What is your preferred method for adding bolus, at CT sim or virtual bolus?

Absolutely, should always apply at sim. Gives you an opportunity to work out the appropriate positioning of the patient to optimize bolus conformality and to select the appropriate bolus type (frequently Superflab but often you don’t know until you get the patient on the sim table whether custom mol...

This varies in my head and neck practice. I always apply 1cm clinical bolus at the time of sim when I treat skin primaries of the scalp when I need to treat a large curved surface area, cover perineural pathways, and/or treat regional nodes. I first wire the primary or post-op bed and then create a ...

I am a big believer that the simulation should do just that ... simulate the actual treatment as much as possible. That means using the actual bolus you intend to use for the treatment. I'd much rather identify and fix a problem with the bolus at the time of sim than while the patient is on the tabl...

The answers to this question definitely depend on the type of bolus you're using and the site you're treating.

I.e., if you're using Brass Mesh Bolus (aka chainmail) on a PMRT chest wall, you definitely can't simulate the patient with the bolus on the skin.

My dosimetrists lose it if I forget to apply it at CT sim. No argument there.