rimer on Theory and Operation of Linear Accelerators in Radiation Therapy by C.J. Karzmark, Ph.D. and Robert J. Morton, M.S.A Primer on Theory and Operation of Linear Accelerators in Radiation Therapy C.J. Karzmark, Ph.D. Professor of Radiology (Radiological Physics Section) Department of Radiology Stanford University School of Medicine Stanford, California Robert J. Morton, M.S. ‘National Cancer Institute Bethesda, Maryland Firt published December 1981 by the ‘Breau of Radiological Health Revised January 1989 by Modical Physies Publishing Corporation (A non-profit organization)Copyright © 1989 hy Robert Mortanand C.J, Karsmarle All vights reserved. No part of thispublication may be reproduced or transmitted in any form or by aly means, without permission in ‘writing from the publisher. Permision is granted to quote excerpts from articles in thie book in seiortife or technical works with ae Iknowledgement of the source, inching the editors names, the book title, and year of publication, Originally published by the Bureauof Radiological Health, 1981, Reprinted and published by Medici! Physics Publishing Corporation, 4378, 1800 University Avenue, Manon, Wisconsin, 53706, ISBN; 0.944898.07-3Preface Blectron linear acelerators evolved from the microwave radar de- velopments of World War Il, The klystron tube, invented at Stanford, provided a vital source of microwave power for radar then as it does how. In the late 1940, the high-power klystron and the microwave principles incorporated in its design were used to construct and power f linac for use in physice research and later for industrial radiogra phy. By the mid 1960s, a Tinae suitable for treating deep-seated tumors ‘vas built inthe Stanford Mierowave Laboratory and installed at Stan- ford Hospital, which was located in San Franciseo at that time. Tt served asa prototype for commercial nits that were built ater. ‘Since that time medical linear seeelerators have gained in popular ity es major radiation therapy devices, but few basie training materi- ‘ls on their operation have been produced for use by medical profes Sonal, Dr_G. J, Karzmark, m radiologieal physiist from Stanford University, has been involved with medial Tinaes sine their devel- ‘opment and he agreed to cllaborate with Robert Morton ofthe Nation= fl Cancer Insitute, in writing this primer on the operation of medical Tinear accelerators. ‘This publication provides an overview of the ‘components ofthe linear acselerator and how they function and inter- relate, ‘The ausliary systems necessary to maintain the operation of the linear accelerator are also described. The primer will promote an ‘understanding of the eafe and effective use of those devices. Tt has been produced in cooperation with the Division of Resources, Centers, and Community Activities ofthe National Cancer Institute, and is in- tended for students of radiation therapy technology, radiological Dhysies, radiation oncology, and radiation contro. Por ease of understanding, much of the text describes the compo nents as they appear in a specific electron linear accelerator treat- ‘ment unit, the Varian Corporation's Clinae 18. This choice in no way fonsttutes an endorsement ofthis particular equipment, Variations in desig do oovur and several are described in Appendix A. ‘Table 1 in Appendix B lists pertinent specifications of all radiotherapy Tinaes known to be commercially available at this time, A three-part video tape, titled "The Theory and Operation of the Linear Accelerator in Radiation Therapy,” has been produced in conjunction with this primer and ean be ordered from Pam Gorman at the National Avdio visual Center, 8700 Edgeworth Drive, Capitol Heights, Maryland, 20743, Order numbers are AO7S1S (VHS videotape format) and AO1822,(G14" tape format "The current revision takes cognizance of significant advances o¢ curring in radiotherapy linaes since the original publication. Again, the level of treating these advances is simplified 0 that the audience of technologists, a5 well as physicians, engineers and physicists can benefit, A new Section 9, Dual X-ray Energy Linaes, deseibes these versatile new units which provide two X-ray and soveral electron beams for a variety of clinical situations. Providing these various ‘treatment modalitcs requires changes in how the standing wave and travelling wave accelerator structures are energized with microwave power. Section 10, Bending Magnet, has been revised to deseribe more fully the properties of complex (doubly achromatie) magnets used in contemporary treatment unite in contrast to the simplified (singly achromatic) magnet shown in Fig. 36. Additional technical infor- ‘mation on advances in accelerator design may be found in the added reference, Karzmark, 1984 and the projected publication ofa text on ‘Medical Blectron Accelerators, by C. J. Karzmark, Craig Nunan and Bi Tanabe. Appendix A has heen revised to include descriptions of| contemporary linac treatment units, and Appendix B provides an up ‘ated Table I of performance speifcations of radiotherapy linecs. Acknowledgments ‘The need to simplify complex microwave and physics phenomena hile retaining rigor inthe treatment of these phenomena presented a significant dilemma in weting this primer. We are deeply indebted to our many clleagues who gave generously of their time in ertiealy reviewing the manuscript, suggesting changes, simplifying analo: fies, and identifying areas that were wnclear. ‘Their incisive com: ‘ments enabled us to havea better pereption of how the primer should be written, We wish also to acknowledge the assistance, critical re- view, and encouragement of BRH staff members Frank Kearly and Marcia Shane, ‘This work has been supported in part by Research Grant CA.05838 from the National Caneer Institute, NIH, and in part by an Interagen- «ey Agrooment with the National Cancer Institute; NCI 2¥01-10606,Ps Acknowledgment L 2 3 4 Introduction 2 nergy Designation in Accelerators 2 [An Elementary Linear Accelerator 5 ‘Similarities and Differences Between Linacs and Diagnostic Xikay Generators 8 ‘Major Linae Moises and Components 9 Introduction to Microwave Power Sources 10 a. Microwave Cavities 10 6b, The Kiystron 22 Se. The Magnetron 19 ‘The Waveguide and Cirealator 14 Introduction ta Acelerator Structures 18 Ba, Traveling Wave Accelerator Structures 16 fb, Standing: Wave Accelerator Structures 19 9, Dual X-Ray Energy Mode Linacs 21 90 Standing Wave 22 9b, Traveling Wave 28 10, Bending Magnet 24 1, Treatment Heads 25 12 Retractable Beam Stopper 26 13, Functional Block Diagram and Auxiliary Systems 27 14, Operational Review 29 Bibliography | 30 Appendix A Representative Linae Treatment Units 31 ‘Sppendix B Specifications of Radiotherapy Linaes 4 Abstract Karzmark, C.J. and R. J. Morton, A Primer on Thoory and Opera- tion of Linear Accelerators in Radiation Therapy. HES Publication (PDA) 828181 (December 1981); reprinted 1988,it Introduction. ‘Cancer patients are treated hy radiation, surgery or ehemotherapy. ‘Atreatment method proving increasingly effective is radiation, wsed iy itself or in combination with other modalities. ‘The principal rai ation modality forthe treatment of deep-seated tumors is xrays of ‘ery high energy and penetrating power. Such x-rays are created ‘when high energy electrons are stopped in a target material such as tungsten, Alternatively, Une eletrons themselves may be used direct: ly to treat more superficial eancers, The eetron linear accelerator accelerates charged pavticles in a straight line, in contrast to Ube er ‘ular orbits that characterize the betatran and eyelotron. ‘The purpose fof this primer is to explain the principles of operation and use of the tlectron linear accelerator and to acquaint the reader with pertinent Teatures and terminalogy. ‘The medical linear aecleratar wil he introduced by first examin Ing the treatment room. Fig. 1 shows a patient being readied for treat ‘ment with a linae. The thick conerete walls ofthe treatment room thield Uh technoloyat and other staff from the penetrating radiation. ‘The linac is mounted in.a gantry which rotates on stand containing electronic and other systems (Fig. 2). The Hina ean be rotated into po- ition about the horizontal gamtry axis for use in treatment. The rai ‘ation beam emerging from the collimator is always directed through tnd centered on the gantry axis. The beam central axis intersects the ‘gantry axis al pont in space ealled the isocenter. In the majority of faces, the couch is positioned so thatthe patient's tumor is centered at the isocenter. Usually, the patient lies supine or prone on the treat- zment couch (sometimes called patient support assembly). The couch incorporates three linear motions and a rotation mation about the iso- ‘xnter ta facilitate positioning the patient for treatment. Side and ceil. ing lasers. project mall dota or lines that intersect ai the isoeenter. ‘These facilitate positioning the patient in conjunetion with reference marks, often tattoos, placed on the patient's skin. The digital position indicators display the treatment field sie together vith collimator tnd gantry rotation angles. ‘The isocentrie system facilitates com fortable, precise reproducible treatment when using multiple fields directed st the tumor from different gantry angles (Pig. 3). In this unit, a constant radiation Source gantry Axis-Distance (SAD), usoal- 1ly 100 centimoters (em), is employed Alternatively, some treatment techniques use a constant radiation Source Skin (of patient»Distance (GSD), usually for larg fields at distances of 100 em or greater. ‘The technologist operator views the patient, and presets and moni- tors the treatment from a contral console outside the treatment room ig. 4). “Much of the ausiliary electronics (as well as control monitoring devices) is housed in the eleetronie card rack eab ‘mounted atthe console. Anearby modulator eabinet houses auxiliary tlectronics for the larger lines, ‘The discussions and illustrations which follow this brit deserip tion ofthe linge wll introduce the necessary concepts behind its oper. ation and extend them tothe building of an elementary electron bine far accelerator. Later, the major modules of a medical linae will be identified. ‘Their principles of operation and how they function eal Tectively to preuce x-ray and electron treatment beams will be de seribed, First, however, there will be an important digression on des ‘gating the energy of radiotherapy beams. Energy Designation in Accelerators Fig. 5 shows a simple device that will accelerate electrons. It eon sists ofa one-vat battery connected to two conducting plates spaced 1 fm apart in an evacuated glass tube. The glass tube ie an electrical insulator. ‘The negative plate is termed the eathode and the postive plate the anode. In order to setup these changes, the battery causes ‘lactrons to flow fom the anode to the eathode via the external crit. ‘This revulls in a deficiency of electrons at the anode (positive charge) and an excess of electrons at the eathode (negative charge) a8 shown, ‘This charge distribution ereates un Bleetrie Field" (denoted by an arrow) in the region between the plates inthe direction shown, ‘The ‘lecirc field is the force that a unit postive charge would fel i placed between the two plates. Its strength or magnitude in this example is ‘one volt per em (1 Vie). ‘That i the diference in the eletical po tential between the plates, divided by the distance botwoon them, is one} i voll per em, By definition, the arrows, which identify the direction of “IE! are in the direction in which a positively charged particle would ‘move, an electron with its negative charge would move inthe opposite flection. Ibis not possible to see "E” elds but they are known to exist ‘because of tho foree they exert on charged particles such as elec trons. Mf electrons, denoted by "e" in Fig. 6, are released from the rhgative plate (the cathode) they willbe accelerated hy the force of the "Efe to the postive plate (the anode). An electron vole (eV) isthe energy gained hy an electron accelerated neross a potential difference ‘one volt [xertng a foroe vhrough distance isa basic measure of work and energy. On the atomic scale, the eletron volt, or multiples of it isthe ‘adopted unit of energy, In Fig. 6 we are dealing with a foree of one ‘oll per em exerted on an electron through a distance of one ‘centimeter. Tagine now that a thousand one-volt batteries are connected in ser ies to provide 1,000 volts or one kilvole potential diferential, across the plates ofthis deviee asin Fig. 7. "The