Elekta® Oncology Engineer 1

TTI Pre-Course Work

Radiation Therapy – An Overview

EOE_1_PW1 Rev.A
Radiation Therapy – An Overview

Radiation Therapy – An Overview

Purpose of External Beam Radiation Therapy

Radiation Therapy
Radiation Therapy, also called Radiotherapy, is the treatment of cancer and other diseases with
ionising radiation. Ionising radiation deposits energy that injures, or destroys, cells in the area being
treated. It damages their genetic material, making it impossible for these cells to continue to grow.
Although radiation damages both cancer cells and normal cells, the latter are able to repair
themselves and function properly.

Ionising Radiation
Ionising Radiation is higher frequency electromagnetic, or particle, radiation. It involves enough
energy to break chemical bonds. X-ray and gamma ray radiation have very high frequency (in the
range of 100 billion billion Hertz) and very short wavelengths (1 million millionth of a metre).
Radiation in this range has extremely high energy. It has enough energy to strip off electrons or, in
the case of very high-energy radiation, break up the nuclei of atoms.

There are three main kinds of ionising radiation:

• Alpha Particles (which include two protons and two neutrons)

• Beta Particles (which are essentially electrons)
• Gamma rays and X-rays (which are pure energy - photons)

Alternatives
Brachytherapy Internal Beam Radiation Therapy. Radioactive materials, encased in capsules,
or needles, are placed directly at the tumour site, either manually or using a
Remote Afterloader.

Surgery Diseased tissue is surgically removed along with some of the surrounding
healthy tissue to safeguard against possible spread of cancer cells.

Chemotherapy A variety of cytotoxic drugs are used to eliminate the cancer.

Combination Any of these techniques may be used alone, or in combinations, as the

Oncologist deems appropriate

03/2009 Elekta Oncology Engineer 1

EOE_1_PW1 Rev. A TTI Pre-Course Work
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 Radiation Therapy – An Overview

Courses of Treatment
Curative / Definitive The aim of the course of treatment is to cure the cancer.

Palliative The aim is treatment is to help improve the symptoms associated with
terminal cancer and enhance the quality of life of the patient.

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Radiation Therapy – An Overview

Biological Effects of Ionising Radiation

Introduction
Ionising Radiation breaks chemical bonds, either directly or indirectly:

Directly Primary or secondary particles break the chemical bond

Indirectly Primary or secondary particles break the chemical bonds in a cell’s water molecules
creating highly active compounds (free radicals).

H 2 O + ionisation energy ⎯⎯→ H 2 O + + e − ⎯⎯→ H + + OH −

(OH— is the hydroxyl radical which is chemically very active)

These free radicals interact with other molecules causing damage.

DNA Damage
Ionising Radiation damages the DNA of the cells, preventing them from dividing and causing them
to die. The most lethal damage caused by the radiation is the splitting of both sides of the DNA
Helix (double strand breakage) either by directly breaking the DNA Strand or by producing free
radicals which then react with the DNA and causes the damage.

During treatment both cancer cells and

normal cells are damaged by the radiation.
The cancer cells are more sensitive to the
radiation, and are less able to repair the
damage. The radiation is given in a series
of daily treatments to ensure that the
damage in the cancer cells accumulates
faster than they can repair themselves but
at a low enough rate to allow normal cells
to regenerate.

Figure 1 Figure 1: Radiation Damage to DNA

03/2009 Elekta Oncology Engineer 1

EOE_1_PW1 Rev. A TTI Pre-Course Work
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 Radiation Therapy – An Overview

Patient Flow Through the Treatment Process

Diagnosis
Initial diagnosis is usually made by a family doctor or by a specialist refer to investigate reported
symptoms. Based on the initial findings, the Doctor refers the patient to a Radiation Oncologist.

Consultation
The Radiation Oncologist reviews all medical records, x-rays, CT Scans, etc. and conducts an
examination. Additional tests may also be required. If after this review the Radiation Oncologist
thinks that Radiation Therapy is appropriate a Simulation is scheduled.

Simulation
Simulation is the process of planning and mapping out the treatment field on an x-ray or CT
machine, which can imitate (or simulate) the motions of the treatment machine. Special moulds, casts
or headrests, used to keep the patient in the exact position every time may be made during this
process. Marks may be made on the patient’s skin in ink or may be tattooed on the skin to indicate
the correct patient position.

Figure 2 Figure 2: A Patient Radiograph

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Radiation Therapy – An Overview

Treatment Planning
The Radiation Oncologist works with the medical physicist and dosimetrist to devise a plan that will
provide the safest and most effective treatment. A Treatment Planning Computer helps design
treatment plans. The Radiation Oncologist prescribes a plan that includes the type of radiation,
length of each treatment, and total number of treatments.

Course of Treatment
Treatments are typically delivered each weekday for 4 to 6 weeks. Each treatment may last 5 to 20
minutes. Most of that time is taken up with the careful positioning of the patient. Radiation may
only be present for a few minutes, or less. Radiographs, either on film or using a portal imager (such
as iViewGT) are taken periodically, to verify the accuracy of the treatments and to adjust the
treatment field as required.

03/2009 Elekta Oncology Engineer 1

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 Radiation Therapy – An Overview

LINAC Modes of Operation

Energies
The Elekta Digital Linear Accelerator is capable of delivering radiation at a number of energies in
both Photon or Electron modes, depending on the machine configuration and software license.

The Elekta Digital Linear Accelerator produces energies in the following ranges:

• Electron Mode 4 to 22 MeV (Mega electron volts)

• Photon Mode 4 to 25 MV (Mega volts)

Energy Comparison
Diagnostic X-ray Machine Photons at 40 kV to 140 kV (kilo Volts)
(or conventional Simulator)
Leksell Gamma Knife Photons at approximately 1.25 MV

The Elekta Digital Linear Accelerator can produce two types of Ionising Radiation; Electrons and
Photons

Radiation Types

Electrons
A stream of negatively charged subatomic particles, accelerated by the machine to very high velocity
and magnetically directed toward the desired treatment field.

An Electron Beam is used for treating superficial tumours (less than 5 cm deep).

Photons
As described above, the machine accelerates a stream of negatively charge subatomic particles to high
velocity, but instead of directing them toward the treatment field, a tungsten target is placed in their
path. As the electrons interact with the target material their kinetic energy is converted to Gamma
Radiation (high energy X-rays).

A photon beam is used for treating deep seated tumors. Photon beams are typically used in
combination, e.g. in opposed pairs. These combinations create very high tumour doses with relatively
low skin doses.

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