The smallest indivisible part of an element having all the characteristics of that element is known as Atom.

Atoms are specified as ZXA

Where, Z = atomic number, and A = mass number.

According to Niels Bohr, electrons revolve in specific orbits around the nucleus, named as K,L,M etc; K being innermost orbit. These orbits are synonymous with energy levels.

Here energy refers to the potential energy of the electron. This energy depends upon the coulomb forces of attraction b/w the nucleus and the orbital electrons. Higher the atomic number greater is this binding energy.
Energy level diagram (H2 nucleus)

The term radiation applies to the emission and propagation of energy through space or a material medium.

RADIATION
PARTICULATE ELECTROMAGNET IC : Refers to the energy propagated by traveling corpuscles, which have definite rest mass, definite

momentum and a defined position at any instant.

Elementary atomic particles: electron, proton, neutron. Positron, neutrino and mesons are subatomic particles.

Mode of energy propagation for phenomena such as light waves,X Rays, Rays etc. Was defined by Maxwell in terms of oscillating electrical and magnetic fields being at right angles to each other.

Travel with velocity of 310m/s in free space Transfer energy from place to place in quanta (E= h) In passing through matter the intensity is reduced because of absorption and scatter Obeys inverse square law in free space, i.e intensity at any place varies inversely as the square of distance (I 1/d2 ) EM radiation ranges from the wavelength of 107 m (radio waves) to 10-13 m (Ultra high-energy x-rays).

TWO MAJOR FORMS OF ELECTROMAGNETIC RADIATION USED IN MODERN DAY RADIOTHERAPY:

Discovered by Wilhelm Rontgen in 1895. Two different mechanism of X Ray production:

Characteristic X rays: Emitted when incident

electrons with a kinetic energy > BE of the orbital electrons, ejects the orbital electron and leaves the atom ionized. The resulting vacancy when filled by outer electrons result in emission of characteristic radiation

Bremsstrahlung: Radiative collision

(interaction) b/w a high speed incident electron and nucleus. The electron passing near a nucleus, suffers a sudden deflection and deceleration due to Coulomb forces of attraction lose a part of its energy as bremsstrahlung radiation The nuclei with unstable n/p combinations undergo intranuclear disintegration to achieve more stable state with release of charged particle/ EM radiations known as GAMMA RAYS. Co Ni+ e- + (2 photons of energies 1.17 and 1.33 MeV)

DIRECTLY IONISING Charged particles: IONISING

electrons protons alpha particle

INDIRECTLY
Uncharged Particles Neutrons Protons

photoelectric effect production

compton effect

pair

High speed electrons ionisation and exitation

Biological Effects

The photon-beam may undergo the following four processes:

Attenuation: removal of radiation from the beam by the matter. Attenuation may occur due to scattering and absorption.

Absorption: taking up of the energy from the beam by the irradiated material. It is absorbed energy, which is important in producing the

radiobiological effects

Scattering: change in the direction of the photons and it contributes to both attenuation and absorption. Its a cause of problem in both

diagnostic and therapeutic radiology.

Transmission: Any photon, which does not suffer the above processes

A reduction in intensity of beam of radiation when it passes through any

material
Attenuation occurs exponentially, that is a given fraction of the photos is removed for a given thickness of the attenuating material. Thus its impossible to reduce this beam to nothing.

Attenuation (dN i.e. reduction in number of photon) is proportional to number of incident photons (N) and thickness of absorber (dx) dN Ndx Also Higher Z more attenuation; Higher photon energy smaller

The fractional reduction produced in any monoenergetic photon beam; is constant for any given material per unit thickness (cm-1). dI/I = - dx = 0.693/ HVL

Depends on: = 0.1/cm 1. energy of the photons 2. nature of material i.e. the no. of electrons present in that thickness and density of the material. dividing linear attenuation coefficient by density; is a more fundamental coefficient. Does not involve density but rather the atomic composition. Other coefficients which are more fundamental include: Atomic attenuation coefficient (atoms/cm) Electronic attenuation coefficient (electrons/ cm)

Thickness of a given material required to attenuate the intensity of a beam to half of its original value. = 0.693/HVL HVL is an expression of the quality/penetrating power of the beam.

For a heterogeneous beam,1st and subsequent HVLs are not constant, but 1st HVL is less than subsequent HVLs.
An important clinical implication of hvl is in SHIELDING. For practical purposes, the shielding material which reduces beam transmission to 5% of its original is considered acceptable.