accelerated electron wosld frre at dhe anode with an eneray of 1,000 electron volts or one kilo- ‘ltr vol (1,000 eV = tkeV). Note, also, thatthe strength ofthe msso- ‘ited "B’ fleld now is 1,000 volts per em (1 kViem). ‘Suppote the plates are spaced 10 em apart and that a thousand one kilovol batteries are connected in series to provide a ono-million-voit power supply (Pig 8). The plate spacing nd glass tube have heen Tengthened to withstand this higher voltage without electrical breal- down, "An electron released from the eathode now gains one million ‘lectron volts of energy during its transit and arrives with an energy ‘of one-million electron volts (1,000,000 eV = 1,000 keV = 1 MoV). Note that the energy gained by the electron depends only on the potential difference between the anode and the eathods, and not the distance traveled. The corresponding electric field strength "E" is one mil- lion volts divided by 10 em, or 100,000 volts per em (100 kVlem). To es tablish the higher electric field strengths of Figs 7 and 8, the + and harge distributions at the anode and eathode ave proportionately Tanger, as compared to Figs. 5 and 6. To simplify the Fig-s which fol- low, the "E” lines and associated charge distsbations at the anode and cathode wil sometimes be omitted rcpt me ree tacit Figur 6, imple elie cera of ney dgnaton oe do {ES Sa dpe ening we ely tbe Thekp ne acne try eatin ein igre, As to ner watt nr SEIT Ni tc cleo eos | ‘ere vt (re trode aa theca Tor telnwer age PigsAn Elementary Linear Accelerator I is possible to convert the simple "linac" just deseribed to = more sophisticated, yet sll elementary, electron linear accelerator. Firs, ‘heated cathode is substituted forthe negative plate (Fig. 9). (In the nae this cathode becomes the electron gun.) The eathode shown here is ‘simple Glament. ‘The small battery, B, heats the flament causing it to literally bol of electrons just asin light bulb filament, Next theoretical 4 MY battery is connected between tho cathode and anode, ‘This battery voltage corresponds tothe electron energy desired, ie, 4 nillion volls for 4 MeV electrons, Now, electrons aro boiled off the lament and nestlerated to n energy of 4 MeV just as they strike the leetron therapy, a thin metal “window” becomes the positive plate or anode Fig, 10. Such a thin, slid, metal sheet main- Tins the necessary vacuum and yet permits the electrons to penetrate ‘the window and emerge with only a small loss of energy. In this ele mentary linac, the electron beam emerges with an energy only sight- Iy ess than 4 Mev. "To adapt this for xray therapy, the positive anode placed outside the window isa tungsten target which stops the electrons abruptly thereby producing penetrating x-rays (Fig. 11). ‘These x-rays will have ener ice from a fraction of an MeV up to 4 MeV, all initiated by electrons Gr MeV energy, since the electrons can give up their energy all at fonce ina single collision or in parts due to several ellsions. The re Sulking spectrom of x-ray energies is designated by "AMV." The no {ation convention of dropping Use "e™ from "MeV" indicates Una the x ‘ay beam will be made up of xrays of different energies produced as the MeV elestrons are slowed and stopped in the target. Tnstead of energizing Uhis simple linear accelerator with a battery, substitute an alternating voltage, a8 shown in Fig. 12. The magni fhde and polarity of euch a vollage changes regularly and repeats i- felt periodically with time in this eyelie pattern which is ealled a sine wave. For the single eyele shown in Fig. 12, the horizontal axis de notes timer the vertical axis denotes the magnitude and polarity ofthe fade vltage,V, relative tothe cathode, that establishes the "E” eld Many electrical and mechanical phenomena change smoothly in this regular pattern of a sine wave, ‘The number of complete sine wave 5 Ture. Au slmeniry fr mln va MeV) electron Hine. The Hama EERvie tn ree iheated by mal tay ure 8, The fr iln vl ae i, 9 ied opie eral 4 MY Beit at tiny Heston ee mclerto mtd conten ‘Sis sapl taser ina.[incon S > The deetry fmiion ane oP 8 pedo pidecycles per second (+ and -or up and down excursions) is called the fre- ‘quency and is expressed in hertz (Hz), kilohertz (kil) or megahertz (ME). One herts equals one eyele per second. Typically, the fre fqueney of home electric power is 60 Hz, a standard broadeast radio ‘wave can be 1000 kil, and the energizing power for medical lina is ‘2000 MHz. ‘The latter high frequency is refereed to as a microwave Frequency. The time for completing a single cycle is called the period and, for the above examples, coincides with 1/60th second, 1/ 41000,000th second fone microsecond) and 1/5,000th ofa microsecond, respectively. ‘Now, investigate the performance of the elementary Tinae when powered by an alternating voltage, as depicted in Fig. 12. With the target positive and the filament negative, as shown in Fig. 13, lec trons emitied from the cathode during interval a-b-e of Fig. 12-are ac felerated to the target. At point "en Fig. 12, the vllage reverses po- larity and "E” fila direction. With the target negative and filament positive, during interval eae as shown in Fig. 14, electrons are sill ‘ited but are not accelerated to the target. lectrons are accelerated only during he frst half of the cycle shown in Fig. 12 Ata time one-fourth through the cycle, point", the ‘ollage, V, reaches positive maximum, and "E” is directed as in Fig. 13. An electron released from the cathode at this time would gain 1 maximum of energy. Conversely, at three-fourth's time through the tycle, point “d” V reaches a negative maximum. Then, "Eis di- ‘ected as in Fig. 4, and maximum energy would have tobe expended Jn pashing” the electron from the eathode ifit were to reach the anode ‘against the opposing "E" field. Therefore, no elestrons are accelerat= fd at this time. Ab other times, intermediate amounts of energy would be gined or expended, including zero at points a, e and e. In ths il- Tustration, we assume that the electron travels between eathode and anode instantly; that is, the electron’ travel time is zero. Note that row the elementary linge aceclerates electrons and emits radiation ‘nly half of the time, and the electrons vary in energy sinusoidally Aduring this time. gure 1, The emery lon insmod to io an berating vege Jone sn wha oar reves eey bl eee Gna Fi. Fr th gear ‘ve a amarante Tet ae he tn ty Figur 4 Th conotary Bae povere bya aerating wag. Fa he pal [BSE Fig eo oor Be dioeae ore Similarities and Differences Between Linacs and Diagnostic X-Ray Generators ‘There are many similarities between the linge and conventional Aingnostic x-ray generators. Both provide a source of electrons from a hot filament or eathode in an evacuated tube. Bath require an acceler ing voltage between the eathode and target anode, This voltage is adjustable in a diagnostic generator, depending on the procedure, from about 30 KV to 160kV. In contrast, linac ecclerating voltages are fixed ina particular unit and range from about AMV to 35 MY. Di ‘agnostic x rays often invalve a single 0.01 ta 10 second pulee with 60 Hz to 720 He frequency, while linae radiation eonsiets of short bursts of about fivemillionths of a second duration repeated several hun Ared times per second, each burst having a 3000 Me frequency. Bath ‘employ collimators to shape the x-ray beam, but Usese must be thicker in the ease of linaes. Because of thei high energy, x-rays from lines fare much more penetrating than diagnostic xraye. This is distinet 8 rdvantage for treating a deep-lying cancer sinc the cancer can be de- Stroyed by the linae beam with less damage to healthy, overlying saves, Linaes require heavily shielded rooms to protect the persons outside, Such rooms are constructed with thick eonerte wall In contrast, di- agnostic rooms are usually shielded by a sheet of lend a few millirne- ters thick hidden in the walls. Diagnostic rays reveal anatomical structures based on diferences in atamie number as well us physical Aencity, eg, bone versus sof tissve or ai, megavoltage xray allen ation is primarily based on density differences. A film produced with megavoltage xrays would show little difference between bone and soft tissue. The importance of xray diagnostic beams js in the infar- ‘mation contained in the transmitted beam which produces an image ‘ona receptor. The importance of x-ray therapy beams, such as provid: ‘hy lines, is in the energy absorbed in the tumer. Orthovoltage (about 250 kV) radiation equipment, which dominated treatment energies of the 1950s, has properties closer to iagmastie rays than megavoltage energy therapy beams, and continues tobe ap Dropriate for some specific treatments ‘Now return to examining a lina, such as seen earlier being read- ied for use. Tt.conssts of a number of major modiles and components ‘that will be identified, and includes operating principles which willbe explained. ‘Then, this information will be combined and interre- lated to explain an operaticnal linae. Major Linac Modules and Components ‘The major modules in the linac ae the gantry, the stand, the control ‘console nnd the treatment couch. Some inact alsa have a modulator feabinet, as this sample linae dacs, Fig. 15 identities the components hhoused in the stand and gantry of « medium-energy linae and will be referred to frequently. The stand is anchored firmly tothe floor and the gantry rotates on bearings in the stand. ‘The operational acceler: tor structure, housed in the gantry, rotates about a horizontal axis fixed by the sland. For ease of understanding, most of the text will de- seribe the components as they appear inthe Varian Cline 18. Varia tons in linac design do aceur and are described in Appendix A ‘The major components in the stand are the: 1. Klystron - which sits atop an insulating oil tank and provides source af microwave power to accelerate electrons 2. Waveguide » which conveys this power to the accelerator in the gentry: 5. Circulator - «device inserted inthe waveguide ta isolate the Kye. tron from microwaves reflaced back from the accelerator; and 4 Cooling water system - which cols various component that dis pate energy as heat and establishes a stable operating temperature sut- ficiently above room temperature ta prevent condensation of moistare from the air "The major components found in the gantry are the: 1, Accelerator structure - which is energized by the microwave power supplied from the Mystron via the waveguide; 2. Bleetron gun (or cathode) - which provides the source of electrons injected into the structure; 3. Bending magnet - which deflects the electrons emerging from the ‘ceelerator structure around a lop inorder to strike the target to pro- duce x-rays oF tobe used directly for electron treatments; ‘4 Treatment head - which contains beam shaping and monitoring devices; 5, Beam stopper - which reduces room shielding requirements for the treatment bearn emerging from the patient, and extends from the bot: 9 a hiheneay ratory nse ning mae gure 15, Sedona dingo, ‘Seon roel tal atom of the gantry as shown in Fig. 400, "The modulator eabinet (Fg. 4) contains components that distribute and control primary electrical power to all areas of the machine from the utility connection and also supplies high voltage pulses. ‘The treatment couch motions are controlled by a hand pendant con- ‘tol operated by the therapy technologist. The three-dimensional po toning of the patient on the couch is motor-driven. Fast and slow speads oF variable speed motor control are provided forthe couch, to- gether with control of gantry rotation and secondary collimator pos tioning (Fig 2. Most eouehes also provide couch rotation around a vertical axis passing through the isoeenter, and some permit attach ment af a treatment chai, ‘The control console (Fig isthe operations center fora linge. Tt supplies the timing pulses that initiate each pulse of radiation, It pro- ‘ides visual and eleetronie monitors fora host of linge operating par meters including the individual patient's dose prescription, ‘Treat- ‘ment cannet proceed when the value of pertinent parameters exceeds limits which have been previously established, Tn addition to these major modules and components, there are a numberof ausliary systems including: vaeuum, pressure, cooling, automatic frequency eontrel (AFC), and monitor and contro 0 ion 12). Introduction to Microwave Power Sources ‘The klystron and magnetron are to special types of electron tubes that are used to provide microwave power to acelerate electrons. Mic crowaves are similar to ordinary radio waves, but have frequencies thousands of times higher. ‘The microwave frequency needed for i ‘ae operation is three billion eyees per secand (3000 MH). ‘The vot- tage and "E” fields associated with microwaves change sinusoidally in direction and magnitude in a regular manner, producing an alter. ‘nating valtage as shown in Fig. 12. Microwave cavities, which are central tothe construction and operation of klystrns and magnetrons ‘8 well as to aecleraor structures wil be described next, Ga. Microwave Cavities Microwave devices, including klystrons, magnetrons and acceler- ator structures, make extensive use of resonant mierowave cavities,{A simple microwave cavity similar to that used in medical Hinges but ‘loved ends, is shown in Figs, 16, 17, and 18, Tks an accurately ‘machined eylinder, about. 