Rtle Radiotherapy

RADIATION
THERAPY
RICHMOND K. QUILATAN, MHA,RRT

INTRODUCTION TO RADIOTHERAPY
• HISTORY
RICHMOND K. QUILATAN, MHA, RRT
• AIM OF RADIATION THERAPY

• CANCER
• RISK FACTOR
• RADIOTHERAPY STAFF
2
RADIATION THERAPY
• It is a medical specialty that involves the treatment of

MALIGNANT AND BENIGN tumors by the
application of ionizing radiation.
• Often referred to as RADIATION ONCOLOGY
• Began approximately a year after x-rays were discovered in
1895 (JANUARY 1896).
3
AIM OF RADIOTHERAPY
• To deliver a precisely measured dose of radiation to a

defined tumor volume with minimal damage to
surrounding healthy tissues.
• This results in eradication of tumor, high quality of life
and prolongation of life.
4
TUMOR
A new growth of tissue characterized by progressive, uncontrolled

proliferation of cells.
• BENIGN TUMOR
• A simple encapsulated tumor that does not infiltrate adjacent tissue or
cause metastases and is unlikely to recur if removed
• However, if left untreated, some benign tumors can grow large and
lead to serious disease because of their size
• MALIGNANT TUMOR
• One that is not encapsulated, and likely to infiltrate adjacent tissue or
cause metastases , to progress , and ultimately destroy life
5
6
CANCER
• Derived from the latin word for crab

• Like a crab, they "grab on and don't let go."
• Cancer cells can also spread to other parts of the body through
the blood and lymph systems.
• Grow out of control and become invasive
• Are able to ignore signals that normally tell cells to stop dividing
or that begin a process known as programmed cell death, or
apoptosis, which the body uses to get rid of unneeded cells.
7
CARCINOMAS
• The most common type of cancer.

• Begins in the skin or in tissues that
line or cover (epithelial cells)
internal organs.
• Formed by epithelial cells, which
are the cells that cover the inside
and outside surfaces of the body..
8
Carcinomas that begin in different epithelial cell types have specific
names
• ADENOCARCINOMA
• Cancer that forms in epithelial cells that produce fluids or
mucus.
• Tissues with this type of epithelial cell are sometimes called
glandular tissues.
• Most cancers of the breast, colon, and prostate are
adenocarcinomas.
• BASAL CELL CARCINOMA
• A cancer that begins in the lower or basal (base) layer of the
epidermis
9
SQUAMOUS CELL CARCINOMA
• Cancer that forms in squamous cells, which are epithelial

cells that lie just beneath the outer surface of the skin.
• Squamous cells also line many other organs, including
the stomach, intestines, lungs, bladder, and kidneys.
• Look flat, like fish scales, when viewed under a
microscope.
• Sometimes called epidermoid carcinomas.
10
SARCOMA
• Cancers that form in bone

and soft tissues, including
muscle, fat, blood
vessels, lymph vessels, and
fibrous tissue (such as
tendons and ligaments).
11
LEUKEMIA
• Cancers that begin in the

blood-forming tissue of the
bone marrow.
• These cancers do not form
solid tumors.
12
LYMPHOMA
• Cancer that begins in lymphocytes

(T cells or B cells).
• These are disease-fighting white
blood cells that are part of the
immune system. In lymphoma,
abnormal lymphocytes build up in
lymph nodes and lymph vessels, as
well as in other organs of the body.
13
TWO MAIN TYPES OF LYMPHOMA:
• HODGKIN LYMPHOMA
• People with this disease have abnormal lymphocytes that are
called Reed-Sternberg cells.
• Highly curable
• NON-HODGKIN LYMPHOMA
• This is a large group of cancers that start in lymphocytes. The
cancers can grow quickly or slowly and can form from B cells or T
cells.
• If in examining the cells, the doctor detects the presence of a specific type of
abnormal cell called a Reed-Sternberg cell, the lymphoma is classified as
Hodgkin's. If the Reed-Sternberg cell is not present, the lymphoma is classified as
non-Hodgkin's
14
TUMOR GRADING
• WELL DIFFERENTIATED CELLS

• MODERATELY DIFFERENTIATED
• POORLY DIFFERENTIATED
• UNDIFFERENTIATED (HIGH GRADE)
15
WELL DIFFERENTIATED CELLS
• These cancers look very

similar to the surrounding
normal cells.
• It can be difficult for the a
pathologist to tell the
difference between the cancer
and the normal cells.
• Grow and spread more slowly
than poorly differentiated or
undifferentiated cancer cells
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MODERATELY DIFFERENTIATED
• The cells in these cancers are clearly abnormal looking

but they still share some features with the surrounding
normal cells.
17
POORLY DIFFERENTIATED
• These cancers look very abnormal.

