THE ELECTRON BEAM ATTENUATING PROPERTIES OF SUPERFLAB,

PLAY-DOH, AND WET GAUZE, COMPARED TO PLASTIC WATER

KOICHI NAGATA, JIMMY C. LATTIMER, JEFFREY S. MARCH

Bolus material is used commonly with electron treatments. The purpose of this study was to compare the
electron beam attenuating properties of SuperFlab, Play-Doh, and wet gauze to that of plastic water, and
evaluate their characteristics as bolus materials for electron beam therapy. Electron beams of 5, 6, 7, 8, 10, and
12 MeV were used. Dose reduction from a range of bolus thicknesses from 2 mm to a thickness well beyond the
thickness required to reach peak ioization was measured for each of the bolus materials to establish independent
isodose curves. Measurements performed at the known water Dmax for all bolus materials indicated similar
results for SuperFlab and plastic water with less than 3% difference for most energies. Play-Doh resulted in
more attenuation or less dose buildup compared with plastic water, especially at lower energies. The difference
was as high as 24.7% for the beam energy of 5 MeV for Play-Doh. Evaluation of the dose build up curves
for all materials indicated the peak dose build up for wet gauze and Play-Doh occurred at lesser thicknesses
compared to plastic water and SuperFlab, particularly at lower energies. If Play-Doh and wet gauze are to be
used for electron bolus materials, dose build up curves should be established for the machine being used and
the appropriate thickness of bolus material be chosen based on those curves.  C 2012 Veterinary Radiology &

Ultrasound, Vol. 53, No. 1, 2012, pp 96–100.

Key words: electron beams, Play-Doh, SuperFlab, wet gauze.

Introduction water, salt and flour.4 Water-soaked gauze is produced on

site by soaking commercial surgical gauze sponges in water.

E LECTRON BEAMS HAVE limited penetration making

them useful for treatment of small superficial tumors.
Energy dependent forward electron scattering results in the
Each of these materials has advantages and disadvantages
as a bolus material. SuperFlab has an even thickness and an
ideal electron density but does not conform well to irregular
point of maximum dose being several millimeters to several patient surfaces. Play-Doh molds to a surface well, but it is
centimeters below the surface. Bolus material is often used difficult to form it into an even thickness and also it dehy-
with electron beams to shift the Dmax closer to the surface.1 drates when exposed to air. It is difficult to control the water
In general, bolus materials are designed to meet three content of wet gauze but it is formable and dehydration is
important criteria: (1) being tissue-equivalent, (2) con- not a problem. When wet gauze was used as substitute for
formable, and (3) easily adjustable to a desired thickness.2 SuperFlab with 6 MV photon treatments, dose buildup and
It is also important that the radiation absorption and absorption were similar at field sizes larger than 7 × 7 cm
scattering characteristics of the bolus material are known. but at smaller field sizes, wet gauze was less effective as a
Several types of bolus materials are used in veterinary bolus. Also, the water content of wet gauze needs to be
practice, including SuperFlab, Play-Doh∗ and water soaked controlled carefully to avoid either inadequate buildup or
gauze. SuperFlab is a synthetic oil gel with a specific grav- excessive photon absorption.5
ity of 1.02. It is based on vinyl plastic containing a large To our knowledge, the properties of SuperFlab, Play-
amount of di-isodecyl phthalate.3 Although the exact for- Doh and water soaked gauze have not been documented
mulation is proprietary, Play-Doh is primarily a mixture of with regard to electron beam attenuation. With regard to
cobalt photons, either Play-Doh or water-soaked gauze was
∗ Hasbro, Wayne, NJ. comparable to SuperFlab (reference) but it is not certain
From the Veterinary Medicine, The University of Missouri, Columbia,
that this similarity will apply to electron beams.6
MO (Lattimer, March), Pittsburgh Veterinary Specialty and Emergency Our purpose was to compare the electron beam attenu-
Center Pittsburgh, PA (Nagata). ating properties of Play-Doh, wet gauze, and SuperFlab to
Address correspondence and reprint request to Koichi Nagata, Pitts-
burgh Veterinary Specialty and Emergency Center, 807 Camp Horne that of NIST certified plastic water,† to assess their relative
Road, Pittsburgh, PA 15237. usefulness as a bolus material for electron beam therapy.
E-mail: [email protected]
Received March 19, 2010; accepted for publication July 15, 2011.
† Victoreen, New York City, NY.
doi: 10.1111/j.1740-8261.2011.01866.x

