Total skin electron irradiation (TSEI) is a specialized radiotherapy technique aimed at irradiating the entire skin while minimizing radiation exposure to other organs. It employs various techniques, including translational, large electron field, and rotational methods, with specific dosimetric parameters and quality assurance protocols required. Possible side effects include skin irritation and fatigue, while more severe effects may occur after treatment, emphasizing the need for specialized referral centers for optimal implementation.

1. TOTAL SKIN ELECTRON
IRRADIATION
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2.  What Is Total Skin Electron Irradiation ?
Total skin electron irradiation (TSEI) is a
special radiotherapeutic technique that
aims to irradiate the patient’s whole skin
with the prescribed radiation dose while
sparing all other organs from any
appreciable radiation dose.
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3. Why Using Total Skin Electron
Irradiation ?
• TSEI technique is available only in major radiotherapy
centres.
• All contemporary TSEI procedures are based on
electron linacs.
• Uniform and High surface dose.
• Certain areas of the patient’s skin as well as some
organs (such as nails and eyes) may have to be
shielded in order to avoid treatment morbidity.
• The typical dose/fractionation regimen for TSEI is 40
Gy in 20 fractions.
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4. Physical And Clinical Requirements For (TSEI)
-
1.Physical specification of the large stationary electron field-
• Nominal SSD
• Electron Beam energy
• Field at treatment position and dose distribution
• Dose rate and photon contamination
2. A physical specification of the distribution resulting from the
super-position of multiple stationary electron fields-
• Dose distribution and dose rate for dose from electron and
photon .
3.Clinical Specification-
• Arise dose prescription
• Dose fractionation
• Boost field for underdose area
• Shielding design
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5. Total Skin Electron Irradiation
Techniques-
• Translational Techniques -
• In which the patient is
translated on a
stretcher through an
electron beam of
sufficient width to
cover the patient’s
transverse
dimensions.
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6. Total Skin Electron Irradiation Techniques-
• Large Electron Field Techniques –
• In which a standing
stationary patient is
treated at a large SSD
with a single large
electron beam or a
combination of large
electron beams.
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7. Total Skin Electron Irradiation Techniques-
• Rotational Techniques –
• In which the patient is
standing on a rotating
platform in a large
electron field.
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8. SELECTION OF TSEI TECHNIQUE-
Before providing TSEI treatment to patient:
(a)An adequate TSEI technique must be
chosen
(b) Commissioning procedure develop
(c) Quality assurance procedures developed
Large electron field used for TSEI is produced either with
single or dual large electron field.
 Patients will be treated:
(a) With multiple large electron beams
(b) Translated through a large electron field
(c) Rotated in a large electron field
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9. Commissioning Procedure Of The TSEI
Technique-
The basic dosimetric parameters of the large
TSEI stationary electron field are-
Field flatness.
The absolute dose rate in cGy/MU at the dose calibration
point..
PDDs measured to a depth of 15 cm in a tissue
equivalent phantom.
Bremsstrahlung contamination of the electron beam.
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10. The Basic Physical Parameters Of The Clinical TSEI Beam
That Is Produced Through Multiple Stationary Fields Or
Through A Rotational Technique Are-
The dose maximum occurs on patient’s
surface because of the superposition of
various electron beams.
The penetration of the clinical beam is
significantly weaker.
The bremsstrahlung contamination of the
clinical beam.
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11. PDD For Photon Contamination-
• The PDD of the clinical
beam is shallower than
that of the stationary
electron beam.
• The dose maximum
occurs on patient’s
surface.
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12. Measurement Of Stationary And Clinical TSEI
Beams-
• Equipment required for calibration of the TSEI stationary and clinical
electron beams consists of-
• Various phantoms:
(a) Water equivalent slab phantoms
(b) Cylindrical phantoms
(c) Anthropomorphic body and head phantoms
• Various dosimeters:
(a) Cylindrical and parallel-plate ionization chambers
(b) Thermoluminescent dosimeters
(c) radiographic films and radiochromic films.
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13. Quality Assurance In Total Skin Electron
Irradiation-
Quality assurance in total skin electron irradiation
requires a strict adherence to quality assurance
protocols.
Quality assurance protocols in TSEI fall in three
categories:
(a) Basic quality assurance protocol
(b) Pre-treatment quality assurance protocol
(c) Treatment quality assurance protocol
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2017
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14. Side Effect Of TSEI-
• Possible side effects during treatment and in the first three months
afterwards-
Itchy Skin
Fissures (cracks in your skin )
Skin infection
Hair loss
Fatigue
• Late effects (after three months) –
Dry skin
Sun sensititivity
Temperature Regulation
Brittle nails
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15. Conclusion-
All the techniques employed for TSEI are specialized
and time-consuming, requiring extensive
development and careful dosimetry, planning,
execution, and quality control.
Referral to centres specialising in TSEI is often the
preferred option, thus balancing the effort required
to implement and maintain such techniques against
the number of patients for which it is provided
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16. Reference Book-
• Radiation oncology physice,E.B podgorsak,IAEA,2005
• Total skin electron theraphy, The Clatterbridge Cancer
Centre,journal
• www.slideshare.net/tsei
• Total skin electron irradiation, Northern Centre for Cancer
Care (NCCH).
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