A technique for total skin electron irradiation using six large flattened electron beams: implementation on linear accelerators having different modes of electron beam production

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Abstract
Total skin electron beam irradiation (TSEI) has been considered for the treatment of mycosis fungoides because of the special characteristics of the electron beam, delivery of a maximum radiation dose close to the entrance surface of the tissues and a rapid fall-off in dose beyond the maximum. However, delivering a homogeneous radiation dose over all surface areas of the human body is complicated. This problem has been dealt with in various ways by different institutions. The use of TSEI dates back to the 1950s (Lo et al, 1979) and clinical studies at Stanford University have demonstrated that TSEI may lead to a long remission or even cure if it is used in the early stages of the disease (Hoppe et al, 1979). Techniques that have been developed to irradiate the entire body surface include the use of pairs of angled beams, two to eight in number (Karzmark et al, 1960; Karzmark, 1964, 1967, 1968; Edelstein et al, 1973; Hoppe et al, 1979; Nisce et al, 1981; Coffey et al, 1982; Fraas et al, 1983; Hogstrom et al, 1984), a pendulum arc technique (Sewchand et al, 1979), and more recently, patient rotation (Kumar & Patel, 1978; Podgorsak et al, 1983). With the use of multiple fields, the depth–dose characteristics of electron beams are changed from those of a single field because of the oblique incidence of electrons (Bjarngard et al, 1977; Pla et al, 1988).