• When the cells from a poorly
differentiated tumor travel to
a LYMPH NODES or other part
of the body, additional tests such
as immunohistochemistry may be
required to determine the type of
tumor and where it started
18
UNDIFFERENTIATED (HIGH
GRADE)
• These cancer look completely
different from normal cells
anywhere in the body. Even with
additional tests, it is often very
difficult for a pathologist to
determine where this type of
tumor started.
• Undifferentiated cancer cells
often grow and spread quickly.
19
RISK FACTOR FOR CANCER
• CHEMICAL SUBSTANCE (CARCINOGENIC)

• INFECTIOUS AGENTS
• LIFESTYLE
• MEDICAL TREATMENT
• ENVIRONMENT
20
CHEMICAL SUBSTANCE (CARCINOGENIC)
• Benzene
• Cadmium and cadmium compounds
• Vinyl chloride
21
INFECTIOUS AGENTS
• Epstein-Barr Virus (lymphomas and

NPCA)
• Hepatitis B Virus and Hepatitis C
Virus (Liver CA)
• Human Papillomavirus (HPV)
22
LIFESTYLE
• Food
• Tobacco use
• Physical activity
23
MEDICAL TREATMENT
• Radiation and medicines

including chemotherapy
• Hormone drugs
• Drugs that suppress the
immune system
24
ENVIRONMENT
• Workplace
• Household
25
RADIATION THERAPY STAFF
• Radiation Oncologist
• Medical Physicist
• Medical Dosimetrist
• Radiologic Technologist (Radiation Therapy
Technologist/Radiation Therapist)
26
RADIATION ONCOLOGIST
• Physician skilled in the act

of applying radiation in the
treatment of
malignant/benign tumors
• Prescribed the amount of
Radiation dose to kill the
tumor
27
MEDICAL PHYSICIST AND
MEDICAL DOSIMETRIST
• Performs Dosimetry works,
Calibration, and design
treatment plans by means of
computer or manual
computation of radiation
doses
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END OF TOPIC
BASIS OF RADIATION
TREATMENT PLANNING

BASIS OF RADIATION TREATMENT PLANNING
• STAGING
• DEFINITION OF GOALS IN RADIOTHERAPY

• THERAPEUTIC DECISION
31
STAGING
• The process of determine details about the cancer, such

as how large the tumor is and if it has spread.
TNM Staging System

• A cancer staging notation system that describes the stage
of a cancer which originates from
solid tumor with alphanumeric codes.
32
In the TNM system:

• The T refers to the size and extent of the main tumor.

The main tumor is usually called the primary tumor
• The N refers to the number of nearby lymph nodes that
have cancer.
• The M refers to whether the cancer has metastasized.
• This means that the cancer has spread from the
primary tumor to other parts of the body.
33
WHY TO STAGE CANCER?

• To choose the best method of treatment

• E.g. early cancer are surgically resectable (operable)
• Late cancers are too advanced to be resected,
chemotherapy and radiotherapy may be used
• To assess the prognosis of cancer
• E.g. the 5 year survival for stage 1 is over 90% and for
stage 4 is below 10%
34
PRIMARY TUMOR (T)
It is categorized by the apparent anatomic extent of the disease, which is determined

by the following features:
• Depth of invasion
• The main criterion and primarily consists of the degree of extension into
adjacent structures, such as into the muscle of hollow organs, bone,
cartilage, and other viscera.
• Surface spread
• Consists of determination of the degree of circumferential involvement by
disease for hollow organs, or of regional sub-site involvement by disease for
hollow cavities like the nasopharynx.
• Size
• Tumor size can be related to cell number, tumor age, and anatomic extent.
35
T - CLASSIFICATION
T0 No evidence of primary tumor

Confined to the organ of origin, usually 2 cm in its largest
T1
diameter; localized; mobile
Deeply invading to adjacent structures, including muscle
T2 and ligaments; from 2 to 5 cm in its largest diameter;
localized; mobile or partially mobile
Regionally confined; usually greater that 5 cm but less
than 10 cm; fixed. Critical criterion is fixation, most often
T3
to bone and cartilage, but invasion of the intrinsic muscle
walls, serosa, and skin is also included.
A massive lesion, greater than 10cm in diameter,
T4 destructive, not confined to the region. Invasion into
major nerves, arteries, and veins is included. 36
N - DESCRIBES SPREAD OF CANCER TO NEARBY LYMPH
NODES
N0 No evidence of disease in lymph nodes
Palpable and movable nodes limited to the first station.
Metastases
N1
Are suggested on the basis of firmness and roundness of the
nodes or its size alone.
Firm to hard nodes, palpable and partially movable; 3-5cm in
N2
diameter.
Complete fixation. Invasion extend beyond the capsule, with
N3 complete fixation to bone, large blood vessels, skin ( dermal
lymphatic invasion), or nerves.
Nodes involved beyond the first station. They are in second or
N4
distant stations. 37
M DESCRIBES METASTASIS (SPREAD OF CANCER TO OTHER
PARTS OF THE BODY).

