Internal and External Shielding

Internal shielding is placed internally during superficial electron beam treatments of the
head and neck, such as lip carcinoma, eyelid, buccal mucosa and nose. Internal shielding is used
to protect the tissue beyond target volume. But this can cause a higher dose to the tissue near the
shield that is caused by backscatter and the dose can increased by 30-70%.¹ To dissipate the
electron backscatter from the lead shielding, a low Z material can be placed between the shield
and the tissue. For example, lead shield coated with dental acrylic will greatly reduce the
backscatter dose if placed in oral cavity and internal eye shield.¹
External shielding is placed outside of the patient’s body on the skin or at the end of a cone.
External shielding is used to give shape to the treatment area and to protect the surrounding
normal tissue. Examples of external shielding are lead shield and electron cutout. An important
consideration is to make sure that the lead thickness is adequate to reduce the surface dose to an
acceptable value. According to Khan et al², the minimum thickness (t) required for lead in mm is
𝐸
equal to half of the energy (E) in MeV and adding 1 mm of lead for uncertainty, or t = 1 + 2 .
Khan also recommended to add 20% to the thickness if a lead alloy is used. For example, a 20
MeV beam will require 11 mm of lead, or 13 mm of lead alloy.
Both internal and external shielding are both beneficial to protect the underlying tissue. In
situation where we need to treat a lesion in the lip, we will utilize an electron cutout as the beam
shaper and also apply a lead coated with wax as an additional shielding to protect the internal
tissue beyond the treatment volume.
References:
1. Washington CM, Leaver D. Electron beams in radiation therapy. Principles and
Practice of Radiation Therapy. 4th Ed. St. Louis, MO. Elsevier Mosby:2016:542-543.
2. Khan FM, Gibbons JP, Sperduto PW. Electron beam treatment planning. Treatment
Planning in Radiation Oncology. 4th Ed. Philadelphia, PA. Wolters Kluwer:2016:291.