RT 312

TELETHERAPY MACHINES

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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 X-ray machines for radiotherapy

The main components of a

radiotherapy x-ray
machine are:
• X-ray tube
• Ceiling or floor mount
for the x-ray
tube
• Target cooling system
• Control console
• X-ray power generator
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The components of a
radiotherapy x-ray
machine:
• X-ray tube
• Applicators

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The main components of
a typical therapy x-ray
tube are:
• Water or oil cooled
target (anode)
• Heated filament
(cathode)

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 X-ray machines for radiotherapy

With x-ray tubes the patient dose is delivered using a

timer and the treatment time must incorporate a shutter
correction time.
􀀁 In comparison with diagnostic radiology x-ray tubes, a
therapy x-ray tube operates:
• At about 10% of instantaneous current.
• At about 10 times average energy input.
• With significantly larger focal spot and a fixed rather than
rotating anode.

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 Kilovoltage Units

• Up to above 1950
• X-rays generated at voltages up to 300 kVps
• Still some use in the present era, esp. treatment of
superficial skin lesions
• Kilovoltage Therapy
– Grenz-Ray Therapy
– Contact Therapy
– Superficial Therapy
– Orthovoltage Therapy or Deep Therapy
– Supervoltage Therapy

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 Kilovoltage Units

• Grenz-Ray Therapy
– Energy : < 20 kV
– Very low depth of penetration
– No longer used in R/T
• Contact Therapy
– Energy: 40 – 50 kV
– Short SSD (< 2 cm)
– Produces a very rapidly decreasing depth dose
– Max irradiated tissue : skin surface
– Application: Tumor not deeper than 1 – 2 mm

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 Kilovoltage Units

• Superficial Therapy
– Energy: 50 – 150 kV
– HVLs: 1.0- – 8.0-mm Al
– Applicator or cone attached to the diaphragm
– SSD: 15 – 20 cm
– Tube current: 5 – 8 mA
– Application: tumors confined to about 5-mm depth

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 Kilovoltage Units
• Orthovoltage Therapy or
Deep Therapy
– Energy: 200 – 300 kV
– Tube current: 10 – 20 mA
– HVLs: 1 – 4 mm Cu
– Cones or movable diaphragm
(continuous adjustable field
size)
– SSD: 50 cm
– Application: tumor located < 2
–3 cm in depth
– Limitation of the treatment:
• skin dose
• Depth dose distribution
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• Increase absorbed dose in bone
 Kilovoltage Units

• Supervoltage Therapy
– Energy: 500 – 1000 kV
– Technical problem
• Insulating the high-voltage transformer
• Conventional transformer systems were not suitable
for producing potential > 300 kVp
– The problem solved by invention of resonant
transformer

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 Kilovoltage Units

• Resonant transformer units

– Used to generate x-rays from 300 to 2000 kV

At resonant frequency
1. Oscillating potential attains very high amplitude
2. Peak voltage across the x-ray tube becomes very large
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 Megavoltage Therapy

• X-ray beams of energy > 1 MV

• Accelerators or γray produced by radionuclides
• Examples of clinical megavoltage machines
– Van de Graaff generator
– Linear accelerator
– Betatron
– Microtron
– Teletherapy γray units (e.g. cobalt-60)

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 Clinical x-ray beams

• In the diagnostic energy range (10 - 150 kVp) most

photons are produced at 90 from the direction of
electrons striking the target (x-ray tube).
• In the megavoltage energy range (1 - 50 MV)
most photons are produced in the direction of the
electron beam striking the target (linac).

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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 Van de Graaff Generator

• Electrostatic accelerator
• Energy of x-rays: 2 MV
(typical), up to 10 MV
• Limitation:
– size
– high-voltage insulation
• No longer produced
commercially
– Technically better machine
(e.g. Co-60 units & linear
accelerators)

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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 LINACS

Medical linacs are cyclic accelerators that accelerate

electrons to kinetic energies from 4 to 25 MeV using
microwave radiofrequency fields:
• 103 MHz : L band
• 2856 MHz: S band
• 104 MHz: X band
􀀁 In a linac the electrons are accelerated following straight
trajectories in special evacuated structures called
accelerating waveguides.

