在放射治療中評估傷口敷料對表面劑量的影響

Assess the Effect of Wound Dressing on Surface Dose in Radiation Therapy

李哲暐(Chi-Wei Li)；趙璽雅(Hsi-Ya Chao)；邱琮祐(Chung-Yu Chiu)；傅筱如(Hsiao-Ju Fu)

Aquacel-Ag ； DuoDerm ； 敷料 ； Markus parallel plate ion chamber ； 輻射變色軟片 ； 急性皮膚反應 ； Aquacel-Ag ； DuoDerm ； dressing ； Markus parallel plate ion chamber ； radiochromic film ； acute skin reaction

中華放射線技術學雜誌

48卷1期（2024 / 03 / 01）

15 - 20

繁體中文;英文

目的：由於傷口敷料的組織補償器（bolus）效應，敷料的提早衰減以及由此引起的散射可能導致皮膚劑量增加。本研究分析了兩種親水性敷料的實際表面劑量，並與我們醫院常用的強度調控放射治療（IMRT）和體積調控放射治療（VMAT）計劃進行比較。材料和方法：本研究使用AQUACEL® Ag^+ Extra^(TM)康威愛康膚銀抗菌親水性纖維敷料和DuoDERM® CGF®威多愛膚滅菌親水性敷料來比較兩種敷料對表面劑量的影響。使用Markus平行板游離腔和輻射變色軟片EBT3作為測量工具，測量Aquacel-Ag和DuoDerm敷料下的表面劑量。並將表面劑量與在IMRT head/neck phantom上常用的兩種臨床治療計劃進行比較，以評估兩種敷料的影響。結果：本實驗中Markus平行板游離腔和EBT3的標準差均在1%之內。校正曲線的變異係數分別為R^2=0.9999和0.9916。兩種劑量計的讀數與給定劑量之間存在著良好的線性關係。左側表面劑量在添加和不添加敷料時的IMRT和VMAT相對劑量比分別為113.65%、114.4%（Aquacel-Ag）和146.17%、122.98%（DuoDerm）。右側表面劑量在添加和不添加敷料時的IMRT和VMAT相對劑量比分別為107.76%、109.74%（Aquacel-Ag）和133.13%、149.04%（DuoDerm）。結論與討論：在最後3至6次療程中放置敷料會增加表面劑量，卻可以減少由於傷口頻繁更換敷料而引起的過渡期不適，但仍然需要將皮膚劑量限制在可接受的範圍內。無論是不同品牌的敷料還是相同品牌的不同材料和厚度的敷料，都需要進行測量做比較。

Purpose: Due to the tissue bolus effect of the wound dressing, early attenuation on the dressing and resulting scattering can lead to increased skin dose. The actual measured surface dose was analyzed for two kinds of hydrophilic dressings and compared with IMRT (Intensity-Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc Therapy) planning commonly used in our hospital. Materials and methods: AQUACEL® Ag^+ Extra^(TM) silver antibacterial hydrofiber dressing and DuoDERM® CGF® antibacterial hydrophilic dressing were used to compare the effect of two wound dressings on the surface dose in this study. Markus parallel plate ion chamber and radiochromic film EBT3 film were used as measurement tools to measure the surface dose under Aquacel-Ag and DuoDerm dressings. And compare the surface dose with the two clinical treatment plans commonly used on the IMRT head/neck phantom in order to evaluate the effects of the two dressings. Result: The standard deviation of the Markus parallel plate ion chamber and EBT3 film in this experiment were all within 1%. The coefficient of variation of the calibration curve is R^2=0.9999 and 0.9916, respectively. There was a good linear relationship between the readings of the two dosimeters and the given dose. The relative dose ratio of IMRT and VMAT while the left side surface dose was added with and without the dressing were 113.65%, 114.4% for Aquacel-Ag and 146.17%, 122.98% for DuoDerm, respectively. The relative dose ratio of IMRT and VMAT while the right side surface dose was added with and without the dressing were 107.76%, 109.74% for Aquacel-Ag and 133.13%, 149.04% for DuoDerm, respectively. Conclusion and Discussion: The placement of dressings in the last 3 to 6 sessions increases the surface dose, but reduces the discomfort caused by the transition period when the wound is difficult to heal due to frequent dressing changes, but it is still necessary to limit the skin dose to an acceptable range. Whether it is dressings of different brands or dressings of the same brand with different materials and thicknesses, measurements are required for comparison.