Series

Clinical
Oncology
Revision Notes
Physics
Radiotherapy
Physics ®

Contents

1. Basic radiotherapy physics

2. The Interaction of Radiation with Matter
3. Interaction of sub-atomic particles with matter
4. Radiation dosimetry
5. Radiotherapy beam physics
6. Electron beam physics
7. Radiotherapy treatment planning
8. Beam therapy equipment
9. Quality assurance
10.Radioactive sources
11.Brachytherapy
12.Unsealed sources
13.Radiation protection
1.Basic radiotherapy physics
Structure of Atom- Consists central nucleus and surrounding „cloud‟ of orbiting electrons

nucleus - Consists of protons and neutrons

- All the protons & neutrons hold together by the “strong force” or
binding energy nucleon(nuclear force exist in very short distance)
- mass defect - arithmetic sum of each proton/neutron > weighted nucleus
- mass defect is conserved to strong force which bind the nucleon- E=mc2

Electron - Neutral atom contained equal no of proton and electron

- Electron s are orbiting the nucleus in shells (K,L,M,N). Each shell may
contain 2n2 of electron (n=shell no) outer most max 8 electrons
- Electrons are attracted to the nucleus by the electromagnetic force
- Energy applied > binding energy of the electron, it will be removed from
the atom→ ionisation
- Excitation - smaller amounts of energy sufficient to lift the electron from
one shell to a more distant shell without being removed from the atom.
Excitation leaves a „hole‟ in the shell, and an outer electron may fall back
into this „hole‟, extra energy is released as characteristic radiation.
- Electrons is different from the number of protons, the atom is said to be
ionized.

Proton - +ve charged

- protons held together in nucleus by strong force against repulsive force
of electromagnetic/coulomb force.

atomic - number of protons in the atom, determines the element of the atom.
number Z
atomic - number of protons and neutrons in the atom
mass no A
Conservation Conservation laws state that 5 components- mass, energy, momentum,
Laws charge and matter/antimatter cannot be created or destroyed.
Energy C=f λ
quantitisation E= mc2 or E= hf or E= hC
λ
8
-speed of light c = 3x10 , h=plancks constant, f=frequency, λ =wavelength
1eV= 1.6x 10-19 J
Electromagnetic radiation
Common - It propagates in a straight line at the speed of light (~ 3x 108 m/s)
features - It transfers energy to the medium through which it passes due to
1. absorption and scattering
2. inversely correlated with 1/d2 (distance traveled)
Electromagnetic Radio wave/ Microwave/Infrared /Visible light /UV/x-ray/gamma
spectrum - arrange according to ↑ frequency & ↓ wavelength

subdivided into ionizing and nonionizing radiations

- Ionizing radiations must λ < 10−7 m, E >34 electron volts (eV)

Ionizing radiation divided into

1. Directly ionizing(charged particles) - alpha, proton, heavy ion
2. Indirectly ionizing(neutral particles) - photons (x, ɤ ) & neutrons

Non-ionizing Radio waves/ Microwaves/Infrared light /Visible light /Ultraviolet

X-Ray production
- Electron produced by thermionic emission in the cathode are accelerated towards the
anode by the difference voltage potential.
- X-ray produced by bremsstrahlung and characteristic X-rays

a. Bremsstrahlung (heterogeneous=continuous/spectrum energy)

- sudden deceleration electron due to Coulomb interactions with nuclei in the anode
- Bremsstrahlung possibility ↑ with ↑ Z number of target, electron energy
- energy & wavelength of the X-rays depend on Z number of target, electron energy

b. Characteristic X-rays (monoenergetic= discrete)

- Electron in an inner atomic orbital is knocked out by an incoming electron; the vacant
orbit is filled by electron that moves from an outer atomic orbital. The excess
energy after filling the vacant orbit released as characteristic X-rays which has lower
energy than Bremsstrahlung x-ray.

-Angular distribution of x-ray produced depends on the energy of incidence beam

-high energy beam(MV) -are mainly forward directed x-ray produced
-low energy beam(KV) – x-ray produced perpendicular to the incident electron beam

Photons X-ray Gamma-ray

production Extranuclearly intranuclearly
Method of production 2 ways 1 way
& Energy level Bremsstrahlung (continuous) Isomeric transition
Characteristic (discrete) (monoenergitic)
Clinical use 1. Bremsstrahlung photons 1.Use in brachetherapy
- Use in LINAC/X-ray
2. Characteristic x-ray 2.Photons fr anhilation
- low energy which filter out for PET-scan
Attenuation photons - progressive loss of energy by a beam as it traverses matter
I=Io e-ut I = intensity of outgoing radiation beam
Io = intensity of incoming radiation beam
t = tissue thickness
u = linear attenuation coefficient proportionate to:
1. Z 4 atomic number of the penetrated tissue, &
2. energy of photon - hv

intensity of the radiation ↓exponentially with

the absorbent thickness & linear attenuation coefficient

attenuation coefficient mainly affected by 3/5 interaction with matter →

photoelectric effect, Compton effect, and pair production
Hardening Refers to the loss of lower energy photons from the beam through
attenuation by adding filter.
- ↓ scatter and skin dose.

Half- value - thickness of material that attenuate the photon beam intensity to 50% of
layer its original value in mm or cm of absorbent
- descript quality of low energy x-ray.
HVL =0.693
µ Blocks with thicknesses of ~4–5 HVLs are used in radiotherapy. Block 5
µ =linear HVLs thick transmits 3.125% of the incoming radiation.
attenuation
coefficient - monoenergetic photons , 1st HVL identical to subsequent HVLs.
- polyenergetic photons, 1st HVL is smaller than subsequent HVLs
because of beam hardening

Attenuation z=atomic no E= energy of the beam(hv)

Coherent Photoelectric Compton Pair
Scattering effect effect Production
Energy zone low KV photons <30KeV 30KeV – 25Mev >25MeV
Predominant (loss of contrast/ (60-100kVp)
blurring)
Proportionate -Z/E -Z3 /E3 -electron density/ E - Z2 X E
2. The Interaction of Radiation with Matter
Six ways in which photons may interact with matter
Photon-orbital electron interactions
Coherent - Photon interact with orbital Electron & deflected or scattered
Scattering - no change in energy of the incident photon

Main point two types of coherent scattering

-no ∆ photon a. Thomson scattering - photon only interacts with one electron
energy b. Rayleigh scattering - interacts with all of the electrons of the atom,
vibrate at its own frequency leads to excitation. So no ionization

Photoelectric - photon interacts with an inner most orbital electron whose binding
effect energy is close to that of the photon energy.
- photon disappears and all of its energy is given to the orbital
Main points electron(total absorb), which it(secondary electron) is then ejected
-inner electron from the atom.
-photon gone -2° electron kinetic energy =photon energy – electron binding energy
-2°/ x-ray/Auger
electron released - space left by the departing electron is filled by another orbital
electron, with emission of charateristic x-rays or Auger electrons
(when a characteristic x-ray causes ejection of another orbital
electron within the same atom)