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 Linac generations

During the past 40 years medical linacs have gone

through five distinct generations, each one increasingly
more sophisticated:
(1) Low energy x rays (4-6 MV)
(2) Medium energy x rays (10-15 MV) and electrons
(3) High energy x rays (18-25 MV) and electrons
(4) Computer controlled dual energy linac with electrons
(5) Computer controlled dual energy linac with electrons
combined with intensity modulation

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 Linear Accelerator

• Use high frequency electromagnetic waves to

acelerate charged particles (e.g. electrons) to high
energies through a linear tube
• High-energy electron beam – treating superficial
tumors
• X-rays – treating deep-seated tumors

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 Linear Accelerator

A block diagram of typical medical linear accelerator

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 The Magnetron

• A device that produces microwaves

• Functions as a high-power oscillator
• Generating microwave pulses of several
microseconds with repetition rate of several
hundred pulses per second
• Frequency of microwave within each pulse is
about 3000 MHz
• Peak power output:
– 2 MW (for low-energy linacs, 6MV or less)
– 5 MW (for higher-energy linacs, mostly use klystrons)

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 The Magnetron

The cathode is heated by an inner filament

Electrons are generated by

thermionic emission

Pulse E-field between cathode & anode

Electron accelerated toward the anode

Static B-field perpendicular to the plane of cavities

Electron move in complex spirals toward the resonant cavities

Radiating energy in form of microwave 23

 The Klystron

• Not a generator of microwaves

• Microwave amplifier
– Needs to be driven by a low-power microwave
oscillator

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 The Klystron

Electrons produced by the cathode Passed in the drift tube

(field-free space)
Electrons are accelerated by –ve pulse
into buncher cavity

Lower level microwave set up an Electrons arrive catcher cavity

alternating E field across the buncher
cavity 1. Generate a retarding E-field
2. Electrons suffer
deceleration
Velocity of e- is altered by the action
of E-field (velocity modulation) 3. KE of electrons converted
into high-power
1. Some e- are speed up microwaves
2. Other are slowed down

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Schematic diagram of a modern
fifth generation linac

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 Electron beam transport

Three systems for electron

beam bending have been
developed:
• 90o bending
• 270o bending
• 112.5o (slalom) bending

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 The Linac X-Ray Beam

• Production of x-rays
– Electrons are incident on a target of a high-Z material
(e.g. tungsten)
– Target – need water cooled & thick enough to absorb
most of the incident electrons
– Bremsstrahlung interactions
• Electrons energy is converted into a spectrum of x-rays energies
• Max energy of x-rays = energy of incident energy of electrons
• Average photon energy = 1/3 of max energy of x-rays
• Designation of energy of electron beam and x-rays
– Electron beam - MeV (million electron volts,
monoenergetic)
– X-ray beam – MV (megavolts, voltage across an x-ray
tube, hetergeneous in energy) 28
 Linac treatment head
􀀁 Components of a modern linac
treatment head:
• Several retractable x-ray targets (one for
each x-ray beam energy).
• Flattening filters (one for each x-ray
beam energy).
• Scattering foils for production of clinical
electron beams.
• Primary collimator.
• Adjustable secondary collimator with
independent jaw motion.
• Dual transmission ionization chamber.
• Field defining light and range finder.
• Retractable wedges.
• Multileaf collimator (MLC). 29
Multi Leaf Collimator (MLC)

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31
 Siemens Elekta Varian

Source Source Source

Y MLC Y Y
Jaw

YY Jaw
X1 X2

39.2 cm
MLC X X
Jaw
55.0 cm 57.6 cm
X X X X
MLC
Accessory

Holder Accessory

Holder Holder

Accessory

100 cm
43 cm 32 cm 29.2 cm

1.0 cm
Isocenter 1.0 cm 1.0 cm
Resolution
Resolution Resolution

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33
Lead or tungsten
Opening from 0 x 0
to 40 x 40 cm at SSD
100 cm

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Production of clinical x-ray beams

Typical electron pulses arriving on the x-ray

target of a linac.

