SGRT Forum

What are people using for bolus with the AlignRT system, especially for DIBH chest wall cases? We are currently using superflab bolus and capturing a bolus reference surface daily (often twice daily if the bolus is not large enough to cover both tangent fields and needs to be moved in between the medial and lateral). Obviously a larger bolus would negate the "capture twice daily" situation, but are there more elegant solutions that limit the need for daily reference captures? Any experience with 3D printed bolus? Aquaplast bolus? Does the brass mesh bolus conform well enough to limit repeat reference captures? Any input would be much appreciated.

For chest wall, the (white) brass mesh works great and covers both tangents. Prior to using that,  we found an extended length superflab (Civco 30x50cm comes in 0.5cm and 1cm) that covers both tangents also! We do always capture a daily reference after bolus is placed though.

We use the white brass bolus QD and have been very happy with it. We chose that because it was easier on the therapists to do QD instead of QOD. Brass also doesn't affect the PDD beyond dmax so if the physician wishes to discontinue it, we just take it off without a replan. If your MDs would still prefer 1cm QOD, I have also heard of people using those shammy-type towels, like at a car wash. They hold water really well and conform nicely.

We are using 30x50x0,5cm Bolus with skin from Unger. We had some problems with reflections and often didn't get a stable signal. That's why we tried different materials, like thin wet paper towels to put on top of the bolus after placing it at the patient. So far we are getting the best results, when we paste up the upper side of the bolus with Leukoplast. It gets us a nice stable Signal. We do a daily reference capture.



Unfortunately it's always a lot of work with disinfection and changing the Leukoplast. So ideally we are looking for a 30x50x0,5cm Bolus with Skin, but the Skin should be bright, opaque(?) and mat so that there are no reflections and it can be disinfected directly.

I am curious about more experiences regarding the bolus topic.

We use Clearsight bolus. It is a transparent bolus material. It is not sticky. OSMS is able to visualize the patient's skin through the bolus. We use one sheet per patient and dispose after the treatment course is complete .

In our center, we currently use the bolus from the company, Anatge https://www.anatge.com/en/Productos/exaskin-en/ . This bolus is non-reflective, so it doesn't have rendering or visualization issues with SGRT systems. We have tested it on both light and dark phantoms and have had no detection problems. Additionally, since this bolus conforms to the patient's shape and then hardens, we don't have any repositioning issues during different radiotherapy sessions.