Page 14 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

external beam therapy are not radioactive. Modern planning techniques and “methods of

delivery such as conformal and Intensity Modulated Radiation Therapy (IMRT) have resulted in

smaller volumes of normal tissue being treated”, [however] “the requirement for multiple beams

tangential to the skin and high doses can result in increased skin reactions” (Faithfull, 2008,

p.343).

Bolus. Great care is taken during radiotherapy to ensure an even 'homogenous' dose

distribution is obtained throughout the treatment field and “it is usual practice to remove all the

dressings to avoid the potential build up dose effect that leaving products in place may have”

(Hollinworth & Mann, 2010, p.63). Though one of the primary reasons that a dressing is

removed prior to radiotherapy is the concern of a bolus effect, bolus is also used in some

radiation treatments. According to Behrend (2010),

Bolus is a tissue-equivalent material that is put directly on the patient’s skin to even the

irregular contours and to create a flat surface that normalizes the radiation z beam. The

use of a bolus differs from the application of a bolus layer, which is sufficiently thick to

provide adequate dose buildup over the skin surface. A bolus layer is often referred to as

buildup bolus. When higher-energy beams are used, bolus application on the skin surface

eliminates the skin sparing advantage.

Radiation dermatitis and skin assessment. Radiation dermatitis, also called

radiodermatitis is defined as “an acute or chronic inflammation of the skin caused by exposure to

ionizing radiation as in cancer radiation therapy” (Mosby’s 2009, p. 1571). Symptoms as

described earlier may appear 2- 3weeks into treatment and subside 2-3 weeks after the

completion of radiotherapy (Faithfull, 2008, p. 344). Skin assessment is the practice of

estimating the “general characteristics of the skin including the color, integrity, temperature,