Radiation Sources in Radiotherapy

External Beam Radiotherapy

IAEA
International Atomic Energy Agency
Day 7 Lecture 4
 Objective

To become familiar with the radiation sources, devices and

ancillary equipment used in external beam radiotherapy.

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 Contents

Treatment planning systems;

Radiotherapy simulators;
Superficial / orthovoltage units;
Cobalt-60 units including Gamma-knife;
Linear accelerators;
Computed Tomography (CT) scanners for radiotherapy;
Multileaf Collimators (MLC).

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 Clinical Objectives

To deliver a dose and dose distribution that is adequate for

tumor control but which also minimizes complications in
normal tissue.

Note: It is not the role of the Regulatory Body to evaluate the

clinical decisions of medical practitioners authorized to
prescribe radiotherapy treatments.

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 Treatment Planning

Prescription

Very important for

optimization of
Planning
protection in medical
exposures

Treatment
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 Treatment Planning

About 1/3 of problems are directly related to treatment

planning;

Problems may affect an individual patient or cohort of

patients.

IAEA Safety Report Series 17; 2000

Lessons learned from accidental exposures in radiotherapy

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 Radiotherapy Simulator

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 External Beam Equipment

Therapeutic x-ray equipment operates in the range of:

10 kVp - 150 kVp (superficial);
150 kVp - 400 kVp (orthovoltage / deep);
Radioactive sources ( ray equipment).
Cobalt 60 & Caesium 137
Megavoltage electron accelerators for X and electron therapy
Linear accelerator

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 Typical Radiation Levels

Cobalt-60 teletherapy

Source activity may be around 400 TBq (~10,000 Ci);

Average radiation leakage (beam off) should not exceed
0.02 mGy/h at 1 m i.e. it would take 50 hours exposure for
1 mSv;
In general, minimize the time spent in the treatment room.

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 Typical radiation levels (cont)

Linear accelerator turned off

There is no useful radiation beam when turned off;
However, immediately after higher energy beams
(> 10 MeV) are turned off there may be induced
radioactivity but typically with very short half lives
(seconds to minutes);
It is suggested that room entry be briefly delayed,
especially after long exposures.

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Superficial and Orthovoltage x-ray equipment
Superficial
40 kVp to 120 kVp
treat small skin lesions to
a depth of ~ 5 cm
maximum applicator size
typically < 7 cm diameter
typical SSD < 30 cm
beam quality (HVL)
typically 0.5 to 8 mm Al
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Orthovoltage (deep)
150 kVp to 400 kVp
treat skin lesions, bone
metastases to a depth of ~ 20 cm
use applicators or diaphragm
SSD 30 to 60 cm
beam quality (HVL) typically 0.2 to
5 mm Cu
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 Superficial x-ray equipment

Interlocks prevent
inappropriate
combinations of kVp
and filtration.

Electron
contamination from
the applicator can
be significant.

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 Superficial x-ray equipment (cont)

Dose is highly
dependent on
source-skin distance,
filtration and
applicator area.

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 Superficial x-ray equipment (cont)

Provides a range of kVp, mA and filtration

Filters are used to

absorb low energy
photons which
otherwise may
unnecessarily
increase skin
dose.

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 Issues with Superficial radiotherapy

Short focus to skin distance (FSD) and

hence high output and large influence of
inverse square law

Calibration difficult due to strong dose

gradient i.e. dose fall off and electron
contamination

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 Issues with superficial therapy

Dose determined by a
timer
on/off effects must be
considered
Photon beams may be
contaminated with
electrons scattered from
the applicator Control panel

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Orthovoltage (deep) x-ray equipment

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 Deep X-ray therapy (Orthovoltage)

Uses conventional X-ray tube

Energy range 150- 400 kV X-rays
Mostly used around 250 - 300 kVp
Treatment depths of around 20 mm
Applicators are used in superficial therapy
X-ray tube

Applicator

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 Deep X-ray therapy (Orthovoltage)

Penetration sufficient for palliative treatment

of bone lesions relatively close to the
surface (ribs, spinal cord)
Largely replaced by megavoltage treatment
modalities for treatment of other lesions

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 Disadvantages of deep x-ray