Typical values:
Pulse height: 50 mA
Pulse duration: 2 μs
Repetition rate: 100 pps
(pulse per second)
Period: 104 μs

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 Collimation System
In modern linacs the x-ray beam collimation is achieved
with
three collimation devices:
• Primary collimator.
• Secondary adjustable beam defining collimator
(independent jaws).
• Multileaf collimator (MLC).
􀀁 The electron beam collimation is achieved with:
• Primary collimator.
• Secondary collimator.
• Electron applicator (cone).
• Multileaf collimator .

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 Production of clinical electron beam

􀀁 To activate the electron mode

the x-ray target and flattening
filter are removed from the
electron pencil beam.
􀀁 Two techniques for producing
clinical electron beams from the
pencil electron beam:
• Pencil beam scattering with a
scattering foil (thin foil of lead).
• Pencil beam scanning with two
computer controlled magnets

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 Narrow pencil about 3
mm in diameter

Uniform electron
fluence across the
treatment field
e.g. lead

Electron scatter
readily in air
Beam collimator
must be achieved
close to the skin
surface
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 Dose monitoring system

􀀁 Transmission ionization chambers, permanently

embedded in the linac clinical x-ray and electron
beams, are the most common dose monitors in
linacs.
􀀁 Transmission ionization chambers consist of two
separately sealed ionization chambers with
completely independent biasing power supplies
and readout electrometers for increased patient
safety.

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 Dose monitoring system

􀀁 Most linac transmission ionization chambers are

permanently sealed, so that their response is not
affected by ambient air temperature and pressure.
􀀁 The customary position for the transmission
ionization chamber is between the flattening filter
(for x-ray beams) or scattering foil (for electron
beams) and the secondary collimator.

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 Dose monitoring system

􀀁 The primary transmission ionization chamber measures

the monitor units (MUs).
􀀁 Typically, the sensitivity of the primary chamber
electrometer is adjusted in such a way that:
• 1 MU corresponds to a dose of 1 cGy
• delivered in a water phantom at the depth of dose maximum
• on the central beam axis
• for a 10x10 cm2 field
• at a source-surface distance (SSD) of 100 cm.

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 Dose monitoring system

􀀁 Once the operator preset number of MUs has been

reached, the primary ionization chamber circuitry:
• Shuts the linac down.
• Terminates the dose delivery to the patient.
􀀁 Before a new irradiation can be initiated:
• MU display must be reset to zero.
• Irradiation is not possible until a new selection of
MUs and beam mode has been made.

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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 Betatron
Betatron is a cyclic accelerator in which the electrons are
made to circulate in a toroidal vacuum chamber (doughnut)
that is placed into a gap between two magnet poles.
􀀁 Conceptually, the betatron may be considered an analog of
a transformer:
• Primary current is the alternating current exciting the
magnet.
• Secondary current is the electron current circulating in the
doughnut.

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 Betatron

• Electron in a changing magnetic field

experiences acceleration in a circular orbit

Energy of x-rays:
6 – 40 MV
Disadvantage:
low dose rate
Small field size

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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 Microtron

is an electron accelerator that combines the

features of a linac and a cyclotron.
􀀁 The electron gains energy from a resonant wave guide
cavity and describes circular orbits of increasing radius
in a uniform magnetic field.
􀀁 After each passage through the
wave guide the electrons gain an
energy increment resulting in a
larger radius for the next pass
through the wave guide cavity.

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 Microtron

• Electron accelerator which combines the principles

of both linear accelerator and the cyclotron

Advantage:
Easy energy selection, small beam energy spread
and small size 50
1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams

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 Cyclotron

• Charged particle accelerator

• Mainly used for nuclear physics research
• As a source of high-energy protons for proton
beam therapy
• Have been adopted for generating neutron beams
recently

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 Cyclotron

Structures
• Short metallic cylinder divided into two section (Ds)
• Highly evacuated
• Placed between the poles of a direct current magnet
• Alternating potential is applied between two Ds

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 Cyclotron
• In a cyclotron the particles are accelerated
along a spiral trajectory guided inside two
evacuated half-cylindrical electrodes (dees)
by a uniform magnetic field produced
between the pole pieces of a large magnet
(1 T).