Semilog plot showing exponential attenuation of a monoenergetic beam

After passing through 5HVL, intensity of a monoenergetic beam reduces to less than 5% of original
The recommended minimum thickness of lead for shielding for various megavoltage beam qualities is Co60 - 5.5cm 4MV - 6.0cm 6MV - 6.5cm 10MV - 7.0cm 25MV - 7.0cm
HVL MEASUREMENT: Material for HVL measurement vary with energy of radiation. Radiation upto 30kV-Cellophane Radiation at 30-150kV-Aluminium Radiation at 120-600kV-Copper Radiation at 500kV-2MV-Lead

 Coherent scattering Photoelectric effect

Compton effect
Pair production. Photodisintegration

(ELASTIC SCATTERING/UNMODIFIED SCATTERING/CLASSICAL SCATTERING/RAYLEIGH SCATTERING)

Process described by considering radiation as waves rather than as particles. Involves bound electrons. Occurs with higher atomic number materials and low energy radiations (<10KeV).

X-rays passing close to the atom cause the bound electrons to vibrate momentarily at a frequency equal to that of the radiation. These in turn emit radiation of the same frequency in all directions.

This is a form of attenuation without absorption Important in X-ray crystallography due to the interference between the X rays scattered from the orderly arrays of atoms in crystal

In this phenomena, the photon disappears altogether after interacting with the bound electron. Entire energy of the photon is transferred to an orbital electron. While part of the incident photon energy is used to overcome the binding energy, the rest of it is used as the K.E. of the photo electron.

h= BE + mv

The process results in ionization of the atom and the resulting vacancy thus created is filled by an outer shell electron with emission of characteristic X rays (fluorescent radiation) of the atom.
internal atomic absorption

Auger electrons (internal PE effect)

The angular distribution of emitted photo electrons depend on the photon energy: For low energy: 90 degrees For higher energies : progressively forward direction.

 Mass photo electric coefficient (/) :

/ = k Z/E
ABSORPTION EDGES : / versus photon energy plot shows discontinuities at levels of energies corresponding with the binding energies of the various electronic shells.

Two important consequences:

Near the absorption edges, the lower energy photons are less attenuated and more penetrating than higher energy photons. Any substance is transparent to its own characteristic radiation, energies of which are always a little less than corresponding binding energies.

Mass photoelectric attnuation coeffecient plotted against photon energy

PE effect forms the basis of many applications in diagnostic radiology. The difference in atomic number of various tissues such as bones, nucleus and fat amplifies the difference in X ray absorption to Z times.
This

Z dependence is also exploited when using contrast mediums with high atomic numbers (BaSO4 and hypaque).

The Z dependence also leads to higher absorption of energy in bones while using orthovoltage machines, where PE effect is dominant.

(MODIFIED/INCOHERENT/INELASTIC SCATTERING)

Arthur Holly Compton in 1923 Predominates between 200KeV and 4MeV. Photons interact with free electrons

The photon collides with electron and hands over part of its energy to it and itself continues in a new direction (i.e. its scattered) but with reduced energy and hence increased wavelength.

If the angle by which the electron is scattered is and the angle by which the photon is scattered is , then the following formula describes the change in the wavelength ()of the photon:
1 2 = = 0.024 ( 1- cos )

The wavelength change depends neither on the material being irradiated nor on the radiation energy, but only upon the angle through which the radiation is scattered. The Compton effect results in both attenuation and absorption.

Energy of scattered electron is : E = h ( 1- Cos) 1 + (1- Cos) Energy of scattered photon is : h = h . 1 + ( 1- Cos)

Where, = h /mc { also, mc = 0.511MeV} h = energy of incident photon

Direct hit (= 180 degree, = 0 degrees): Will result in electron receiving maximum possible energy while the scattered photon will be left with minimum possible energy. Grazing hit(= 0 degree, = 90 degrees): Will result in scattered electron with no energy and scattered photon with maximum energy.

Independent of Z, depends only on the number of electrons per gram. The coefficient is practically same for all elements except hydrogen, since electron per gram for all elements except hydrogen is

The Compton attenuation coefficient does

not depend on the atomic number, so, for shielding in megavoltage radiation any material can be used with similar efficacy. There is no excess radiation absorption by bones as compared to soft tissues in the megavoltage range where Compton effect is dominant. No bone shielding effect, as seen in orthovoltage radiation with dominant

photoelectric effect.