10 em in diameter and several em in length. Such a cavity has the approximate sie and shape of a 7 ox u- nafish ean. In Fig. 18, th cavity is shown modified by eutting open- Ings in its to ends along the axis, for use in a klystron or an acceler ater structure. A microwave cavity is an enormously efficient device in the sense thatthe intense "E” elds needed for these applications are established by a small amount of electrical power. This isa reso- rhance phenomenon that occurs at ono frequency, in this ease 3000 Ma, which is determined by the dimensions ofthe cavity much as a musical organ pipe of a partieular length resonates to a particular pitch, Such eavities are formed of copper walls for high eletreal and thermal conductivity. An electric current 1 flows on thece inner walls, moving electric chargo from one eavity end to the ether, a6 ‘hovwn in Figs. 16, 17, and 18. ‘These end regions of dense electric ‘charge are central ia both klystron and accolerator structure operation Deca they give rise to the intense "E” ies along the axis of the cavity asin Figs 16, 17b, and 18. ‘The magnetic" field pattern of Figs. 16, 17, and 8 tha exists inthe cavity will be omitted in thei lustrations which follow, since they are unimportant for our purposes. "The clectrie and magnetic folds, eurronts and charge distributions that exist in a cavity have a complex dependence on time and have been separated arbitrarily in Figs. 16,17, and 18a, bande, for elarty. ‘The polarity of the electric charge and current, and the "E” and "H" field directions reverse twice each microwave cycle; thats, six bil lion times a second! ‘The patterns of Fig. 16 and 17 are one-half ele ‘apart in time, In order to take advantage ofthese intense "E” Fields to build klystron oF an accelerating structure, cirelar openings on ais at the cavity ends are cut as shown in Pig. 18 20 that electron Iheams ean be introduced to interact with these fields. The electron beam current passes through these openings along the cylindrical aris 2. The large cavity wall currents I should not be confused with the eleevon beam current which originates from an electron gun in a Ikystron or in an accelerator structure. The arrows denoting I in Figs. 1a, 17a, and 18a point inthe direction that a postive charge cur- rent would flow. The electrons, which in actuality are the charge ear- "ers, low i the opposite direction the eneruy transfer from a static, and then an alternating, field to an electron transported between two conducting plates was studied. Recall that in one diseetion of the "E” eld energy 4s transferred to the electron. An electron travel th clectun to the "E" fleld. This latter phenomenon willbe examined in 2, The cre care (creat Lele" ld and gai Perna cr layne iy The eta ere Sie ic rh th nar By ianig tne vic ncn Cost pendrin et u ey pote Te Fear 12. Cc enn mire vy with ly apni af hat ho inee eee cei merr ne ee eee els more detail, It provides the basis for the operation of bath the klystron and magnetron. 6b. The Klystron ‘The elementary lystron, depicted in Fig. 19, is a microwave am plifer tube Uhat makes use of two cavities ofthe fype illustrated in Fig. 18. The erose-ection drawing shown in Fig. 19 is a view that con- {ains the cylindrical Z axis of the cavities similar to the view shown in Fig, 18. On the Tet isthe eathode, the source of electrons forthe Inystron, which is given a negative pulse of voltage. his accelerates ‘lectrons into the first, or buncher eavity, as itis called. The buncher tavity is energized hy very low-power microwaves which set up alter- "fields across the gap between lft and right cavity wall ‘The "fields vary in time, as shown in Fig. 19, Recall that it is the negative “E" field that aceelerates the electrons. Those electrons ‘which arrive early in the micro ‘at times between points a red. The velocity Gt those electrons arriving at time "by" when tho "E’ field is zero, is hot affected. Electrons arriving at later times, between points "band are speeded up by the negative "E feld. This process is elle ve locity modulation, since t alters the velocity but not the average num- ber ef electrons in the beam and enuses the eleciren stream to be formed into bunches, The drift tube connecting the two cavities pro- vides the distance aleng which the electrons moving with different ve- Tocities merge into discrete bunches as shown "The second, or catcher eavity, is resonant atthe arival frequency of ‘the bunches, As the electron bunches leave the drift tube and traverse the calcher cavity gap, they generate a retarding "E" field by indue ing charges on the ends of the cavity and thereby initiate an energy conversion process. By this process, muuch of the electrons kinetic en trny af motion is converted ta intense "” Gelds in the second cavity treating microwave power whichis used to energize the accelerator Structure. The residual heam energy that is not converted to the mi ‘rowave power is dissipated as heat in the eletron beam collector on the far right, and the heat is removed by the water cooling system. The beam callector of high-powered Kiystrons is shielded with Tend to at- tenuate hazardous x-rays ereated by these stopped electrons. Such Inystrons have three ta five cavities and are sed with high energy li- hats, ey 18 MeV and above. ‘The additional eavities improve high fcurrent bunching and inerease smplifcation. ‘They ean provide a tremendous (e., 100,000:1) amplification of microwave power. The Iiyatron is located inthe stand as shove in Fig. 15 Fig. 20 illustrates « 3-dimensianal cutaway high power klystron which produces about § MW of peak power and is similar to Uhat used BR se 1, Cyne conan avi wit th same play ae Fge 17, ta th Soe ple nth end tb vy: The efron th sae ‘hangs a SST WN igure 19 (Crone sein dang fn amestrytwo-ly Kston abe wed Sctownre pam hwo eatne are 2m ela) sacs ‘ike tao own PiitTie ned ge dnt openen oe snerbetomtonc the ensue lone othe athe) Di [line tht fh tor uchreoviyThe Tis ay sha (Fics the type arte forneresiagie{forthe Clinae 18, ‘The electron gun (cathode) ofthe tubo is atthe bot. tom. ‘The center section contains four amplifying cavities separated by drift tubes; the upper section consists of the water-coled collector ‘and eutput waveguide, This kystron is about one meter in length and Sits atop an oil-filled tank with its eathode-eleetron gun portion sub- ‘merged to provide the requisite electrical insulation (see Pig. 18). The cathode is pulsed with a negative voltage of about 120 kV. ‘The four tavities each have tuning adjustments (Pig. 206) that provide small changes in cavity dimensions, bringing them to the correct resonance frequeney of operation (some kiystrons are pretuned at the factory). The buncher cavity nearest the eathode (Figs. 20a and b) is energized from a low power microwave source, Cylindrical current carrying ails, not shown hero, surround the eavities and drift tubes and pro- vide a magnetic field to confine and focus the electron beam travers ing the klyetron along the axis, ‘The rectangular waveguide conducts ‘the mierowave power pulses out ofthe tube from the output cavity to the aceclerating structure 6c, The Magnetron ‘The magnetron isthe microwave source usually emplayed to power lower energy Tinacs, typically 12 MeV or less, but occasionally as high as 20 Mev. Like the kiystron, itis « two-lement tube o diode with a eathode and anode, ‘The magnetron ig usually a less costly (hut {less stable) microwave power souree than the kystron. The magne- tron shown in Fig. 21 has eslindrieal geometry (circular in cress- section) As shown in the eireular cross-section of Fig. 2 the central cylindrical cathode is surrounded by the evacuated drift space and then by an outer anede having twelve cavities. The eylindrial ca thode is heated by an inner filament connected to each end ofthe ey inder, one end of which can be seen in Figs, 218 and b. Circular ge ometry is characteristic of the magnetron; Iinear geometry is charac: teristic of the kystron. (Contrast igs. 19 and 20 with Figs. 21 and 22) "Fig. 22 isa eros-section made by euting a slice at mid-depth, paral Jel to the surface shown in Fig. 21a. A statie magnetic field, H, is ap plied perpendicular to the plane of the erost-seetion shown. In adai- ton, a pulsed electrie field, Bp, directed radially inward all round, is applied between the central cathode and the segmented anode that includes twelve cavities arranged peripherally on the outer circular wall ‘The electrons emitted from the cathode are aceolerated by the pulsed clestrie ld, Ep, toward the anode across the evacuated drift space be- tween cathode and anode. ‘The accelerated electrons induce an adai- ‘tional (+,-) charge distribution shown on the anode poles and an elee- trie field, Bm, of microwave frequency between adjacent segments of B Ferg ry to nr et fe sa fe lr Soa atone har eetane ‘DEaTeitskartesad iy phe een teen eS ee a ‘Gen the ops by the Seen ena ned or eating he ct). Two wea ‘Sing ot yn he bt cosmos pe eo rar ta Pu igi cvacn n ce) The re ‘eau A fanning kh onthe =the anode (8 Fig, 22) n a manner simslar to that in the entcher envi ty ofthe klystron, In addition, the magnetic fel, H, imparts a ies lar are component to the electrons’ motion. "Thus, they move in com: plex spirals, 5, under the combined influence of Ep; the magnetic field, Hy and the induced mierowave electric field, Em. In the pro cess, approximately 60 percent of the kinetic energy of the eleetron beam is converted into microwave energy. Magneteons almost in- variably function as high-power eseillators; that is, originators of mic ‘rowave power, but kiystrns usually operate at amplifies driven by {low-power oscillator, However, ifene feeds back a small portion of the output of a Kiystron to ite first cavity, ib can function as an oscillator, “The power output of magnetron and klystrons is measured in thou sands of watts (LW) or millions of watts (MW). ‘The watt isthe unit of ‘lctrcal power; that is, the rate at which eletrcal energy is expend fed, A household electric iron or toaster consumes about 1 RW of ele tical power. ‘Typically, magnetrons that operate at a frequency of ‘3000 Miz (corresponding to a 10 em wavelength) previde 2 MW peak power outpat during a burst of radiation, although 4 MW ta 6 MW ver- sions are available at increased east. The magnetron need only be en- frgized for one ane-thousandth ofthe time to provide the usual short Dburets of radiation, ‘Thus, Use magnetron shown in Fig. 21 operates at 2 MW penk power and 2 kW average power output and is widely used. in medieal Linaes. The Waveguide and Circulator Microwave power is conveyed from the klystron (or magnetron) to the accelerator structure by a system of hollow pipes called wave> feuides (Fig. 15). These are either rectangular or ecular in ervas ection, at shown in Fig. 23. For example, the waveguide between the nd and gantry (Fig. 15) facilitates rotation and involves a short Circular section between rectangular waveguides. Waveguides re: place the traditional electrical wies and cables which are inefficient fn transmitting power at microwave frequencies. Waveguides con- we microwaves hy reflecting them forward off the walls ike a hose or pipe confines water flowing through it. "They are pressurized with Freon or sulphur hexafluoride gas which reduces the possibility of u ‘Sipe funder beaten stb Hage Bald eas ppc oh ‘Shane the tu of ects od a, Akh ewe partly {01 Chiral weveguie npprnsmately 7 em in tside amcters (Coury of Sta fon enor Aserr Cter ir, Caria)lectrical breakdown and thus inereases their power-handling eapac "Two ceramic windows separate the pressurized waveguide from the evacuated klystron atone end and from the evacuated accelerator Structure at the other end, ‘The windows