ACPSEM ROSG TBE working group recommendations for quality assurance in total body electron irradiation

  • Raelene NelliganEmail author
  • Zoë Baldwin
  • Trish Ostwald
  • Thu Tran
  • Michael Bailey
Scientific Paper


The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Radiation Oncology Specialty Group (ROSG) formed a series of working groups in 2011 to develop recommendations for guidance of radiation oncology medical physics practice within the Australasian setting. These recommendations are intended to provide guidance for safe work practices and a suitable level of quality control without detailed work instructions. It is the responsibility of the medical physicist to ensure that locally available equipment and procedures are sufficiently sensitive to establish compliance to these recommendations. The recommendations are endorsed by the ROSG, and have been subject to independent expert reviews. For the Australian readers, these recommendations should be read in conjunction with the Tripartite Radiation Oncology Reform Implementation Committee Quality Working Group: Radiation Oncology Practice Standards (2011), and Radiation Oncology Practice Standards Supplementary Guide (2011). This publication presents the recommendations of the ACPSEM ROSG Total Body Electron Irradiation Working Group and has been developed in alignment with other international associations. However, these recommendations should be read in conjunction with relevant national, state or territory legislation and local requirements, which take precedence over the ACPSEM recommendations. It is hoped that the users of this and other ACPSEM recommendations will contribute to the development of future versions through the Radiation Oncology Specialty Group of the ACPSEM. This document serves as a guideline for calibration and quality assurance of equipment used for TBE in Australasia.


TBE Total body electron irradiation QA recommendations 



American Association of Physicists in Medicine


Australasian College of Physical Scientists and Engineers in Medicine






High-dose total skin electron


In-vivo dosimetry


Left anterior oblique


Linear accelerator


Left posterior oblique


Multi-disciplinary team


Mycosis fungoides


Metal-oxide-silicon field-effect transistor


Monitor unit


Optically stimulated luminescence




Percentage depth dose


Polymethyl methacrylate


Quality assurance


Right anterior oblique


Radiation oncologist


Radiation oncology medical physicist


Radiation Oncology Specialty Group


Right posterior oblique


Radiation therapist


Source-to-surface distance


Total body electrons


Thermoluminescent detector



The authors would like to acknowledge the work done by ACPSEM ROSG for implementation of the concept of the recommendation papers and organisation of the Radiation Oncology working groups.