 The fraction of the energy imparted to the recoil electron increases as the beam energy increases. So, higher beam energies allow greater absorption of radiation dose in the body with less scattering of energy. As the photon energy increases there is a corresponding increase in the forward scatter of the beam, resulting in better dose distribution. The radiation scattered is independent of incident energy and has a maximum energy of 0.511 MeV at 90 degrees and 0.255MeV for the radiation scattered backwards; the photons scattered at angles < 90 degrees will have energies more than 0.511MeV gradually approaching the incident photon energy

Photon of energy > 1.02 MeV interacts strongly with electromagnetic field of nucleus, the photon disappears, and a positron (e+) and an electron (e-) appear. This effect is known as pair production

Particles travel in a forward direction relative to the incident photon. Any energy distribution is possible, but usually divided equally i.e. half of the available energy (hv - 1.02) MeV

ANNIHILATION RADIATION

e+ + e Ray 0.511Mev Ray 0.511Mev

CLINICAL IMPLICATIONS:
Pair production results from an interaction with the electromagnetic field of the nucleus and as such the probability of this process increases rapidly with the atomic number ( Z2) In addition, the likelihood of this interaction increases as the logarithm of the incident photon energy above the treshold ( log(E)

Beyond 4 MeV pair production results in increasing mass attenuation coefficients specially for higher atomic number elements. High energy radiations (>20 MeV) are less penetrating than some lower energy radiations and are not used in radiotherapy.

Interaction of a high energy photon with an atomic nucleus leading to emission of one or more nucleons, mostly neutrons.

Occurs when the photon has energy greater than the binding energy of the nucleus itself. Example : Cu + Cu + n Threshold energy: the difference between the rest energy of the target nucleus and that of the residual nucleus plus the emitted nucleons. For majority of atoms the threshold energy for this effect is about 10 MeV. Chances of occurrence increases rapidly with increasing energy until maximum is reached at 5MeV above threshold, after this the chance falls off with equal rapidity.
Nowadays, the main use of this reaction is for energy calibration of machines producing high energy photons.

 Total mass attenuation of beam is sum of four individual coefficients

(/) = total (/) P.E + (coh/) + coherent (/) compton + (/) pair

pair production PE is medium energy range i.e At low energies starts at 1.02MeV 4 increases with from 0.2 todecreases rapidly dominant and MeV, Compton photon the predominant effect is energy, energy to with increase inmaking very high of attenuation in mode a minimum at 0.1less reachenergy(>20 MeV) low penetrating atomic low Z materials MeV, innumbermaterials.

So, the energies important for radiotherapy ranges from orthovoltage (50 - 500kev) to megavoltage( 4-20 MeV).

Taking up of energy from the beam by the irradiated material Most of electrons set in motion by the above interactions lose energy by inelastic collisions with the atomic electrons of the material. A few electrons will lose energy by the Bremsstrahlung interactions with the nuclei. This energy is irradiated out of the local volume as X-rays and is therefore not included in the calculation of locally absorbed energy. In most interactions involving the soft tissues, the bremsstrahlung component is negligible

ENERGY ABSORPTION COEFFICIENT: The product of the energy transfer coefficient(tr) and (1-g) where g is the fraction of energy of secondary charged particles lost to Bremsstrahlung in the material. en = tr (1-g)

Mass energy absorption coefficient: en/

91%

% of attenuated energy which is absorbed 15% 46% 71%

96%

ORTHOVOLTAGE VERSUS MEGAVOLTAGE

FEATURE ENERGY ORTHOVOLTAGE 50-150-500 KeV MEGAVOLTAGE 4-20Mev

SOURCE
SKIN SPARING PENETRATION

Electricity
Absent Less

Electricity/Radioisotopes
Present More

BONE SPARING
BONE SHEILDING DOSE RATE PDD SSD BEAM MODIFICATION RBE LET

Absent
Present Less Lower 40 cm Difficult More More

Present
Absent High Higher 80-100 cm Easy Less Less

PARTICULATE RADIATION Ionizing/ Charged particles Electrons (e+) Protons (p+) Alfa particles (4He2) Pi-mesons (+/ -/ 0) Uncharged particles Neutrons

The charged particle interactions are mainly mediated by Coulomb forces between the electric fields of the travelling charged particle and the electric fields of orbital electron and nuclei of atoms

modes of interactions of charged particles

COLLISIONAL LOSS
Collision between the particle and the electron cloud resulting in ionization or excitation ( more important in low Z elements)

RADIATIVE LOSS
Collision between nucleus and charged particle, resulting in Bremsstrahlung radiation

STOPPING POWER
Rate of kinetic energy loss per unit path length of the particle
S=dE/dx

Rate of energy loss or stopping power is proportional to the square of particle charge and inversely to the square of its velocity. S= k charge/velocity Thus as the particle slows down, its rate of energy loss to the medium increases

As the particle slows down its rate of energy loss increases and so does the ionization or absorbed dose to the medium. This peaking of dose at the end of the particle range is called the Braggs peak. Seen with protons and heavier charged particles, not with electrons.

CLINICAL IMPLICATION :

The protons and heavier charged particles provide a much

sought after advantage in radiotherapy; their ability to concentrate dose inside a target volume and minimize dose to the surrounding normal tissues

Electrons are light particles with negligible mass and single negative charge. As a result they penetrate deeper than other charged particles but at the same time

undergo greater scattering

Electrons lose energy predominantly by ionization and excitation. May interact with the electric field of the nucleus and result in Bremsstrahlung

radiation. The probability of Bremsstrahlung increases with electron energy and

atomic number of medium.