are transparent to the ‘The elreulator (Fig. 15), placed in the waveguide between the Klys- ‘ton and the accelerating structure, acts lke a one-way sign, permit- ting traf to move forward through a street intersection but allowing ‘two-way traffic just beyand the intersection. Reflected microwave ‘power is diverted aside in the circulator and absorbed, similar to the Way traffic approaching the intersection from just beyond it ean be di verted toa side strect. Microwave power is allowed to proceed forward from the klystron and through the circulator tothe accloratar; bat mi- crowave power that ie rflested back from the accelerator structure is ‘prevented from reaching the klystran (or magnetron) where it could Introduction to Accelerator Structures Alinae accelerator structure (sometimes called the accelerator waveguide) consists of a lang series of adjacent, ylindrical,evacuat- ‘ed mirowave cavities and is Ioeated in the gantry as shown in Fig. 15. It makes use of the eavity principles for power generation that Ihave been discussed and applied to Klystrons. Here, however, the ob- Jective isto teanster energy frm the cavity "E” fields to am aceelerat- ing cleeton boom. ‘Typically, medical accelerator structures vary in length from S0em for a4 MeV nit to one or more meters for the high nergy units, "The first fow cavities vary in size, They bath accelerate and bunch the electrons in a manner Ike that of our klystran huncher cavity de seribod earlier. ‘Typically, only about one-third ofthe injected elec. {rons are captured and accelerated by Uhe microwave "B" field. As they gain enerey, they travel faster and faster until Uney reach almost wbthe speed of light, Therefore these Grat cavities are designed to propa sate an "E" field with an inereasing velocity in order to stay in step with the electrons and to further bunch and accelerate them. Later cavities are uniform in size and provide a constant velocity traveling wave, ust less than the velocity of light. Initaly, electrons gain en ‘ergy predominantly by increasing their velocity; later, by an in. crease in their mass since their velocity eannot attain the speed of light. For example, a2 MeV electron moves at 98 pereent the speed of light. Tts mass in motion is almost five times its mass at rest Here, ‘we are invoking Binstein's famous mass-energy equivalence con cept; that i, increased energy of rapidly moving partiles appears as increased mass ‘Accelerator structures are of two types: traveling-wave and stand- ing-wave. The "E" fold patterns behave differently in those struc. tures, and are central to understanding the linaes, First, traveling- ‘wave linaes will be looked at from this "E”feld viewpoint 8a. Traveling-Wave Accelerator Structures ‘A hollow, cylindrical pipe, such as the waveguide used for micro wave power transmission in Fig. 23b, has an "E” field pattern show in the cross-section in Fig. 24a. This pattera travels one way ‘down the pipe from the klystron (or magnetron) faster than the cee trons ean keep up. Hence «hollow pipe would not he usefil for accel erating electrons. ‘These traveling-wave flds are slowed by “loading” the pipe with washerlke inserts called disks as shown in Fig, 24b. Now the wave {guide pipe has been transformed into along series of resonant cay ties. (Compare Fig. 24 with Fig. 18.) When energized, very high “E ficlds which are suitable for electron acceleration (Fig, 20 are devel ‘oped along the axis. ‘The microwave cavities ofthe acceleratar structures are constructed from copper. Copper is used because ofits high heat conductivity which improves temperature contral snd beeause of its high electrical conductivity which reduces power losses. ‘The accelerator structure shown in Fig. 25 consists of a teries of precisely-machined parts washer-ike disks sandwiched between short cylindrical sections, This sequence of disks and short cylinders is assembled on a Tong spindle fora particular length (energy) structure and soldered togedh. rin a furnace. ‘The soldering material isin the form of very thin silver washers, shown at the bottom of Fig. 25. These are placed be- tween each disk and cylinder junetion surface and, when melted, fuse the components together. Once fased, the sections become rigid, ‘vacuum-tight accelerator structure. Higher energies require more cavities and longer structure, Teor Siete tee en oa eae a mises eee ee ah aren psig) Clemo petite heal Re eee ero et, ecified cos naa 2202 62D? rhb ales areore Searcy af lcd Linear Acer Btton Seat Calaria)‘he process is still not finished, however. ‘The structure must be tuned toa single, precise, resonant frequency. Machining of the cay ty components isthe first stop in establishing the corret dimension for each cavity. ‘This amounts to @ "rough tining” and results in crude resonance with most cavities “afEtune." Next, each cavity is “fine-tuned” by mechanically squeezing it to create very stall die mensional changes, perhaps a few thousandths of a cm ‘Then, like a finely-tuned symphony orchestra, they all play the same note. The ‘avites now resonate tothe same frequency and provide optimal en- ‘ergy gain forthe accelerating electrons. ‘As noted earlier, the electrons are captured and bunched on a mov. ing "E” field, gaining energy by traveling instep on the advancing electric wave. AL the far end, the residual microwave power is ab sorbed by resistive material fused to the wall ofthe last cavity, and hone is reflected, Further detail of how this wave progresses appears in Fig. 26. The "E" field along the axis varies smoothly in a sine wave pattern, as shown for three sequential instants of time, and the pattcen moves smoothly from left to right as time progresses, ‘The sol 'd arrows along the axis denote the instantaneous positions of the ‘maximum positive (to the right) and maximum negative (to the left) values ofthe traveling cleetrie wave ("E" Geld). Electrons are acel- erated on the negative portions ofthe "E” wave; that i, just t the right ofthe sine wave crest identifi by arrows directed to the left. In any ‘one cavity, the "E" field maximum reverses direction from time ty to ty (@ halfycle of time) but a given wave crest (direction arrow) ‘raves frward by one cavity from tine tt ta and again from time te tots. From this traveling wave, an electron at a corresponding speed will guin energy in each sucessive cavity. An early prototype travel: ing-wave accelerator structure, cut in haf along its elindrical axi is shown in Fig. 27, Note thatthe buncher section onthe left incorpo rates Targer and variable aperture sizes and more closely spaced disks than the uniform section on the right. ‘The input waveguide a taches on the let (buncher) end, Bunchers in contemporary linaes are significantly shorter in length A boy surfing on a water wave provides a useful traveling-wave analogy in Fig. 28a. Here, he is shown riding the forward edge ofthe crest, moving in stop with the wave traveling ta the right. If he slips ‘backward over the crest ofthe wave, he will just bob wp and dawn asthe ‘waves pass under him and he will move slowly, if a all, towards the right. Similarly, electrons move forward on the front of the advanc ing negative "E- wave or are lost from it (Figs. 28b and o), The water particles themselves just go up and down and do not move forward, yet the wave of maximum water particle height travels forward, Simi lary, the conduction electrons in the cavity walls are confined to a Colerain at dee medals ey tag preted one’ Spare cle aime The dosed owe nate hte“ son snc fo SSL a tae ee ber coin pr eta Teradata cto ceo c teem |Pure 2. Traveling wave prin ( ty marin on a water wae adrang SEDC igi ect scp lr gon veg Siete he mone hae ett wh pear) ore 2, tadng-nve ping aria rdf exit he et) and [etter cr mnogo he kil wave mast te cuenta a ne ‘erst tne ns unger ce te se Pipe 0, Stanigenate date El pater in on lero srr or ‘ia fareard and bck wate mre soma stan aT rat ‘Souter mering nope retusa showin i 50 oreard opp ma teehee trial geass sling wv ar ret‘moving back and forth between walls ofa single eaity, yet the posi ton of the "E” field maximom travels forward asa result of that ‘movement as shown ia Fig. 26 8b, Standing-Wave Accelerator Structures Most present-day medial Tinack are ofthe standing wave type be- cause te accelerator drcare can be mach shorter and theretre, the treatment unit i less bulky than traveling-wave linac of compa bie energy. Standing wave lines operate fomewhat ike the travel ing wave init just dered bt with one shgifeant difference, The "wave varies in magnitude with time in a snuaoiel manner but the patiern remaing statonary slong the axis and does not advance Aik te travling"—F wave or water wave an studied. A god sand ingewave analogy isthe patter of «violin string fed at bath ends ain vibrating up and down to produce a musta nte in the ease of traveling wave neslerstos, microwave power i fed tothe stsueare vi the iat waveguide tthe proximal (electron gun) tnd. ‘The veidual power fs absorbed atthe dttal arget) end of the Structire. In the standing wave aedlerator the microwave power ean te fe anywhere along the length ofthe tructure, benuse the power proceeds in both forward and backward direction frm the inpot aveguide and is verted at both ends. ‘Te incident forward wave reflected backward from the distal end, and the backward wave is ctad forward from the proximal end. ‘There are now two waves! ivancing incident. wave and a refleted wave, ‘These two waves ‘re reflected back and forth from one end ta the other end ofthe accel: erator structure about one hundred times during a five microsecond pulse. The circulator, described earlier, stops reflected power from reaching and detuning or damaging the klystron or magnetron. Fig. 29 shows the "E field maximum values, denoted by arrows for ‘hese two waves at three sequential instants in time t,t, and t3. The forward wave erests (instantaneous positions denoted by arrows) ‘moving tothe right advance one cavity length during the time inter val from ¢1 to t2, 12 to t3, ete, Similarly, the backward wave erests ‘move atthe same speed tothe let. These sequential movements ean he seen by examining each of the two patterns of arrows at the three times. Here, the sine wave "E” eld patlerns have heen omitted and attention is confined to the wave creste denoted by arrows. ‘The effective "Efe, in accelerating the electron beam, is the sum ofthe forward and backward waves, as shown in Fig. 30." Its magai- tude, assuming 100 percent reflection and no losses i double that of cither the ferward ot backward wave when the fields are in the same tireetion. But ite zero when the fields added are in opposite direc tions. The effective "B" Feld exhibits « sinusoidal variation with »distance along the accelerator structure as shown in Fig. 80, The ‘exes of the sine wave patter oscillate up and down with the progres: sion of time, Note that every other cavity ofthis standing-wave structure in Fg. ‘0 has a zero "E" field at ts center at all times, at times {1 and (3 be: tause both the forward and backward "E’ fields are zero, and at time (2 because the forward and backward "field are equal in magni tude but opposite in direction, and cancel completely (eee Wg. 29). ‘These zero "E” field cavities are essential in transporting microwave power but do not contribute to electron acceleration, Their role is to transferor couple povter between accelerating eavities, Because they play no role in acceleration, they ean be moved off-axis and the length fof the structure ean be shortened Fig. 31 illustrates how the shortened, side-coupled standing-wa structare evolves from the standing-wave structure of Fig. 80. First, every other eavity of Fig. 3a, which couples power between accelerat- ing cavities, Is shortened in length as in Pig. 31b, Next, they are ‘moved off-axis as in Fig. 3le. and finally, in Fig. 41d, placed on. temating sides of the axial aecclerating cavities. The spatial "B° field pattern shown below each sequential accelerator structure fs for the same time in the mierowave evel. In Figs 26 and 28b and c, the 7 Tour cavities per wavelength 2. At any given instant, only one of four cavities is accel. trating the electron bunch and the ether three cavities re coasting” In Figs. 3le and d, the "E" wave repeats every two axial cavities £0 that, a any instant, half of th axial cavities are accelerating the eee tron bunch, and the relatively lossless off-axis coupling cavities re place half ofthe cavtis ofthe traveling-wave aceleratar; hence, the Shorter length and greater efficiency for the