The lack of skin sparing with electron treatments is due to the nature of electron scatter.

At
lower energies, electrons are scattered more easily and through larger angles, which causes the
dose to build up more rapidly and over a decreased distance.1 A charged particle such as an
electron is surrounded by its Coulomb electric field and will therefore interact with one or more
electrons or with the nucleus of practically every atom it encounters.2 This begins immediately as
the electron interacts at the skin surface as opposed to photons that have no charge and may have
to travel a distance within tissue before they start to interact with electrons to deposit dose.

The higher the electron beam energy, the further distance the scattered electrons can travel,
increasing the likelihood that the scatter within the patient will be scattered back to the surface of
the patient, further increasing skin dose at the surface. Due to this, the ratio of surface dose to
maximum dose is lower for lower energy electrons than for higher energy electrons. The graph
below demonstrates how surface dose compares to maximum dose, showing that surface dose is
higher for higher energy electrons.
2

1 Khan, FM, Gibbons, JP, The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014. ISBN-13: 978-1-4511-8245-3
2. Strydom W, Parker W, Olivares M. Electron Beams: Physical and Clinical Aspects.
International Atomic Energy Agency Web site.
https://pdfs.semanticscholar.org/a724/393913cd6453bf06f64f58b8055c06f75e4e.pdf. Accessed
April 7, 2018.