Higher dose to bone - photoelectric absorption

Maximum dose on the surface hence higher skin
dose
Treatment to a depth of only a few centimeters
possible
Low energy, hence high scattered radiation and
larger penumbra

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 Gamma ray equipment

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 Gamma ray equipment (cont)

Source head and a typical source transfer mechanism

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Why prefer Cobalt unit over Orthovoltage?
Othovoltage unit
150-400 KV x-rays
Maximum dose on the skin
Higher absorption by bone
Treatment to a depth of few centimeters
non uniform dose distribution
Higher side scatter hence larger penumbra
Vertical unit
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Telecobalt unit
1.25 MeV Photon
Maximum dose at depth of 5 mm
Relatively uniform dose absorption
Higher penetration deep seated tumours
Relatively uniform distribution
More of forward scatter, lesser penumbra
Mostly isocentric unit
 GAMMA KNIFE

The gamma knife device contains 201 cobalt-60 sources of

approximately 30 curies each
It is placed in a circular array in a heavily shielded
assembly.
The device aims gamma radiation through a target point in
the patient's brain.
The patient wears a specialized helmet that is surgically
fixed to their skull so that the brain tumor remains stationary
at target point of the gamma rays.
Therefore it is also known as the stereotactic surgery.

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 Gamma Knife

The Gamma Knife:

uses numerous high activity 60Co sources positioned in a
device so that the radiation beams converge at the specified
point of treatment;
is used to treat head tumors.

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 Linear Accelerator

Modern accelerators have a

number of treatment options e.g.

X-rays or electrons (dual

mode);
2 X-ray energies;
5 or more electron energies.

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 Linear Accelerator (cont)

Concept

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 Linear Accelerator (cont)

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.

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 Linear Accelerator (cont)

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.

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 Linear Accelerator (cont)

Complex head structure to

handle multiple energies
and multiple modalities.

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 Linear Accelerator (cont)

Complex control system

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 Linear Accelerator (cont)

Verification systems
All accelerator manufacturers 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

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 Linear Accelerator (cont)

X-ray Collimators

Rectangular (conventional)
The transmission through the collimators should be less
than 2% of the primary (treatment) beam.

Multi-leaf collimators (MLC)

the transmission through the collimators should be less than
2% of the primary (treatment) beam.
The transmission between the leaves should be checked to
ensure that it is less than the manufacturers specification.

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 Linear Accelerator (cont)

Electron applicators 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.

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 Linear Accelerator (cont)

Neutrons:-

should be considered if the x-ray energy is greater than 10

MV

Issues which need to be considered when neutrons are

presents include:

neutron activation
shielding problems

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A comparison: Cobalt unit Vs Linac

Telecobalt unit Linear Accelerator

1.25 MeV Photon 4 to 21 MV photon beams
Maximum dose at depth of 5 Maximum dose at higher depth with
mm energy
Source to be changed every No radioactive source
4 to 5 years
Leakage radiation present Radiation only when the source is
even while the beam is off switched is ON
1-2 cm source diameter 1mm source nearly point source
Larger penumbra Smaller penumbra
Relatively uniform dose Uniform dose absorption
absorption
Higher penetration deep Higher energy than Cobalt possible.
seated tumors Also possible to select higher energy
depending on patient thinkness.
Photon only Electron beam of various energies
possible

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 General Safety Requirements

Clear indication shall be provided at the control console

and in the treatment room to show when the equipment is
in operation.

Dual interlocks shall be provided on all doors to the

treatment room such that opening a door will interrupt the
treatment. It should only be possible to resume treatment
from the control console.

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 General Safety Requirements

Warning Signals and Signs

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 General Safety Requirements

Fail safe systems

There shall be at least two independent fail safe systems

for terminating the irradiation. These could be:

two independent integrating in-beam dosemeters;

two independent timers;

an integrating dose meter and timer.

Each system shall be capable of terminating the exposure.

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 General Safety Requirements

Collimation

The exposure shall be limited to the area being examined or

treated by the use of collimating devices aligned with the
radiation beam.

Exposure rates outside the examination or treatment area due

to leakage or scatter shall be kept as low as reasonably
achievable.

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