Prinicples of radiotherapy equipment

Mischa Hoogeman
Erasmus MC
Rotterdam
The Netherlands
Introduction

 Photons (X-rays) cannot be accelerated

 Charged particles, e.g. electrons can be accelerated
 What is an electron?
 How to create/free an electron?
 How to accelerate an electron?

electron mass = 9.1×10-31 kilograms

X-ray Tube

Coolidge X-ray tube, from around 1917. The

heated cathode is on the left, and the anode
is right. The X-rays are emitted downwards.
 Early devices

Stabilivolt (200 kV) Betatron

Schematic Accelerator Structure

~ ~ ~ ~ ~

- +- +
 Traveling Wave Accelerating Guide

+ + - - + + -

power in
vacuum
Standing Wave Guide
Electric field at instant t
 End of waveguide terminated by conducting disc
  reflected with π/2 phase
 Electrons in 2, 4, 6 will receive no acceleration
 Serve only as coupling cavities
 Can be moved out to the side of waveguide

 Half cycle later: situation has reversed

Traveling vs. Standing Wave Guides

 Traveling Wave Guides (Elekta)

 Easier, less costly

 Standing Wave Guides (Varian, Accuray)

 More efficient
Powering the System: Klystron and Magnetron

10.000 hrs 2.000 hrs

Beam Transport (Chromatic and Achromatic 90°Bending)
Linac Head

Photons Electrons
Energy Distribution Photons vs. Electrons

Photons Electrons

Papanikolaou (1993)
 Beam Collimation

 Leaf width 5-10 mm  Rounded leafs

 High leaf velocity required for high
dose rate with unflattened beams
 Interdigitation

65 mm/s
Wedge

 Mechanical fixed wedge

 Motorized wedge
 Dynamic wedge
Varian and Siemens
CT SCANNER
CT Scanner of Hounsfield
Back Projection

http://www.impactscan.org/impactcourse.htm
Filtered Back Projection

http://www.impactscan.org/impactcourse.htm
Modern CT Scanners for Radiotherapy

 Flat couch top & positioning devices

 Wide bore
 CT simulation software
 External positioning lasers
 4D and Respiratory gated CT

 64 Multislice
 Spiral acquisition
 Dual Energy
SPECIAL MACHINES
CyberKnife System Components

kV X-ray source

Robot
6-MV Linac
Synchrony camera

Fixed cones

Robotic table
aSi flat panel imagers
CyberKnife

node

Various node sets

Up to 180 node
positions
CyberKnife prostate

4 x 9.5 Gy @ 60%
Tracking tumors that move with respiration

 Beam moves with moving tumor

Accuracy better than 3 mm

Hoogeman et al. IJROBP 2009
GammaKnife (Elekta)

 Invented by Lars Leksell (1967)

 Contains 192 Co-60 sources (half-life is 5.27 years)
Tomotherapy (Accuray)

 Helical delivery of dose by fan beam

 Fan beam with binary MLC
 MV CT capability
Truebeam STx (Varian)

No flattening filter!

Very high dose rate

 Linac Integrated MRI

Raaymakers Phys Med Biol (2009)

 MRI-Integrated Radiotherapy Systems

ViewRay Elekta-Philips Utrecht

Stages of Development Elekta System

Images from Bas Raaymakers

MRIDIAN vs. Elekta System
 Clinically released
 Using three Cobalt sources
 Linac under development
 0.35 Tesla MR scanner
 Less magnetic interference, e.g.
electron return effect
 Hardly any geometric distortion
 Less suited for functional
imaging
 Under development
 Linear accelerator
 1.5 Tesla MRI scanner
 More magnetic interference, e.g.
electron electron return effect
 Geometric distortion
 Functional imaging possible
Vero (Brainlab/Mitsubishi)

 Dual orthogonal kV X-
ray system
 Stereoscopic imaging
 Fluoroscopy
 kV CBCT

 Gimbaled LINAC/MLC
for real-time tumor
tracking

 Static conformal beam

 Arc therapy
 IMRT
 Non-coplanar ARC
Proton Therapy Center

Bron: Vu Nguyen / The New York Times

HollandPTC (Erasmus MC, TU Delft, LUMC)
Rotating Gantry
Thank you!