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Title: SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials

Abstract

Purpose: High-density materials used in dental restoration can cause significant localized dose enhancement due to electron backscatter in head-and-neck radiotherapy, increasing the risk of mucositis. The materials used in prosthetic dentistry have evolved in the last decades from metal alloys to ceramics. We aim to determine the dose enhancement caused by backscatter from currently-used dental materials. Methods: Measurements were performed for three different dental materials: lithium disilicate (Li{sub 2}Si{sub 2}O{sub 5}), zirconium dioxide (ZrO{sub 2}), and gold alloy. Small thin squares (2×2×0.15 cm{sup 3}) of the material were fabricated, and placed into a phantom composed of tissue-equivalent material. The phantom was irradiated with a single 6 MV photon field. A thin-window parallel-plate ion chamber was used to measure the dose at varying distances from the proximal interface between the material and the plastic. Results: The dose enhancement at the interface between the high-density and tissue-equivalent materials, relative to a homogeneous phantom, was 54% for the gold alloy, 31% for ZrO{sub 2}, and 9% for Li{sub 2}Si{sub 2}O{sub 5}. This enhancement decreased rapidly with distance from the interface, falling to 11%, 5%, and 0.5%, respectively, 2 mm from the interface. Comparisons with the modeling of this effect in treatment planning systemsmore » are performed. Conclusion: While dose enhancement due to dental restoration is smaller with ceramic materials than with metal alloys, it can still be significant. A spacer of about 2–3 mm would be effective in reducing this enhancement, even for metal alloys.« less

Authors:
; ;  [1]; ; ;  [2]
  1. Brigham and Women’s Hospital / Harvard Medical School, Boston, MA (United States)
  2. Harvard School of Dental Medicine, Boston, MA (United States)
Publication Date:
OSTI Identifier:
22649019
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 62 RADIOLOGY AND NUCLEAR MEDICINE; ANIMAL TISSUES; BIOLOGICAL RECOVERY; INTERFACES; IONIZATION CHAMBERS; PHANTOMS; RADIATION DOSES; ZIRCONIUM OXIDES

