Term 2 Aims:

 Radiation Therapy Equipment

 Immobilisation and positioning devices Session 1
 Beam modification and Beam direction devices
 Basic Operations: Session 3
 Megavoltage RT Units
 Cobalt & Brachytherapy units Session 2

Test for term two  first week of term 3

 Face masks with neck- polyurethane or thermoplastic
mask fixed to a baseplate, heads support under head.
Cranial fixation (Stereotactic) – a headring attached to
the patient’s skull by screws.
Non-invasive (Stereotactic) – often based on using a
dentition and cranial mask/cast for patient fixation.

Usually a support under the head and a facial

fixation mask, both attached to a base plate on top
of the treatment couch. Base plate – made of strong
material, facilitate fastening of the facial mask & yet
must minimal attenuate the radiation beam.
Head support – to achieve desired elevation above
couch. Face masks – minimum requirement for
effective mask is that extends from hairline to chin.
Cast could be polyurethane or thermoplastic that is
fixed to the base plate. Biteblock – another system
where the patient bites onto a hardened
personalised impression that is attached to an
external reference system fixed to the base plate. A
tube inserted in the biteblock makes breathing
easier.

Total-body plaster shell

Total-body foam mould (Alpha cradle)
Vacuum bag device + thermoplastic
mask draped over
posterior portion of head

Total-body foam mould – Alpha cradle.

Thermoplastic casts attached to a base plate
Kneeflex – straightens lumbar spine

At iThemba LABS
Protons
Breast board to elevate chest with hand grips and arm
support.
A thermoplastic immobilization mask can be attached to
each side of board.
Total-body foam mould – Alpha cradle or Vacuum bead
bags. .
Linear Accelerator
 Linear Accelerator
Introduction
The linear accelerator uses high-
frequency electromagnetic waves to
accelerate charged particles to high
energies through a linear tube
Components
The main operating components of a medical
linac usually grouped into 6 classes.

1. Injection system
2. RF power generating system
3. Accelerating wave guide
4. Auxiliary system
5. Beam transport system
6. Beam collimation and Monitoring system
Injection System
Electron Gun
Electrons are produced by thermionic emission from a heated
cathode.
Two basic types of electron gun exist:
1. The diode type
Electrostatic fields used to accelerate the electrons in the
diode guns are supplied directly from the pulsed modulator
in the form of a negative pulse delivered to the cathode
2. The triode type
The cathode is held at a static negative potential (typically 20kV) .
The grid of triode gun is normally held sufficiently negative
with respect to the cathode to cut of the current to the anode

the emission of electrons from a heated source

 The injection of electrons into accelerating waveguide is then
controlled by voltage pulses , which are applied to the grid
and must be synchronized with the pulses applied to the
microwave generator.

The electrostatic fields used to accelerate the electrons are Grid used to control the flow of electrons
supplied directly from the pulsed modulator in the form of from the cathode to the anode (plate)
negative pulsed delivered to the cathode of the gun. electrode.
RF power generating system
Microwave radiation used in the accelerating waveguide to
accelerate electrons to the desired K.E is produced by RF
power generation system.
RF system consist of :
1. RF power source (Magnetron or Klystron)
2. Pulsed modulator