M0 No evidence of metastases.
Solitary, isolated metastasis confined to one organ or anatomic
M1
site
Multiple metastatic foci confined to one organ or system or one3

M2 anatomic site, for example, lungs, skeleton, or liver, with
minimal or no functional impairment.
Multiple organs involved anatomically, with no or minimal to

M3
moderate functional impairment of involved organs
Multiple organs involved anatomically, with moderate to severe

M4
functional impairment of involved organs
38
DEFINITION OF GOALS OF RADIATION THERAPY

• CURATIVE
• PALLIATIVE
• PROPHYLACTIC
39
CURATIVE
• There is a probability of long term survival after

adequate therapy, some side effect of therapy although
undesirable, may be acceptable.
• Goal:
• To definitively sterilise the cancer cells within the
irradiated volume in order to obtain total cure of the
cancer
• Necessary conditions:
• Absence of remote metastases.
40
PALLIATIVE
• There is no hope of total eradication of the tumor, done to

relieve suffering and to prolong life.
• Goal:
• To slow down the progression of already advanced local
tumors or those with remote metastases which cannot be
cured using local treatment.
• To relieve the patient from a major symptom, for instance:
• Pain from bone metastases.
• Hemorrhage syndrome,
• Compression such as spinal cord or radicular compression
41
PROPHYLACTIC
• Treatment of some parts of the body that is suspected of

harboring tumor cell but without any symptoms.
42
THERAPEUTIC DECISION
• SURGERY
• Involves the removal of the tumor plus some surrounding tissues.
• CHEMOTHERAPY
• Uses drugs taken by mouth or injected into the patient’s vein. These
drugs travel throughout the body working to destroy cancer cells.
• RADIATION THERAPY
• Uses photons, electron and other sources of radiation to destroy
cancer cells.
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• IMMUNOTHERAPY
• Type of cancer treatment that helps your immune system fight cancer
• TARGETED THERAPY
• A type of cancer treatment that targets the changes in cancer cells that
help them grow, divide, and spread
• HORMONE THERAPY
• Treatment that slows or stops the growth of breast and prostate
cancers that use hormones to grow
44
• STEM CELL TRANSPLANTS

• Procedures that restore blood-forming stem cells in cancer patients
who have had theirs destroyed by very high doses of chemotherapy or
radiation therapy.
❖Radiation Therapy and surgery are used for the control of localized tumors
while chemotherapy is reserved for disseminated widespread disease
45
TELETHERAPY METHOD OR EXTERNAL BEAM

RADIATION THERAPY (EBRT)

• Radiotherapy technique in which the source of radiation
is at some distance from the patient
BRACHYTHERAPY OR PLESIOTHERAPY
• Placement of radioactive substance or nuclides in or on
neoplasm to deliver cancericidal dose
46
International Commission on Radiation
Units and Measurements (ICRU) Reports

No. 50 and 62 define and describe several
target and critical structure volumes that
aid in the treatment planning process and
that provide a basis for comparison of
treatment outcomes.
• GROSS TUMOR VOLUME
• CLINICAL TARGET VOLUME
• INTERNAL TARGET VOLUME
• PLANNING TARGET VOLUME
47
GROSS TUMOR VOLUME (GTV)
• Is the gross palpable or visible/

demonstrable extent and location
of malignant growth” (ICRU
Report No. 50)
48
CLINICAL TARGET VOLUME (CTV)
• Is the tissue volume that contains a

demonstrable GTV and/or sub-clinical
microscopic malignant disease, which
has to be eliminated.
• This volume thus has to be treated
adequately in order to achieve the aim
of therapy, cure or palliation” (ICRU
report no. 50).
49
INTERNAL TARGET VOLUME (ITV)
• Consists of the CTV plus an internal

margin.
• The internal margin is designed to take
into account the variations in the size
and position of the CTV relative to the
patient’s reference frame (usually
defined by the bony anatomy); that is,
variations due to organ motions such as
breathing and bladder or rectal
contents (ICRU report no. 62).
50
RICHMOND K. QUILATAN, MHA, RRT 51
PLANNING TARGET VOLUME
(PTV)
• Is a geometrical concept, and it is
defined to select appropriate beam
arrangements, taking into
consideration the net effect of all
possible geometrical variations, in
order to ensure that the prescribed
dose is actually absorbed in the
CTV” (ICRU Report No. 50)
52
NORMAL TISSUE TOLERANCE TO THERAPEUTIC IRRADIATION
Organs TD5/5, 1/3 vol TD5/5, 2/3 vol in TD5/5, 3/3 vol in Sequelae
in Gray Gray Gray
Kidney 50 30 23 Nephritis
Brain 60 50 45 Necrosis, Infarction
Necrosis, Infarction
Brainstem 60 53 50
Spinal Cord 50 (5cm) 50 (10cm) 47 (20cm) Myelitis, Necrosis

Lung 45 30 17.5 Pneumonitis
Heart 60 45 45 Pericarditis
Esophagus 60 58 55 Strictures, Perforation
53
NORMAL TISSUE TOLERANCE TO THERAPEUTIC IRRADIATION
Organs TD5/5, 1/3 vol in TD5/5, 2/3 vol TD5/5, 3/3 vol in Sequelae
Gray in Gray Gray
Stomach 60 55 50 Strictures , Perforation