  1. 1.
    Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group (2011) Tripartite radiation oncology practice standards.
  2. 2.
    Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group (2011) Tripartite radiation oncology practice standards supplementary guide.
  3. 3.
    Reynard EP, Evans MD, Devic S, Parker W, Freeman CR, Roberge D, Podgorsak EB (2008) Rotational total skin electron irradiation with a linear accelerator. J Appl Clin Med Phys 9(4):2793CrossRefPubMedGoogle Scholar
  4. 4.
    Trautinger F, Knobler R, Willemze R, Peris K, Stadler R, Laroche L, D’Incan M, Ranki A, Pimpinelli N, Ortiz-Romero P, Dummer R, Estrach T, Whittaker S (2006) EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome. Eur J Cancer 42(8):1014–1030. doi: 10.1016/j.ejca.2006.01.025 CrossRefPubMedGoogle Scholar
  5. 5.
    Hauswald H, Zwicker F, Rochet N, Uhl M, Hensley F, Debus J, Herfarth K, Bischof M (2012) Total skin electron beam therapy as palliative treatment for cutaneous manifestations of advanced, therapy-refractory cutaneous lymphoma and leukemia. Radiat Oncol 7:118. doi: 10.1186/1748-717X-7-118 PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Skórska M (2014) Total skin electron beam (TSEB) therapy in pediatric patients: a review of the literature. Rep Pract Oncol Radiother 19:109–113PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Bao Q et al (2012) A technique for paediatric total skin electron irradiation. Radiat Oncol 7:40PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Chin DM, Chow S, Kim YH, Hoppe RT (1999) Total skin electron beam therapy with or without adjuvant topical nitrogen mustard or nitrogen mustard alone as initial treatment of T2 and T3 mycosis fungoides. Int J Radiat Oncol Biol Phys 43:951–958CrossRefGoogle Scholar
  9. 9.
    Micaily B, Vonderheid EC, Brady LW, Andrews C (1985) Total skin electron beam and total nodal irradiation for treatment of patients with cutaneous T-cell lymphoma. Int J Radiat Oncol Biol Phys 11:1111–1115CrossRefPubMedGoogle Scholar
  10. 10.
    Mazzeo E, Rubino L, Buglione M, Antognoni P, Magrini SM, Bertoni F, Parmiggiani M, Barbieri P, Bertoni F (2014) The current management of mycosis fungoides and Sézary syndrome and the role of radiotherapy: principles and indications. Rep Pract Oncol Radiother 19(2):77–91. doi: 10.1016/j.rpor.2013.07.009 PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Piotrowski T (2014) Total skin electron irradiation—The technique where the electron beams are still irreplaceable. Rep Pract Oncol Radiother 19(2):69–71. doi: 10.1016/j.rpor.2013.11.002 PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    De Moraes FY, de Carvalho HA, Hanna SA, da Silva JLF, Marta GN (2014) Literature review of clinical results of total skin electron irradiation (TSEBT) of mycosis fungoides in adults. Rep Pract Oncol Radiothe 19:92–98. doi: 10.1016/j.rpor.2013.08.003 CrossRefGoogle Scholar
  13. 13.
    Kamstrup MR, Lindahl LM, Gniadecki R, Iversen L, Skov L, Petersen PM, Loft A, Specht L (2012) Low-dose total skin electron beam therapy as a debulking agent for cutaneous T-cell lymphoma: an open-label prospective phase II study. Br J Dermatol 166(2):399–404. doi: 10.1111/j.1365-2133.2011.10670.x CrossRefPubMedGoogle Scholar
  14. 14.
    Kaźmierska J (2014) Clinical results of the total skin electron irradiation of the mycosis fungoides in adults. Conventional fractionation and low dose schemes. Rep Pract Oncol Radiother 19:99–103PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Hoppe R (2003) Mycosis fungoides: radiation therapy. Dermatol Ther 16:347–354CrossRefPubMedGoogle Scholar
  16. 16.
    Rosenblatt E, Kuten A, Leviov M, Cederbaum M (1998) Total skin electron irradiation in mycosos fungoides dose and fractionation considerations. Leuk Lymphoma 30(1–2):143–151PubMedGoogle Scholar
  17. 17.
    American Association of Medical Physics (1987) AAPM report 23: Total skin electron therapy: technique and dosimetry. American Association of Physicists in Medicine, College ParkGoogle Scholar
  18. 18.
    Earley L, Moeller J, O’Rear J, Leavitt DD (1995) A method for total skin electron treatment for infants. Med Dosim 20(4):243–248. doi: 10.1016/0958-3947(95)02010-1 CrossRefPubMedGoogle Scholar
  19. 19.