standing-wave design. Fig. 82 iMlustrates in datall how the axial "E” spatial pattern changes in Lime ever a completo microwave eyele for a standing-wave Tinas Contrast the time variation ofthis pattern to that for a traveling-wave Tinae in Fig. 26. Note thatthe "Ele pattern does not advance, but changes in magnitude and direction with time. We can now optimize the cavities along the beam axis for acceleration, and the off-axis coupling eavities for microwave power transport.” ig. 23 is a cut ‘away view of such an optimized standing-wave accelerator structure. This is ealled a bimodal or side-coupled accelerator structure. ‘Two standing wave accelerater structures constructed in this way are shown in Figs. 34 and 35. They are shorter in length than a travel. ing-wave structure for a given energy gain and a given klystron or smajgnetron power Electrons injected into etanding-wave structures, such as those i Tustrated in Figs, $4 and 35, are eapturee, bunched and accelerated in Fo. dn of eal ang ave srt src iar pie eh rut sows te spa el lng the a the ae imei the ‘igre 32 aegatl kat the al staniog wave“ el aor fone ll Ikponae cl a ime far th moda srctur opel Fig Ne oe Fed ptrn dosnt sane bt chasing ad Eatin ih oethe first few cavities, just a in the teaveling-wavo accelerator, They pss through the following eavitice during the "E” wave's negative Excursion and are accelerated (recall that electrons are actelerated in the opposite direction of E)- During that time, the "E" wave ofthe next fdjacent cavity is positive and electrons are not accelerated init However, as th electron bunch erases the boundary between adjacent cavities, the "E” wave in the next cavity starts its negative exeursion land the electron bunch is again accelerated, Each eavity accelorates Cletrons only when its "E" field is negative. ‘This process continues ‘until the electrons acquire their final energy. Dual X-Ray Energy Mode Linacs In recent years there has been a move toward use of dual xray ener- provide a 6 MV xray mode, an 18 MV x-ray mode, and an electron mode with energies of 6, 9,12, 15 and 18 MeV. For patients benefiting from trestment ia more than one mode, greater precision of patient poitioning ean be obtained because the patient does not have to be Imoved from one tretinent couch and treatment room to another when Feceiving radiation. ‘There are also cost savings in having the full ‘ange of radiation modes within only one treatment room and ma- ‘chine instead of two, such as for radiotherapy departments having ‘modest volume, Dual x-ray energy mode linacs have become availa- ble using either a standing wave er traveling wave accelerator 9a, Standing Wave If, in order to reduce beam eneray (eg, fom 18 to 8 MeV), the mag: nitude of the accelerating "E” field is reduced in the second portion (output end) of an unmodified standing-wave accelerator structure, the magnitude ofthe "E" field drops correspondingly inthe first por tion (gun end), Similarly, i the phase of the sine wave "E” field is ‘hited in the soeond portion, it shifts equally in the frst portion. Be- fause the RF power fs reflected back and forth in a standing-wave Structure, the first portion senses and adjusts tothe field in the second, fy mode lnacs in radiotherapy. For example, such a machine might Sort” and vice versa, Ifthe ampltade of Une "E* feld was correct a Page 34, Canny fe standings nae care, Elect tino eur of For 3, Guta fs ino eeu nd we mtr ate Heed ar cymante ody the ng ‘ant (Casey of Lan {THY inate ev ong ecu having re celerniog enc The np ee ‘pidbinen tet the caren cs nh od ea pr ‘Sey sent arte era et nae core ‘aren hao.a eT RRR PN in the first portion (for optimal capturing, bunching and positioning of eleetrons injected from the electron gun on the "E” wave erst for ‘scceleration through the remainder of the structure) eg 18 MeV, then the amplitude of the "E” field ie reduced for acceleration to e. 6 ‘MeV. In present dual xray energy linac there are two fundamental ly different ways ta modify standing-wave aceclerator structures to climinate or reduce this problem of atherwise inearrect electron eap- ture and bunching and positioning in low x-ray energy mode 1). Change the ratio of RF power fed to the first and second portions of the standing wave accelerator structure. ‘This ean be done by use of compact energy switch in a side cavity located between the first and fecond portions. In ene position of the energy switeh, the side cavity provides high coupling between the first and second portion, creating high amplitude of "E" field in both portions of the aceelerator struc- ture for high x-ray energy mode. In the second position of Uhe energy triteh, the side cavity provides low coupling, creating low amplitude {Efe inthe second portion ofthe aecelerator structure for low x ray energy mode. In either position of the energy switeh, the same famplitude of" Geld is maintained in the frst portion af the acceler Stor structare in order to maintain optimal capture and bunching of the injected electrons from the gun, positioning the reslting bunch on the erest ofthe "E" wave in the seand portion ofthe accelerator struc- ture, This results in an elostron beam with a nerrow energy spreed fand stable energy, hence high transmission through the bending ‘magnet and minimal leakage radiation from electrons lost before ‘Teaching the xray target. This provides high dose rate and a stable x= ray beam in both low and high energy modes. Tho energy switch em- ploys.a moving part, « plunger which was unrlisble sn some early machines. Instead of an energy switch, a high power microwave cir- ‘uit ean be used, employing a power divider and a phase shifter. Such ystems are quite bulky and empley many moving parts. 2), Use oa broad band buneher in a standing wave aceclerator struc ture, In the fret portion of such an accelerator stracture (the bunch fer), the cavities are made very short. Also, the coupling slats to the Side cavities may be small to reduce the amplitude of the "E” Feld in first portion. ‘There is no energy switch, so Uhe amplitude of the fold is one value for high energy x-ray mode and a much lower value for low energy xray mode, throughout the accelerator structure. ‘Because the initial eavities are s0 foreshortened, the electrons in- Jeoted from the gun are captured and bunched around a position very far forward ofthe crest ofthe accelerating "E” field sine wave. lowing this bunching section there is one especially long cavity. In ppssing through this eavity the electron bunch slips backward relative to the field sine wave to near (ot not on) its crest, for acceleration 2 ‘through the reat of the accelerator structure; ahond of tho eesti a high "E” feld for high x-ray energy mode; behind the crest in a low "E” field for low xray energy mode. This technique avoids use of me Chanically moving part, namely the plunger in Uhe energy switch However, itis wasteful of RF power, requiring & higher power Klys ton or magnetron, and the offerest acceleration produces an output beam with larger energy spread and greater energy instabilities. ‘This makes it more dificult to obtain high transmission of the elec tron beam through the bending magnet to ensure high dose rate at- ‘ened fully to the corners of large fields in low energy x-ray mode, with stable dose distribution overall gantry angles. 9b. ‘Traveling Wave In traveling-wave accslerator structures without RP feodback through an externa citeuit, the fist portion docs not sense the field in the second portion because the wave travels only forward. The ampli tall ofthe accelerating "E” eld ean be changed in the second portion of the accelerator structure without significant effect on the capture land burehing properties of the first portion. One way of producing a downvard taper of Uhis"E Geld from first to second portions is by beam loading, simply increasing injected beam eurrent from the gun ‘and keeping the klystron or magnetron power constant. Because the [RP power is being transferred to the high curren eletron beam, a pro [ressively decreasing fraction of the RF power flowing through the tecelerator structure is left to produce the "E” eld in the cavities of the second portion. Also, the phase of the "Eid sine wave can be tw pered from fst portion to second portion, simply by changing the fe- {quency of the hystron or mametron; the electron bunch then slips in hase over the “E” fleld sine wave, receiving less than maximal ac feleration, As pointed out in Section 8b, traveling-wave structures fre much longer than standing wave structures for the same input RF power, beam energy and beam current. Such long aceolerator struc tures for dual xray mode accelerators ean be accommodated more casily ina drum-type gantry because the accelerator structure ean project through the dram bearings which support the rotating gantry from the stand. External RF feedback from second portion to first por~ tion is used for some traveling-wave structures in order to improve frequency stability (eo Uhat a magneteon can be used in a high energy accelerator) and in Uis respect the first portion tenses the field in the ‘second portion. Variable eoupling is used in such feedback cireuits to maintain the same sceclerating “E"feld in the frst portion both in high ray energy mode with light beam loading and in low x-ray en ‘rfy mode with heavy beam loading, ‘Because the frequency and beam stability of traveling wave struc a ea‘ures and magnettons is inherently lest stable than standing wave structures and klystrons, such linac designs rely more heavily on loctronie feedback, suchas with computer lock-up table, to maintain treatment beam stability, 1 0 Bending Magnet ‘The electron beam leaving the accelerator structure continues ‘through an evacuated bending magnet system. Tlie deflected magnt- ieally 60 as to either strike a target for x-ray therapy orto ext through the treatment head, va a thin metalic window, for electron therapy. Note the lecation ofthe bending magnet in Fy. 15. "The bending magnet deflects the beam in loop of approximately 270" (Pigs. 46 and 87). ‘This magnet eanfiquration provides desirable achromati focusing properties. As shown in Fig. 36, che lower ene fy component is deflected through a loop of smaller radius and the higher energy component is deflested through a lop of large radius ‘The important property af the achromatic magnet i that tsese compo nents of energy are brought hack together to the same postion, angle and beam eross-secton atthe target as they were when they left the ac- Celeratar structure. ‘The achromatic oeusing property is analogous to fan achromatic camera lens wherein the different colors (wavelengths) of light from the object are forused to the image on the 3mm diameter bam out of the eeleator i rear lation in beam energy will est in a change in the angle ofthe boam atthe target, producing angular x-ray field asymmetry, even though the foal point position stays fixed. To cor: root for this angular dependence on energy, madern magnets are oubly achromatic. ‘The mean energy of the beam can vary without changing the mean position or angle ofthe beam at the x-ray target, hhenee, maintaining symmetry of the treatment Geld. ‘This small x. ay focal spot will help ensure Unat the x-ray treatment fields wil have sharply dafined edges (i, a small penumbra), a feature which is of assistance in treatment. ‘This feature improves uniformity of radia- tion of the tumor, and spares nesrhy eritical organs. Medium and high-energy accelerators employ bending magnets. However, many low-energy units have straight through beams without bending mag a se ith eng re Tei ina pane noha to tha stn (Courteny of Pisa Med ‘het tay, Ve Mp 2135 8S aC, Rerasoe PRD)nets, This is because these accelerator structures ean be made short ‘enough to be vertically mounted and sil allow isoeentrie rataton 1 1 Treatment Heads ‘The treatment head (Fig. 37) contains a numberof beam-shaping, localizing, and monitoring devices. The high-energy xrays emerg ing from the target are forward-pesked in intensity, being of higher intensity along the beam central axis and of progressively leas int sity aveay from i (Gee Fig. 88). The forward: peaked x-ray labo is fat tened to provide uniform treatment field, This i accomplished by the flattening filter, a conical metal absorber, placed on the axis as shown, ‘The dual fonization chamber system samples the radiation beam (x rays or electrons) passing through the treatment head and produces clctrial signals that terminate the trestment when the prescribed dose is given. Two