S. Intestine 50 - 40 Ulceration, Perforation
Colon 55 - 45 Obstruction, Fistula
Obstruction, Fistula
Rectum 75 65 60
Liver 50 35 30 Liver Failure

Eye (lens) - - 10 Cataract
54
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END OF TOPIC
CLASSIFICATION OF
EBRT MACHINES

CLASSIFICATION OF EBRT MACHINES
• Grenz Ray Therapy
• Contact Therapy or Endocavitary

• Superficial Therapy Units
• Orthovoltage Therapy or Deep Therapy Unit
• Supervoltage Therapy Unit
• Megavoltage Therapy Unit
58
GRENZ RAY THERAPY
• Uses very soft (low-energy) x-rays

produced at potentials below 20kV.
• Because of the very low depth of
penetration, such radiations are no
longer used in radiotherapy
• For skin lesions
59
CONTACT THERAPY OR ENDOCAVITARY
• Operates at potentials of 40 to 50 kV
• Facilitates irradiation of accessible lesions at very short source
(focal spot) to the surface of the skin (SSD of 2cms.)
• It operates with a tube current of 2 mA.
60
SUPERFICIAL THERAPY UNITS
• The term superficial therapy applies to treatment with x-rays

produced at potentials ranging from 50 to 150 kV.
• This equipment produces a large amount of soft (low energy) x-
rays which can produce severe skin reaction thus, it is useful for
irradiating tumors to about 5mm depth.
• The Source-to-Skin Distance (SSD) typically ranges from 15 to
20 cm.
• The machine is usually operated at the tube current of 5 to 8
mA.
61
ORTHOVOLTAGE THERAPY OR
DEEP THERAPY UNIT

• The term orthovoltage therapy, or
deep therapy, is used to describe
treatment with x-rays produced at
potentials ranging from 150-500 kV.
• Reasonable tissue penetration of the
resultant x-ray beam is achieved with
this equipment, which also must be
operated with filters to reduce the 200 kV orthovoltage x-ray tube used for
soft x-rays radiation therapy, 1938.
62
SUPERVOLTAGE THERAPY UNIT
• X-ray therapy in the range of 500 to

1,000 kV has been designated as
high-voltage therapy or supervoltage
therapy.
• Since the electron attain high
energies before striking the target, a
transmission type target may be
used to obtain the x-ray beam on
the other side of the target.
63
MEGAVOLTAGE THERAPY UNIT
• X-ray beams of energy 1 MV or greater can be classified as

megavoltage beams.
• Although the term strictly applies to x-ray beams, the gamma ray
beams produced by radionuclides are also commonly included
in the category if their energy is 1 MeV or greater.
64
VAN DE GRAAF GENERATOR
• An electrostatic accelerator
designed to accelerate charged
particles.
• Accelerates electrons to
produced high energy x-rays
typically at 2MV
65
BETATRON
• The operation of a betatron is based on

the principles that an electron in a
changing magnetic field experiences
acceleration in a circular orbit.
• The accelerating tube is shaped like a
hollow doughnut and is placed
between the poles of an alternating
current magnet.
• Betatrons were first used for
radiotherapy in the early 1950s.
66
67
MICROTRON
• A type of PARTICLE
ACCELERATOR concept originating
from the CYCLOTRON in which the
accelerating field is not applied
through large D-shaped electrodes, but
through a linear accelerator structure.
• Developed by VLADIMIR VEKSLER
in 1944
68
69
COBALT – 60 UNIT
• Source irradiating ordinary stable Co-59 with

neutrons in a reactor produces Co-60 source.
• The Co-60 source is usually in the form of solid
cylinder, discs, or pellets. T
• The beta decay energy is 2.824 MeV, and the
Gamma rays are produced at 1, 173,210 and
1,332,470 Ev (1.17MeV & 1.33 MeV) energies
with nearly 100% frequency of occurrence.
• Half-life: 5.27 years
• Energy: Ave. 1.25 MV gamma ray
• SAD: 80cm
70
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END OF TOPIC
LINEAR ACCELERATOR
(LINAC)

LINEAR ACCELERATOR
LINEAR ACCELERATOR (LINAC)
• Machine most commonly used for external

beam radiation treatments for patients with
cancer.
• Used to treat all parts/organs of the
body.
• It delivers high-energy x-rays or electrons
to the region of the patient's tumor
• Developed by Wilderoe in 1928 which
accelerate heavy ions. Electron accelerators
was first developed during the late 1940s by
Fry, Ginzton, and Chodorow.
74
LINEAR ACCELERATOR
GANTRY
• The gantry of an external beam radiotherapy

machine moves a radiation source around a
patient
• The gantry is supported by a DRIVE
STAND, which rotates the gantry on a fixed
horizontal axis as the linac revolves around a
patient
MODULATOR
• Provide high voltage pulses to the microwave
transmitter (klystron
75
LINEAR ACCELERATOR
DRIVE STAND
• A drive stand is a large part of a linear

accelerator
• It is a cabinet in the shape of a rectangle
that is attached to the floor within the
treatment room.
• The horizontal axis bearings that the
gantry rotates on are positioned within
the drive stand.
76
LINEAR ACCELERATOR
Parts of Linear Accelerator
• Electron Gun • Ion Chamber