Incoherent - photon has energy much ≥ the binding energy of the Electron
Scattering - photon interacts with the „free‟ electron (K-shell or above),
(Compton Effect) loss its energy and undergoing scattering.
- Photons may be scattered in any direction
Main points - 2° electrons only scattered in a forward direction (max 90 o from the
-outermost original path of the photon)
electron - proportionate to electron density, as Z ↑, electron density ↓,
- photon scatter slightly less likely in high Z materials
-2° electron - inverse proportionate E
released
-Electron scatter - Direct impact scatters the photon at 180 o and gives a large amount
<90° of energy to the electron which continuous in the photons original
path.
- Glancing hits because no photon scattering & give a small amt of
energy to the electron, this moves at 90 o away from the photon
direction. (electron never backscatter)

Interactions of photons with nuclei

Pair - photon (i.e 6MeV)passes close to the nucleus of an atom
production - photon disappear and „create‟ an Electron & a positron (1.02MeV)
- particles paired move away with the remaining energy of the
Main points photon converted to kinetic energy(i.e remaining 4.98/2 MeV)
-near nucleus - positron annihalate to 2 photons with energy of 0.511 MeV each
-E gone - Photon must > 1.022 MeV to generate a positron/Electron pair
-paired productn - proportionate Z2 and photons energy esp>25MeV
- annihalate

*Triplet -photon pass close to orbital Electron, photon disappears and the
production energy is used to create an Electron and positron. The orbital
(2 Electron& 1 Electron also receives energy (gamma from annihilation of positron)
positron) and is freed from the atom. The threshold for this to occur is a photon
-similar paired of 2.044 MeV
- gamma also
ionized Electron

Photodisintegrati - photon is absorbed by the nucleus of an atom

on - photon is destroyed and a nucleon (proton or neutron) is released
- The threshold for this effect is over 10 MeV for most nuclei
(exception of beryllium and deuterium, where it is 2 MeV)

Clinical Implication
Diagnostic imaging Portal imaging

KV energy MV energy

Small focal size (0.5mm) Larger focal size (2mm)

Better sharpness Less sharpness

Photoelectric absorption predominates Compton effect more important

3. Interaction of sub-atomic particles with matter
Electron loses 2MeV/cm for above 1MeV energy electron.
Interaction with electron
Elastic - leading to scattering of the incident electron but no transfer of energy

Inelastic - loss of energy from the incident electron to the orbital electron
- If this energy is sufficient to excite the electron to a higher shell
- space left by the departing Electron is filled by another orbital Electron,
with emission of charateristic x-ray

- If sufficient energy to ionize an orbital

- Reactive ionized atoms react with another atom to achieve stable state
- propagate further ionizations before loses its energy & captured by atom.

Interaction with nuclei

Elastic - scattering of the electron with no loss of energy
- scattering proportionate to Z of the nucleus

Inelastic - sudden deceleration/changing direction of the electron due to Coulomb

interaction with nuclei
- energy that is lost by the electron is released as photon –bremsstrahlung
- „bremsstrahlung tail‟- photon contamination of the therapeutic electron
beams

Electron - attenuated by inelastic (orbital or radiative collisions) and elastic scattering

Collisional Stopping important at lower energies and low Z (higher Electron/per
Power gram)
- Due to inelastic collision with electron

Radiative Stopping proportional to the beam energy(>1Mev) and Z2

Power - d/t inelastic interact with nucleus-bremsstrahlung radiation

Total mass stopping = collisional + radiative mass stopping power

power
Scattering power Proportional Z2 / (kinetic energy of electron)2

- Electron passing through an inhomogeneity (i.e bone,

muscle)
- >backscattering fr the high Z to low Z side → ↑ dose in low
Z side
Protons - have a low LET when they enter the phantom, but give up a lot of energy
at the end of their track (the Bragg Peak)
4.Radiation dosimetry
Exposure Ion created by photons per unit mass of air ~ C/kg or R

Kerma Define- Sum of the initial kinetic energies of all charged particles
per unit mass of medium produced by the indirect ionizing radiation)

Kinetic Energy Mechanism

Released in -photon radiation transfers E to the 2° Electron through photon
Material interactions (photoelectric effect, Compton effect, pair production)
-In the second stage, the 2° Electron transfers energy to the medium
through mainly collision loss (excitations/ionizations) and negligible
via radiative loss(bremsstrahlung).
- .
- same units as absorbed dose J/kg or Gray

Absorbed dose amt of energy absorbed from a radiation beam via radiation
interactions (mainly excitations and ionizations) in the medium per
unit mass of absorbent ~1J/Kg=1Gy= 100cGy= 100Rad

Absorbed dose = kerma during CPE

Equivalent dose Absorbed dose X radiation weighting factor (WR)
~1 sievert= 100rem
Photon/electron W R = 1 for all energy; Neutron WR=20

Effective dose Equivalent dose X tissue weighting factor (WT )

Relation 1Rad=1Rem =1R

Dosimeter
Ideal Dosimeter -Be accurate, Be precise , Show a linear response to dose

Gas- filled detectors

Principle Ionization of gas
- ionising radiation interacts with known mass of air hence produces ions in the tube
- Ions created in the tube are accelerated by an electric field bet. anode & cathode

Principle of dose measurement

- charge collected & connected to electrometer which converted charge to signal(current,
impulse) which defines the present or dose rate of a radiation

Maintained accuracy of Ion chamber

- T0 must maintained at 220 C and pressure at 760mmHg
- any changes in the above standard value should corrected with [(273+To )/295] x [760/p]
- if T ↓(gas less expanded) or pressure ↑(gas compressed),
resulting in higher collected charge resulting false reading.
Type of Gas- filled detectors
-Ionization chambers (most common used)
-Proportional detectors (with or without a window)
-Geiger–Müller detectors (with or without a window)
-Gas scintillation detectors

Type of Ionization chamber

Cylindrical chamber consists of a
-farmer/thimble type -central electrode surrounded by air
(absolute dosimetry) -the outer shell functions as the outer electrode
-The chamber is connected to electrometer

Parallel plate used with slab phantoms and measuring dose at small point

Well-type chambers calibration and standardization of brachytherapy sources

Extrapolation chambers -Measure low energy x rays/surface doses in Orthovoltage,

megavoltage x-ray beams and beta rays
-used as dosimeter when directly embedded into a tissue
equivalent phantom
GM detector
Principle

 ionising radiation interacts with air and produces ions in the tube
 Ions created in the tube are accelerated by an electric field bet. anode & cathode
 The ions will collide with other gas atoms, more ions are produced.
 The result is ‘Avalanche’ or gas multiplication effects, in which the arrival of a
single ionizing radiation triggers release of a sizeable pulse of ionisation current.
 The electrical pulse, caused by the detection of each single photon, is amplified
electronically and then actuates an electronic circuit.
 The counter output is often applied to a loudspeaker circuit, providing a series of
audible clicks, each one triggered by the arrival of a single photon of radiation.

Advantage Disadvantage
- beam calibration/absolute dosimetry - Connecting cables required
- Instant readout/reusable - High voltage supply required
-Accurate and precise - Many corrections required
- Necessary corrections well understood
Film detector

Principle
- film is coated with a silver bromide (Ag+ Br-) emulsion.
- exposed to ionising radiation, an Electron released by Br atom & captured by Ag atom
- Neutralized Ag atom fix itself to the polyester sheet,dragging nearby Ag atoms with it.
- When developed silver bromide emulsion is removed but the Ag atoms remain on the
sheet, giving a dark appearance.
- The amount of darkness corresponds to the dose
- optical density (OD) is a function of dose measured.

