Beam Modification devices

in Radiotherapy
Dr Susmita Sadhukhan
Dr Anirban Halder
IPGME&R
Contents :

What is beam modification?

Why is it needed?
Type of beam modifiaction devices
What are block,wedge and MLC and their
application in modern radiotherapy
Defined as desirable modification in the spatial
distribution of radiation - within the patient - by
insertion of any material in the beam path.
Why Beam modification required:

 Tight conformation
 Shielding of vital organs
 Shaping of field
 Tissue compensation
 Modification of skin sparing
 Matching of adjacent fields
 Achieve flattening of beam
 Types of beam modification
There are four main types of beam modification:

– Shielding: To eliminate radiation dose to some special

parts of the zone at which the beam is directed.
– Compensation: To allow normal dose distribution data to
be applied to the treated zone, when the beam enters
obliquely through the body or where there is irregular or
sloping surface .
– Wedge filtration: Where a special tilt in isodose curves is
obtained.
– Flattening: Where the spatial distribution of the natural
beam is altered by reducing the central exposure rate
relative to the peripheral
 Devices to be discussed
o Field blocking and o Compensators
shaping devices: o Beam flattening filters.
 Shielding blocks.
o Bolus
 Custom blocks.
o Breast cone.
 Asymmetrical jaws.
 Multileaf collimators. o Penumbra trimmers.
o Wedge filters o Electron beam
o Beam spoilers modification
 Shielding Blocks

• Since radiation attenuation is exponential and

because of scattering, complete shielding can
never be achieved.
• The aims of shielding are:
– To protect critical organs.
– Avoid unnecessary irradiation to surrounding normal
tissue.
– Matching adjacent fields.
• An idea shielding material should have the following
characteristics:
– High atomic number.
– High-density.
– Easily available.
– Inexpensive.
• The choice of the shielding material is also dictated by the
type of beam being used!!
• The most commonly used shielding material for photons is
lead.
• The thickness used depends upon the energy of the radiation.
• For practical purposes, the shielding material which reduces
beam transmission to 5% of its original is considered
acceptable.
• If n is needed HVL to achieve this transmission,then-
½ⁿ = 0.05

• Ideally the blocks should be shaped(divergent) to

minimize transmission penumbra.

• BUT divergent blocks give little advantage for beams

with LARGE geometric penumbra
 Shielding
Beam energy Required lead
thickness
The higher scatter contribution
to the overall dose results in
4 MV 6.0 cm
lower dosage adjacent to the
shielded area in kilovoltage
radiation.
6 MV 6.5 cm

100%

10 MV 7.0 cm
Lesser amount of scattered
radiation with megavoltage
Co60(1.25 MeV)250 KV 5.0 cm
radiation means that the
attenuation produced by
50%
shielding is also more.
4 MV
• In kilovoltage radiation
shielding is readily achieved
by placing sheets of lead on
the surface directly.
• This is necessary, because of
the lower penetrating
power of the beam.
• In megavoltage radiation,
– Thicker blocks used.
– Placed higher up in
shadow trays (15 -20
cm)--
1.Avoids increase in skin
dose due to electron
scatter.
2.Also impossible to place
the heavy block on the
body !!
 Custom blocks
• Material used for custom
locking is known as the
Lipowitz metal or Cadmium,

Cerrobend. Tin,
13.30%
10.00% Bismuth,
50.00%

• Melting point 70°C.

• Density 9.4 g /cm3 at 20°C
(83% of lead). Lead,
26.70%
• 1.21 times thicker blocks
necessary to produce the Bismuth Lead
same attenuation. Tin Cadmium
• Most commonly thickness
of 7.5 cms used.
 Electrically heated wire
pivoting around a point
(simulating the source)
cutting the styrofoam block
 Cavities in the styrofoam
block being used to cast the
Cerrobend blocks.
 CERROBEND BLOCK
Shielding blocks can be of two
types:
– Positive blocks, where
the central area is
blocked.

– Negative blocks, where

the peripheral area is
blocked.
CAUTION TO BE TAKEN :

 Cerrobend should be poured slowly to prevent

bubble formation
 Styrofoam block should be pressed tightly against a
rubber pad at the bottom to prevent leakage.
 Inside walls of the cavity may be sprayed with
silicone for easy release.
Advantage of cerrobend Disadvantages of
block: cerrobend block:

 The blocks are cast from

 Can be easily cast into any
alloys which need careful
shape.
handling as they contain
 Edges focused towards the toxic materials.
target-less penumbra
 The density of these alloys
is usually lower than lead
and therefore they need to
be thicker.
 Manufacturing is time
consuming.
Special Shielding
 Wedge Filters
• Most commonly used beam
modifying device
• causes a progressive
decrease in intensity across
the beam, resulting in tilting
the isodose curves from
their normal positions.
• Degree of the tilt depends
upon the slope of the
wedge filter.
• Material: tungsten, brass.
Lead or steel.
WEDGE ISODOSE ANGLE
• Usually wedges are
mounted at a distance
of at least 15
centimeters from the
skin surface
• Mounted on trays which
are mounted on to the
head of the gantry.
• The sloping surface is
made either straight or
sigmoid in shade
Type of wedges:
– Manual wedges:
1.Individualized wedge .
2.Universal wedge
– Internal or Motorized wedge
– Dynamic wedges
– Virtual wedges
– Pseudo wedges
 A motorized or internal or automatic wedge is a similar
device, a physical wedge integrated into the head of the
unit and controlled remotely.
 A dynamic or virtual wedge produces the same wedged
intensity gradient by having one jaw close gradually while
the beam is on. Dynamic wedges are used to achieve any
arbitrary wedge angle in the range 0°–60º.
Automatic wedge filter
• Fixed jaws can be used to produce pseudo
wedges where part of the treatment field
requiring greater dose would be irradiated
using smaller field sizes.
• Virtual wedge (Siemens GmbH) –
the speed of collimator is constant
and the dose rate is changeable.
The smallest opening distance of
collimator is 1 cm. The dose rate
varies for every 2 mm movement of
collimator jaws. The monitor units
appropriate for prescribed dose are
calculated on the base