Suffer multiple scattering and direction change, because of smaller mass. This leads to a smudging of the Bragg's peak which is hence not seen in electrons.

DELTA RAY: An electron ejected as a result of ionization, having sufficient energy to produce an ionization track of its own is called secondary electron or delta ray.

The ionization pattern produced by a beam of electrons is characterized by a constant value from the surface to a depth equal to about half the range, followed by a rapid dose fall off to almost zero at a depth equal to the range.

This Rapid dose fall off is specially is specially seen in electrons in the energy range of 6 -15 MeV making these useful treatment modality for superficial lesions.

Neutrons are indirectly ionizing. Interact basically by two processes:

1)

Nuclear disintegrations, with emission of heavy charged particles,

gamma rays and neutrons; contributing around 30% of the total dose in tissues. Recoiling protons (predominant process) from hydrogen and recoiling heavy nuclei from other elements, leading to redistribution of energy between the colliding particles. The most efficient recoil is seen if the colliding particle have same mass(e.g. hydrogen nucleus) and this leads to the maximum absorption. This phenomenon has some practical implications: Hydrogenous materials like fats absorb neutrons more than heavier materials and thus there is a 20% greater absorption in fat relative to muscle.

2)

The recoil protons, set in motion after interaction with neutrons,

further cause ionization. The dense ionization produced by these particles in the vicinity, results in high LET values more likely to

induce lethal damage in cells due to the dense ionization they

produce.

Biological effects of neutrons do not depend much on the presence or absence of oxygen i.e. low Oxygen Enhancement Ratio (OER). Neutrons, being uncharged particles also penetrate deeply into matter.

Despite these attractive radiobiological and physical properties, neutrons are not commonly used in practical radiotherapy, because of technical difficulties in production of these beams as

well as their complicated dosimetry.

Have a very high linear energy transfer (LET) that is they have a very high ionization density Exhibit the phenomena of Braggs peak However there are several practical and theoretical difficulties with the use of these charged particles. Some of them include: Width of the Braggs peak is very small (0.5cm) leading to inhomogeneous tumor dose in larger tumors Generation of these charged particles requires expensive and large machines. These large machines necessary for production of these beams often make it necessary to move the patient instead of the gantry!

Radiation interacts with the atoms of the DNA molecule, or some other cellular component critical to the survival of the cell

When radiation interacts with water to produce free radicals cell destruction Ionizing radiation + HO HO + e HO + HO HO +OHcell damage

The reactions that most commonly lead to cell damage usually occur at the level of the DNA although they may occur at the level of cell membranes, proteins etc. Lethal double stranded DNA breaks are often irreparable and persist in the form of micronuclei formation, chromosomal aberrations and loss of reproductive integrity. Some degree of protection from chemical effects can be provided by addition of anti oxidants which compete and take up some of the free radicals

Cells can die in several ways: Apoptosis Mitotic catastrophe Senescence Necrosis Autophagy
: delayed, over a

period of days. Most important for the effect of radiotherapy of solid tumors is mitotic catastrophe, which is caused by lethal chromosome damage. After irridiation, cells can pass through one or few mitotic cycles before mis-segregation of chromosomes leads to loss of replicative potential (or clonogenicity) of cells multimicronucleated cells can be detected.

: A characteristic of radiosensitive cells eg. neoplastic hematopoitic or lymphatic cells, is death from radiation induced apoptosis via the intrinsic, caspase 9 dependent pathway. Early/premitoticP53 dependent; occurs within 2 - 6 hours after irradiation before cells enter mitosis (primarily a consequence of DNA damage) Late/postmitosis occurs after mitosis; due to radiation induced lethal chromosome abberation.

Radiation induced senescence (p53 mediated cell cycle arrest) plays an important role for development of normal tissue damage, for example fibrosis.

The three major forms of interaction of radiation with matter, which are of clinical importance in radiotherapy are: 1. Compton effect. 2. Photoelectric effect. 3. Pair production. Compton effect is the most important in modern-day megavoltage radiation therapy. Photoelectric effect is primarily important in diagnostic radiology. There are several unresolved issues pertaining to the use of particulate radiations. Radiation ultimately affects cells by two mechanisms, direct (DNA dependent) and Indirect (free radical dependent).

COMPTON EFFECT

BREMMSTRALUNG RADIATION

CHARACTERISTIC X-RAY

PHOTOELECTRIC EFFECT

Pair production

CHARACTERISTIC X RAY

PHOTO-DISINTEGRATION