I0 is the initial light intensity

or {-OD= log10 (I/Io )} I is the intensity transmitted through the film

Advantage Disadvantage
- 2-D spatial resolution - not reusable
-detect small area dose changes - develop the films,variation bet. film & batch
- Very thin: doesnt perturb the beam - not used for beam calibration
-detect only > 20mR

TLD (crystal)
Principle

- no electron in forbidden zone between the valance band & conduction band
- crystal is excited by radiation, traps appear, Electron coming from the valance band or
returning from the conductive band are caught in these traps
- no of Electrons trapped is proportional to the amt of ionising radiation absorbed by the
Crystal
-Upon stimulation- heated to certain Tº

- Electrons gain enough energy to release themselves from the traps and
- return to the valance band by releases E as light (i.e., luminescence)
-This luminescence can be measured by an photomultiplier
Advantage disadvantage
- in vivo dosimetry - sensitivity ↓ after repeated used
- detect small area dose ∆ - No instant readout
- personal monitor- small, portable, reusable - Not for beam calibration
Semi- - p-type and a n-type semiconductor fuses together
conductors - a depletion layer at the junction where no free electric carriers.
- Radiation interaction with the depleted layer &
- produces electrical charges, making this junction conductive.
-An electrometer connects to the two ends of the junction collects these
charges, which is proportional to the amount of radiation absorbed.

Advantage Disadvantage
- invivo dosimetry-Small - Requires connecting cables
- detect small area dose ∆ - not for beam calibration
- Instant readout
- High sensitivity

5. Radiotherapy beam physics

Superficial Beams
-on/off effect
-Maximum dose(100%) occurs at the surface
-dependence on SSD significantly affects output(cone length-Inverse square law)
-Electron contamination from the applicator/cone (significant for skin dose ard 100kVp)
-Very sharp penumbra at the surface(sharper for lower energy beams)
-High atomic number inhomogeneity causes markedly increased attenuation
- useful for superficial lesions, this limits their application for deeper treatments
Lesion HVL(quality measure)
Diagnostic radiology 10-100 kV
Kilovoltage < 0.5 cm 40-120kV 1-4mm Alu
i.e 100kV 2.07 mm Alu
Orthovoltage < 2 cm, 120-400 kV 1-4mm copper
bone mets i.e 150kV 1.5mm Cu
250kV 3mm Cu
Supervoltage 500-1 MV 4-6mm copper

Megavoltage Beams >1 MV

- low surface dose, build up region, depth of maximum dose, dmax
- A gradual loss of dose with depth beyond zmax
- A sharp physical penumbra at the beam edge
- Inhomogeneity cause ↑or ↓ attenuation d/t density of material not Z number
Photon profile
10 radiation originating from the target or source
20 scattered attenuation of the 10 radiation→ 20 electrons set in motion
radiation In kilovoltage- 20 electrons stopped immediately
In megavoltage, 20 electrons have distance range
Entrance /surface - dose at the point where the beam intersects the patient or phantom.
dose - Surface dose is due to a combination of
- 10 radiation
- scatter from the collimators and air
- backscatter from the treated volume

kilovoltage - entrance dose of 100% and they fall off rapidly

megavoltage - surface dose 20% of Zmax & ↓ as beam energy ↑
Patient contour -irregular surface
- patient‟s part that are closer to the beam source, the beam will be
attenuated more than in other parts of the patient distant to the beam
source. This can lead to undesired changes in isodose curves at depth

Build-up & Define-range of Electron set in motion prior to dose deposition

falloff
region -As the photon beam enters the patient/phantom interact with matter
-20 Electron are ejected from the surface & subsequent layers
-20 Electron deposit their energy at a distance away from their site of
origin
-Electron fluence ↑ and hence absorbed dose ↑ with depth until
achieve CPE then photon fluence continuously ↓with depth hence
production of 20 electrons also ↓ with depth →rapid fall-off

Charged particle - 20 scattered radiation is distributed to neighbouring areas.

equilibrium(CPE) - CPE achieved if the amt of scattered radiation leaving a point is
equivalent to that entering the point at dose max
- transient CPE after Dmax

Inhomogeneities MV- Campton account for attenuation depends on Electron density

Absorbed dose -↑ dose on the low Electron density side (d/t ↑no of Electrons
entering the tissue from the high Electron density side), ↓ in dose on
the high density side

KV- PE predominate and absorbed dose ↑ at high Z no material

Electrons may be backscattered if they encounter a dense material ie

bone interfaces/ metal prostheses→ ↑ dose in the soft tissue
surrounding the dense material
Exit dose - dose at the point where the beam exits the patient.
- rapid fall off in absorbed dose as lack of scatter from the beam
Dose distribution Photon
PDD Define as the ratio (%) of the dose absorbed at a predefined depth (Dx)
Percentage to Dmax (max dose) for a predefined SSD and field size.
depth dose
(along central
beam axis)
- dependent on beam field size, energy, SSD and inhomogeneities
Field size ↑ field size →
 Zmax ↑(less rapidly for very large field sizes over 20 cm)
 PDD ↑ at other points along the central beam axis
 The ratio of the penumbra to the central portion of the field ↓

Field
5X5cm Dmax photon ↑ with ↑ photons energy
<5x5cm Dmax ↑ with field size with same energy
>5x5cm Dmax ↓/surface dose ↑ with field size due to treatment
head(collimator & filter) & interact with air scattering
Beam energy ↑ beam energy → Percent depth dose ↑
→ Zmax ↑ due to ↑ range of scattered electrons

Source Surface - intensity beam is related to the distance from the source by the
Distance inverse square law- dose rate at an increased distance is lower
- the attenuation of the beam is reduced due to the slower fall off in
intensity at greater distance

↑ SSD→
- Zmax and percent depth dose ↑
- The geometric penumbra increases with increasing distance
SSD ∆
Mayneod‟s To calculate new PDD2 with the change in new SSD 2
factor(PDD) PDD2 = PDD1 <(SSD1 + d) /(SSD1 +dma x) > 2 <(SSD2 +d max)/SSD2 +d)>2

SAD ∆ D2= D1 (TMR2 /TMR1 )x <distance d1 (SAD)/d2 (SAD)>2

TMR> PDD at the same depth.TMR only attenuation; PDD
TMR attenuation & inverse square law
Penumbra - Penumbra ↓ in size (from kilovoltage to low megavoltage) before
slightly increasing with high megavoltage energies (18 MV)
- ↑ in penumbra at higher energy due to ↑ lateral range of electrons
generated by the higher energy photons

Beam Obliquity - beam directed <60o lead to ↑surface dose ↓ of depth dose

Beam profile
Beam profile measured at multiple points on a plane perpendicular to the central
beam axis at a certain depth(10cm) at 100SSD, field size largest 40cm2

F<3%

S = areaL- areaR x100

areaL+areaR
S< 2%
- flat and includes doses over 90% of the central beam axis
Central region
-Beam flatness, F- variation dose within the central dose region~103%
(100-90%)
-Beam Symmetry,S- ratio of dose at a pair of points located opposite
 each other from the central beam axis~ 2%
Penumbra - defined as the region of steep dose fall at the edge of radiation beam
region Lateral distance between two specified isodose curves at a specified
(90-20%) depth. (e.g. lateral distance between 90% and 20% isodose lines at the
depth of Dmax.)