• Enhanced dynamic wedge (Varian )

– the dose rate is constant and the
speed of collimator is changeable.
The Multiple Asyncronous Parallel
Processing controlled the dynamic
wedge system. The treatment
monitor unit is determined on the
base of Segmented Treatment
Tables.
The following figure shows the
comparison of Varian dynamic and
Siemens virtual wedge of
algorithm.
UNIVERSAL WEDGE
 Same wedge can be used
for all field size
 Center of wedge is fixed at
beam center axis
 Only a small portion is
effective ,unwedged portion
unnecessarily reduce the
beam intensity.
 Simpler to use and more
useful for LINAC
• The width (W) of the wedge
is fixed and important.
INDIVIDUALIZED WEDGE
• Require separate wedge for
each beam width
• Optimally designed to
minimize the loss of beam
output
• Thin edge is alligned with
the border of the light field
• More useful for cobalt
machines.
• Come in one size of 20 x 30
cms (except 60°).
Individualized wedge Universal wedge
• The presence of the wedge decreases output of the
machine.
• That need to be corrected using WTF
• In some isodose charts used in cobalt machines the
wedge transmission factor is already incorporated,
and no further correction is necessary
• For small depths (<10 cms) most of the calculation
parameters however remain unchanged.
• Use of wedge will result in a preferential hardening -
more pronounced in case of linear accelerators.
 RULES OF WEDGE USE
• Wedged fields are generally used for relatively superficial
tumors
• Beams are usually directed from the same side of the patient.
• The broad edges of the wedges should be aligned together.
• The wedge angle choosen depends on the angle between the
central rays of the two beams also called the “hinge angle”
• Wedges:
– Reduce the hot spots at the surface
– Rapid dose falloff beyond the region of overlap.
• Thus the 2 factors on which the wedge angle is choosen are:
– The hinge angle.
– The wedge separation
 Multileaf Collimators
• Multileaf collimators are a bank of
large number of collimating blocks
or leaves
• Can be moved automatically
independent of each other to
generate a field of any shape.
• 40 pairs of leaves or more having
a width of 1 cm on less (projected
at the isocenter).
• Thickness = 6 – 7.5 cm
• Made of a tungsten alloy.
• Density of 17 - 18.5 g/cm3.
• Primary x-ray transmission:
– Through the leaves < 2%.
– Interleaf transmission < 3%.
– For jaws 1%
– Cerrobend blocks 3.5%
• MLC systems may have double focus or single focus leaves.
• Edges may be rounded to ensure constant beam transmission
through a leaf edge regardless of its possition in the
field,though this can lead to significant beam transmission
(20%) when the leaves abut each other.
• In order to allow fast interleaf movement, while reducing
radiation transmission a tongue and groove design is often
used.
• This design in turn leads to some under dosing in the region
of the tongue (17 – 25%).
• MINI MLC:width 2-5mm
• Micro MLC: width below 2mm
Penetration through curved leaves is
independent of leaf position
• Technical parameters that characterize the nce of
MLC are-
1.The maximum field size
2.Width
3.Max overtravel
4.Interdigitation
5.Configuration of MLC with respect to the collimator
jaws
6.Min &max leaf speed
7.Precision of leaf positioning
MULTILEAF COLLIMATOR
• Accessory MLC(add-on):

 high resolution MLC

 Used in conjunction with stereotactic CRT
 Attached to the accessory holder of the t/t head
 Leaf resolution in the range of 1.5-4mm
MLC CONFIGURATION IN THE TREATMENT
HEAD:

1.Total replacement of upper jaws

2.Total replacement of lower jaws
3.Tertiary collimator configuration
 Multileaf Collimators
• The degree of conformity
between the planned field
boundary and the boundary
created by the MLC depends
upon:
– Projected leaf width.
– Shape of target volume.
– Angle of collimator rotation.
• RCI = Treated Volume (inside
95% isodose curve) / PTV
• The direction of motion of the
leaves should be parallel with
the direction in which the target
volume has the smallest cross-
section.
The advantages are: The disadvantages are:
 Time for shaping and • The physical penumbra is a
inserting of custom blocks is problem.t/t of small fields is
not required. difficult
 The hardening of beam,
scattered radiation, and • Island blocking is not
increase in skin doses and possible.
doses outside the field, as • The jagged boundary of the
seen with physical field makes matching
compensators is avoided. difficult.
 Automation of reshaping
and modulation of beam
intensity in IMRT.
 MLCs can also be used to
as dynamic wedges and
electronic compensators
(2D).