96
VOL. 53, NO. 1 ELECTRON BEAM ATTENUATING PROPERTIES OF SUPERFLAB, PLAY-DOH, AND WET GAUZE 97

Materials and Methods as to provide uniform coverage of the field, with exten-
sion of the bolus beyond the margin of the field. Since the
The electron beams from a medical linear accelerator
100 cm electron contact cones had a compressible faceplate,
(Mevatron 74.40‡ ) was used. Weekly quality assurance
wooden shims were used under the edges of the cones to
(QA) testing of all electron beams for beam energy and
prevent compression of the Play-Doh and wet gauze at the
uniformity is performed using a multichamber ionization
margin of the field.
chamber instrument Double check model 171074.† A com-
The parallel-plate ionization chamber was embedded
plete QA of the electron beams was performed before the
into a 2 cm plastic slab. A hole was made in the plastic
experiment. Electron beams with nominal energy of 5, 6, 7,
slab so that the surface of the chamber corresponded to the
8, 10, and 12 MeV were evaluated.
surface of the slab. This entire assembly was set on a 5 cm
Various thicknesses of SuperFlab and plastic water were
slab of plastic water to provide backscatter.
stacked to provide the desired thickness of material appro-
For all measurements described above, blue Play-Doh
priate for individual electron energies and measurements
was used. However, to assess a possible color-dependency
to be made. Gauze was saturated with water and then
of electron absorption, the electron density of different
squeezed gently so there was no dripping of water. The
colors and batches of Play-Doh were made using a cali-
thickness of all slabs was confirmed with calipers before be-
brated CT scanner.†† Six different colors of Play-Doh were
ing placed in the storage bags. Aggregate thickness of these
imbedded in 1inch holes in a 6-inch polystyrene disc which
materials when stacked was also confirmed using calipers
was then scanned in the transverse plane. Attenuation in
before measurements were made.
Hounsfield units was measured in a uniform area of inter-
First, the thickness of each bolus material was arbitrarily
est for each sample. These measurements were compared
made to equal the known Dmax derived from the acceler-
within and between batches of material. Similar measure-
ators commissioning documents (measured at source to
ments were made of the actual slabs of Play-Doh and water
surface distance 100 cm), that is, 1.1, 1.3, 1.5, 1.7, 2.2, and
soaked gauze used for the experimental studies described
2.5 cm for electron energy of 5, 6, 7, 8, 10, and 12 MeV,
above.
respectively. Four dose measurements were made at each
Statistical analysis was performed using a Student’s t-test
energy-specific Dmax for each bolus material using an
and commercial software SAS.‡‡ Comparisons were made
NIST traceable calibrated parallel plate ionization chamber
between each bolus material and plastic water. Significance
ExradinModel A10§ and electrometer Model 1010 Dosime-
was determined to occur at the P = 0.05 level.
try Electrometer.∗∗ Dose was measured in nanocoulomb.
Each measurement counted 100 monitor units (MU) for
the integral machine dosimetry system. Results
Subsequently, electron dose build up curves were gen-
erated for each bolus material at all electron energies. For SuperFlab had electron attenuation/buildup similar to
these measurements, uniform slabs of each bolus of various plastic water with less than a 3% difference except at
thicknesses were used and combined, when needed. Each 12 MeV, where SuperFlab had more attenuation (5.9%)
individual slab of bolus material was placed in an evacu- than plastic water (Fig. 1). Play-Doh had more attenua-
ated plastic storage bag to maintain hydration. All mea- tion compared to plastic water, especially at lower energies.
surements were corrected for temperature and atmospheric The difference was as high as 24.7% at 5 MeV and as low
pressure. Deposited energy measurements were made for as 5.5% at 12 MeV. Wet gauze had less attenuation com-
each bolus material and plastic water from a thickness of pared to plastic water, up to 8% at 5 MeV. There was a
2 mm to a thickness that was well beyond the thickness statistically significant difference of absorption between all
required to reach peak ionization levels. In the region near bolus materials for all electron energies except at 12 MeV
peak ionization, measurements were made every mm for where Play-Doh and SuperFlab were not different from
several mm less and more than this thickness. Repeatability each other.
was evaluated by performing all measurements again two Depth-dose curves for the bolus materials at electron en-
weeks later. ergies 5, 8, and 12 MeV are shown in Figs. 2–4. Also, Dmax
A 15 cm × 15 cm field was used, and the distance from (mm) was measured for each bolus material and plastic wa-
the source to the parallel-plate ionization chamber was ter at each electron energy (Table 1). At the low energy of
fixed at 100 cm to eliminate the influence of distance on 5 MeV there is marked divergence of the attenuation curves
dose rate. All bolus materials were arranged in such a way at the water Dmax derived from the accelerators commis-
sioning documents. All materials reach a peak dose before
the depth of 11mm. However Play-Doh, and to a lesser
‡ Siemens, Berlin/Munich, Germany.
§ Standard imaging, Middleton, WI. †† Picker International, Unitown, OH.
∗∗ Sun Nuclear Corporation, Melbourne, FL. ‡‡ SAS Institute Inc., Cary, NC.
98 NAGATA, LATTIMER, AND MARCH 2012