Penumbra
Geometrical - A region where it can receive radiation from some
parts of the source but not from the whole source.
- large sources size, ↑ geometrical penumbras
-penumbra calculation
P = s (SSD+d-SCD)/SCD
p=penumbra
s=source size d=depth SCD=source to diapharm
Transmission penumbra resulted when radiation pass through the
edges of the collimating blocks.
Scatter Electron scatter
Physical combination of the geometri, transmission
penumbra and electron scatter at the beam edges
-physical penumbra of MLC larger lead block
- usu not a serious drawback except for the Rx of
small fields or close to critical structures

↑ penumbra ↓ penumbra
↑ in SSD ↓ SSD
↑ in source diameter ↓ source diameter
↓ SDD or SCD ↑ SDD or SCD
↑ Depth from surface
umbra region -region outside the radiation field, where dose is minimal
(<20%) -20% isodose lines at the depth of Dmax d/t transmission through
collimator/head shielding)

lateral horns -necessary compromise in the flattening filter design

-passes through the centre of the flattening filters gets attenuated more
compared to those that passes through the edge of the flattening filter
-This produces the dose horns at dmax
- x-ray traverse the thinner part of the flattening filter have more low
energy components
-At 10 cm depth,the outer distribution of softer x-rays have been
absorbed by water/tissue, hence the dose horns disappear
OAR - x-ray traverses the thinner part of the flattening filter, more low
(Off Axis energy components are included (dose at the edge slightly > central
Ratio) region)
-At greater depths, softer x-rays have been absorbed by water/tissue
(horn disappeared slowly)

-ratio dose at a point (Q) relative a point(P) on central axis at same

depth

Isodose curve Points of equal dose are joined together

(combining depth dose curves with the beam profile at multiple depths)

6.Electron beam physics

Surface dose

- A high surface dose relative to photon beams

- surface dose(70%+E), Dmax (E/5) , R90 (E/4), R80 (E/3), R50 (E/2.33)
- Rp(practical range) defined as the depth at which the tangent plotted
through the steepest section of the Electron depth dose curve intersects
with the extrapolation line of the bremsstrahlung background
- Rmax(maximum range) defined as the depth at which extrapolation
of the tail of the depth dose curve meets bremsstrahlung
-the largest penetration depth of Electrons in the absorbing medium
- A bremsstrahlung tail d/t generation of photons from inelastic
collisions' with nuclei 2-5% - electron interact the LiNAC head
- shield thickness = E/2 (mm) lead

- target volume should lie within 90% isodose curve

- chest wall RT, 80% isodose curve chosen to spare lung

Factors affect surface dose

Field size -surface dose ↑ with field size
-min field size 4x4, if smaller field size use- depth dose & dmax ↓ &
closer to skin surface as not enough lateral electron equilibrium
-superficial tumour near critical structure, kv xray better than electron
 as electron has more lateral scatter(scatter to nearby critical area)
Beam energy - Surface dose ↑ with beam energy

2Mev/cm
SSD - surface dose ↑ with SSD d/t ↑ lateral scatter of electrons within air
- Electrons travelling at a tangent away from the central beam axis
will tend to deposit their dose more superficially
- beam edge will become blurred at a longer distance from the
treatment head (penumbra ↑)

Effective SSD from virtual source

Virtual‟ source position is defined
-“Spread” beam appears to diverge from a point (virtual source)
-Electron beam “spread” due to collimatn system & air column above
patient
Beam Obliquity - beam directed <60o lead to ↑surface dose ↓ of depth dose.

Beam profile Similar to photons

Isodose - E>15MeV ;
-Electron beam more bulging out at <20% isodose due to scattering
-Electron beams exhibit a lateral constriction at >80% isodose
-Higher the Electron beam energy,the more pronounced of
contriction/bulging effect
- curving in/bulging out limit matching of 2 electron fields

penumbra Wider ↑ energy

Internal shields Shield- lead coated with low atomic number materials(wax) to ↓ the
electron back-scattering into surrounding healthy tissue
Compare low and higher energy electron beam
Low energy beam High energy beam
lower surface dose relative to zmax higher surface dose (over 90% of zmax )
- rapid attenuation of electrons - minimal lateral scatter
-Shallower R50 and Rp -Deeper R50 and Rp
-narrower penumbra -larger penumbra
Retain bulging of low dose isodose lines More prominent bulging of the low dose
<20% isodose lines at depth
No lateral restriction at depth of high dose Lateral restriction at depth of high isodose
isodose lines >80% lines

7. Radiotherapy treatment planning

Simulation - radiotherapy field determination using a diagnostic X-ray machine/ CT/MRI
with similar physical and geometrical features to the actual radiotherapy
treatment machine.
- consists of localization, immobilization, imaging & planning
Localisation - accurate determination of the rx isocentre
- assisting with patient positioning
- laser use in localization in simulation and treatment room
Immobilisation is designed to be comfortable and position reproducible
equipment - i.e BDS, headrest, Breast/Wing board, Kneefix, Vaclock

a.BDS -accurate position reproducible each day

-Guarantees an accurate and constant patient contour
-determine locatn of the lesions accurately fr surface markers on the shell
-Can be labelled and marked without draw marks on the patients
-Offer accurate beam entry and exit points.
-Provides a base for build- up material and/or local shielding

b. Kneefix - beneath patient‟s knees in the supine position

- support the ankles during prone treatments

c. Vaclock - easily shaped to fit the patient contour

Imaging- Patient data acquired by CT/MRI/PET fusion
Conventional CT MRI PET
Good Cheap, 3D spatial & good differentiation bet localising GTV as
less radiation resolution of soft tissues i.e in FDG-avid area (high
exposure inhomogeneities muscle or brain glucose metabolism
such as bone, lung -no radiation i.e tumours)
or air spaces
Bad -Tumor not visible discrimination long scanning poor resolution.
-knowledge of visible between different times → movement Must fuse with CT
landmarks to locate soft tissue artefacts i.e lung. or MRI for
tumor planning.
- pt stay still finish
Comparison
Goals Conventional CT simulation
Treatment position Till imaging done Pt on ct-scan once
Identify of target volume Bony landmarks From CT data
Determine- beam geometry Fluoroscopy BEV/DRR
Shielding design Bony landmark Conformal to target
Contour acquisition Manual From CT data

Planning
SSD/SAD technique
SSD - SSD calculations use PDD
- SSD need frequent patient repositioning between treatments
SAD
- same distance from the beam source to the isocentre
- use of tissue-air, tissue-phantom or tissue- maximum ratios for SAD calculation
- advantages:
1. Ease of set up - Patient‟s (couch) position remains the same throughout treatment
2. Less set up errors
3. Less time consuming

-isocentre
Mechanical main axes of rotation of the gantry, the radiation head and the patient
couch intersect though the same point(usu 100 SAD) in space
Radiation the axes of all the radiation beam pass throughs

