Dose variation at bone/titanium interfaces using titanium hollow screw osseointegrating reconstruction plates

Purpose: To evaluate dose variations at bone/titanium interfaces in an experimental model designed to simulate postoperative radiotherapy in patients with mandibular reconstructions using a titanium hollow-screw osseointegrating reconstruction plate (THORP) system. Materials and Methods: The model consisted of a 25 x 25 x 10 mm(3) block of fresh bovine femoral diaphysis, to the surface of which a segment of THORP system reconstruction plate was fixed by means of a solid titanium screw 4 mm in diameter and 10 mm in length, Using specially designed thermoluminescent dosimeters (TLD) 2 mm in diameter and 0.13 mm in thickness, dose measurements were carried out at four distances from the screw axis (0.1, 0.3, 0.6, and 1 mm), Co-60 and 6-MV photon beams were used at incidences both perpendicular and parallel ("axial") to the screw axis. Results: For 6-MV X-ray beams incident perpendicular to the screw axis, the maximum dose enhancement (due to backscatter) and the maximum dose reduction (due to attenuation) at the bone/titanium interface were 5% (+/-2%) and 6% (+/-2%), respectively. The corresponding values for Co-60 beams were 6% (+/-5%) and 10% (+/-5%). For the axial incidences, a maximum dose enhancement of 5-7% was noted for both 6-MV X-rays and Co-60 for beams incident on the surface containing the THORP plate segment, whereas beams incident on the opposite surface induced only a very small dose enhancement (2-3%). Conclusion: Using a new experimental model, TLD measurements showed only marginally significant dose variations at bone/titanium interfaces around THORP screws, all measured values being very close to the uncertainty limits (+/-5%) associated with the method. For both Co-60 and 6-MV beams, dose variations appeared smaller for axial than for perpendicular incidences. Because photon beams used in head and neck cancer treatment are most often directed parallel to the screw axes, these results suggest that failures of prosthetic osseointegration are unlikely to be explained by an overdosage at the bone/titanium interface. (C) 1998 Elsevier Science Inc.