SUSSEX CANCER CENTRE

Pre-treatment - Normal Planning Practice - ELECTRONS ONC-WI-0806

Introduction
This WI is to be used by entitled staff. It describes the normal pre treatment planning practice for electrons.
It should be read in conjunction with the departmental procedures and treatment protocols.
Applicability
This WI is applicable to simple manually planned electron treatments only.
Electron treatments are planned in the CT simulator or another appropriate place, with reference to
standard data charts.
The most suitable energy and applicator (possibly with a cutout shape) are chosen to adeuately
encompass the Clinical Target !olume (CT!) with the "#$ isodose.
Dose Prescription and Recording
These are recorded on the treatment sheet.
The dose is prescribed%
&t the geometric centre of the field.
&t the depth of pea' dose, i.e. to the (##$ isodose.
The organ at ris' ()*) doses are only recorded if an )* dose limit has been defined on the treatment
sheet.
Planning
Energy Selection and Dose Homogeneity
The following electron energies are a+ailable% ,, -, (#, (., (/, (- and .# 0e!.
The energy is selected by the practitioner, so that the depth e1tent of the CT! is adeuately co+ered by
the distal "#$ isodose cur+e.
0inimum and ma1imum doses are not normally calculated so the following is a guideline only%
The ma1imum dose is normally defined as (##$.
The minimum dose is normally defined by the distal "#$ isodose or the s'in dose whiche+er is the
lower, typically the s'in dose is in the region of the "#$ isodose.
Bolus
The following bolus is a+ailable%
2lan'et bolus 3 4le1ible bolus in large sheets (thic'nesses (.# cm and (./ cm)
/cm strips 3 4le1ible bolus in / cm wide strips (thic'nesses (.# cm and (./ cm)
Wet gau5e to infill air gaps or le+el off treatment areas.
Custom bolus, made in the mould room, in the form of shaped wa1 bloc's.
Custom bolus, made in the mould room, in the form of specific thic'nesses and shapes of paraffin
wa1.
2olus may be prescribed by the practitioner either to
le+el off any surface irregularities or infill ca+ities in the treatment area
reduce the depth in tissue of the distal "#$ isodose
increase the dose to the s'in surface
pro+ide lateral scatter to protruding structures
2olus should e1tend at least (.#cm beyond the cutout dimensions.
Issue 6o. 7 8age ( of . Issue date% 4eb .#(.
SUSSEX CANCER CENTRE
Pre-treatment - Normal Planning Practice - ELECTRONS ONC-WI-0806
Field Size and Shaping
&pplicator si5es range from ,1, cm to ./1./ cm.
&n endframe or 9cutout: is inserted into the applicators to create the reuired field si5e and shape.
The field si5e is defined by the /#$ isodose which corresponds to the cutout si5e.
In order to encompass the CT! by the "#$ isodose at depth, a margin of at least (.# cm should normally
be added to the CT! dimensions.
In order to preser+e adeuate lateral scatter the following minimum cutout dimensions should be
obser+ed.
Energy 6 MeV 8 MeV 10 MeV 12 MeV 15 MeV 18 MeV 20 MeV
Minimum cutout
dimension (cm)
3 3 4 5 6 7 8

SSD
The distance from the source to the end of the applicator is "/cm.
Ideally "/cm ;;< should be used to pro+ide s'in apposition, howe+er ;;<:s up to ((#cm may be used
when necessary.
Field Matching
Electron fields are not normally matched to other electron fields.
Electron fields can be matched to photon fields. This routinely ta'es place in post nec' electron fields
where electron beams are matched to non3di+ergent photon beams. This techniue is computer planned
and so not within the scope of this document, but is described in WI3.#7,
Internal Shielding
Internal shielding may be used to protect normal structures beyond the target +olume (eg in the treatment
of lip or buccal mucosa). This normally consists of a lead plate faced with an aluminium front plate. The
aluminium is reuired to reduce the electron bac'scatter from the lead, which would otherwise increase
the dose at the tissue3shield interface by up to appro1imately ,#$.
M !alculation and !hec"ing
0=s and )* doses are manually calculated from data tables or by the treatment planning system.
&n independent 0= calculation is performed either using the in3house software pac'age or manually
using the same data tables or other data tables specifically designed to pro+ide a safe chec'.
#$ut o% Protocol # star &
The 9out of protocol: star is used to highlight any parameter within the pre treatment process that does not
comply with the electron normal planning practice. It is also used to highlight any technical difficulty that
warrants an alert in the opinion of the appropriate staff.
The star will be stamped on the rele+ant patient:s treatment record (e.g.set up sheet, calculation result
sheet, etc) together with e+idence to support the decision to treat.
E1amples where the star would be used on an electron treatment are as follows%
The prescribed electron isodose le+el > (##$.
The ;;< is greater than ((#cm
The cutout dimensions are below the minimum reuired for adeuate lateral scatter.
Issue 6o. 7 8age . of . Issue date% 4eb .#(.