Contouring- ICRU 50 and 62 reports define the target volumes and organs at risk

Volume Definitions According to ICRU 50

GTV Gross demonstrable extent and location of malignant growth
CTV Demonstrable GTV and/or microscopic malignant spread
PTV ensure that the prescribed dose is actually absorbed in the CTV, all possible
geometrical variations need to take into consideration
=CTV + IM+EM included
- internal target margin
- intra-treatment variations
- set-up uncertainties
- machine tolerances
TV total volume that receives dose required to achieve the treatment aim
IV volume receiving a dose that is considered significant in relation to normal tissue
tolerance

Volume Definitions According to ICRU 62

IM physiological organ movements
SM or EM movements relating to the treatment and technique
ITV internal target volume= CTV+IM
OAR Organs that are known to be radiation sensitive
PRV Margin given to OAR
Dmax is the maximum dose point within the PTV and the organ at risk
Dmin is the minimum dose point within the PTV
Range +7% to - 5% of the prescript dose within the PTV
Hot spots high-dose regions in the treated volume

Dose reporting according ICRU

1.min dose, max dose, mean target dose & ICRU reference point
2.ICRU reference point set at with criteria below
a. dose at this point is clinically relevant and representative of the dose throughout the
PTV.
b. The point should not lie in the penumbra region or where there is a steep dose
gradient.
c. easy to define in a clear and unambiguous way.
d. where the dose can be accurately calculated.

Beam energy clinical indication

Kilovoltage For superficial lesions of the skin < 5mm invasion
beams - malignant-Bowen's Disease,BCC,SCC
- Non-malignant i.e keloid scars

Clinical:better than e- in areas where near critical structures as

- smaller penumbra/lateral scattering, higher skin dose, thinner lead
shield & easy shaping the target, inhomogeneity↑ attenuation high Z
Megavoltage Clinical: superficial lesion
electron beams -posterior neck, breast boost,skin lesion

Megavoltage - inhomogeneity↑ attenuation on e density i.e thorax-6MV are better

photon beams due to a thinner penumbra and faster buildup
- Higher MV better for deeper targets in the abdomen & pelvis

Field Size - beams must be chosen to cover the volume adequately

- penumbra must be accounted for when choosing a field size
- KV beams relatively small penumbra ~ 0.5 cm
- MV beams have a sharp penumbra ~ 0.7 cm, ↑ with beam energies
Beam arrangement

Direct/ - single field rarely used as the dose distribution rarely of clinical use
single field i.e SCF treatments or single palliative spine fields.

Parallel opposed - more homogeneous dose distribution with ↑ beam energy

fields -↑ PDD(↑energy& field size)→↓ total dose at hotspot (dmax ) cf MPD
-↑ pt thickness →↑ total dose at hotspot (dmax ) cf MPD
wedge pair - used for irregular contours/tissue missing compensator or in an
attempt to treat a relatively superficial lesion without dosing deeper
structures
Multiple fields - when the target volume is located near critical structures.
- Multiple fields allow the dose to be concentrated on the target
volume, with a lower dose spread out to neighbouring tissues. This
lower dose field leads to less deterministic side effects, but may
increase the risk of stochastic effects in the treated organs

Beam Modifiers
Bolus Irregular pt contour lead to hot and cold spot
- bolus- tissue equivalent material i.e wax added
• To ↑ the surface dose.
• shorten the range/penetration of a given e beam in the patient
• To flatten out irregular surfaces
Shielding
Megavoltage
conventional block made of
Custom blocks 1. lead 4-5HVL- transmission 3%
2. Cerrobend alloy contained lead, bismuth, cadmium, zinc
electron shield requirment - E/2+20%
Pros: -Good conformity to the treatment field shape/island block
Cons:
-Treatment preparation more tedious than using MLC as blocks
need to be fabricated in the mould room using the template
obtained during simulation
- Treatment delivery- Treatment of multiple fields using blocks
takes much longer time as needs to enter the treatment suite to
exchange the blocks

Linac -two sets of jaws capable of forming a rectangular field of differing

Independent jaws dimensions - unable to create irregular fields
( 20 collimator) -generate fields with a non-divergent edge and do not suffer from
interleaf transmission associated with MLCs

multileaf made of lead, contains a set of leaves to define any field shapes
collimator -quality of the shape depends on the width of each leave
(smaller leave width can shape better)
-tongue and groove design reduces interleaf leakage
-Penumbra-MLC > penumbra by conventional blocks due to larger
effective perimeter of MLC
- A small amount of transmission (<5%) occurs between each leaf
-pros: allow complex, automated, multi- field shaping
-cons: Jaggedness of treatment field due to finite width of each leaf
and cannot achieve certain shielding shape i.e. island block
Compensating -dose distribution not homogeneous if the surface not flat
Filters or -compensating filter placed bet beam source & skin ↓ the dose
Beam spoiler delivered to the area with thinner tissue(tissue compensator) to
achieve a more homogeneous dose distribution

Wedge Filters -tissue compensator -more homogeneous dose distribution

Wedge angle = angle which isodose at 10cm depth rotated fr position in open beam
90- hinge angle/2 - 3 types:static (physical), dynamic (collimator), universal(flying)

Hinge angle- angle 1.physical wedge

bet two axes - physical fixed angles piece of lead which is manually placed on
the linac‟s head
Wedge factor= - to produce a gradient in radiation intensity.
dose with wedge
dose open field 2.dynamic wedge
- is the secondary collimator
- wedged intensity gradient produced by having one jaw close
gradually while the beam is on.
- wedge field depends on proportion of open and wedged fields ie
on speed of jaw movement

3.universal
- physical fixed angles piece of lead which is integrated into the
linac's head and controlled remotely.
- angle of wedge depends on the ratio of wedged and open fields to
a maximum angle depending on the wedge.

Field Junctioning
Photon-photon two photon beams are placed side-by-side with parallel central axes
- cold spot at surface, above the point of intersection of the 2 beam
- hot spot at depth, below the point of intersection of the 2 beam

two primary 1.half beam block- moving one of the independent jaws to midline
methods 2.gap- leaving 0.5-1cm gap bet 2 adjacent fields
3.couch rotation to avoid divergent
Electron- - have a larger penumbra at depth (seen with higher electron energies)
electron - junction on the skin surface, hot spot at within the deeper structures
- moving the junction at least once during treatment(avoid hotspot)
Electron-photon - e bulge laterally into photon field →hot spot on the photon side
- corresponding cold spot form on the electron side of the field

Total body irradiation

three goals - Eradication of the recipients bone marrow
- Preserve the marrow stroma to allow grafting of stem cells
- In combination with chemotherapy, eradication of tumour cells
D0 - Stem cell D0 - between 0.5 and 1.4 Gy, suggesting significant cell
killing at low doses and therefore intrinsic radiosensitivity.
- Leukaemia cells D0 – low
- Bone marrow stromal cells D0 of 1.46 Gy

Fraction size - important in TBI

- T-lymphocytes and lymphoblasts appear to have a shoulder on
their cell survival curve, indicating that higher fraction sizes (or a
single large fraction) are required.

- Stromal cells, which must survive to allow taking of the graft, are
also sensitive to large fraction size.