FIG. 1. Average electron beam ionization relative to plastic water at the previously determined peak ionization depth for water.

FIG. 2. Depth dose curves, relative to plastic water, for SuperFlab, wet FIG. 3. Depth dose curves, relative to plastic water, for SuperFlab, wet
gauze and Play-Doh at 5 MeV. gauze and Play-Doh at 8 MeV.

extent, wet gauze reach their Dmax well before plastic wa- The repeated measurements differed from the original
ter and SuperFlab. measurements by an average of 2.4%, with a range of
At 6 MeV and above the depth of peak ionization for 0.4–5.9%. The range of differences was greatest for wet
plastic water and SuperFlab agreed with the depth of peak gauze.
ionization in water indicated by the machine’s commission- CT imaging of the Play-Doh from different batches as
ing documents. For 8, 10, and 12 MeV the peak value is well as from the slabs used in the experiments consis-
broad for all bolus materials (data not shown for 8 and tently resulted in Hounsfield Unit values similar to those in
10 MeV). The peak dose deposition value is similar for all Table 2. The range of values was from 311.6 to 350.8 for
materials. However at all energies maximum ionization was the batch of Play-Doh evaluated. The standard deviations
reached well before the thickness required in plastic water indicate a lack of homogeneity in the samples as well. These
for both wet gauze and Play-Doh and had begun to de- values are well above those for soft tissues.
cline before the plastic water peak ionization thickness was HU measurements from saturated wet gauze yielded HU
reached. This was particularly prominent for Play-Doh at measurements of –38 to –40. The same images indicated
5 MeV with an approximately 28% relative ionization dis- numerous air voids within the gauze despite the fact that
parity between plastic water and Play-Doh at 11-mm depth the gauze had been saturated with water to the point where
(Fig. 2). it would no longer hold any more water.
VOL. 53, NO. 1 ELECTRON BEAM ATTENUATING PROPERTIES OF SUPERFLAB, PLAY-DOH, AND WET GAUZE 99

TABLE 2. The Hounsfield Units of Various Colors of Play-Doh on a

Single Representative CT Slice. Each Hounsfield Units Were Measured
Using an Area of 221 mm2

Colors of Play-Doh Hounsfield Unit Standard Deviation

Blue 311.6 13.27
Yellow 312.2 10.61
Black 319.3 8.57
Red 325.6 10.68
Green 340.5 19.50
White 350.8 13.65