• Magnetron • Collimators
• Klystron • Electron Applicator
• Wave Guide
• Bending Magnet
• Target
• Beam Flattening Filter
• Scattering Foil
77
LINEAR ACCELERATOR
ELECTRON GUN
• It produces electron to be accelerated

• Located in the stand of the LINAC
78
LINEAR ACCELERATOR
MAGNETRON
• An electron tube that is

responsible for providing the
microwave power to accelerator
electrons.
• Often chosen for linac needing
smaller amounts of electron
energy such as 4 MeV to 6
MeV linac
• Magnetron can be used in place of
a klystron.
79
LINEAR ACCELERATOR
KLYSTRON
• Responsible for the microwave power that is used to accelerator the

electrons.
• This process occurs through intensification of present RF (Radio
Frequency) electromagnetic waves.
• The basic description of the operation of a Klystron is that it is a
RF amplifier
• Often chosen for LINAC needing larger amounts of electron
energy.
80
LINEAR ACCELERATOR
RF WAVEGUIDE
• A vacuum tube where the electrons are accelerated

• The structure in which the microwave powered RF electromagnetic
waves are accelerated from the Klystron or Magnetron.
81
LINEAR ACCELERATOR
RF WAVEGUIDE
82
LINEAR ACCELERATOR
BENDING MAGNET
• Component of a LINAC
that changes the direction
of the beam down
towards the patient.
• It bends the beam
towards the target and
produces different paths
for the beam for different
energy needs.
83
LINEAR ACCELERATOR
TARGET
• Transmission type
• Source of x-ray
84
LINEAR ACCELERATOR
BEAM FLATTENING FILTER
• Placed along the path of the

x-ray beam in order to attain
homogenous intensity of the
x-ray beam in the entire field.
85
LINEAR ACCELERATOR
SCATTERING FOIL
• In the electron mode of linac operation, narrow pencil electron

beam, about 3 mm in diameter., 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
86
LINEAR ACCELERATOR
ION CHAMBER (IC)
• The radiation beam is

monitored with an integrated
ion chamber(IC) in the linac.
• This ion chamber consists of
two layers for dosimetry and
one to measure the spectrum of
the beam.
• The beam symmetry is
measured with two sets of
plates in the ion chamber.
These plates measure a tilt in
symmetry as percentage of dose
87
LINEAR ACCELERATOR
COLLIMATOR
• Restrict the x-ray beam to a

desired field size
• PRIMARY COLLIMATOR
• SECONDARY
COLLIMATOR
• MULTI-LEAF
COLLIMATOR
88
LINEAR ACCELERATOR
COLLIMATOR
• Restrict the x-ray beam to a desired field size

• PRIMARY COLLIMATOR
• may be constructed of depleted uranium as this material is
approximately 1.6 times more dense than lead
• Fixed collimator
• SECONDARY COLLIMATOR
• The secondary motorized collimators which greater define
the beam shape are constructed of lead or tungsten
• Movable collimator
89
LINEAR ACCELERATOR
• MULTI-LEAF COLLIMATOR
• Multileaf collimators (MLCs)

which are now in widespread use
in medical linacs consist of two
collimator banks of thin tungsten
'leaves' with each bank consisting
of 40 to 80 leaves (so a total of 80
to 160 leaves).
• This allows each collimator leaf to
move independently under
computer control.
90
LINEAR ACCELERATOR
ELECTRON APPLICATOR
• Electron collimator
• Used to restrict the electron beam to a
desired field size because the restriction of
the primary and secondary collimators are
not enough
91
LINEAR ACCELERATOR
Photon (X-ray) Mode Electron Mode

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END OF TOPIC
SIMULATION AND
SIMULATORS

SIMULATION AND SIMULATORS
SIMULATION
• Is a planning session done before the first external beam

radiation treatment is given.
• It is done to make sure the radiation is aimed at exactly the
same area each time treatment is given.
• Usually done in one session and may take anywhere from 15
minutes to an hour or more.
95
SIMULATOR
• The radiation therapy simulator is

a Diagnostic x-ray machine
mounted on a rotating gantry
which provides geometries
identical with those found on
megavoltage therapy machines.
• Can be used in either a
radiographic or fluoroscopic mode
to provide diagnostic quality
images on film or a television
monitor respectively
96
CT-SIMULATION
97
SKIN MARKINGS
• The skin may be marked to act as a

map and help ensure that each
radiation treatment is targeted to the
same area.
• The skin may be marked with a pen
or ink, and the person must be
careful not to wash off these
temporary markings.
• Tiny permanent tattoos – about the
size of a freckle – may also be used.
98
99
100
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END OF TOPIC
RADIATION
DOSIMETRY

RADIATION DOSIMETRY
• Is the measurement, calculation and assessment of the
absorbed doses and assigning those doses to individuals.