Late effects in the lung limit dose, as do other solid organs.

Two strategies to ↓ the risk

1. fractionate the dose or
2. use a low dose rate method (2 – 3 hours)

Treatment technique
3D conformal - 3D anatomical information combined with dose distributions that
radiotherapy conform to the target volume

Intensity modulated inverse planning techniques where the target volume, organs at risk
radiation therapy with doses are specified, and a computer calculates the most
(IMRT) appropriate field and fluence arrangement

IMRT during delivery- both required more MU than 3DCRT

Both 3DCRT/IMRT Static Dynamic

Are non-coplanar -easier to implement as it -rapidly moving MLC leaves (over
requires fewer resources 2 cm per second)
- beam „on‟ and „off‟ -deliver continuous variable dose
cycling and takes longer intensity
to deliver -requires additional resources to
measure the position of leaves and
ensure accuracy
Intensity Modulated - similar to IMRT but ↑ speed of treatment delivery
Arc Therapy -beam rotates around the patient, the leaves of the MLC alter the
intensity of the beam as desired
Accuracy of Treatment Planning and Delivery
Immobilisation - comfort, reproducible,custom fitted, easy to setup, cheap
accurate patient positioning- vital in accurate radiation delivery-
improves tumour control and normal tissue sparing

surface contour - patient contour may change due to seroma, edema, ascites, weight
loss can be detected by daily SSD measured.

- highly immobilised patient, SSD less deviation

- less immmobilised pt, SSD more tolerance of deviation
Monitoring
IGRT use of imaging modalities during treatment to monitor and adjust
radiotherapy delivery
i.e Portal imaging, EPID, on board imaging(OBI)-cone beam CT

Verification film
Portal films - film is placed on the distant side of the patient to the beam
- xray given one with collimation „on‟ and one with an open beam
-This double exposure allows the position of the collimation
relative to the patient‟s anatomy
-taken first 3 days and wkly basis
- Portal images to compare the daily treatment position with the
planned DRR.

Electronic portal electronic detector replacing the radiographic film for portal
imaging (EPID) imaging
Cone beam CT Cone beam CT is performed with either EPI (megavoltage cone
beam CT) or the OBI (kilovoltage cone beam CT).

Kilovoltage CBCT - better tissue contrast and resolution

Megavoltage CBCT - poorer contrast but has less problems with high-Z artefact seen
with kilovoltage imaging.

Photos beam calculation

SSD technique
PDD - ratio of dose at a point on the central axis (P) relative to the point of
maximum dose (zmax )
- calculate MU in SSD technique where point of calculation is not zmax

OAR - ratio of the dose at a point (Q) relative a point on the central axis at the
same depth (P)
- calculation of dose at points away from the central axis

PSF -Ratio point P (Zmax) /Point P‟ (in air) where P are the same distance from
peak the source (SSD + z cm)
scatter factor - determines the ratio of dose at zmax that is due to scatter from other
parts of the beam

Backscatter -kilovoltage beams at zmax - which is located on the surface --All scattered
Factor (BSF) radiation reaching this point has been backscattered (undergone at least a
180o turn)
- PSF in this situation is known as BSF

↑ as the energy increases (gets closer to 1)

↑as the field size increases (gets closer to 1)
Is independent of SSD

SAD technique
TAR -ratio of the dose at depth d (Dd ) in a phantom to the dose at the
Tissue to Air Ratio same depth in air (Dair)

- use in low MV

TPR -ratio of the dose at d at two different medium

Tissue Phantom Ratio
- use in high MV
TMR -ratio of the dose measured at a depth p (Dp ) to DZmax in a
Tissue Maximum phantom
Ratio
- use in high MV

SAR Ratio TAR with a field size of A cm, at a depth of x cm in water /

Scatter Air Ratio The TAR with a field size of 0 cm, at a depth of x cm in water

-how much of the dose at a point on the central axis is due to dose
scattered from lateral parts of the beam.

8. Beam therapy equipment

Principle of Superficial/orthovoltage
X-rays are produced in a vacuum tube consists
heated cathode(-ve) which emits electrons
copper anode with accepting e and production of x-ray by brehmsstrahlung
tungsten target (+ve)
high voltage applied bet. accelerating electrons- ↑ likelihood of brehmsstrahlung
cathode & anode
beryllium window in the path of the x-ray beam, filters out the lowest energy
photons to harden the beam
cooling system to disperse the heat generated in the target as
~ 1% x-ray production, ~ 99% heat production
applicator - cones or Cut-out - made up of tungsten or some other high Z
cylinders with cuttout preventing scatter of e to regions outside the area of treatment

X-ray of kilovoltage
Superficial therapy machines Orthovoltage therapy machines
- 50–150 kV - 150–500 kV
- Filtered with 1–4 mm aluminum. - Filtered with 1–4 mm copper
- SSD = 20 cm - SSD = 50 cm(for a field size of 20×20cm)
- 50% depth dose is 1–2 cm. - 50% depth dose is 5–7 cm
-lesion<5mm -lesion< 2cm

Linac- device uses electromagnetic field to accelerate electrons close to the speed of light.
 Free electrons emitted from a metal wire via thermionic emission
 accelerated in an electromagnetic field to increase their kinetic energies.
 These accelerated high-energy electrons can either be used
- directly (superficial Rx)
- directed to a target and high-energy X-rays are produced (for deeply seated tumors).

Component function
Electron gun E produced thermionic emission injection controlled by grid
Pulsed Modulator Produce
- voltage (↑ energy of photons with ↑ accelerating voltage )
- current ( affect the treatment time duration)
- short pulse for electron gun and microwave chamber
Radiofrequency Generator Microwave generator/amplifier
i.e
Klystron/Magnetron Photon/electron used
Cyclotron Neutron/proton
Synchotrons Heavy ion- alpha
Accelerating waveguide electrons are accelerated linearly by passing from one
chamber to other one.

The velocity of an electron is equal to the sum of the

velocities gained by the electron within each chamber

Type of waveguide
Travelling Standing(short)
Rf injected at one end RF can be injected into the
system anywhere
Longer guide length and shorter Guide length
more expensive to produce

Lower vacuum High vacuum

Electron acceptance high Electron acceptance low
Bending magnet - act as a band pass filter & an energy focusing device
Linac treatment head: Production of photons/x-ray beam
Beam production

Photons beam
1. x-ray targets(tungsten) For photons-2 buttons for energy selection
2. Flattening filters Flatten the beam= filter low-energy beam –high energy cont
the path (modulation intensity)
Horn effect- x-ray traverses the thinner part of the
flattening filter, more low energy components are included
-At greater depths, softer x-rays have been absorbed by
water/tissue (horn disappeared slowly)

Electron beam - Production of electron beam by removing the

target/flattening filter
1. Scattering foils - scattering foil to produce larger electron beam
or
2. scanning magnet - scanning with two computer controlled magnets with its
electromagnetic field

Dose monitoring system

Dual transmission permanently sealed, not affected by ambient air T0 &
ionization chamber. pressure

1º / 2 º chamber -1º should te rminate the exposure after exceeded the

correct number of monitor units
-2 º terminate the exposure after an additional 0.4 Gy
Each chamber segmented - allows feedback for flatness and
symmetry of the beam

