IAEA Training Material on Radiation Protection in Radiotherapy

Radiation Protection in
Radiotherapy

Part 5
External Beam Radiotherapy
Lecture 2 (cont.): Equipment and safe design
3. Medical Linear Accelerators
 Short: “linac”
 Most radiotherapy
patients are treated
using linacs
 Several
manufacturers

Courtesy Siemens

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 2

Photon percentage depth dose
comparison
 PHOTONS  ELECTRONS

Linac beams

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 3

Different designs
Touch guard

Wall panel to
hide stand

Couch with
Hand control controls
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 4
The problem: require >4MeV
electrons
 Not possible to achieve
this conventionally
using a potential
difference
 Electrons are
accelerate using
microwaves

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 5

Schematic drawing of a linac

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 6

Electron Accelerators
No bending
 6 MV short waveguide magnet

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 7

Electron Accelerators
 18 MV long waveguide

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 8

Electron Accelerators
 Waveguides for
acceleration of
electrons using
microwaves
Short standing
wave guide

Buncher for initial

acceleration of
electrons
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 9
Electron Accelerators
 Bending the electron beam
Achromatic magnet:
All energies are
focused onto the
target

Slits for selection

of electron energy
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 10
Treatment
head

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 11

Electron Accelerators
 Radiation exposure is controlled by two
independent integrating transmission
ionization chamber systems.
 One of these is designated as the
primary system and should terminate
the exposure at the correct number of
monitor units
 These also steer the beam via a
feedback loop
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 12
Monitor ion chamber design

 Two independent chambers - redundant check of dose

delivered
 Each chamber segmented - allows feedback for
flatness and symmetry
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 13
Electron Accelerators
 The other system is termed the
secondary system and is usually set to
terminate the exposure after an
additional 0.4 Gy
 Most modern accelerators also have a
timer which will terminate the exposure
if both ionization chamber systems fail

Defense in depth at work!!!

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 14

Electron Accelerators
 Modern accelerators have a
lot of treatment options, for
example
 X Rays or electrons (dual
mode)
 multiple energies
 2 X Ray energies
 5 or more electron energies

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 15

Electron Accelerators
 Head complexity
to handle multiple
energies and
multiple
modalities
 different flattening
filters and scattering
foils on a ‘carousel’
 monitor chambers
 collimators

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 16

Electron Accelerators
 X Ray Collimators may be (1)
 rectangular (conventional)

 the transmission through the collimators

should be less than 2% of the primary (open)
beam

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 17

Electron Accelerators
 X Ray Collimators may be (2)
 Multi-Leaf collimators (MLC)

 the transmission through the collimators

should be less than 2% of the primary (open)
beam
 The transmission between the leaves should
be checked to ensure that it is less than the
manufacturer’s specification

Siemens MLC
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 18
Electron Accelerators
 Electron applicators, these may be
 open sided for modern accelerators using double
scattering foils or scanned beams
 enclosed for older accelerators using single
scattering foils
 both types should be checked for
leakage
 adjacent to the open beam
 on the sides of the applicators

Varian open sided

electron cone
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 19
Important Accessories
 Wedges
 Dynamic wedges
 Blocks
 Multileaf Collimator (MLC)
 Electronic Portal Imaging (EPID)

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 20

Electron Accelerators angle
 Wedges
 3 or more fixed
wedges
 auto-wedge
 dynamic wedge
 Modify dose
distribution

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 21

Electron Accelerators
 Dynamic wedge

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 22

Wedges
 ‘standard’ treatment accessory
 required for example in breast and head
and neck treatment
 dynamic wedge most popular because:
 no weight
 any wedge angle possible
 but difficult to commission

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 23

Electron Accelerators
 Asymmetric collimator

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 24

 Electron Accelerators
 Asymmetric collimators
 Read-outs on the linac gantry
Collimator
rotation Right collimator
read-out read-out

Left collimator Lower collimator

read-out read-out

Gantry
read-out
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 25
Multileaf Collimator (MLC)
 Used to define any
field shape for
radiation beams
 Several variations to
the theme:
 different leaf widths
(1cm to 0.4cm)
 replaces collimators
or additional to
normal collimators

