Study on the impact of different wound dressings on surface dose and deep dose analysis in head and neck radiation therapy

Wound dressings are essential for managing skin reactions in patients who have undergone treatments lasting over three to four weeks preventing the progression to more severe wounds, particularly when frequent dressing changes are necessary. However, the use of wound dressings can influence surface radiation doses in the treatment area. This study aimed to evaluate the dosimetric impact of two commonly used hydrocolloid dressings—Aquacel® Ag+ Extra™ (Aquacel-Ag) and DuoDERM® CGF® (DuoDERM)—on surface and near-surface doses in head and neck radiotherapy using IMRT and VMAT techniques. Surface dose measurements were performed using a Markus parallel plate ionization chamber and EBT3 film on both polystyrene slabs and a head-and-neck (HN) IMRT verification phantom. Field sizes of 5×5, 10×10, and 15×15 cm 2 were investigated. Dressing thicknesses were 0.47 mm (Aquacel-Ag) and 2 mm (DuoDERM). Paired sample t-tests were conducted to evaluate dose differences between no dressing, Aquacel-Ag, and DuoDERM, including analysis of D s /D 1cm ratios. The calibration of the dosimeters demonstrated standard deviations within 1% for both the Markus ion chamber and EBT3 film, indicating high precision with coefficients of variation (R 2 = 0.9999 and 0.9916, respectively). Both dressings increased surface dose significantly (p ≤ 0.05), with DuoDERM causing a maximum increase of 31.67% under a 5×5 cm 2 field. Aquacel-Ag showed modest increases (<6%) across all field sizes. In the HN phantom, DuoDERM significantly elevated surface dose and Ds/D1cm ratio under IMRT (p = 0.006), whereas Aquacel-Ag had no statistically significant impact. VMAT plans showed less dose enhancement due to the technique’s distributed angular weighting. All measured Ds/D1cm values remained within the clinically acceptable range (below 95% of the prescription dose), per ICRU Report 83. This study highlights the significant impact of hydrocolloid dressings on surface radiation doses during treatments lasting over three to four weeks. These findings emphasize the importance of considering dressing materials when planning radiation treatments to ensure accurate dose and patient safety. • This study is the first to evaluate the dosimetric effects of Aquacel-Ag and DuoDERM under both IMRT and VMAT techniques in head and neck radiotherapy. • DuoDERM significantly increased surface dose under IMRT, while Aquacel-Ag demonstrated minimal dosimetric perturbation. • All Ds/D1cm ratios remained within ICRU Report 83's acceptable dose range, confirming clinical safety in most conditions. • Dry dressing conditions were used to establish a reproducible baseline; future studies will assess moist dressing effects. • Unlike previous studies focused on creams or bolus, this study investigates real-world wound dressings routinely used in clinics.