Collimation Photon beam collimation is achieved with 3 collimator

• Primary collimator. • 1º collimator- field size(square,rectangle) selection
• Secondary • adjustable independent jaw motion - beam defining
• Tertiary • Multileaf collimator (MLC) average 2% leakage

electron beam collimation is achieved with:

• Primary collimator.
• Secondary collimator.
• Electron applicator-required to produce good field
delineation on the patient (electrons scatter readily in air)
Place as close as the skin~5cm
Differences bet Cobalt and Linac
Characteristics Cobalt-60 Linear accelerator
Differences (LINAC)
Source of radiation From nucleus of radionuclide From bombardment of high
(by decay or disintegration) energy electrons on a metal
target
Type of radiation Gamma rays X-rays
(monoenergetic beam) (polyenergetic beam)
Source size Large (>/= 2cm) Small (~ 2mm)
Geometric Large small
penumbra
Dmax Close to surface or skin Away from surface (skin
sparing effect)

Advantages of Linac over Cobalt-60? If cost is not a problem, Linac is better

Linac Cobalt-60
-Can generate both directly & -Has on/off effect
indirectly ionizing radiation -Large focal size →wider geometric penumbra
-polyenergetic beam -monenergetic beam
-Skin sparing effect -Limited half life, source changed every 5 years

9.Quality assurance
Quality Assurance all those planned and systematic actions necessary to provide
adequate confidence that a product or service will satisfy the given
requirements for quality.

Quality Control is the regulatory process through which the actual quality
performance is measured, compared with existing standards, and
the actions necessary to keep or regain conformance with the
standards.

QA programme for linear accelerators

Daily - X-ray/ Electron output constancy 3%
- Lasers 2 mm
- Distance indicator 2 mm
 - Door interlock functional
- Audiovisual monitor functional
Monthly - X-ray/Electron output constancy 2%
- X-ray beam flatness constancy 2%
- Electron beam flatness constancy 3%
- X-ray and electron symmetry 3%

All either 2% or 2mm except e flatness/e/x-ray symmetry3%

Annually - X-ray/Electron output constancy 2%

All either 2% or 2mm except monitor chamber linearity1%

10. Radioactive sources

SI unit – Bq – 1 disintegration/seconds or 1 Ci= 3.7 x 10 10 Bq
Isotope same atomic number(proton) but different mass numbers chemical
property similar in each isotope of an element
i.e
Isotone same number of neutrons, different numbers of protons
i.e
Isobar same number of nucleons(mass no A) but different numbers of protons
i.e
Isomer same atomic and mass numbers but which are in different e nergy states
i.e Tc99m

Radioactive Decay
Alpha Decay 1. usually observed in nuclei with
a. mass numbers of ≥190,
b. atomic no >82
2. excessive number of both protons and neutrons
3. ejection of two protons and two neutrons= 1- 8 MeV

Radium 226 to Radon 222

Beta Decay
b− decay (N>P)Neutron turn into a proton & an electron(b− particle/negatron )
(above n/p stable
ratio line)
i.e Cobalt 60 to nickel 60, Cs-137

b+ decay
(below n/p ratio (P>N) protons turn into a neutron and +vely charged particle positron
line)
 i.e Nitrogen 13 to carbon 13
electron capture -Electrons close to nucleus captured by the nucleus‟s proton, yielding
(below n/p ratio a neutron and a neutrino.
line) -inner orbital is filled by an electron from an outer orbital, resulting in
the emission of characteristic X-rays

iodine-125&123
Gamma 1. excess energy of the nucleus emitted as gamma radiation
Emission 2. no change in the atomic/mass no of the nucleus - “isomeric” decay
99m
Technetium

Brachytherapy sources decay through electron capture or beta decay,

leaving the daughter nucleus in an excited state. This is released as a
gamma photon.

Internal Instead of releasing a gamma photon, the energy may be transferred

coversion to an orbital electron (this may be considered to be some type of short
range photoelectric effect). The electron is ejected from the atom as
an Auger electron. When another electrons falls into the hole left by
the Auger electron, characteristic x-rays may result

Beta Decay – continuous spectrum energy

Alpha/gamma- discrete energy

Artificial radionuclides - are produced by bombarding particles
Fission element is bombarde d with neutrons, causing its nucleus to break
-separating apart into a number of fission products
Fusion - the combination of small nuclei into a larger nuclei
-combining - requires incredible energy to occur & not used to produce nuclides
137
Cs, 90Sr Separation from reactor fuel rods
192 60
Ir, Co bombarding with neutron
99m
Tc Elution of metastable daughter from parent
positron emitter Bombard with proton from cyclotron
18 11
F C 14 O 18
F used in PET scan

Radioactive Decay
Activity=
no of decay per
unit of time

decay constant
or N=N0 . e -0.693t/ t1/2
N= N0 is the number of atoms to start with
after time t the number of atoms N remaining will be
-Half Life T1/2 -time for half the radioactive nuclei in sample to undergo decay
-mean T1/2
Mean T1/2 = half- life x 1.44

Total dose= dose rate x mean T1/2

Physical T1/2 tp time for half of the radionuclide to decay( physical decay constant)

Biological T1/2 tb time it takes for half of the radionuclide to be excreted from the body
Effective decay
constant λe= λp + λb
Effective Half Physical Half Life+ Biological Half Life
Life te

Radioactive occurs when the amounts of a parent nuclide and its daughters are in
equilibrium equilibrium – meaning stable amounts of all the daughter nuclides in
relation to the parent nuclide.

occurs when the parent nuclide has a longer half life than the
daughter nuclide

Transient tphys of the parent is approximately 10 times greater than the tphys of
equilibrium the daughter
equilibrium after 4-6 half- live of daughter

Secular half life of the parent greatly exceeds that of the daughter
equilibrium

11.Brachytherapy
Brachy- Very short source-tumour distance allows a high dose of radiation to be given to
the tumour while the surrounding normal tissues receive a low dose.

Type implant
Intracavitary Sources are placed into body cavities close to the tumour volume
Interstitial Sources are placed surgically within the tumour volume
Surface Sources are placed over the tissue to be treated
Intravascular A single source is placed into small or large arteries.
Intraluminal Sources are placed in a lumen
Intraoperative Sources are placed into target tissue during surgery

Dose rate
HDR > 12 Gy/hr 192 Ir (high dose rate) in remote afterloader
Medium Dose 2 – 12 Gy/hr rarely used
LDR 0.3 - 2 Gy/ hr 137Cs, 192 Ir (low dose rate) as wires/needles

Advantage Disadvantage
HDR - rapid delivery of a large dose - no repair in normal tissue
- overcome the rapidly growing tumours
- safe-remote loading
LDR - tissue repair during treatment - not able overcome the rapidly
- long stay inpatient except permanent growing tumours
implant - not safe- manual loading

