Craniospinal irradiation (CSI) is a critically important technique in the treatment of several malignancies, in that coverage of the craniospinal axis contributes to cure in both the definitive [1,2] and salvage [3] settings. Although CSI is traditionally described using photons, the advent of new proton centers has opened opportunities for more patients to be treated with proton CSI. Most sources describe CSI performed in the prone position [4,5]. Supine CSI (SCSI) is preferable if possible because it allows a uniform source-to-skin distance for the spinal field and is technically challenging [6]. Our proton center did not perform craniospinal therapy routinely before July 2010, and we wished to offer CSI to our patients using a supine technique.
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