{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:20:43Z","timestamp":1784136043200,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Electron beams are used at extended distances ranging between 300 to 700\u00a0cm to uniformly cover the entirety of the patient's skin for total skin electron therapy (TSET). Even with electron beams utilizing the high dose rate total skin electron (HDTSe) mode from the Varian 23iX or TrueBeam accelerators, the dose rate is only 2500 cGy\/min at source\u2010to\u2010surface distance (SSD)\u00a0=\u00a0100\u00a0cm. At extended distances, the decrease in dose rate leads to long beam delivery times that can limit or even prevent the use of the treatment for patients who, in their weakened condition, may be unable to stand on their own for extended periods of time. Previously, to increase dose rate, a customized 6 MeV electron beam was created by removing the x\u2010ray target, flattening filter, beam monitor chamber, and so forth. from the beam path (Chen, et at IJROBP 59, 2004) for TSET. Using this scattering\u2010foil free (SFF) electron beam requires the treatment distance be extended to 700\u00a0cm to achieve dose uniformity from the single beam. This room size requirement has limited the widespread use of the 6 MeV\u2010SFF beam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study explores an application of a dual\u2010field technique with a 6 MeV\u2010SFF beam to provide broad and uniform electron fields to reduce the treatment distances in order to overcome treatment room size limitations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The EGSnrc system was used to generate incident beams. Gantry angles between 6 MeV\u2010SFF dual\u2010fields were optimized to achieve the similar patient skin dose distribution resulting from a standard 6 MeV\u2010HDTSe dual\u2010field configuration. The patient skin dose comparisons were performed based on the patient treatment setup geometries using dose\u2010volume\u2010histograms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Similar dose coverage can be achieved between 6 MeV\u2010SFF and 6 MeV\u2010HDTSe beams by reducing gantry angles between dual\u2010field geometries by 8\u00b0 and 7\u00b0 at treatment distances of 400 and 500\u00a0cm, respectively. To achieve 95% mean dose to the first 5\u00a0mm of skin depth in the torso area, the mean dose to depths of 5\u201310\u00a0mm and 10\u201315\u00a0mm below the skin surface was 74% (74%) and 49% (50%) of the prescribed dose when using 6 MeV\u2010SFF (6 MeV\u2010HDTSe) beam, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 6 MeV\u2010SFF electron beam is feasible to provide similar TSET skin dose coverage at SSD \u2265 400\u00a0cm using a dual\u2010field technique. The dose rate of the 6 MeV\u2010SFF beam is about 4 times that of current available 6 MeV\u2010HDTSe beams at treatment distances of 400\u2013500\u00a0cm, which significantly shortens the treatment beam\u2010on time and makes TSET available to patients in weakened conditions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.17186","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T11:29:52Z","timestamp":1717414192000},"page":"5563-5571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A scattering\u2010foil free electron beam to increase dose rate for total skin electron therapy (TSET)"],"prefix":"10.1002","volume":"51","author":[{"given":"George X.","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe (Jay)","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Therapeutic Radiology Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Homann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2016.08.019"},{"key":"e_1_2_8_3_1","volume-title":"Chapter 15.4. TOTAL SKIN ELECTRON IRRADIATION (TSEI) in Review of Radiation Oncology Physics: A Handbook for Teachers and Students","author":"Podgorsak EB","year":"2003"},{"issue":"2","key":"e_1_2_8_4_1","first-page":"397","article-title":"Total skin electron arc irradiation using a reclined patient position","volume":"17","author":"Gerbi BJ","year":"1989","journal-title":"IJROBP"},{"key":"e_1_2_8_5_1","unstructured":"DingGX ChenZ HomannKL Total skin electron therapy (TSET) using a scattering\u2010foil free electron beam with a dual\u2010field technique.Medical physics.2023;AAPM 2023 Annual Meeting abstract:TU\u2010345\u2010IePD\u2010F3\u20104."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2004.02.046"},{"key":"e_1_2_8_7_1","unstructured":"KarzmarkCJ AndersonJ FessendenP et\u00a0al.TOTAL skin electron therapy: technique and dosimetry.Report of Task Group 30 Radiationtherapy Committee AAPM.AAPM;1987."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597215"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.595296"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/85.2.356"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15433"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598917"},{"key":"e_1_2_8_13_1","unstructured":"KawrakowI RogersDWO Mainegra\u2010HingE TessierF WaltersBRB The EGSnrc Code System: Monte Carlo simulation of ionizing radiation transport NRCC Report PIRS\u2010701.2021."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597552"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/abedd7"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15907"},{"key":"e_1_2_8_17_1","unstructured":"WaltersBR KawrakowI RogersDWO.DOSXYZnrc Users Manual.NRCC Report PIRS\u2010794revB.National Research Council of Canada;2009."},{"issue":"3","key":"e_1_2_8_18_1","first-page":"872","article-title":"Matching the dosimetry characteristics of a dual\u2010field Stanford technique to a customized single\u2010field Stanford technique for total skin electron therapy","volume":"59","author":"Chen Z","year":"2004","journal-title":"IJROBP"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.595446"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21357"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.17186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T19:06:09Z","timestamp":1730228769000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.17186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,3]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1002\/mp.17186"],"URL":"https:\/\/doi.org\/10.1002\/mp.17186","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,3]]},"assertion":[{"value":"2024-02-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}