• It is the science and practice that attempts to quantitatively
relate specific measures made in a radiation field to
chemical and/or biological changes that the radiation
would produce in a target.
• Deals with the measurements of the absorbed dose
resulting from interaction of ionizing radiation with matter.
104
RADIATION DOSIMETRY
ABSORBED DOSE MEASUREMENT METHOD
• CALORIMETRY DOSIMETRY
• FRICKE DOSIMETRY
• FILM DOSIMETRY
• IONIZATION METHOD
• THERMOLUMINESCENCE DOSIMETRY
105
RADIATION DOSIMETRY
CALORIMETRY DOSIMETRY
• Involves the measurement of radiation

based on the change in the thermal
energy per unit mass of the medium.
• It is based on the fact that almost all
the energy deposited in the medium by
the radiation beam eventually appears
as heat within the medium.
• For water, 1 Gy produces a temperature
rise of 2.4x 10-4 Calories/gram which
can be measured using a sensitive
device called thermistors.
106
RADIATION DOSIMETRY
FRICKE DOSIMETRY
• Based on chemical changes

caused by radiation.
• The chemical radiation
dosimeter most commonly used
is ferrous sulfate in which it is
oxidized by radiation into ferric
sulfate.
• Ferric ion concentration is
measured by absorption
spectrometry at 224 nm and 304
nm.
107
RADIATION DOSIMETRY
FILM DOSIMETRY
• The degree of blackening

of the film is proportional
to the energy absorbed
and is measured by
determining the optical
density with a
densitometer.
108
RADIATION DOSIMETRY
IONIZATION METHOD
• Measurement of radiation energy

based on ion pairs produced in a
given mass of medium.
• Thimble Chamber
• used in photon beam
• Farmer Chamber
• used for photon beam
• Markus Chamber
• used for electron beam
109
110
RADIATION DOSIMETRY
RADIATION DOSIMETRY
ELECTROMETER
111
RADIATION DOSIMETRY
DOSIMETRY PARAMETERS
• OUTPUT FACTOR
• Defined as the ratio of the dose rate at the depth of maximum dose
for the given field size to that for the reference field size (10x10cm) at
its dmax.
112
RADIATION DOSIMETRY
TISSUE-AIR RATIO
(TAR)
• It is the ratio of dose
at a specific point in
a medium to the dose
at the same distance
in free space
113
RADIATION DOSIMETRY
TISSUE-PHANTOM RATIO (TPR)
➢Ratio of the central axis dose at the

point of interest in the phantom to the
central axis dose at a reference depth
in the phantom.
𝐷
➢TPR =
𝐷𝑟𝑒𝑓
➢If the phantom depth is chosen to
be at the depth of maximum dose,
TPR is often referred as TMR
(Tissue-Maximum Ratio)
114
RADIATION DOSIMETRY
PERCENTAGE DEPTH
DOSE (PDD)
• It is the absorbed dose at
80% @ 6.5cm
a given depth expressed
as a percentage of the
absorbed dose at a
reference depth on the
central axis of the field.
115
RADIATION DOSIMETRY
ISOCENTER
• A point in space where the x,

y and z axis intersect.
• The point of intersection of
the collimator axis and the
gantry axis of rotation.
119
RADIATION DOSIMETRY
MONITOR UNIT
• unit used in linear accelerator to determine the dose. Most

linear accelerator is calibrated to 1 MU = 1cGy
• A measure of output linear accelerators
• MU = Prescribed Dose÷ (Output Factor x Wf x TAR x TMR x
TPR)
120
END OF TOPIC
MODIFICATION TO
RADIATION FIELD

MODIFICATION TO RADIATION FIELD
• BOLUS
• COMPENSATOR
• WEDGE
• BLOCKS
123
BOLUS
• A tissue equivalent material that have electron density, physical

density, and atomic number similar to that of tissue or water.
• It increases the dose to the skin.
• ex. Paraffin Wax, Gauze soaked in water, “Super-Slab”,
Elastomeric Polymer
124
COMPENSATOR
• It is intended to compensate for

some topographical deficit.
• Placed in the tissue deficit of the
patient is the simplest way to
compensate, but because it
diminishes the skin sparing effect,
retracted tissue compensators are
usually employed.
125
BLOCKS
• Used to shield organs at risk, made

of lead or lipowit’s metal
(cerrobend) which consists of
13.3% tin, 50% bismuth, 26.7%
lead, and 10% cadmium.
• The physical density of lipowit’s
metal at 20o celsius is 9.4 g/cm3 ,
compared with 11.3g/cm3
• Melting point: 70 celsius
127
128
129
130
END OF TOPIC
FIELD ARRANGEMENT IN
EXTERNAL BEAM RADIATION
THERAPY