    Baugh G, Al-Alawi T, Fletcher CL, Mills JA, Grieve RJ (2011) A preliminary comparison of total skin electron treatment techniques to demonstrate the application of a mid-torso phantom for measurement of dose penetration. Br J Radiol 84(1008):1125–1130. doi: 10.1259/bjr/52924135 PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Chen Z, Agostinelli AG, Wilson LD, Nath R (2004) Matching the dosimetry characteristics of a dual-field Stanford technique to a customized single-field Stanford technique for total skin electron therapy. Int J Radiat Oncol Biol Phys 59(3):872–885. doi: 10.1016/j.ijrobp.2004.02.046 CrossRefPubMedGoogle Scholar
  21. 21.
    Piotrowski T, Malicki J (2006) The rotary dual technique for total skin irradiation in the treatment of mycosis fungoides—a description of the applied method. Rep Pract Oncol Radiother 11(1):29–37. doi: 10.1016/S1507-1367(06)71047-1 CrossRefGoogle Scholar
  22. 22.
    Hensley FW, Major G, Edel C, Hauswald H, Bischof M (2014) Technical and dosimetric aspects of the total skin electron beam technique implemented at Heidelberg University Hospital. Rep Pract Oncol Radiother 19(2):135–143. doi: 10.1016/j.rpor.2013.07.002 PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Ulutin HC, Beyan C, Pak Y (2002) Total skin electron beam therapy for cutaneous T-cell lymphoma: Turkish experience with translational technique. Haematologia (Budap) 32(4):397–403Google Scholar
  24. 24.
    Anacak Y, Arican Z, Drumea K, Rosenblatt E, Tamir A, Chetver L, Stein M, Deroma RB, Kuten A (2002) Total skin electron irradiation in mycosis fungoides: comparison between a modified christie hospital translational technique and the stanford technique. Leuk Lymphoma 43(11):2093–2097. doi: 10.1080/1042819021000016177 CrossRefPubMedGoogle Scholar
  25. 25.
    Hsieh C-H, Shueng P-W, Lin S-C, Tien H-J, Shiau A-C, Chou Y-H, Wu M-H, Wang J-Y, Chen C-K, Chen Y-J (2013) Helical irradiation of the total skin with dose painting to replace total skin electron beam therapy for therapy-refractory cutaneous CD4+ T-Cell Lymphoma. BioMed Res Int 2013:11. doi: 10.1155/2013/717589 Google Scholar
  26. 26.
    Evans MDC, Hudon C, Podgorsak EB, Freeman CR (2014) Institutional experience with a rotational total skin electron irradiation (RTSEI) technique—a three decade review (1981–2012). Rep Pract Oncol Radiother 19:120–134PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Podgorsak EB, Pla C, Pla M, Lefebvre PY, Heese R (1983) Physical aspects of a rotational total skin electron irradiation. Med Phys 10:159–168CrossRefPubMedGoogle Scholar
  28. 28.
    Piotrowski T, Milecki P, Skórska M, Fundowicz D (2013) Total skin electron irradiation techniques: a review. Postep Derm Alergol 30:50–55CrossRefGoogle Scholar
  29. 29.
    Diamantopoulos S, Platoni K, Dilvoi M, Nazos I, Geropantas K, Maravelis G, Tolia M, Beli I, Efstathopoulos E, Pantelakos P, Panayiotakis G, Kouloulias V (2011) Clinical implementation of total skin electron beam (TSEB) therapy: a review of the relevant literature. Phys Med 27(2):62–68. doi: 10.1016/j.ejmp.2010.09.001 CrossRefPubMedGoogle Scholar
  30. 30.
    Shouman T, El-Taher Z (2004) Total skin electron therapy: a modified technique for small room linear accelerator. J Egypt Natl Cancer Inst 16(4):202–209Google Scholar
  31. 31.
    Marinello G, Jaffre F, Slosarek K, le Bourgeois J (1998) Total skin electron irradiation. Rep Pract Oncol Radiother 3(1):19–22CrossRefGoogle Scholar
  32. 32.
    Van Dyk J (ed) (1999) The modern technology in radiation oncology. Medical Physics Publishing, Madison Ch 17B Special Techniques in Radiotherapy: Total Skin Electron Irradiation by Podgorsak EB and Podgorsak MB Google Scholar
  33. 33.
    Gerbi BJ, Khan FM, Deibel FC, Kim TH (1989) Total skin electron arc irradiation using a reclined patient position. Int J Radiat Oncol Biol 17:397–404CrossRefGoogle Scholar
  34. 34.
    Friedman RB, Schmidt-Ullrich RK, Lu J, Ali MM (1996) Cutaneous T-cell lymphoma, total skin electron beam irradiation—a comparison of rotational and stationary field techniques. Int J Radiat Oncol Biol 36(1):356CrossRefGoogle Scholar
  35. 35.
    Jones GW, Kacinski BM, Wilson LD, Willemze R, Spittle M, Hohenberg G, Handl-Zeller L, Trautinger F, Knobler R, Group ECLP (2002) Total skin electron radiation in the management of mycosis fungoides: consensus of the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group. J Am Acad Dermatol 47(3):364–370CrossRefPubMedGoogle Scholar
  36. 36.
    Desai KR, Pezner RD, Lipsett JA, Vora NL, Luk KH, Wong JYC, Chan SL, Findley DO, Hill LR, Marin LA, Archambeau JO (1988) Total skin electron irradiation for mycosis fungoides: relationship between acute toxicities and measured dose at different anatomic sites. Int J Radiat Oncol Biol Phys 15(3):641–645. doi: 10.1016/0360-3016(88)90306-9 CrossRefPubMedGoogle Scholar
  37. 37.