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 26

Linac mounted MLC

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 27

MLC  The quality of the
field definition
depends on the width
of the leafs
 There is always
some interleaf
leakage
 Typically the
transmission through
the MLC is larger
than through a
standard collimator

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 28

Multileaf Collimator (MLC)

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 29

Dynamic MLC
 Concept similar to dynamic wedge
 When MLC moves during treatment
different parts of the field are shielded
resulting in different overall radiation
levels delivered in different parts of the
beam: Intensity modulated radiotherapy

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 30

Intensity MLC pattern 1

Modulation MLC pattern 2

 Achieved using a
Multi Leaf Collimator (MLC) MLC pattern 3

 The field shape is altered

step-by-step or dynamically
while dose is delivered Intensity
map

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 31

Two approaches to IMRT
Linac based IMRT
 Multiple individual
fields, each of them
intensity modulated in
two dimensions

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 32

Two approaches to IMRT
 Continuous rotation of
a one dimensional fan
beam which consists
of many beamlets
which can be turned
on or off

Tomotherapy

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 33

 Binary
Components of MLC
Helical Tomotherapy

Ring detector at exit side

Radiation Protection in Radiotherapy
Helical Scanning
Part 5, lecture 2 (cont.): Equipment - linacs 34
Comments on IMRT
 Best possible dose distribution with
photons
 No intuitive link between MLC settings,
monitor units and the delivered dose
distribution
 Impossible without computers in
diagnostics, planning and delivery
 Challenges for QA

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 35

Electronic Portal Imaging
 Imaging device at the beam exit side of
the patient to record the treatment field
 Allows to verify that the field was
delivered to the correct location in the
patient
 Many different systems available...

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 36

Electronic portal imaging devices
in practice

Siemens Varian
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 37
Electronic portal image

Comparison of
simulator and portal
image (right)
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 38
 Electron

Electron beams
Beam

Primary
 No target required Collimator

 Scattering foil used to Scattering Foil

Ion Chamber
produce larger beam -
alternative would be to Secondary
Collimator
scan the pencil beam
using electromagnetic
fields Electron
 Applicator required to applicator

produce good field

delineation on the
Patient
patient

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 39

Electron
applicator on
a modern
Varian linear
accelerator

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 40

Electron applicators
 may be
 open sided for modern accelerators using
double scattering foils or scanned beams
 enclosed for older accelerators using single
scattering foils
 must be checked for leakage
 adjacent to the open beam
 on the sides of the applicators

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 41

Model of an
electron
applicator for
Monte Carlo
Calculations

Electron
applicator

patient

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 42

 Electron
Accelerators
 With such a large number of possible
settings it is essential that interlocks be
provided to prevent inappropriate
combinations from being selected
 It is also essential that the control
console provides a clear indication of
what functions have been set
Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 43
Electron Accelerators
 Complex control system
 Reliance on computers

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 44

Varian Clinac operation screens
 Clinical mode  Service mode

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 45

Electron Accelerators
 Verification systems
 All accelerator manufacturers now produce
computer controlled verification systems
which provide an additional check that the
settings on the accelerator console are
correct for
 proper accelerator function and
 correspond exactly with the parameters
determined for the individual patient during the
treatment planning process

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 46

Electron Accelerators
 Head leakage
 the Air Kerma Rate (AKR) due to leakage
radiation at any point outside the maximum useful
beam, but inside a plane circular area with a
radius of 2 meters centered around, and
perpendicular to, the central axis of the beam at
the normal distance of treatment shall not exceed
0.2% of the AKR at the central axis of the open
beam. The measurement shall be done with a
thick shielding block covering the open beam

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 47

Electron Accelerators
 Head leakage
 Except in the area defined in the previous
slide the Air Kerma Rate (AKR) due to
leakage radiation (excluding neutrons) at
any point 1 meter from the path of the
electrons between their origin and the
target or electron window shall not exceed
0.5%

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 48

Electron Accelerators
 Neutrons
 these will only be a problem if the X Ray
energy is equal to or greater than 15 MV
 issues which need to be considered when
neutrons are presents include:
 neutron activation
 shielding problems

Radiation Protection in Radiotherapy Part 5, lecture 2 (cont.): Equipment - linacs 49