independent ionization chamber channels ensure that the prescribed dose is delivered accurately and safely: one serv- Jing as a check on the other "The field defining light simulates the x-ray Geld and facilitates positioning the patient for x-ray treatment. It provides an intense Tight field, duplicating in size and shape the x-ray field incident on the patients dined by the eaiimatrs or other beam-tmiting ‘Arrange finder light projects a namerical sale on the patents skin to define the source-skin distance (SSD) from 80 em to 130 em. "The x-ray target is retractable and is moved offaxis for electron therapy ‘Additional details of the treatment head beam subsystem for xray therapy are shown in Fig. 8. A primary collimator limits the maxi ‘mum field size or x-ray therapy. The effec of the Nattening filter on ‘beam wnifermity is shown, ‘The forward peaked xray beam has been flatned. Treatment fel size is defined by the secondary collimator ‘onsictng of fur thick metel blocks, often made of tungsten. To help provide sharp edges for treatment feds, the movement ofthe Blocks onfined to ars so that the bioek faces presenta Mat edge tothe beam diverging from the target. They aro adjustable in pairs and, in some & rap A pam B ha igre 38 Beam mbes fos: ray Boum tenetlinaes, provide rectangular treatment fields as lage as 40 em x 40 em ft one meter from the target, ‘The secondary ellimator rotates about the beam axis, allowing angulation of fields. Accessories to modify the emergent xray Geld externally, such as wedges, tissue compense tors, individually shaped spertares and shadow blocks, may be ‘mounted on trays that slide inte slots ofan actessory mount attached {ache treatment head “Additional details of the treatment head subsystem for eleetron ‘beam therapy are shown in Fig. 38. The xray target is moved out of ‘he beam and a thin seattering foil replaces the fattening filter on fans, A rotating carousel facilitate the lator exchange, The seatter- {ng fell spreads out the small, penel-lke beam of electrons and pro- ‘ides a flat uniform electron treatment field. Por electron therapy a “etachable electron applicator i attached tothe accessory mount of the treatment head, Field definition is provided by a removable aperture Tocnted at the end of the applicator elose ta or in contact with the pa tient’ skin. In addition, the secondary x-ray collimator is set to a field size somewhat larger than Uhat defined by the applicator, In Some linacs the small, penil-like beam of electrons emerging from the aceclerating structure is seaned in a television-tke raster pat tem to achieve uniformity over the electron treatment field. Retractable Beam Stopper {In most eases Uhe major portion of Uh treatment beam is absorbed in the patient; the remainder continues on through. This exit Beam, ‘which emenges from the patient, spreads ot (to widths of few meters) tn the walls, ceiling and floor ofthe treatment room. Conerete bar- riers of approximately two meters thickness are needed to reduce the ‘Cray intensity and protect personnel outside the room from these di eet beams. ‘The extra barrier thickness requirement in the region ‘caposed directly by the beam can be reduced significantly by use of a ‘beam stopper (Fig. 40a). ‘The beam stopper, constructed of steel and onerete, absorbs 99.9 pereent of the incident radiation. As a result, tnly the leakage and seatter radiation need be shielded and a concrete Barrier of more uniform thickness for all walls will then be suiMi- lent, thus simplifying room construction and also saving space. Al ‘though use ofa beam stopper reduees barrier Vhickness requirements, gure 38, Beam thse fr lton Beam orp [chat of Universty a Ariss, Tuto, Arca, ol Vorcess to the patient being readied for trentment is more restrited w Teas tenn be retracted asin Fig. 40D. ‘The beam stopper is flly ex tended by motor control price ta treatment and is interlocked to pre ‘vent teestment when i ie not im postion. ‘Te treatment unit Mlustrat- ‘ed in Figs. 1,2, and 15 incorporats a counterweight instead of « beam Sopper and would be installed in a room of sufficient wall thickness to protect personnel Functional Block Diagram and Auxilliary Systems ‘A number of auxiliary systems are essential for operation, contol, and monitoring of the line treatment unit, These systems, together ‘vith the major components described earlier, are shown in Fig. 41; fanctional block diagram, The modulator cabinet and eontrol con sale, shown on the left, are located outside the treatment room; the Stand, gantry, and treatment couch, shown on the right, are inside ‘The medulator cabinet may be placed inside the treatment room in some installations. "The modulator eabinet contains « pulsed power supply, a= shown in Fig. 41, which energizes the klystron and the electron gun whem trig gered by a timing pulse (Fig. 42a) from the control console. ‘The pulsed power supply provides a 120 kY pulse of approximately 5 micro- Seconds duration to th klystron which generates the microwave pow tr, and a similar 15 RV pulse which speeds electrons from the electron fgon into the accelerator structure (Figs. 42h, e, and d). ‘The timing palse rata, which is set by the techaologist, provides a convenient ‘method of varying the linge output dose rate, ‘Blecteons are injected into the structure on axis from the electron gun as shown in the upper left of the gantry in Figs. 15 and 41. The zon is pulsed with a negative 18 KV pulse. As result, electrons enter the cavities with about 18 keV of energy and a veloity approaching ‘one-fourth the speed of Tight, ‘The vacuum system provides the extremely low pressures needed for ‘operation ofthe electron gun, accelerator structure, and bending mag net system. Without a vacuum, the electron gun would rapidly "burn ‘ut, like alight bull filament exposed to air. In addition, the acceler- ted electrons would collide with air molecules, deflecting them and Feducing their energy, and the small, penil-like beam of electrons lc sna of «hgh energy Ber eam medline, Major ity yt ad ittoneens se red. (Cnc 1 a Faure 42. Tining dag showing ier tinelwat relation for tw coun {fief asain Rte th ws ferent shes met a morse lejos ther mised mee‘would be diffused and broken up. The vacuum is maintained by an leetronie Jon pump. It was this later development, more than any transformed the line from s Iaboratory instrument into a practical elinical tol, Earlier aecelerator vacuum systems involved Sibased retary and diffusion pumps which required significant maintenance, "The pressure system pressurizes the waveguide with Freon or sul- phur hexafluoride gas. ‘This is needed to prevent electrical break flown from the high power microwave electric "E” fields ‘Acooting system, providing temperature-controlled water, estab lishes the operating temperature of sensitive components and operatas primarily ¢o remove residual heat dissipated in other components ‘Temperature conte is particularly eritial for the accelerator struc: tare sell. Without i, the series of cavities comprising the accelerator Structure will change dimensions slightly. ‘The effect of this is to "detane” them in the same way a mosial instrament changes its pitch; they are thon ‘offfrequency,” and their acceleration capability Is seriously impaired ‘An automatic frequency sontrol (ABC) system continuously senses the optimum operating frequency of the accelerator structure bo maxi ‘ive radiation output. It wes Una information to “tune” the Klystton br magnetron to this microwave frequency. SSS eaSsSservr An elaborate monitor and control system maintains contol of line operation and patient treatment. It monitors operation to assure prop tr linge performance snd to ensure that the prescribed treatment 1s faithfully delivered ina safe manner. Deviations, depending on their nature and magnitude, wil give rise to fault warning signals or termination of the treatment, when appropriate. ‘The center of this ‘manitor and contr funetion is at the control console with eonnce- tons to all other units. ‘The control console provides status informa- tion on treatment modality accessories in use, prescribed dose and ‘dose delivered, interlock status, emergency off, as well as other data pertinent to linae operation and patient treatment. Frequently, the ‘monitor function is directly linked to the control function and current Salus information ie used in a feedback manner to maintain optimal performance. ‘A multitude of quantitative and procedural checks are incorporated in the contole to assure correct, safe operation. ‘The digital lgie ci tuts used in modern computers are the basis for these checking proc dures, ‘They ean be carried ou ina few seconds and are assessed au tomatially, prior to each treatment. "A counting system, tied tothe dose monitor, terminates the treatment when the preset dose monitor prescription is delivered. An interval timer is act to terminate treatment in the event of dose-monitor fail 8tre. The technologist monitors the treatment both visually and aural 1y. A closed-ireuit TV aystem provides visual contact, and a two- ‘way audio system facilitates instant communication with the patient. 1 A Operational Review ‘The patient is positioned on the treatment couch; the gantry angle, collimator angle, ekd size, and treatment distance are set. Access Fy beat- modifying devies such as blacks or wedges are altached and Positioned. ‘The techaclogict then proceeds ta the control eonsole and presets the controls and dose monitor ta deliver the dose preseription for that treatment field. The technologist must select the treatment modality: electrons or xrays, If electrons are selected, the energy must alap be selected, In typieal medical linac, electrons used di ‘etl for treatment have energies from about 8 MeV to 35 MeV. How. ‘ver, in the care of xray selection, a particular medical linac has ‘only one energy, although it may be anywhere from 4 MeV to 95 MeV. For example, the Clinae 18 allows electron selection of 6 MeV, 8 MeV, 12)MaV, 15 eV, or 18 MeV, and preduces beams of 10 MV x-rays. ‘fore the treatment begins, however, an internal check system is automatically activated which sequentially verifies linae operating parameters for correct values, In many units a method for testing the {lsimetry system ie used to ensure that the prescribed dose will be de- livered. ‘The treatment may also include a computer-based record ‘and verify program, which compares the trestment that has been setup ‘vith record of the intended treatment (Pig. This treatment pro- Seription assessment may include Geld size and collimator angul tion, gantry angle, couch position, the daily dose for that fel, and the preset monitor readings to provide the dase, Such reeord and verify programs identify etap errors prior to treatment so thet they ean be forrected when they exceed a preset magnitude; for example, more than one degree of are. Such programs verify and record exch treated field on continuing, daily bats Uhroughout the course of treatment. ‘Typically, the linac i pulsed several hundred times per second, with the exposure for each treatment field lasting a few minutes, When the "beam on” button is pushed, an elaborate sequence ic initiated, in part, as deseribed by the timing diageam of Fig. 42. Fist, the modulator accumulates energy forthe first pulse of radiation. It »sends out two high voltage pulses in unison: one to give the electrons Teaving the electron gun their frst boost of energy a they enter the ac: cclerating structure (Pig. 24), the other to energize the klytron (Fg 42h). The klystron then delivers the microwave power tothe acclerat- ‘ng structure (Fig, 42e) and, in turn, to the electron beam emerging from the electron gun. Here, the intense "E” fields come into play bunching the electrons and accelerating them ta their nal energy. "The electron beam next traverses the bending magnet and is divet- fed on the rray target, or seattering fi, n the case of electron thera- py. The emerging cone of radiation traverses the two monitor ioniza tion chambers and is further shaped by the collimator and other beant- shaping devices, Fig. 42 summarizes pertinent time relationships for two sequential Darsts of radiation. In this diagram of idealized timing, the linac is plsed every 5 milliseeonds, that is, 200 times per sesond, The timing pulse that initiates each sequence is very shor, and all other pulses are of about 5 microseconds duration. During this 5 microsecond in: terval, 15,000 complete microwave eyeles occur (3,000/user x 5). This ‘microstructure is also preset inthe radiation