Citation Formats

Hurwitz, M, Margalit, D, Williams, C, Tso, T, Lee, S, and Rosen, E. SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials. United States: N. p., 2016. Web. doi:10.1118/1.4956611.
Hurwitz, M, Margalit, D, Williams, C, Tso, T, Lee, S, & Rosen, E. SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials. United States. doi:10.1118/1.4956611.
Hurwitz, M, Margalit, D, Williams, C, Tso, T, Lee, S, and Rosen, E. 2016. "SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials". United States. doi:10.1118/1.4956611.
@article{osti_22649019,
title = {SU-F-T-426: Measurement of Dose Enhancement Due to Backscatter From Modern Dental Materials},
author = {Hurwitz, M and Margalit, D and Williams, C and Tso, T and Lee, S and Rosen, E},
abstractNote = {Purpose: High-density materials used in dental restoration can cause significant localized dose enhancement due to electron backscatter in head-and-neck radiotherapy, increasing the risk of mucositis. The materials used in prosthetic dentistry have evolved in the last decades from metal alloys to ceramics. We aim to determine the dose enhancement caused by backscatter from currently-used dental materials. Methods: Measurements were performed for three different dental materials: lithium disilicate (Li{sub 2}Si{sub 2}O{sub 5}), zirconium dioxide (ZrO{sub 2}), and gold alloy. Small thin squares (2×2×0.15 cm{sup 3}) of the material were fabricated, and placed into a phantom composed of tissue-equivalent material. The phantom was irradiated with a single 6 MV photon field. A thin-window parallel-plate ion chamber was used to measure the dose at varying distances from the proximal interface between the material and the plastic. Results: The dose enhancement at the interface between the high-density and tissue-equivalent materials, relative to a homogeneous phantom, was 54% for the gold alloy, 31% for ZrO{sub 2}, and 9% for Li{sub 2}Si{sub 2}O{sub 5}. This enhancement decreased rapidly with distance from the interface, falling to 11%, 5%, and 0.5%, respectively, 2 mm from the interface. Comparisons with the modeling of this effect in treatment planning systems are performed. Conclusion: While dose enhancement due to dental restoration is smaller with ceramic materials than with metal alloys, it can still be significant. A spacer of about 2–3 mm would be effective in reducing this enhancement, even for metal alloys.},
doi = {10.1118/1.4956611},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To establish a simple relation of backscatter dose enhancement around a high-Z dental alloy in head and neck radiation therapy to its average atomic number based on Monte Carlo calculations. Methods: The PHITS Monte Carlo code was used to calculate dose enhancement, which is quantified by the backscatter dose factor (BSDF). The accuracy of the beam modeling with PHITS was verified by comparing with basic measured data namely PDDs and dose profiles. In the simulation, a high-Z alloy of 1 cm cube was embedded into a tough water phantom irradiated by a 6-MV (nominal) X-ray beam of 10 cmmore » × 10 cm field size of Novalis TX (Brainlab). The ten different materials of high-Z alloys (Al, Ti, Cu, Ag, Au-Pd-Ag, I, Ba, W, Au, Pb) were considered. The accuracy of calculated BSDF was verified by comparing with measured data by Gafchromic EBT3 films placed at from 0 to 10 mm away from a high-Z alloy (Au-Pd-Ag). We derived an approximate equation to determine the relation of BSDF and range of backscatter to average atomic number of high-Z alloy. Results: The calculated BSDF showed excellent agreement with measured one by Gafchromic EBT3 films at from 0 to 10 mm away from the high-Z alloy. We found the simple linear relation of BSDF and range of backscatter to average atomic number of dental alloys. The latter relation was proven by the fact that energy spectrum of backscatter electrons strongly depend on average atomic number. Conclusion: We found a simple relation of backscatter dose enhancement around high-Z alloys to its average atomic number based on Monte Carlo calculations. This work provides a simple and useful method to estimate backscatter dose enhancement from dental alloys and corresponding optimal thickness of dental spacer to prevent mucositis effectively.« less
  • Purpose: To quantify the clinically observed dose enhancement adjacent to cranial titanium fixation plates during post-operative radiotherapy. Methods: Irradiation of a titanium burr hole cover was simulated using Monte Carlo code MCNPX for a 6 MV photon spectrum to investigate backscatter dose enhancement due to increased production of secondary electrons within the titanium plate. The simulated plate was placed 3 mm deep in a water phantom, and dose deposition was tallied for 0.2 mm thick cells adjacent to the entrance and exit sides of the plate. These results were compared to a simulation excluding the presence of the titanium tomore » calculate relative dose enhancement on the entrance and exit sides of the plate. To verify simulated results, two titanium burr hole covers (Synthes, Inc. and Biomet, Inc.) were irradiated with 6 MV photons in a solid water phantom containing GafChromic MD-55 film. The phantom was irradiated on a Varian 21EX linear accelerator at multiple gantry angles (0–180 degrees) to analyze the angular dependence of the backscattered radiation. Relative dose enhancement was quantified using computer software. Results: Monte Carlo simulations indicate a relative difference of 26.4% and 7.1% on the entrance and exit sides of the plate respectively. Film dosimetry results using a similar geometry indicate a relative difference of 13% and -10% on the entrance and exit sides of the plate respectively. Relative dose enhancement on the entrance side of the plate decreased with increasing gantry angle from 0 to 180 degrees. Conclusion: Film and simulation results demonstrate an increase in dose to structures immediately adjacent to cranial titanium fixation plates. Increased beam obliquity has shown to alleviate dose enhancement to some extent. These results are consistent with clinically observed effects.« less
  • Clearly, there is ample evidence of adverse effects of radiation in sufficient doses. There is at present no proof of such effects from doses commonly employed in dental practice; however, it has not been possible to prove the absence of such effects. Most experts now agree that there may be a small, difficult to quantify risk of cancer or genetic mutation from diagnostic exposure in patients and in personnel exposed during work. Prudence dictates acceptance of this position until proof to the contrary is available. This report has presented recent attempts to quantify the risk to patients based on speculativemore » calculations and extrapolations. Indices of population risks indicate that medical radiology is the largest source of human-made genetic and leukemogenic radiation burden to the American public. Dental radiology contributes a small-but not necessarily insignificant-portion. Of major concern is the increasing use of radiation for diagnostic purposes in both medicine and dentistry. Technological advances have reduced exposure per examination; presumably this trend will continue so that total exposure of populations to radiation in the healing arts will not increase. Recent analyses suggest that the cancer risk to a patient from a dental radiographic examination is of the order of one in a million; the genetic risk is substantially less, about one in a billion. The risks appear to be essentially equal for full-mouth intraoral and for panoramic examinations. These estimates are numerically quite small, but the effects are severe. Thus, these risks cannot be ignored. However, we currently accept risks of similar magnitude in our daily lives (Table 9)50,51 In addition, the risk of failure to make an accurate diagnosis may be greater than the risk from exposure to the radiation from a justified and properly conducted radiographic examination.« less