{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:16:21Z","timestamp":1762542981859},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T00:00:00Z","timestamp":1548288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Malignancies with a superficial involvement of the scalp\/skull present technical challenges for radiation\u2010treatment\u2010planning, such as achieving skin coverage with the prescribed dose and with the desirable conformity, homogeneity, and lower brain dose. We report a radiotherapy treatment technique for a patient diagnosed with diffuse basosquamous cell carcinoma of the scalp and adjacent skull\u2010bone. This study presents the plan's quality parameters, patient's dosimetry, and patient's outcome. The patient was treated using volume\u2010modulated\u2010arc therapy (<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content>) and a double\u2010shell\u2010bolus full\u2010head device (<jats:styled-content style=\"fixed-case\">DSBFD<\/jats:styled-content>) designed for patient immobilization and better skin coverage. A <jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> plan was generated using an Eclipse treatment\u2010planning system for a prescribed dose of 60\u00a0Gy in 30 fractions. The treatment plan was analyzed to determine the conformity index (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>), the homogeneity index (<jats:styled-content style=\"fixed-case\">HI<\/jats:styled-content>), the target\u2010coverage, and the dose to the organs\u2010at\u2010risk (<jats:styled-content style=\"fixed-case\">OAR<\/jats:styled-content>s). Skin\u2010doses were measured using optically stimulated luminescence (<jats:styled-content style=\"fixed-case\">OSL<\/jats:styled-content>) dosimeters. Clinical follow\u2010up was performed by the radiation oncologist during and after the course of radiotherapy. With regard to planning target volume (<jats:styled-content style=\"fixed-case\">PTV<\/jats:styled-content>) coverage, the <jats:italic>V<\/jats:italic><jats:sub>95<\/jats:sub> was 99%. The measured and calculated dose to the skin was in the range 100\u2013108% of the prescribed dose. The mean brain\u2010<jats:styled-content style=\"fixed-case\">PTV<\/jats:styled-content> dose was 711\u00a0<jats:styled-content style=\"fixed-case\">cG<\/jats:styled-content>y. The <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HI<\/jats:styled-content> were 1.09 and 1.08, respectively. The mean positioning accuracy for the patient over the course of treatment was within 2\u00a0mm. The measured accumulated skin dose and planning dose was agreed within 2%. Clinical examination of the patient 6\u00a0months after radiotherapy showed good response to the treatment and a 90% reduction in scarring. The <jats:styled-content style=\"fixed-case\">DSBFD<\/jats:styled-content> technique combined with RapidArc treatment was useful in terms of the target dose distribution and coverage. Daily patient alignment was found very precise, reproducible and less time\u2010consuming.<\/jats:p>","DOI":"10.1002\/acm2.12536","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T06:46:34Z","timestamp":1548398794000},"page":"84-93","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Customized double\u2010shell immobilization device combined with <scp>VMAT<\/scp> radiation treatment of basosquamous cell carcinoma of the scalp"],"prefix":"10.1002","volume":"20","author":[{"given":"Noor","family":"Mail","sequence":"first","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)\/King Saud bin Abdulaziz University for Health Science Ministry of National Guard Health Affair Jeddah Saudi Arabia"},{"name":"Princess Norah Oncology Center (PNOC) Department of Radiation Oncology King Abdulaziz Medical City Ministry of National Guard Health Affair Jeddah Saudi 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