Skin Dose Comparison of CyberKnife and Helical Tomotherapy for Head-and-Neck Stereotactic Body Radiotherapy

Purpose: This study conducts a comparative evaluation of the skin dose in CyberKnife (CK) and Helical Tomotherapy (HT) to predict the accurate dose of radiation and minimize skin burns in head-and-neck stereotactic body radiotherapy. Materials and Methods: Arbitrarily-defined planning target volume (PTV) close to the skin was drawn on the planning computed tomography acquired from a head-and-neck phantom with 19 optically stimulated luminescent dosimeters (OSLDs) attached to the surface (3 OSLDs were positioned at the skin close to PTV and 16 OSLDs were near sideburns and forehead, away from PTV). The calculation doses were obtained from the MultiPlan 5.1.2 treatment planning system using raytracing (RT), finite size pencil beam (FSPB), and Monte Carlo (MC) algorithms for CK. For HT, the skin dose was estimated via convolution superposition (CS) algorithm from the Tomotherapy planning station 5.0.2.5. The prescribed dose was 8 Gy for 95% coverage of the PTV. Results and Conclusions: The mean differences between calculation and measurement values were $-1.2{\pm}3.1%$, $2.5{\pm}7.9%$, $-2.8{\pm}3.8%$, $-6.6{\pm}8.8%$, and $-1.4{\pm}1.8%$ in CS, RT, RT with contour correction (CC), FSPB, and MC, respectively. FSPB showed a dose error comparable to RT. CS and RT with CC led to a small error as compared to FSPB and RT. Considering OSLDs close to PTV, MC minimized the uncertainty of skin dose as compared to other algorithms.