Power supply provides dc power to the modulator, which

includes pulse forming network and a switch tube know as
Hydrogen thyratron.
High voltage pulses from the modular section are flat
topped dc pulses of few μs (Microsecond) in duration.
These pulses are delivered to magnetron and klystron and
simultaneously to the electron gun.
Radio frequency (RF) is the oscillation rate of an alternating
electric current or voltage or of a magnetic, electric or
electromagnetic field
RF Power source : Either magnetron or klystron both are device
used electron acceleration and deceleration in vacuum
for production of high power RF fields.
Magnetron:
It produces microwave required for electron acceleration.
Low power operation(3-6MW)
Low voltage(45KV)
6MeV for low power, lifetime comparatively low.(5-8yr)
Variable PRF (pulse repetition frequency)
Magnetron
Device that produce microwaves.
It has cylindrical construction , having central cathode and outer anode.
Space between cathode and anode is evacuated.
Cathode is heated by an inner filament and electrons are generated by
thermionic emission.
Static magnetic field is applied perpendicular to the plane of cross section
of cavities and pulsed dc electric field is applied between cathode and
anode.
Electrons emitted by cathode are accelerated towards anode by the
action of pulsed dc electric field and by influence of magnetic field
electrons move in complex spirals towards resonant cavities,
radiating energy in the form of microwaves.
RF System- Klystron
It acts as a RF power amplifier.
12MeV for high power lifetime is comparatively high.
High Voltage 140k.
High power (7+MW)
Typical 10000 hr life.(6-10 yr)
Electromagnet (solenoid).
Mainly using in high energy linacs
Fixed PRF (pulse repetition frequency)
Klystron
It is a microwave amplifier.
The electrons produced by the cathode are accelerated by a
negative pulse of voltage into first cavity called Buncher Cavity.
The microwave set up alternating electric field across the cavity.
The velocity of the electron is altered by the action of this electric field to a
varying degree velocity modulation.
Some electrons are speed up while others are slow down and some are
unaffected results and this results in bunching of electrons.
As the electrons bunch reaches catcher cavity they induce charges on the ends
of the cavity and there by generate a retarding electric field .
The electrons suffer deceleration and by the principle of conservation of energy
the K.E of electrons is converted into high power microwaves.
Pulsed modulator
The high voltage (approx 100kV),high current (approx. 100A),short
duration (approx 1s)pulses required by RF power source
(Magnetron or Klystron ) and the injection system are produced
by pulsed modulator.
The circuitry of the pulsed modulator is housed in the modulator
cabinet , which depending on the particular linac installation
design is located in a special mechanical room next to the
treatment room or in the linac control room.
 Accelerating Waveguide

Accelerating waveguide is obtained from a cylindrical uniform

waveguide by adding a series of disks (irises) with circular holes at
the centre, placed at equal distances along the tube to form a series
of cavities.
There are two different type of waveguides used in LINAC
1. RF power transmission waveguide
2. Accelerating waveguide
RF power transmission waveguide:
The power transmission waveguide transmit the RF power from
the power source to the accelerating waveguide in which electrons
are accelerated
Two types of Accelerating waveguide
1. Standing wave structure
2. Travelling wave structure
Travelling Wave Stationary wave
Microwaves reflect from distal surface to
Microwaves are absorbed at the end of
produce a standing wave.
the waveguide or exit the waveguide to
Each end of the wave guide is terminated
be absorbed in a resistive load or fed
with a conducting disk to reflect the
back to the input end of waveguide
microwave power.
 Accelerating wave structure

It consist of a copper tube with its interior divided by copper disc or diaphragms of varying aperture and
spacing.
This section is evacuated to allow free propagation of electrons.
The cavities of accelerating wave guide serve two purpose
1. To couple the distribute microwave power between adjacent cavities
2. To provide a suitable electric field pattern for the acceleration of electrons
Electrons interact with the electromagnetic field of microwaves.
Electron gain energy from the sinusoidal electric field by an acceleration process
Accelerating waveguide for intermediate (8-15MV) and
high (15-30MV) energy linacs are located:

Either in the gantry parallel to the gantry axis of rotation

or in the gantry stand
In both cases , a beam transport system is used to transport
the electron beam from the accelerating waveguide to the
x-ray target.
The radiofrequency power source in both configuration is
mounted in gantry stand.
 Auxiliary System
It consist of four systems producing high vacuum in
the accelerating waveguide.

1. Vacuum pumping system: Producing high vacuum in

the accelerating waveguide
2. Water cooling system: For cooling the accelerating
waveguide, target circulator and RF generator.
3. Air pressure system: for pneumatic movement of the
target and other beam shaping component.
4. Shielding against leakage radiation: Producing by the
target , beam transport system and RF generator.
Electron Beam Transport
It is used in transporting the electron beam from the
accelerating waveguide to the X-ray target or to the exit
window for electron beam therapy.
Steering and focusing coils installed on the accelerating wave
guide are usually linked with the electron transport system.
Beam transport system consist of :
1. Drift tubes
2. Bending magnets
3. Steering coils
4. Focusing coils
5. Energy slits
In low energy linac the target is embedded in the
accelerating waveguide and no beam transport between the
accelerating waveguide and target is required .