FIELD ARRANGEMENT IN EBRT
SINGLE FIELD
• Treatment through one single field

arrangement is the simplest treatment
and the dose distribution in tissue is
essentially as represented on an
isodose chart for the particular energy
and the field used.
• With this field arrangement, Electron
is usually the type of radiation used to
treat shallow tumors where a rapid
drop in dose beyond the depth of the
tumor.
133
PARALLEL OPPOSED FIELD
• Is a pair of fields directed along the same axis from opposite sides of the
treatment volume. Parallel opposed fields are relatively easy to set-up and
to reproduced from day to day.
• The 100% isodose line is within the entire treatment volume.
Advantages of Parallel Opposed Field
• Simplicity and reproducibility of set-up
• Homogenous dose to the tumor
• Less chances of geometrical miss
Disadvantage of Parallel Opposed Field
• Excessive dose to normal tissues critical organs above and below tumors
134
135
MULTI-FIELD ARRANGEMENT
• The use of multi-fields directed at the target volume requires

that the beam entrance and exit of each field be aimed at
different angles/segments, thereby reducing the dose to adjacent
tissues.
• The most popular multi-field arrangement is the “box
Technique”, which is often used in the treatment of pelvic
malignancies.
• The technique consists of opposed anterior and posterior fields
and opposed right lateral and left lateral field.
136
137
WEDGE FIELDS
• Wedges are frequently inserted into the

beam to alter the shape of the isodose
curve.
• Two fields w/a hinge angle of 90 degrees
resulting a very high dose near the
shallow intersection while in the opposite
diagonal corner, the dose is considerably
lower.
• Inserting a 45 degree wedges so that the
thick part of the wedge is directed at the
region of high dose results in a uniform
dose distribution
138
MOVING FIELD TECHNIQUE (ARC)
• A technique in which the axis of the

rotation of the therapy machine, the
isocenter, is positioned in the center
of the target volume.
• The radiation source is moved
around the patient through ARC,
often a complete circle. It yields a
high dose in the target volume where
the dose outside this volume falls off
rapidly.
139
END OF TOPIC
BRACHYTHERAPY

BRACHYTHERAPY
• Is a procedure that involves
placing radioactive material

inside your body.
• Sometimes called internal
radiation.
142
BRACHYTHERAPY
CLASSIFICATION OF BRACHYTHERAPY TREATMENT

WITH RESPECT TO DOSE RATE
CLASSIFICATION DOSE RATE
LOW DOSE RATE (LDR) 0.4 – 2.0 Gy/hr
MEDIUM DOSE RATE (MDR) 2.0 – 12.0 Gy/hr
HIGH DOSE RATE (HDR) >12.0 Gy/hr

143
BRACHYTHERAPY
CLASSIFICATION OF BRACHYTHERAPY TREATMENT WITH RESPECT TO
DURATION
TEMPORARY IMPLANT
Dose is delivered over a short period of time and the sources are
removed after the prescribed dose has been reached.
PERMANENT IMPLANT
Dose delivered over the lifetime of the source until complete
decay
144
BRACHYTHERAPY
CLASSIFICATION OF BRACHYTHERAPY TREATMENT WITH RESPECT TO
SOURCE LOADING
HOT LOADING
The applicator is preloaded and contains radioactive sources at
the time of placement into the patient
AFTERLOADING
The applicator is placed first into the target position and the
radioactive sources are loaded later, either by hand or by machine
145
BRACHYTHERAPY
Implantation Technique in Brachytherapy
• INTRACAVITARY TECHNIQUE
• INTERSTITIAL TECHNIQUE
• MOULD THERAPY OR PLESIOCURIE
• TRANSLUMINAL BRACHYTHERAPY
146
BRACHYTHERAPY
INTRACAVITARY
TECHNIQUE
• Consists of positioning
applicators containing
radioactive sources into a
body cavity in close proximity
to the target tissue.
• Ex. Cervix Intracavitary
Brachytherapy
147
BRACHYTHERAPY
INTRACAVITARY APPARATUS
• Fletcher Suit system

(gynecological ) = tandem + a pair
of ovoids
• TANDEM - hollow tube with
internal diameter slightly
greater than the radioactive
tubes
• PAIR OF OVOIDS - on each
side (15 mg or 10 mg tandem ;
15 mg ovoids)
148
149
BRACHYTHERAPY
150
BRACHYTHERAPY
BRACHYTHERAPY
CYLINDERS
• For treatment of vaginal

lesions consists of
hollow cylinder with
different sizes where
plastic inserts could be
placed
151
BRACHYTHERAPY
INTERSTITIAL TECHNIQUE
• Consists of surgically placing small

radioactive sources directly into the
target tissue with the use of
needles.
• Hollow stainless steel needles are
inserted through the lesion with
both ends visible, plastic tubing
with button affixed to the sealed
end is threaded through each
needle.
• The tubing can accommodate the
radioactive source.
152
153
BRACHYTHERAPY
BRACHYTHERAPY
MOULD THERAPY OR
PLESIOCURIE
• Consists of an applicator
containing an array of
radioactive source usually
designed to deliver a uniform
dose distribution to the skin
or mucosal surface.
154
BRACHYTHERAPY
TRANSLUMINAL BRACHYTHERAPY
• Consists of inserting a line source into a body lumen to treat its