burst (Fig. 4) but the timing details have been omitted for simplicity Bibliography 14 N.C. Pering. “Electron Linear Accelerators for iy: History, Principles and Contemporary Physice in Medicine and Biology 18:321-554 Developments 973). Karemark, Radiotherapy.” Medical Physi 11(2):105-128, 1984, Kramer, S., N. Suntharalingam, and G.F. Zinninger, Bds. High “Advances in Linear Accelerator Design for Energy Photons and Electrons: Proceedings of an International symposium on the Clinical Usefulness of High-Bneray Photons and Electrons (6-45 MeV) in Cancer Management. ‘Thomas Jefferson, University, Philadelphia, Pa, May 22.24, 1976, John Wiley and Sons, N-¥. (1976). ‘Tapley, Norah duV, Ed. Clinical Applications of the Electron Beam. ‘John Wiley & Sons, N-Y. (1976) The Use of Becton Linear Accelerators in Medical Radiation Therapy: Physieal Characteristics. HEW Publication (FDA) 76 027 1976. wDAppendix Representative Linac Treatment Units Deseriptions-and photographs ofa variety of medical linear acceler ators have been elicited from various manufacturers. The manufae- turer is solely responsible forthe information provided. This scetion is provided for the education ofthe student and isnot an endorsement ‘of any product by the editors or publisher. ‘Varian Associates, Inc. 611 Hansen Way Palo Alto, CA 94303, Varian's CLINAG 18 features a standing-wave accelerator struc- ture. Ie provides a heam of 10 MV x-rays and electrons from 6 MoV to 18 MeV in ive discrete steps. Tt delivers a flattened x-ray beam at a dose rate vp to 500 rads/minute at 1 meter target-skin distance, for field sizes continuously variable from 0 em x O em to 36 em x 35 em. ‘Are therapy is available whereby the treatment is delivered as the gantry rotates slowly Uhrough a defined are. For this modality, pre- ‘laely controled dose rates are programmable from 0.5 rads to 5.0 rule per degree "The electron treatment bearn covers field sizes up to 25 em x25 em at meter at similar dose rates for energies of 6 Mev, 9 MeV, 12 MeV, 15, ‘MeV and 18 MeV. A number of fixed field sie electron applicators fare provided, The accelerator is a 1¢-meter standing-wave structure, ‘powered by a 5 megawatt klystron tube, The isocenter is 130 em above the floor. ‘he treatment couch is equipped with motorized, contin: fously variable speed control of vertieal, longitudinal and transverse Imotions. All gantry and couch motions are controlled from a single hhandeld pendant to facilitate fst, precise setup by one technologist. ‘An electronic check of the dosimetry system is made prior to each radiation, A retractable beam stopper is available as an option. Many hhuman engineering features, which increase its versatility and ease of operation by tesined technologists, are incorporated in the design Varian's newest product development is the C-Series family of ac ‘olerators. Tt is a complete line of computer-controlied accelerators 3 ova CLINAC 2100 Ln esertr‘The Clinae 600C combines advanced micro-processor control with the reliable, straight-through accelerator design used in Varian low- energy machines. ‘The Clinae 2100C is literally two accelerators in one. Its dual x-ray energy standing-wave accelerator provides multi-modality treat- ‘ments with a choice of x-ray combinations from 6 to 18 MV and five clectron beams energies ranging from 4 to 16 MeV or 6 to20 Mev. ‘The Clinae 2500C offers two widely separated x-ray energies of MV ‘and 24 MV, as well as six electron energies ranging from 6 MeV to 22 (MeV, giving you the most powerful and penetrating medical accelera- tor available today. Philips Medical Systems Linear Accelerators 710 Bridgeport Ave. Shelton, CT 06484 Philips Medical Systems manufactures two types of linear accelera tare, They are prefixed with SL and a subsequent number which d single X-ray energy accelerator which may bo set to 4, 50r 6MV, ‘The gantry i of the C-arm type with a 0° bending spec ‘Yometer bending system. The system is microprocessor controled "The SL series is a range of computer contrlled aceeleratars. The series is based on a common design configuration and eomprises the following models all with dual X-ray energies and multiple electron energies. To suit different use requirements the energies are set follows: ‘Model X-ray energies (MV) Electron energies (MeV) Sas +10 %6,8,10,124 15, sus 65 4.88 10,12, 15418 siz 6418 4,6,8,10, 2,15 18420, 5125 635 46,8,10, 12,1, 18 20422 For X-ray energies s number of options are available as altern tives ta those statad. Essential features are: drum gantry construction, ow isocenter, doal foil electon scattering systems, automatic prescription entry, ‘computer control system and ease of service. lectronie components fare mounted on the gantry to give extra space in the realment roam. Pin Modine SLT Linear ela | Phila Mati System SL Sores Liner coasterveral design differences between Phil companies accelerators; the following are of particular interest, ‘Traveling waveuide structure and spectrometer bending system. All Philips aecolerators have a high effcieney traveling waveguide structore for high dose rates and maximum veraaility. The low rae ‘sum requirement leads to easy replacement of vacuum components land rapid return Uo lineal use, The spectrometer type bending sys tems, 00° for the SLTS(S, and °3-in‘ine’ Slalom, for the SL series, give very accurate control of energy. Demountable Electron Guns. ‘All Philips acsslerators are fitted with easily removable electron szuns and have quickly replaceable filaments. ‘This is a major cost fnd time saving advantage when compared with accelerators which require an entire sealed accelerating waveguide assembly to be re- placed following a failure in any of its components parts. 100 em Source Axis Distance -128/118 em Isocentrie Height. Philips accelerators are designed for ease of use. The ow isocentrie height of 125 em above oor level (118 cm inthe cae ofthe SL.75-) en- ables operators to.work at convenient level without the need for stools tor other objects in order to sce patient alignment aids. This fal fctor when trying to improve Usroughput and accuray. “Applicator Accessories. ‘moval. On the SL series, individual endframes may be encoded for tach patient and ean be included fer verification in the patient pre feription. This encoding and verification also applies tothe use of i ‘dividual shadow trays, ‘Automate Wedge Fiter System (SL7S/ and SL series. ‘The miroprocessor control console or computer control systems ‘used with all Philips accelerators enable operators to select the precise wedge angle required by automatically combining a 60° wedged Feld With a normal field By varying the dose with and without the wedge, ‘any wedge angle from 0 to 60" can be abtained without the operator hav- ing to insert individual wedges manually Control Systems (SL series). The contol system of the SL series is computer based and forms an integral part ofthe linear accelerator, controlling both patient treat- ‘ment management and machine performance. ‘The patient prescription, which is stored within the system, includes not only gantry angle, eid size, radiation modality, energy and dose Dut also details of the planned series of treatments which ean be custo. ‘mized to mateh existing department practice. ‘With the prescription stared in this manner, the operator has only to BSdentify the patient to call up the complete prescription. ‘This is auto- raticaly sein the system and greatly assists patient throughput by reducing data entry ‘Verification is a standard feature and only when the patient set-up is in accordance with the prescription, is treatment commenced. "The "Vericord’ option on the SL series incorporates w dose record ing system which provides a hard copy reord af tentment delivery to» finer with postive patient identity whieh ean be read by bar code reader Slalom Beam Bending System ‘The slalom aystem consists of 3 inline beam bending magnets. ‘These are psitoned along the evacuated flight tube earrying the elec- tron beam as it leaves the accelerating wavemuide "The frst electre- magnet acts at an energy analyser and turns the pencil Beam of electrons through an angle of bout 45°. Tt has shaped pole pieces to produce dispersed beam having a spectrum of energies ‘with high energy eleetrons on the one side and low energy eleetrons ‘on the other. “The strength ofthe magnetie eld is adjusted to transmit the desired mean energy electrons. Complete control ofthe energy is achieved by ergy sensors which continually monitor the energy dispersed beam in the high and low energy positions ow ie ‘The second converging electre-magnet roverses the 45° deflection and its ple pieces are shaped to start the focusing action in two ortho: ‘nal directions as the electrons enter the third magnet which direct ‘them into the target or window. "The thd eleetro-magnet turns the eleetron beam through an angle of about 112° and also has thaped pole pieces to complete the two dimen ional focusing action started by the socond magnet, ‘The electrons fare focused on a small area of the Larget approximately 2mm in diameter. ‘The Philips system thus provides very small diameter beam of ‘leetrons which is positionaly fixed and inherently stable Asea Brown Boveri, Ltd. CH.5401 Baden Switzerland ABB's DYNARAY linear actelerators all have the same mechani cal design with a drum-type gantry. The enly difference between them seen from the treatment area is isocentre height, the multi modality models being at 127 em and the single photon energy mode) ft 122 em. The accelerating structures are ofthe traveling wave (ype ‘with replaceable cathode, There are three basic models withthe desig-nations LAG, LAG and LAO. The LAG ie a magnetron driven, photon only linae with an energy between 4 and 6 MV. Both the LAT6 and EA2O are equipped with a kiyston RF souree, the LA16 having asi ile photon enerny and five electron energies and the LA20 dual phaton ‘energies and seven electron energies. ‘The beam bending system in all cases is 270%. The features ofthe treatment head are an advancement on anything previously availa bie. Itis fully motorized snd continuously rotatable in cther dire ton, The distance from the focus to the face of tho head is only 82 em, leaving adequate working space between the head and the isoenter. ‘The maximum field site of 40 x40 em is achieved without any round ing af the corners. Asymmetrical fields are optionally available on ‘the LAG, standard on one pair of jaws to 10cm beyond central beam on ‘the CA20, The basic eapability of asymmetry en both pais of jaws and With a further option of 15 em beyond central beam is available on all ‘model "The head movements, as is the ease with all relovant movements on ‘the accelerators, are prepared fora second verification channel for the ‘implementation of dynamic therapy techniques. An automatic wedge system is standard equipment, permitting any wedge angle between (and 60° to he set. ‘The wedge does not obstruct the light field. ‘The anti-collision system operates eapacitively in the manner of a prox ity switeh and any accessories attached to the head are automat- cally incied in the system, "ABE Dynaray linear acelerators are controlled by a rugged micro processor, which has proved itself n many arduous industrial appli fations and environments. The settings for treatment are entered at the console in two logically arranged tables, one for dose, dose rate and other beam parameters and the second one for the geometrial parameters. The linac status and the operation of interlocks are also fignalled on the sereens. Assisted setup is a standard fality. Geo- ‘metrical parameters are shown in large charaeters on the seen in the treatment room to 0¢1" or 0¢1 er, ‘The Dynaray micro-processor also provides many aids forthe phys: icist and servie engineer. By operating a key-switeh a series of ser- vice Sereens ean he viewed, which provide information on all aspects of linae operation. ‘he linaes are supplied with a flly motorized treatment table, hav ing extremely wide ranges of movement and yet requiring a floor pit of only 30 em.Siemens Medical Systems, Inc. 70 Jackson Drive Cranford, NJ_07016 Siemens produces a product family, Use MEVATRON, unique for its modularity, high-level of structural and component commonality ‘and compactness. Both magnetron and Klystron driven models fea- ture dual photon and electron beam capability. The table below exhib- its the variety of models available as a result of the basic building block approach ‘The 6740, with its electron beams, is clinical workhorse for head, neck and