Source strength and unit

 Equivalent mass of radium (mg-Ra eq)- obsolete
 Activity (mCi or Bq)
 Air kerma strength (µGym2 h-1 )or air kerma rate (uGy/h)
Source Decay Emissions HVL (Pb) Half Life Daughter Sites Indication
Type Mean-
(MeV)
60
Co 1.17, 1.33 11 5.26 years
137
Cs β- γ -ray 5.5 mm 30 years Ba-137 intracavity, LDR temporary
0.66 interstitial implants
(tube, needle,
pellet)
192
Ir β- 95% γ -ray 2.5mm 74 days Pt-192, interstitial HDR
EC-5% 0.38 Os-192 intracavity - prostate, gynae
(seed, wire) LDR seeds
-prostate
125
I EC γ –ray 0.025 mm 60 days Te-125 Interstitial, Permanent seed
0.028 eyeball implants (prostate),
uveal melanoma
103
Pd EC γ –ray 0.008 mm 17.0 days Rh-103 Interstitial, Permanent seed
0.021 implants (prostate)
90
Sr 90 Y β- β- N/A 90
Sr 90
Zr surface Treatment of
2.24 28.9 yr (eyeball); pterygium of the eye,
intravascular or intravascular
(90 Y) treatments
64 hours
Source loading
Hot loading applicator is pre- loaded and contains radioactive sources at time of
placement into the patient

Afterloading- applicator is placed first into the patient and the radioactive sources are
loaded late
type
Manual insertion of radioactive sealed sources into the patient by a staff member

Remote performed by a machine while the therapy staff are outside of the bunker
- minimize radiation exposure to medical and support staff

Manchester

Distribution rule of Paris system

- Sources must be linear and their placement must be parallel
- Centres of all sources must be located in the same (central) plane
- Linear source strength (activity) must be uniform & identical for all sources in the
implant
- Adjacent sources must be equidistant from one another

Measurement of sealed sources

Reference Air measures the air kerma rate at a distance of 1 m from the source.
Kerma Rate The units is Gy/h

Air Kerma Strength measures that air kerma rate at a distance of 1 m from the source,
which is equal to the air kerma rate multiplied by the distance
squared (hence, still 1).
Units is Gy.m2 /h
Exposure rate in air at point P in air at a distance d from the source:
Xp
Management of sealed sources
ALARA principle handling sources (TDS)
Time training with dummy sources prior to hot sources
Distance using long handled tools
Shielding Lead gowns are also advisable when dealing with kilovoltage
emissions.
Storage Sources should be kept in a locked safe that attenuates most of
their radiation.

12. Unsealed sources

Unsealed sources are radionuclides which are not sealed
Physical Half the time it takes for half of the radionuclide to decay. The physical
Life tp half life is related to the physical decay constant

Biological Half the time it takes for half of the radionuclide to be excreted from the
Life tb body.
Effective decay
constant λe= λp + λb
Effective Half Physical Half Life+ Biological Half Life
Life te

Properties of unsealed sources

Source Emissions Tp Indications
131
I β 8 days - Thyroid imaging
0.606MeV - treatment of thyrotoxicosis, thyroid cancer
606 keV
89
Sr β 50.5 days Bony metastases
1.46 MeV - concentrates in areas of high bone turnover
Dose calculation
- Medical Internal Radiation Dose (MIRD) Method to estimate dose
13. Radiation protection
Radiation Error- received ≤ twice the effective dose
incident -i.e plan to receive a dose of 2 Gy but d/t machine error received 3 Gy

Radiation ≥ twice the effective dose

accident
Deterministic - a specific threshold dose
effects - severity of effects ↑ proportional to dose
- severity can achieve 100%
Stochastic -no threshold dose
effects -probability of severity ↑ with dose
-once developed & severity cant achieve 100%

Principle of 1.Justification- risk/benefit ratio

Radiation 2.Optimization- doing the best you can under the prevailing conditions
protection (i.e dose optimization to target)governed by ALARA principle
3.Dose limit- annual dose limit
Hazard ALARA “As Low As Reasonably Achievable” principle
reduction
method
Time As radiation dose is dependent on the time exposed, it makes sense to
limit the time a pe rson is exposed to radiation.

Distance Radiation loses its intensity over distance as per the inverse square law.
Doubling the distance from the source leads to a 4x reduction in dose

Shielding - Radiation is attenuated by shielding- radiation will be significantly

reduced (depending on the radiation quality and the shield thickness).

- ALARA principles state that shielding should be cost effective

(concrete is better than metal) and should reduce the dose rate beyond the
shield to insignificant levels (not to zero)

IRR 99
Controlled areas - any area where
> 6 mSv/yr or
>3/10th dose limit or
> 7.5 uSv/h

Supervised areas > 1 mSv/yr or

>1/10th dose limit

Classified workers -received effective dose >6 mSv/yr, or

- 3 /10th of a dose limit(e.g.150 mSv hand dose, or 50 mSv
lens dose
radiation protection adviser - approved by HSE (e.g. RPA2000 certificate)
- Must be appointed in writing
- Must be consulted on
- controlled and supervised areas.
- prior examination of plans
- regular calibration of dose monitoring equipment
-incidents where more then 6 mSv has been received.

radiation protection -less responsibility of RPA

supervisor -ensure compliance with these Regulations
-know local rules & regulations
-act during emergency

Regulation IR(ME)R
Employer -Write procedures/protocol for all medical exposures
-legal responsibility to ensure that one have received appropriate
theoretical and practical training for the job and to keep a record of this
training
i.e hospital
- get advise fr RPA i.e for designation/installation controlled area

Referrer All doctors act as referrers

- request that X-ray investigations be undertaken and provide the
information that allows the practitioner and operator to undertake the
most appropriate examination

Operator In accordance employer‟s procedure, carry out technical aspect

-do not have to be health-care registered
i.e oncologist, physicist, radiographer

Practioner Health-care registered professional entitled by employer to justify and

authorize patient to radiation exposure.
i.e oncologist

Dose limit
1Sv=100rem Occupational Public Medical Foetal
(mSv/year) diagnosis 10-25th wk
Effective dose 20 (average over 5 yr) 1 (average 5 yr) 0.4-0.5 5 mSv max
- whole body 50 single yr 5 in single yr 0.5 mSv
mthly
Equivalent dose
- lens 150 15
- hands,skin,feet 500 50
Background Total 3Sv
radiation
– Radon 2
LINAC room design
Primary barriers are the portion of the treatment room walls and ceiling that may be
irradiated directly by the primary beam which originates in the x-ray
target or radionuclide source
- concrete barrier – 2m thick

Transmission factor B = pd2 /WUT

-p=radiation limit -d= distance SSD
-w=workload cGy/wk at 1m (measure radiation output)
-u= use factor : # of time beam directed to that barrier
-t= occupancy factor : # of time area is occupied

Secondary are all portions of the treatment room walls, floor and ceiling that
barriers cannot be irradiated directly by the primary beam.

These barriers must provide shielding against two types of radiation:

1. scattered radiation produced by the primary beam(fr pt)
2. leakage radiation from the source/target.
-concrete barrier -1.2m thick

maze - Maze connects treatment area to controlled area.

- maze + treatment area -bunker - prevents scattered or leakage
radiation from travelling directly out of the bunker.

Neutron -Neutrons are produced by high energy >15Mev linacs

radiation Neutron shielding
-Long maze - many „bounces‟
-Neutron door - typically filled with borated paraffin
Typical Concrete HDR-70cm
thickness Co-60- 100cm
Linac-1º 200cm ,2º 120cm