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 Cyclotron

Positive charged particles (e.g. protons or deuterons) are

injected at the center of the two Ds

Under B-field, the particles travel in a circular orbit

Accelerated by E-field while passing from one D to the other

Received an increment of energy

Radius of its orbit increases

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
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The important characteristics of radionuclides useful for
external beam radiotherapy are:
• High gamma ray energy (of the order of 1 MeV).
• High specific activity (of the order of 100 Ci/g).
• Relatively long half life (of the order of several years).
• Large specific air kerma rate constant.
􀀁 Of over 3000 radionuclides known only 3 meet the
required characteristics and essentially only cobalt-60 is
currently used for external beam radiotherapy.

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 Machines Using
Radionuclides
• Radionuclides have been used as source of γrays
for teletherapy
• Radium-226, Cesium-137, Cobalt-60
• Co has proved to be most suitable for external
60

beam R/T
• Higher possible specific activity
• Greater radiation output
• Higher average photon energy

I- Value
Half-Life γRay Energy Specific Activity Achieved
Radionuclide (Years) MeV
( Rm2_)
Ci – h in Practice (Ci/g)

Radium-226 (filtered 1622 0.83 (avg.) 0.825 ~ 0.98

by 0.5 mm Pt)
Cesium-137 30.0 0.66 0.326 ~ 80
Cobalt-60 5.26 1.17, 1.33 1/30 ~ 300
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 Teletherapy sources
Teletherapy radionuclides: cobalt-60 and cesium-137
• Both decay through beta minus decay
• Half-life of cobalt-60 is 5.26 y; of cesium-137 is 30 y
• The beta particles (electrons) are absorbed in the source
capsule.

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 Teletherapy machines

Treatment machines used for external beam radiotherapy

with gamma ray sources are called teletherapy machines.
They are most often mounted isocentrically with SAD of
80 cm or 100 cm.
􀀁 The main components of a teletherapy machine are:
• Radioactive source
• Source housing, including beam collimator and source movement
mechanism.
• Gantry and stand.
• Patient support assembly.
• Machine control console

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 Teletherapy machines
Cobalt-60 teletherapy machine, Theratron-780, AECL (now MDS Nordion), Ottawa, Canada

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 Cobalt-60 Unit

• Source
– From 59Co(n, γ) nuclear reactor
– Stable 59Co → radioactive 60Co
– In form of solid cylinder, discs, or pellets
• Treatment beam
60Co →60Ni + 0β(0.32 MeV) + γ(1.17 & 1.33 MeV)
• Heterogeneity of the beam
– Secondary interactions
– βabsorbed by capsule → bremsstrahlung x-rays (0.1MeV)
– scattering from the surrounding capsule, the source
housing and the collimation system (electron
contamination)
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 Teletherapy sources
To facilitate interchange of sources from one teletherapy
machine to another and from one radionuclide production
facility to another, standard source capsules have been
developed.
􀀁 Teletherapy sources are cylinders with height of 2.5 cm
and diameter of 1, 1.5, or 2 cm.
• The smaller is the source diameter, the smaller is the physical
beam penumbra and the more expensive is the source.
• Often a diameter of 1.5 cm is chosen as a compromise between
the cost and penumbra.

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 Teletherapy sources

􀀁 Typical source activity: of the order of 5 000 - 10 000 Ci

(185 - 370 TBq).
􀀁 Typical dose rates at 80 cm from source: of the order of
100 - 200 cGy/min
􀀁 Teletherapy source is usually replaced within one half-life
after it is installed. Financial considerations often result in
longer source usage.