breast treatments and up to 804 or more ofthe typical clini- fal eases. The MD models provide in a single unit at modest price ‘the capability to cover 90% to 95% ofall clinical cases. The KD/KDS models are used in a variety of clinical environments and ean be ‘used to treat the entire spectrum of eases. ‘The product line also features two types of eantral technology, that provide the users fortherchoies and flexibility to achive the best fit to ‘heir particular clinical emphasis. ‘The choice is available of hard- wired, IC-chip control technology or mieroprocessor-based, mult theking operating system that employs instructional code embedded in firmware. The lattr is designed to provide for more sophisticated 6 ‘control functions and the possibility to add new functions, or make ‘changes and upgrades as therapy practice evolves. For ether type, ‘beam performance characteristics are the same, as woll as the modu lar and commonality features across the produc line. ‘Commonality of system logic, operator interface and accessory sys ‘tem give the stinieal advantage tothe Mevatron systom to reduce de lays and errors. The welldesigned and optimized control loge for the aceelerator and couch, as well as forthe control console make pos sible Uhe handling of unusually high daily patient loads, Other fea- ‘tures provided include independently adjustable photon collimators to bbe used as hear splitters, independently programmable radiographic setup low dose rate photon output (or total body iradiation) and mass dose selection for electron beam output, ‘Al Mevatrons use a 270 tiple focusing hending magnet to place a small eam spot on target o seattering fol, and to assure that ts pos tion, size and angle remain stable. Photon beams are prodaced ‘through bremsstrahling production from a thin target. The use of a ‘hin tangot reduces the phaton yield, but provides (with the use of ed ‘tional beam conditioning elements) a beam with higher than typical fverage photon energy, or stated otherwise, with fewer low energy (aot) photons. The result is a build-up profile in the depth dose curve that is consistent on-orofaxi, wih oF without wedges or other woscuss‘beam modifying devices, The same properties also limit the shit of ‘max under the seme conditions and also limit Uhe shit from large to sual Gelds, ‘The profil of the attenuated dopth dose curve is searely ‘ered Blectron beams are produced by seattering twice. A primary fil different for each energy, provides the fst seattering. A fixed, shaped secondary fil placed further downstream scatters the beam ‘agnin, The resul of tis technique is to yield a beam at isocenter that is flat over a large diameter, Inserting the applicator merely Blocks fut the beam without affecting the dopth dose curve characteristics, fand further blacking of the beam (even off-axis) has litle or no far- ther impact. Other benefits of this approach are to reduce energy loss of the primary beam, reduce energy stragaling (which gives a steep falleftin depth dose pre) and to reduce x-ray contamination, 'For both electron and photon beams, as well as for dual photon mod- cls, the energy of the accelerator heam is changed by varying the high ‘lage applied to ether magnetron or klystron. RF power output var- proximately linearly with this change. Injected beam current is ontelled through a grid on the tungsten matrix gun. ‘The correct fombination of RF power, injected beam and bending magnet eur- Tent all controlled through independent pre-set values for each mode, ‘vith the correct pulse repetition frequency provide a controled dose rate for treatment, ‘Dose rate is controlled through a servo system that varies the pulse repetition frequency in way to maintain constant output. Each beam pulse amplitude on target is held constant. In this way dose chamber Tesponse remains constant over a wide range af dose rate 0 th ‘rity and saturation effects donot eur. ‘An array of safety interlocks protects against an improper setup of beat producing elements for any mode selected, and beam sensing interlocks protect against excessive beam even if an improper setup ‘evurred, The dose per pulse and dose rate must remain within nar- ‘ow limits or an interlock willbe aetivated. In edition to beam sym- metry interlock (primarily a protection against positioning errors of sam elements oF beam wander), « beam flatness interlock protects, ‘against a variety of effects, such at incorrect energy, incorrect la taning filter, inorret scattering fil, or incorrect mode. ‘During operation, the real-time operating parameters of the accslor- tors can be remotely monitored through a phone line modem eonnec tion, ‘Service personnel can observe performance from service offe- fe In addition, extensive interlock, Lime-average and shape-average {information are stored and accessed by phone, This service tool is ‘available on all Mevatrons (Movanet) Bach Mevatron ean be equipped with one of several types of averification and recording systems which have different levels of Capability ranging from essential functions to sophistiated computer based syatems. ‘The digital verification system is « microchip based system that ean store and bo used to verify approximately 300 patient fatups. Its aperation is simple and rapid, yet provides safeguards against treatment setup errors. Optional equipment extends its per. formance to recording and other useful features. The Mevemstic 3 is 1 sophisticated minicomputer based patient data base management system capable to store up to 2000 patient files, provide data links ‘among several Mevatrons and external data systems (through DEC- INET) in addition to baci veriiation and recording functions. ‘The Siemens treatment couches, ZII and ZIV, are standard clinie workhorses that are designed to assist the technologist in the many complex sotups used in elinical practice. Their wellconceived de- ‘sign speeds the work and reduces the stress placed on the technologist in-a busy dln Finally, Siemens has produced an accelerator, the ME, designed specifically for intraoperative applications. It is a wall-mounted, ‘magnetron driven accelerator with an electron heam energy to & ‘MeV. Tis designed to be mounted on vpper loos in operating roms, requiring litle epace and minimal room shielding. A unique design is used to place the electron cone in the patient in a desired position and angle, secure it tothe table and then move the patient, cone and table under the accelerator and postion and align the accelerator beam with a system of laser light. This speeds the process and be saute there it not a rigid connection fom patient to accelerator, the Fisk of injury during the “docking” procedare is eliminated. GE Medical Systems P.O, Box 414 Milwaukee, WI 53201 ‘With tho acquisition of CGR in 1987, GH Medical Systems expanded to:meet the needs of the radiation therapy community. The fll range of products currently available has been develeped from the years of experience gained by CGR-MeV in the field of particle accelerators, CGH-MeV piancered their application of high energy x-ray and elec- ton medical linear accelerators in the treatment of cancer with the Sogittire™ in 1967. Sagitaire with 12 and 25 MV photon fo electrons are still in clinical use today; however, langer in production, ‘Today, GE-CGR continues to manufacture a full range of radiother- ‘apy systems, including the Saturne 4™ and Orion"™ series of linac 8 ‘sm ben 6 od 1830 ead clon ba fT‘High Bnergy Capabilities ‘Wall-mounted, Satume family of linacs are usefl for a broad spe trum of treatment challenges, Optimized use of a double accelerating (Standing wave) section enables the working energy points. The streamlined magnetron powered Saturne 41 provides the user with to ‘photon beams from 6'to 15 MV and 8 electron beams from 6 1018 Mev." ‘The Seturne 42, 4 medium range klystron powered accelerator, pro- vides users with 2 photon beams from 6 to 18 MV; and 12 electron beams between 3 and 20 MeV. The high energy, klyeiron powered Sat- ‘ame 43 provides 2 photon beams from 6 to 25 MV and 16 electron beans from 8 0 15 MeV. ‘Bach Satarne system offers a numberof capabilites designed to for ther extend its linial utility; for example, clockwise and counter ‘lockovise photon and eleetron are therapy, multiple mieroprocessar- ‘based contol eonscles and automatic pre-tetup are standard. "The Saturne series provides users with eleetron and photon beams meeting exceptionally high standards of homogeneity and purity. lowing Ge rie carn om the Pod ond og Adminratinn (DA) ll {Secon Sch FDA harance nn wy oes FDA approval ef the devi, ‘The 270" achromatic beam path and the use ofan automatically ad- justed energy slit provide excellent electron energy definition, An ‘optional high dose rate of 1,000 pin. is avaiable. “Other key features ofthe Saturne 42 and 43 include: Irradiation Fields. Sature series linacs offer exceptionally large, tunelipped treatment fields; the fixed pre-ollimator defines a 56 em ‘diameter circle at 1 m from the target. ‘In photon mode, the Satumne 42 and 43 provide continaously variable, ‘unclipped fields of up to 40 x40 em: in electron mode, up to 30x 30 mn, ‘via two paire of trimmers on the photon jaws Photon Mode. A single, internal wedge filter, intograted with the ‘beara limiting device, permits automatic wedge angles of up to 60° for ‘maximiom Fields of 40 x 20 cm. Electron Mode, The combination ofthe double fel principle for Toy ‘energies and the stanning procedure for medium and high energies maximizes the advantage of both techniques; excellent homogeneity ‘ind minimum photon contamination over the available range of elee- ‘ron energies are the results Dosimetry. To promote symmetry, homogencity, high and low dose tutpat end offset of eumulated doce rave, Saturne linacs emplay two Separate, sealed chambers associated with tw independent dosimetry channels 2 | ‘the Satrne 41 proc dei here wl Bosom commer aval nly feBeam Limiting Device (Collimator). ‘The beam limiting system works in both symmetrical and asymmetrical mode, Asymmetry possible on one pair of jaws up tothe central axis ofthe field in both photon and electron modes Light Simalation. To permit esincidence between the light feld and ‘the radiation field, a lamp housed in the target bar takes the place of the target during light simulation. Commands in Treatment Room, A newly designed control pendant allows all eometreal parameters to be set manually or automatic ly in the treatment room. A monitor within the treatment room pro- Vides the necessary display. All commands for the couch are also on the control pendant. Control Console. ‘The ontralconcole has as is principal function the dialogue between operator and unit, as well as maintaining control of ~ goometrie and dosimetric treatment parameters beam quality control = safety device management ‘Two ather computer functions are also included, one for physics, r- soarch and testing, and one for technical adjustments and mainte: rnanee, In addition, the Sineer™ treatment management tystem can be connected to the control console, Low Energy Alternatives. GE-CGR alao offers a series of single photon linear accelerators for low-energy applications in space limited environments. ‘The Orion and Orion 6 are housed in one of the smallest lina structures available, and thelr surface-mountable ‘antries require only a shallow eouch pit Both systems are magnetron powered. The Orion linae supplies a single photon beam, with 64% (22%) of the dose at 10 em: Uhe Orion 6, a ‘Single photon beam delivering 67.7% (22%) ofthe doe at 10 em 1m addition, both systems offer many features of far larger inaes, including the industry’ largest unclipped treatment fields; continu: ously variable fields of up to 40 x 40 em; symmetrical and completely asymmetrical collimation; variable penumbra; are therapy; and ‘computerized controls. ‘The Orion and Orion 6, with miroprocessor- based eontrol consoles, offer presoleet and free select: modes to streamline operation and ae ‘ommodate new techniques as they evolve, 0Appendix Specifications of Radiotherapy Linacs ‘The table on the following page Mustrates a partial list of specifca- tions for eontemporary radiotherapy lines. All linaes listed operat at S-band frequencies of approximately 4000 Mile corresponding to a free space wavelength of about 10 em, ‘The accelerator structure nota- tion TW stands for traveling-wave and SW stands for standing- wave design. The specifations of energy for electron beams vary land, hence, may aot be comparable. 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