    Weaver RD, Gerbi BJ, Dusenbery KE (1995) Evaluation of dose variation during total skin electron irradiation using thermoluminescent dosimeters. Int J Radiat Oncol Biol Phys 33(2):475–478. doi: 10.1016/0360-3016(95)00161-Q CrossRefPubMedGoogle Scholar
  38. 38.
    Piotrowski T, Fundowicz D, Pawlaczyk M, Malicki J (2003) Thermoluminescent dosimetry in rotary-dual technique of the total skin electron irradiation. Neoplasma 50(2):125–130PubMedGoogle Scholar
  39. 39.
    Antolak JA, Cundiff JH, Ha CS (1998) Utilization of thermoluminescent dosimetry in total skin electron beam radiotherapy of mycosis fungoides. Int J Radiat Oncol Biol 40:101–108CrossRefGoogle Scholar
  40. 40.
    Guidi G, Gottardi G, Ceroni P, Costi T (2014) Review of the results of the in vivo dosimetry during total skin electron beam therapy. Rep Pract Oncol Radiother 19:144–150PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Hussein S (2003) Time dose fractionation in total skin electron therapy. Radiat Oncol 69(Supp 1):S39Google Scholar
  42. 42.
    Specht MD et al (2015) Modern radiation therapy for primary cutaneous lymphomas: field and dose guidelines from the international lymphoma radiation oncology group. Int J Radiat Oncol Biol 92:32–39CrossRefGoogle Scholar
  43. 43.
    Jones GW, Rosenthal D, Wilson LD (1999) Total skin electron radiation for patients with erythrodermic cutaneous T-cell lymphoma (mycosis fungoides and the Sézary syndrome). Cancer 85(9):1985–1995. doi: 10.1002/(SICI)1097-0142(19990501)85:9 PubMedGoogle Scholar
  44. 44.
    Lindahl LM, Kamstrup MR, Petersen PM, Wirén J, Fenger-Grøn M, Gniadecki R, Iversen L, Specht L (2011) Total skin electron beam therapy for cutaneous T-cell lymphoma: a nationwide cohort study from Denmark. Acta Oncol 50(8):1199–1205CrossRefPubMedGoogle Scholar
  45. 45.
    Morris SL, McGovern M, Bayne S, Wain M, Child F, Whittaker S (2013) Results of a 5-week schedule of modern total skin electron beam radiation therapy. Int J Radiat Oncol Biol Phys 86(5):936–941. doi: 10.1016/j.ijrobp.2013.04.042 CrossRefPubMedGoogle Scholar
  46. 46.
    Khan FM (2010) The physics of radiation therapy, 4th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  47. 47.
    American Association of Medical Physics (1991) Report of task group 25: clinical electron-beam dosimetry. Med Phys 18(1):73CrossRefGoogle Scholar
  48. 48.
    Diamantopoulos S et al (2014) First treatment of mycosis fungoides by total skin electron beam (TSEB) in Greece. Rep Pract Oncol Radiother 19:114–119PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    NCRP Report No 151. NCRP Scientific Committee 46-13 on design of facilities for medical radiation therapy and the American Association of Physicists in Medicine (AAPM) Task Group 57. structural shielding design and evaluation for megavoltage X- and gamma-ray radiotherapy facilities, National Council on Radiation Protection and Measurements, 1992Google Scholar
  50. 50.
    McGinley PH (2002) Shielding Techniques for Radiation Oncology Facilities, vol 2. Medical Physics Publishing, MadisonGoogle Scholar
  51. 51.
    El-Khatib E, Hussein S, Nikolic M, Voss NJS, Parsons C (1995) Variation of electron beam uniformity with beam angulation and scatterer position for total skin irradiation with the Stanford technique. Int J Radiat Oncol Biol 33:469–474CrossRefGoogle Scholar
  52. 52.
    Chen Z, Agostinelli A, Nath R (1998) On the use of unshielded cables in ionization chamber dosimetry for total-skin electron therapy. Phys Med Biol 43(3):539–546CrossRefPubMedGoogle Scholar
  53. 53.
    Radiation Oncology physics: a handbook for teachers and students. E.B. Podgorsak Technical Editor, International Atomic Energy Agency, Vienna, 2005Google Scholar
  54. 54.
    American Association of Medical Physics (2009) Report of task group 142: quality assurance of medical accelerators. Med Phys 36(9):4197–4212. doi: 10.1118/1.3190392 CrossRefGoogle Scholar

Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2015

Authors and Affiliations

  • Raelene Nelligan
    • 1
    Email author
  • Zoë Baldwin
    • 2
    • 3
  • Trish Ostwald
    • 4
  • Thu Tran
    • 5
  • Michael Bailey
    • 6
  1. 1.Royal Adelaide HospitalAdelaideAustralia
  2. 2.Cancer Care Services Royal Brisbane and Women’s HospitalHerstonAustralia
  3. 3.Genesis Cancer Care Mater HospitalCrow’s NestAustralia
  4. 4.Calvary Mater NewcastleWaratahAustralia
  5. 5.Barwon Health University HospitalGeelongAustralia
  6. 6.Illawarra Cancer Care Centre Wollongong HospitalWollongongAustralia

Personalised recommendations