IAEA Training Material on Radiation Protection in Radiotherapy

Radiation Protection in
Radiotherapy
Part 5
External Beam Radiotherapy
Lecture 2: Equipment and safe design
Objectives

• To review physics and technology of

external beam radiotherapy equipment
• To understand the design and functionality
of the equipment including auxiliary
equipment
• To appreciate the role of international
standards such as IEC 601-2-1 for
equipment design

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 2

Contents

1. Superficial/orthovoltage equipment
2. Telecurie treatment units
3. Linear accelerators (linacs)
4. Other accelerator types
5. Associated equipment

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 3

1. Superficial and Orthovoltage

• “conventional” X Ray tube with

electrons accelerated by an electric field
• stationary anode (in contrast to
diagnostic tubes which have a rotating
anode to allow for a smaller focal spot)
• filtration important

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 4

Photon percentage depth dose comparison

Superficial beam

Orthovoltage
beam

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Superficial and orthovoltage

Superficial Orthovoltage
• 40 to 120kVp • 150 to 400kVp
• small skin lesions • skin lesions, bone
• maximum applicator metastases
size typically < 7cm • applicators or
• typical FSD < 30cm diaphragm
• beam quality measured • FSD 30 to 60cm
in HVL aluminium (0.5 • beam quality in HVL
to 8mm) copper (0.2 to 5mm)

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 6

Superficial X Ray tube (Philips RT 100)

• Manufacturers picture...

X Ray tube
Cooling
water Target

Applicator/
collimator

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 7

Use of cones essential

• Large focal spot and close treatment

distance (Focus to skin distance FSD often
10cm or less) means the beam MUST be
collimated on the skin
• Cones are highly suitable to do this.
Additional shielding can be achieved using
lead cutouts on the skin as detailed in part
10 of the course.

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 8

Output in superficial beam depends on:

• On/off effect
• Strong dependence on
FSD --> applicator
length significantly
affects output
• Electron contamination
from the applicator
(significant for skin
dose around 100kVp)
Inverse
Square Law
Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 9
On/off effect

on off
output

time

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 10

Kilovoltage Equipment (10 - 150 kVp)

• Filters are used to remove unwanted low

energy X Rays (which only contribute to skin
dose)

Interlocks must
ensure that the
correct filter is
in place

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 11

Kilovoltage Equipment (10 - 150 kVp)

• Dose rate is approx. proportional to kVpn

where 2 < n < 3
• Dose rate is approx. proportional to electron
current (mA)
• Therefore it is important that kVp and mA
are stable.
• It is also obviously important that the timer is
accurate and stable - and that the on/off
effect is accounted for.

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 12

Kilovoltage Equipment (10 - 150 kVp)

• Dose control is achieved by a dual timer

system - one should count time up, one
should count time down from a pre-set
treatment time
• Interlocks must be present to prevent
incorrect combinations of kVp, mA, and
filtration

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 13

Operator control
Radiation on
indicator

kV and mA
indicator
Dual timer

Emergency
off button
Selection
of filter
Key for
lock-up

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Beam Half Value Layer (HVL)

• Possibly the most important test to

characterize beam quality
• Checks whether there is sufficient filtration in
the X Ray beam to remove damaging low
energy radiation
• Need not only a radiation detector, but also
high purity (1100 grade) aluminium - most Al
has high levels of high atomic number
impurities e.g. Cu

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 15

HVL Measurement
• Be careful of beam
hardening (semi-log plot is Relative response
not a straight line) 10
• The second HVL is typically
larger than the first
• Use points either side of
half initial value
• Calculate HVL :
(initial value = 9
1
50% of this = 4.5, 0 1 2 3 4
thus HVL = 2.6 mm Al)
mm Al

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 16

Orthovoltage units

• 120 to 400kVp
• conventional X
Ray tube
• Applications:
• deeper skin
lesions
• bone metastasis

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 17

Orthovoltage Equipment (150 - 400
kVp)

• Different applicators and filters

filters

Applicators for
different field
sizes and
distances

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 18

Orthovoltage units

• Uses mostly cones

• More recently also a
diaphragm with light
field has been
introduced. Care must
be taken to:
• ensure correct
distance
• account for wide
penumbra due to large
focal spot

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 19

Orthovoltage Equipment (150 - 400
kVp)

• The Inverse
Square Law is
important
• Depth dose
dramatically
affected by
FSD FSD 6cm, FSD 30cm,
HVL 6.8mm Cu HVL 4.4mm Cu

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 20

Orthovoltage Equipment (150 - 400
kVp)
• Control console
mA and kV control

Dual timer

On and emergency
off button

Filter and kV selection

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 22

Orthovoltage Equipment (150 - 400
kVp)

• It is possible to use a transmission ionization

chamber as the primary dose control system
instead of treatment time
• The backup (secondary) dose control
system can be either an independent
integrating dosimeter or a timer
• Alternatively, two independent timers are
used - this is the most common scenario