Bending magnets are used in LINACs operating at energies

above 6MeV, where the accelerating waveguides are too
long for straight through mounting.
The accelerated waveguide is usually mounted parallel to
the gantry rotation axis and the electron beam must be bent
to make it strike the X-ray target or be able to exit through
the beam exit window.
 Linac Head
The important component found in a typical head of a
fourth and fifth generation linac include :
X-ray target
Flattening filters and electrons scattering foils (also called scattering filters).
Primary and adjustable secondary chambers.
A field defining light.
Wedges
Optional MLC
Beam Collimation and
Monitoring
In a typical modern linac ,
the photon beam
collimation is achieved
with two or three
collimator device.
1. Target
2. Primary collimator
3. Flattening filter or
Scattering coils
4. Dual ion chamber
5. Secondary collimator
6. Multileaf collimator
Target
There are 3 types of targets: thin, intermediate
and thick
In linac we use a thick target
Efficiency of photon production in thick target
is proportional to the atomic number Z of
the target material
In medical linac high Z target (eg Tungsten Z=
74) would produce beams with highest
efficiency.
The treatment beam is first collimated by a fixed
primary collimator located immediately beyond the
x-ray target.
The flattened x-ray beam or the electron beam is
incident on the dose monitoring chambers.
The function of the ion chamber-to monitor dose rate
,integrated dose and field symmetry.
Bias voltage in the range of 300 to 1000V are applied
across the chamber electrodes depending on the
chamber design.
The Monitor chamber in the treatment head are
usually sealed so that their response is not influenced
by temperature and pressure of the outside air.
The target to surface distance (that is SSD for 10x10cm
for thin layer in linac) =100cm
Primary Collimator
It defines the largest available
circular field size and is
essentially a conical opening
projecting into a tungsten
shielding block.
One end of the conical opening of
the collimator projecting onto
edges of the target and the
other to the flattening filter
Flattening filter
The photon dose
distribution produced by
a linac is strongly forward
peaked.
To make the beam
intensity uniform across
the field , a flattening
filter is inserted in the
beam.
Made of lead , aluminium,
tungsten ,uranium ,steel
Dual Ionization Chamber
The flattened beam is incident on the dose monitoring chambers.
The monitoring system consist of several ion chamber or a single
chamber with multiple plates.
The chambers are usually transmission type i.e. flat parallel plate or
cylindrical thimble chamber and sealed is used in some linacs
Scattering foil
In the electron mode of
linac operation ,the
beam instead of striking
the target ,is made to
strike an electron
scattering foil to spread
the beam as well as get
a uniform electron
fluence across the
treatment field.
It consist of thin
metallic foil usually of
lead.
Secondary collimator
After passing through the ion chamber , the
beam is further collimated by a continuously
movable x-ray collimator .
This collimator consist of four blocks ,two
forming upper jaws and two forming lower jaws.
Made up of lead or tungsten blocks(jaws) that
provide a rectangular opening from zero to
maximum field size (40*40cm or a little less).
It is projected at a standard distance such as 100
cm from the x-ray source (focal spot on the
target)
Multileaf Collimator
Using MLC’s we can
conform the treatment
fields to the tumour
volume.
The number of leaves in
the commercial MLC’s are
steadily increasing.
Leaves:82,120,160 and
width:1cm and 1.5cm to
6mm is currently
available.
Each leaves is controlled
by computer controlled
motors.
Light localizer
System
A combination of a mirror and a
light source located in the
space between the chambers.
The jaws project a light beam as if
emitting from the x-ray focal
spot.
Thus, the light field is congruent
with the radiation field.
Next time:
Brachytherapy