Play-Doh is estimated to have a physical density of ap-

proximately 1.25 g/cm3 (measured by the author), which
supports the observed differences in absorption between
Play-Doh and plastic water. Therefore, even though attrac-
FIG. 4. Depth dose curves, relative to plastic water, for SuperFlab, wet
gauze and Play-Doh at 12 MeV.
tive because of its pliability, Play-Doh should only be used
as bolus material for electrons if its absorption curve is
known for that machine and energy. Assuming that Play-
Doh is water equivalent, it likely leads to significant under-
TABLE 1. Measured Dmax (mm) for Each Bolus Material and Plastic
Water at Each Electron Energy dosing of tumors treated with an electron beam.
SuperFlab, while closely representative of water, is less
5 MeV 6 MeV 7 MeV 8 MeV 10 MeV 12 MeV
pliable and does not conform to the patient surface as well
Plastic Water 10 12 14 16 22 23 as Play-Doh, resulting in more air gaps between the patient
SuperFlab 9 11 14 16 19 23
Wet Gauze 8 8 12 16 19 19 and the bolus. Air gaps have been shown to reduce the dose
Play-Doh 7 10 9 12 14 17 to the tissue irradiated.7
Wet gauze resulted in less attenuation compared to plas-
tic water at all electron energies, up to 8% at 5 MeV in the
first experiment (Fig. 1). However, this tendency was not
Discussion
observed in the subsequent experiments (Figs. 2–4). This
SuperFlab had electron attenuation characteristics sim- observation underscores the importance of measuring the
ilar to plastic water, with less than 3% difference, except density of the gauze. The actual water content of soaked
at 12 MeV. The reason for this difference is not known gauze can vary widely between individuals preparing it and
although it is likely due to experimental error. from day to day even if the same individual prepares it un-
Play-Doh was characterized by more rapid attenuation less adequate steps are incorporated into its preparation
of the electron beam as compared with plastic water. The ef- to insure the electron density is adequate. Measuring the
fect was especially evident at lower energies. The difference density of the gauze can be performed by weighing and cal-
was as much as 24.7% at 5 MeV and lowest for 12 MeV culating the volume of the gauze pad. The wet gauze used
at 5.5%, when measured at the depth of maximum ion- in this study was carefully maintained at the same level
ization in plastic water (Fig. 1). This probably results from of hydration throughout the study. However it was shown
the higher electron density of Play-Doh causing more rapid to have a lower electron density than water by CT eval-
build-up of ionization in the Play-Doh than in Plastic water. uation even though it was initially saturated to the point
Examination of Figs. 2–4 indicate the difference in ioniza- that it would barely hold water. This may be the result of
tion is far less dramatic when the comparison is made at the insufficient saturation of the gauze with water causing it
depth of maximum ionization in the Play-Doh rather than to have a lower electron density compared to other bolus
that of plastic water, particularly at the higher energies. For materials tested. This is probably the reason why it reached
the 5 MeV beam the difference is approximately 13% at the peak ionization at a slightly lower level than and before the
Play-Doh peak and 28% at the plastic water peak while for plastic water and the SuperFlab and fall off more quickly
the 12 MeV beam the difference is only 0.8% and 2.2%, as well (Figs. 2–4 and Table 1). The authors concluded
respectively. However, beyond the ionization peak of the that while wet gauze is a perfectly acceptable bolus mate-
plastic water the separation of the curves is very evident rial if carefully constructed and maintained, it should be
at all energies. The greater electron density associated with avoided in the absence of sufficient quality control in order
Play-Doh than the other materials tested as indicated by to avoid dosing errors, particularly with low-energy electron
the CT study would correctly predict this result. beams.5
100 NAGATA, LATTIMER, AND MARCH 2012

We maintained a constant source-detector distance of sociated with the intrinsic characteristics of the material
100 cm along the central axis of the beam to eliminate the itself.
influence of distance on dose rate. The authors are aware Although this was not a main purpose of this study,
of the fact that since the machine’s scattering foil adjusts Hounsfield units of various colors and batches of Play-Doh
the beam so that the beam is flat at a 100 cm source-to- were measured (Table 2). The variability of the results indi-
surface distance, at an altered source-to-surface distance, cates Play-Doh is not a homogenous material with regard
the electron beams are not flat. However, the effect of dis- to electron density and though the differences are relatively
tance can be difficult to predict with electron beams, par- small there could still be implications for the development
ticularly with small field sizes and low-energy beams. This of early and late radiation effects.
is also a common clinical practice. It is stressed that all This study has demonstrated the important charac-
of the bolus materials were tested under the same con- teristics of bolus materials, and these properties should
ditions and setup so the variability in the results of the be considered when electron beam radiation therapy is
measurements between the materials could only be as- conducted.

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