Case Report In vivo dose perturbation effects of metallic dental alloys during head and neck irradiation with intensity modulated radiation therapy Clifton D. Fuller a, *, Irma Diaz b,c , Sean X. Cavanaugh a,d , Tony Y. Eng a,c a Department of Radiation Oncology, University of Texas Health Science Center—San Antonio, 7703 Floyd Curl Drive, Mail Stop 7889, San Antonio, TX 78229, USA b Cancer Therapy and Research Center, 7979 Wurzbach, San Antonio, TX 78229, USA c San Antonio Cancer Institute, 7979 Wurzbach, San Antonio, TX 78229, USA d Division of Radiological Sciences, University of Texas Health Science Center—San Antonio, 7703 Floyd Curl Drive, Mail Stop 7800, San Antonio, TX 78229, USA Received 10 November 2003; accepted 21 November 2003 Summary A patient with base of tongue squamous sell carcinoma, with significant CT artifact-inducing metallic alloy, non-removable dental restorations in both the mandible and maxilla was identified. Simultaneous with IMRT treatment, thermo- luminescent dosimeters (TLDs) were placed in the oral cavity. After a series of three treatments, the data from the TLDs and software calculations were analyzed. Analysis of mean in vivo TLD dosimetry reveals differentials from software predicted dose calculation that fall within acceptable dose variation limits. IMRT dose calculation software is a relatively accurate predictor of dose attenuation and augmentation due to dental alloys within the treatment volume, as measured by intra-oral thermoluminescent dosimetry. IMRT represents a safe and effective methodology to treat patients with non-removable metallic dental work who have head and neck cancer.  c 2004 Elsevier Ltd. All rights reserved. KEYWORDS IMRT dental metallic alloys radiation head neck cancer dosimetry Introduction Metallic alloy dental materials demonstrably cause perturbations of absorbed radiation dose to adjacent tissue during radiation therapy of the head and neck. 1 The variation in dose may be substantial. Several studies have assessed the de- gree of radiation scatter on tissue immediately adjacent to endosseous and restorative dental al- loys in conventional radiation treatments, 1–3 and have discovered substantial dose enhancement and * Corresponding author. Tel.: +1-210-616-7998. E-mail address: fullercd@uthscsa.edu (C.D. Fuller). 1368-8375/$ - see front matter  c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.oraloncology.2003.11.010 Oral Oncology (2004) 40 645–648 http://intl.elsevierhealth.com/journals/oron/