Discussion Week 3

Electron treatments haven't changed as much as photons over the years of

advancement. Does your clinic perform CT planning for electron treatments? Does it use
the treatment planning system MU, or do the staff use the MU from a hand calculation?
Why/or why not?
How does your department deal with electron treatments that do not have a clinically
attainable SSD of 100cm. What is the process for the involved staff; therapists,
dosimetrists, and/or physicists?
At my clinical site, all the electron beam treatments are done either with CT planning or the
radiation oncologist will draw on the patient’s skin. For the breast electron boost, depending on
the doctors, he or she will draw on the patient’s skin or contour on the CT planning. For
superficial tumor like cancer of skin region (keloid, skin melanoma) and gynecomastia, the
therapists or the CT technicians will perform CT.
The electron calculation is done using RadCalc treatment planning system. According to the
dosimetrist, RadCald is more accurate than the hand calculation.
SSD ≠ 𝟏𝟎𝟎 𝐜𝐦
The source of the electron beam originate from a point in space that does not coincide with the
scattering foil or the accelerator exit window. The effective SSD for electron beam (SSDeff) is
defined as the distance from a virtual point in space to the point of the nominal SSD (usually the
isocenter of linac). Since the difference is very small from the nominal SSD, the inverse square
law can be applied to make corrections to the absorbed dose for variations in air gaps between
patient surface and applicator.1

One way to determine SSDeff is to measure the dose at various distance from the electron
applicator by varying the gap between the phantom surface and the applicator (0 to 15 cm).
At gap = 0, the phantom is in contact with the cone applicator, then the dose is measured in a
phantom at the depth of maximum dose dm. Different measurements are taken with various
distances g from the applicator.1

From the inverse square law:

𝐼𝑜 𝑆𝑆𝐷𝑒𝑓𝑓+𝑑𝑚+𝑔 ²
=( )
𝐼𝑔 𝑆𝑆𝐷𝑒𝑓𝑓+𝑑𝑚

𝐼𝑜 𝑔 𝐼𝑜
√𝐼𝑔 = 𝑆𝑆𝐷𝑒𝑓𝑓+𝑑𝑚
+ 1 ; √𝐼𝑔 is the slope of the gap distance g

1
Slope = 𝑆𝑆𝐷 𝑒𝑓𝑓+𝑑𝑚

1
SSDeff = – dm
slope

The process
CT planning
The dosimetrist will produce an electron treatment plan with the template for the electron cutout.
The therapist or the staff will make an electron cutout based on the treatment plan.

Physician to draw on patient’s skin

The radiation oncologist draws the treatment field on patient’s skin. The therapist traces that
treatment field on a clear template that is inserted in the cone applicator and then makes an
electron cutout.

After the electron cut-out is ready, the dosimetrist or the physicist will take a reading using a
diode to obtain the output factor. The output factor is ratio of the reading with the block and
without the block.

Reference:
1. Strydom W, Parker W, Olivares M. Electron beams: physical and clinical aspects.
Radiation Oncology Physics: a Handbook for Teachers and Students. IAEA. 2005