Open Access Highly Accessed Research

Measurement of skin and target dose in post-mastectomy radiotherapy using 4 and 6 MV photon beams

Melanie Fischbach1, Roger A Hälg12, Matthias Hartmann12, Jürgen Besserer12, Günther Gruber1 and Uwe Schneider12*

Author Affiliations

1 Medical Physics, Radiotherapy Hirslanden, Witellikerstrasse 40, Zürich, CH-8032, Switzerland

2 Science Faculty, University of Zürich, Zürich, Switzerland

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Radiation Oncology 2013, 8:270  doi:10.1186/1748-717X-8-270

Published: 16 November 2013



For patients with high risk breast cancer and mastectomy, radiotherapy is the treatment of choice to improve survival and local control. Target dose is mainly limited due to skin reactions. The feasibility of using 4 MV beams for chest wall treatment was studied and compared to standard 6 MV bolus radiotherapy.


Post-mastectomy IMRT was planned on an Alderson-phantom using 4 and 6 MV photon beams without/with a 0.5 cm thick bolus. Dose was measured using TLDs placed at 8 locations in 1 and 3 mm depth to represent skin and superficial target dose, respectively.


4 MV and 6 MV beams with bolus perform equally regarding target coverage. The minimum and mean superficial target dose for the 6 MV and 4 MV were 93.0% and 94.7%, and 93.1% and 94.4%, respectively. Regarding skin dose the 4 MV photon beam was advantageous. The minimum and mean skin dose for the 6 MV and 4 MV was 76.7% and 81.6%, and 69.4% and 72.9%, respectively. The TPS was able to predict dose in the build-up region with a precision of around 5%.


The use of 4 MV photon beams are a good alternative for treating the thoracic wall without the need to place a bolus on the patient. The main limitation of 4 MV beams is the limited dose rate.