surface and adjacent tissues
155
BRACHYTHERAPY
PHYSICAL STATES OF
BRACHYTHERAPY SOURCES
TUBES
• Are the standard capsules for radioactive
sources used in the treatment of
gynecological diseases.
• An inert material, it prevents contact
with the body fluids and tissues. It also
serves as a filter to screen out the Beta
radiation emmitted by Cs-137 and alpha
particles of Ra-226.
156
BRACHYTHERAPY
NEEDLES
• Used for interstitial treatment, longer than tubes but have

smaller diameters to allow penetration through tissues; an eyelet
in one end is necessary for insertion of the thread used for
suturing the needle in place, opposite end of needle is sharp;
length 2.5-5.5 cm active length is shorter diameter is <2mm 0.5-
3 mg of ra eq
157
BRACHYTHERAPY
SEEDS
• These radioactive substance is left in place permanently in the

target tissue since it has short half-life.
• ex. Iodine-125 and Au-198
158
BRACHYTHERAPY
FLUIDS
• Radioactive substance in the form of

fluids and directly injected to target
tissue.
• These radioactive fluids are commonly
used in therapeutic nuclear medicine.
159
BRACHYTHERAPY
OPTHALMIC APPLICATOR
• These sources, Strontium-90, are encapsulated in a small, semi-

circular applicator placed directly on the conjunctiva
160
BRACHYTHERAPY
COMMON RADIOACTIVE MATERIALS USED IN BRACHYTHERAPY
Isotope Energy (MeV) Half-life Source Form Clinical Application

LDR Intracavitary/
Ra-226 0.83(avg.) 1,626 yrs. Tubes/needles
Interstitial
Cs-137 0.662 30 yrs. Tubes/Needles
Ir-192 0.397 (avg.) 73.8 d Seeds LDR/HDR
Co-60 1.25 5.27 yrs Spheres
I-125 0.028 59.6 d Seeds Permanent Interstitial
Pd-103 0.020 17 d Seeds Permanent Interstitial
Au-198 0.412 2.7 d Seeds Permanent Interstitial
Sr-90 2.24 max 28.9 yrs. Plaque Ocular Lesion
161
END OF TOPIC

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RADIATION

RICHMOND K. QUILATAN, MHA,RRT

• AIM OF RADIATION THERAPY

• It is a medical specialty that involves the treatment of

• To deliver a precisely measured dose of radiation to a

A new growth of tissue characterized by progressive, uncontrolled

• Derived from the latin word for crab

• The most common type of cancer.

• Cancer that forms in squamous cells, which are epithelial

• Cancers that form in bone

• Cancers that begin in the

• Cancer that begins in lymphocytes

• WELL DIFFERENTIATED CELLS

• These cancers look very

• The cells in these cancers are clearly abnormal looking

• These cancers look very abnormal.

• CHEMICAL SUBSTANCE (CARCINOGENIC)

• Epstein-Barr Virus (lymphomas and

• Radiation and medicines

• Physician skilled in the act

RICHMOND K. QUILATAN, MHA,RRT

• DEFINITION OF GOALS IN RADIOTHERAPY

• The process of determine details about the cancer, such

TNM Staging System

In the TNM system:

• The T refers to the size and extent of the main tumor.

WHY TO STAGE CANCER?

• To choose the best method of treatment

It is categorized by the apparent anatomic extent of the disease, which is determined

T0 No evidence of primary tumor

PARTS OF THE BODY).

Multiple metastatic foci confined to one organ or system or one3

Multiple organs involved anatomically, with no or minimal to

Multiple organs involved anatomically, with moderate to severe

DEFINITION OF GOALS OF RADIATION THERAPY

• There is a probability of long term survival after

• There is no hope of total eradication of the tumor, done to

• Treatment of some parts of the body that is suspected of

• STEM CELL TRANSPLANTS

TELETHERAPY METHOD OR EXTERNAL BEAM

RADIATION THERAPY (EBRT)

Units and Measurements (ICRU) Reports

• Is the gross palpable or visible/

• Is the tissue volume that contains a

• Consists of the CTV plus an internal

Spinal Cord 50 (5cm) 50 (10cm) 47 (20cm) Myelitis, Necrosis

Stomach 60 55 50 Strictures , Perforation

Liver 50 35 30 Liver Failure

RICHMOND K. QUILATAN, MHA,RRT

• Contact Therapy or Endocavitary

• Uses very soft (low-energy) x-rays

• The term superficial therapy applies to treatment with x-rays

DEEP THERAPY UNIT

• X-ray therapy in the range of 500 to

• X-ray beams of energy 1 MV or greater can be classified as

• The operation of a betatron is based on

• Source irradiating ordinary stable Co-59 with

RICHMOND K. QUILATAN, MHA,RRT