Total Skin Electron Therapy: Technique and Dosimetry

Total skin electron irradiation (TSEI) has been used as a treatment for mycosis fungoides. Our center has implemented a modified Stanford technique with six pairs of 6 MeV adjacent electron beams, incident perpendicularly on the patient who remains lying on a translational platform, at 200 cm from the source. The purpose of this study is to perform a dosimetric characterization of this technique and to investigate its optimization in terms of energy characteristics, extension, and uniformity of the treatment field. In order to improve the homogeneity of the distribution, a custom‐made polyester filter of variable thickness and a uniform PMMA degrader plate were used. It was found that the characteristics of a 9 MeV beam with an 8 mm thick degrader were similar to those of the 6 MeV beam without filter, but with an increased surface dose. The combination of the degrader and the polyester filter improved the uniformity of the distribution along the dual field (180 cm long), increasing the dose at the borders of field by 43%. The optimum angles for the pair of beams were ± 27°. This configuration avoided displacement of the patient, and reduced the treatment time and the positioning problems related to the abutting superior and inferior fields. Dose distributions in the transversal plane were measured for the six incidences of the Stanford technique with film dosimetry in an anthropomorphic pelvic phantom. This was performed for the optimized treatment and compared with the previously implemented technique. The comparison showed an increased superficial dose and improved uniformity of the 85% isodose curve coverage for the optimized technique.PACS numbers: 87.53.Bn, 87.55.ne, 87.56.bd

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

(> 300 cm)

, the use of double electron fields with symmetric angulations of

\pm 20 °

Section: Introductionmentioning

confidence: 99%

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Dosimetric characterization and optimization of a customized Stanford Total Skin Electron Irradiation (TSEI) technique

Lucic

Sánchez‐Nieto

Caprile

et al. 2013

“…Irradiation of large parts or all of a patient's skin is technologically challenging and several techniques have been developed over the years . However, modern techniques such as intensity modulated radiation therapy (IMRT) and image guidance had very little impact on the development of TSET techniques and the report of the American Association of Physicists in Medicine (AAPM) task group 30 of 1988 is still widely used as a guidance . Most treatment techniques rely on extended source to skin distance (SSD) to cover larger areas of the patient.…”

Section: Introductionmentioning

confidence: 99%

A technique for total skin electron therapy (TSET) of an anesthetized pediatric patient

Kron

Donahoo

Lonski

et al. 2018

PurposeTotal skin electron therapy (TSET) is a technique to treat cutaneous lymphomas. While TSET is rarely required in pediatric patients, it poses particular problems for the delivery. It was the aim of the present work to develop a method to deliver TSET to young children requiring anesthetics during treatment.MethodsA customized cradle with a thin window base and Poly(methyl‐methacrylate) (PMMA) frame was built and the patient was treated in supine position. Two times six fields of 6 MeV electrons spaced by 60° gantry angles were used without electron applicator and a field size of 36 × 36 cm2. The two sets of six fields were matched at approximately 65% surface dose by rotating the patient around an axis 30 cm distance from beam central axis, effectively displacing the two sets of fields in sup/inf direction by 60 cm. Electron energy was degraded using a 12 mm PMMA block on the gantry. Focus to skin distance was maximized by displacing the patient in opposite direction of the beam resulting in a different couch position for each field.ResultsA 2‐yr‐old patient was treated in 12 fractions of 1.5 Gy over 2.4 weeks. Dose to skin was verified daily using thermoluminescence dosimetry and/or radiochromic film. The treatment parameters were adjusted slightly based on in vivo dosimetry resulting in a dose distribution for most of the treatment volume within ±20% of the prescribed dose. Six areas were boosted using conventional electron therapy.Conclusion TSET can be delivered to pediatric patients using a customized couch top on a conventional linear accelerator.

Validation of the dosimetry of total skin irradiation techniques by Monte Carlo simulation

Tseng

2020

Purpose To validate the dose measurements for two total skin irradiation techniques with Monte Carlo simulation, providing more information on dose distributions, and guidance on further technique optimization. Methods Two total skin irradiation techniques (stand‐up and lay‐down) with different setup were simulated and validated. The Monte Carlo simulation was primarily performed within the EGSnrc environment. Parameters of jaws, MLCs, and a customized copper (Cu) filter were first tuned to match the profiles and output measured at source‐to‐skin distance (SSD) of 100 cm where the secondary source is defined. The secondary source was rotated to simulate gantry rotation. VirtuaLinac, a cloud‐based Monte Carlo package, was used for Linac head simulation as a secondary validation. The following quantities were compared with measurements: for each field/direction at the treatment SSDs, the percent depth dose (PDD), the profiles at the depth of maximum, and the absolute dosimetric output; the composite dose distribution on cylindrical phantoms of 20 to 40 cm diameters. Results Cu filter broadened the FWHM of the electron beam by 44% and degraded the mean energy by 0.7 MeV. At SSD = 100 cm, MC calculated PDDs agreed with measured data within 2%/2 mm (except for the surface voxel) and lateral profiles agreed within 3%. At the treatment SSD, profiles and output factors of individual field matched within 4%; d max and R 80 of the simulated PDDs also matched with measurement within 2 mm. When all fields were combined on the cylindrical phantom, the d max shifted toward the surface. For lay‐down technique, the maximum x‐ray contamination at the central axis was (MC: 2.2; Measurement: 2.1)% and reduced to 0.2% at 40 cm off the central axis. Conclusions The Monte Carlo results in general agree well with the measurement, which provides support in our commissioning procedure, as well as the full three‐dimensional dose distribution of the patient phantom.