 2000 µm. The difference in average skin dose between depths was up to 37%, depending on the thickness and region of the skin to be measured. The results indicate that the skin dose has been overestimated when the skin is evaluated using commercial TPS. Although it is not possible with traditional TPS, our skin dose evaluation technique can realistically express the absorbed dose at thin skin layers from a patient-specific phantom.