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 23

2. Telecurie units

• Very high activity

source (>1000Ci)
• Virtually all 60-Co
• Some older units
using 137-Cs

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 24

Stamp to celebrate
the 50th anniversary
of 60-Co external
beam radiotherapy

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 25

Telecurie units

• 137-Cs
• Photon energy 0.66MeV
• Relatively large source to relatively low specific
activity
• Medium FSD (around 60cm)
• No isocentric mounting - similar to orthovoltage
equipment in set-up
• Not sold anymore and should not be in use

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 26

Cobalt - 60

• Photon energy around

1.25MeV
• 2 lines at 1.17MeV and
1.33MeV

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 27

Cobalt - 60

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 28

Cobalt - 60

• Photon energy around

1.25MeV
• Specific activity large
enough for FSD of
80cm or even 100cm
• Therefore, isocentric
set-up possible

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 29

Cobalt - 60 equipment

• Isocentric set-up allows movement of all

components around the same centre

• collimator
• gantry
• couch

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 30

Photon percentage depth dose comparison

60-Co
beam

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 31

Control area of a 60-Co unit

• Dual timer control

• Patient monitoring
• lead glass
• video system

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 32

On/off effect

on off
output

Shutter opens
Shutter
closes

time

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 33

Gamma-ray equipment

• A more recent Cobalt - 60 unit

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 34

Gamma-ray equipment

• Source head and transfer mechanism

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 35

Gamma-ray equipment
• Other source drawer transfer mechanisms

Moving jaws

Rotating source draw

Mercury shutter
(employed in the first
60-Co unit in 1951)
Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 36
Gamma-ray equipment

Source assembly:
• The source must be
sealed so that it can
withstand
temperatures likely
to be obtained in
building-fires
• Dual encapsulation
is recommended to
avoid leakage

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 37

Cobalt source design

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 38

Source
assembly

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 39

Gamma-ray equipment

• Limited half life: 60-

Co 5.26years
• Source change
recommended
every 5 years to
maintain output
Source transport
container

Treatment
unit head

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 40

Picture of a Co source change

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 41

Gamma-ray equipment

• Mechanical source position indicator

Essential to:
• indicate if source
is out of safe
• often coupled with
mechanical device
to push source back
if stuck

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 42

Cobalt unit head for a source in a
rotating source draw

Beam on
indicator

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 43

Gamma-ray equipment

• The beam control mechanism shall be a ‘fail

to safety’ type.This means the source will
return to the Off position in the event of:
• end of normal exposure
• any breakdown situation
• interruption of the force holding the beam control
mechanism in the On position, for example failure
of electrical power or compressed air supply

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 44

Gamma-ray equipment

• Geometric
penumbra
typically wide
because
source
diameter is
large (>2cm)

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 46

Gamma-ray equipment

• Penumbra
trimmer bars
may be
employed to
reduce
penumbra
width

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 47

Gamma-ray equipment
• Gantry rotation There should be
two independent
read-outs for all
mechanical
movements:
1. Electronic at
console and or
monitor in the
treatment room
2. Mechanical

Second non-isocentrical
rotational axis for the
60-Co source

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 48

Gamma-ray equipment

• Leakage from the head with the

source in the Off position
• max. 10 Gy h-1 at 1 meter from source
• max. 200 Gy h-1 at 5 cm from housing
• This can contribute a significant
proportion of the maximum permissible
dose to staff

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 49

 Quick question

Please estimate the dose to a staff member

setting up patients at a 60-Co unit.
Annual dose to staff

• Assume:
• 200 days, 8hours per day working time
per year
• 10% of this time in treatment room
• 3 Gy h-1 typical dose averaged over all
locations of the staff member in the
treatment room
• Dose = 200 x 8 x 0.1 x 3 Gy 
0.5mGy/year (half of dose limit for
general public)
Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 51
Gamma-ray equipment
• At commissioning, drawings
of the head should be
examined to identify locations
where radiation leakage could
be a problem.
• Accurate ionization chamber
readings should be made at
the location of any hot spots
and also in a regular pattern
around the head.
• Film wrap techniques can be
used to identify positions of
‘hot’ spots.
Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 52
Film wrapping technique

• Here shown with

only a single film
on a linac
• In practice film can
be wrapped around
all the treatment
head
• This technique is
useful also for
other treatment
units such as
superficial and
orthovoltage. Never forget to mark and label
the film

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 53

Gamma-ray equipment

• Wipe tests should be carried out initially at

installation and at regular intervals to check
for surface contamination. This test need not
be carried out directly on the source surface
and can be carried out on a surface which
comes into contact with the source during
normal operation of the equipment.

Radiation Protection in Radiotherapy Part 5, lecture 2: Equipment - superficial, telecurie 54