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 Teletherapy source housing
􀀁 The source head consists of:
• Steel shell with lead for shielding purposes
• Mechanism for bringing the source in front of the collimator
opening to produce the clinical gamma ray beam.
􀀁 Currently, two methods are used for moving the
teletherapy source from the BEAM-OFF into the BEAM-
ON position and back:
• Source on a sliding drawer
• Source on a rotating cylinder

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 Teletherapy source housing

􀀁 Both methods (source-on-drawer and source-on-cylinder)

incorporate a safety feature in which the beam is terminated
automatically in the event of power failure or emergency.
􀀁 When the source is in the BEAM-OFF position, a light
source appears in the BEAM-ON position above the
collimator opening, allowing an optical visualization of the
radiation field, as defined by the machine collimator.

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 Teletherapy source housing

􀀁 Some radiation (leakage radiation) will escape from the

teletherapy machine even when the source is in the
BEAM-OFF position.
􀀁 Head leakage typically amounts to less than 1 mR/h
(0.01 mSv/h) at 1 m from the source.
􀀁 International regulations require that the average
leakage of a teletherapy machine head be less than 2
mR/h (0.02 mSv/h).

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 Collimator and penumbra

Collimators of teletherapy machines

provide square and rectangular radiation
fields typically ranging from 5x5 to 35x35
cm2 at 80 cm from the source.

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 Penumbra

• The region, at the edge of a radiation beam, over

which the dose rate changes rapidly as function
of distance from the beam axis

1. Transmission penumbra
2. Geometric penumbra

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 Source
• Transmission penumbra
– The region irradiated by photons Collimator SDD SSD
which are transmitted through the
edge of the collimator block
– The inner surface of the blocks is
made parallel to the central axis of
the beam
– The extent of this penumbra will be
more pronounced for larger
collimator opening
– Minimizing the effect
• The inner surface of the blocks remains
always parallel to the edge of the beam

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• Geometric penumbra
• Radiation source: not a point source
– e.g. 60 Co teletherapy → cylinder of diameter ranging
from 1.0 to 2.0 cm

From considering similar

triangles ABC and DEC
DE = CE = CD = MN = OF + FN – OM
AB CA CB OM OM
AB = s (source diameter)
OF = SSD
DE = Pd ( penumbra)

Pd = s (SSD + d – SDD)
SDD
Parameters determine the width of
penumbra
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• Geometric penumbra (con’t)
– Solutions
• Extendable penumbra trimmer
– Heavy metal bars to attenuate the beam in the penumbra
region
• Secondary blocks
– Placed closed to the patient for redifining the field
– Should not be placed < 15 – 20 cm, excessive electron
contaminants
– Definition of physical penumbra in dosimetry
• Lateral distance between two specified isodose
curves at a specified depth
– At a depth in the patient, dose variation at the field border
– Geometric, transmission penumbras + scattered radiation
produced in the patient

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1. Kilovoltage Units
2. Van de Graaff Generator
3. Linear Accelerator
4. Betatron
5. Microtron
6. Cyclotron
7. Machine Using Radionuclides
8. Heavy Particle Beams
73
 Heavy Particle Beams

• Advantage
– Dose localization
– Therapeutic gain (greater effect on tumor than on
normal tissue)
• Including
– neutrons, protons, deuterons, αparticles, negative pions,
and heavy ions
• Still experimental
• Few institutions because of the enormous cost

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 Neutrons

• Sources of high energy neutron beams

– D-T generator, cyclotrons, or linear accelerators
• D-T generators
2
1
H + 13H →2 4He 0+ 1n + 17.6 MeV
– Monoenergetic (14 MeV)
– Isotropic (same yield in all directions)
– Major problem
• Lack of sufficient dose rate at the treatment distance
• 15 cGy/min at 1 m
– Advantage
• Its size is small enough to allow isocentric mounting on gantry
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 Protons and Heavy Ions

• Energy of therapeutic proton beams

– 150 – 250 MeV
• Sources: produced by cyclotron or linear
accelerator
• Major advantage Bragg peak

– Characteristic distribution of
dose with depth

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