SETTING UP RADIOTHERAPY

MACHINES – REGULATIONS IN INDIA

DR.FATHIMA THASNEEM.T
MODERATOR.DR. ARUN.S.OINAM
 Atomic energy regulatory board
• The Radiological Safety review and Regulation of facilities using
ionising radiation in India are carried out by Atomic Energy
Regulatory Board (AERB).

• It is a statutory requirement, in accordance with the Atomic Energy

(Radiation Protection) Rules, 2004 issued under Atomic Energy Act
1962, to obtain a requisite License from AERB, which is issued after
ensuring overall safety in handling of radiation sources.

• The growth in the application of ionising radiation technology has

posed a challenge to the AERB for regulating all these facilities with
the limited resources available with AERB.
 eLORA
• In order to meet the challenge AERB took initiative of
implementing a state of art e-Governance system, eLORA (e-
Licensing of Radiation Applications) through automation of
regulatory processes associated with the use of ionising radiation
in India.

• eLORA is a web-based Information and Communication

Technology application establishing direct communication
channel between AERB and its stakeholders for exchange of
information and communication transaction for delivering its
regulatory services as well as for achieving higher efficiency,
reliability and transparency in dealings.
 AERB
• AERB was constituted on November 15,1983 by exercising the powers
conferred by section 27 of the atomic energy act 1962

• It is an apex body that regulates the use of ionizing radiation in the

country

• The chairman AERB is the competent authority, recognized by the

government for enforcing provisions of radiation safety in the use of
ionizing radiation

• AERB has jurisdiction over all the units of department of atomic

energy and all radiation installation in the country

• The board is assisted by health, safety and environment group of

BARC
 Objectives of AERB
1. Develop and publicize specific codes and guides which will
deal with the radiation safety aspects of various application
of radiation

2. Issue authorization related to site, design, manufacture,

construction, commissioning, operation, maintenance and
decommissioning and disposal of radioactive sources and
radiation emitting devices.
 Atomic energy act-1962
• The primary legislation to regulate the use of ionizing
radiation in India

• The act and the secondary legislation (radiation protection

rules 1971) provides necessary regulatory infrastructure for
effective implementation of radiation protection programme

• The RPR-1971 was revised in 2004 and named as Atomic

energy (RPR) rules, 2004

• The act empowers the government of India to exercise control

over protection and the use of atomic energy
 Legislations and rules related to radiation
protection

1. Atomic energy act 1962

2. Atomic energy regulatory board,1983
3. Atomic energy radiation protection rule,2004
4. Safe disposal of radioactive waste rule,1987
5. Radiation surveillance procedures for medical applications-
1989
6. AERB safety code SC/MED-1, tele gamma therapy equipment
and installations
7. AERB safety code SC/MED-3, brachytherapy sources,
equipment and installation, 1988
8. AERB safety code SC/TR-1, transport of radioactive materials
 Radiation protection rules-2004
1. Short title, extent & commencement
2. Definitions
3. Licence
4. Fees for license

5. Exemption
6. Exclusion

7. Conditions precedent to the issuance of a license

8. Issuance of licence
9. Period of validity of license
10. Suspension, modification or withdrawal of license
11. Modification of radiation installation

12. Restrictions on use of sources

13. Restriction on certain practices

14. Radiation symbol or warning sign

15. Dose limits and other regulatory constraints

16. Safety standards and safety codes

17. Prohibition of employment of persons below certain age

18. Classified worker

19. Radiological safety officer

20. Responsibilities of the employer

21. Responsibilities of the licensee

22. Responsibilities of the radiological safety officer

23. Responsibilities of worker

24. Records of workers

25. Health surveillance of workers

26. Medical exposures

27. Radiation surveillance requirements

28. Directives in the cases of exposures in excess of regulatory

constraints

29. Power to appoint or recognize persons or agencies

30. Inspection of premises, radiation installation and conveyances

31. Power to investigate, seal or seize radiation installation or

radioactive material and to give direction to the employer

32. Directives in case of accidents

33. Emergency preparedness

34. Decommissioning of radiation installation

35. Offences and penalties

 Regulatory control for radiotherapy
equipment and installations
1. Handling of a telegamma therapy source/equipment or linear
accelerator shall be done only in accordance with the terms
and conditions of a licence granted by the competent authority

2. Sources and equipment shall meet the design specification

stipulated in the safety code

3. Construction of the teletherapy installation shall be undertaken

only after obtaining prior approval from the competent
authority for the room design and equipment lay out from the
radiation protection point of view
4. Installation shall be made available by the licensee for
inspection by the competent authority

5. Decommissioning and disposal shall be undertaken with prior

approval of the competent authority

6. The employer must ensure that persons handling equipment

duly abide by the provisions of the safety code issued by the
competent authority

7. Sources shall not be transported in public domain without prior

approval of competent authority
8. Tele therapy sources shall be used only in the premises
authorized in the license

9. Equipments shall not be lent, gifted, sold or disposed off by

the licensee without the prior approval of the competent
authority

10. Any persons who contravenes the provisions of these rules or

any other terms and condition of approval granted to
him/her by the competent authority, shall be punishable
under section 24, 25 and 26 of the Atomic energy act, 1962
STEPS IN RADIOTHERAPY MACHINE INSTALLATION
 Programme Purchase of
Programme Radiotherapy
implementatio equipment
design facility design
n
Installation of the
Acceptance Commissioning of
machine, safety
testing of machines for
checks & initial
machine clinical use
radiation survey
 Establishment of
Training of the baseline quality
Final report and
staff and safe use assurance
documentation
of the accelerator parameters &
schedule
 MINIMUM QUALIFICATIONS AND EXPERIENCE REQUIRED FOR
PERSONNEL IN RADIATION ONCOLOGY FACILITY

1. Radiation Oncologist
• (i) a basic degree in medicine from a recognised university; and
• (ii) a post-graduate degree in radiation oncology or an equivalent
qualification.

2. Medical Physicist/Radiation Physicist/Radiological Physicist

• (i) a post graduate degree in Physics from a recognised university;
• (ii) a Post M.Sc. diploma in radiological/medical physics from a recognised
university; and
• (iii) an internship of minimum 12 months in a recognised well-equipped
radiation therapy department
3. Radiological Safety Officer
• (i) minimum qualifications required for a Medical Physicist/Radiation
Physicist/ Radiological Physicist as mentioned above; and
• (ii) an approval from the competent authority to function as Radiological
Safety Officer.

4. Radiation Therapy Technologist

• (i) 10 + 2 or equivalent with science subjects from a recognised board; and
• (ii) two years’ radiation therapy technologists’ course, or equivalent, based
on the minimum course content prescribed by the competent authority,
from a recognised institution with in-field training in radiotherapy.

5. Radiation Therapy Service Engineer

• (i) basic degree/diploma in electrical/electronic/biomedical/mechanical
engineering from a recognised university; and
• (ii) certification from the competent authority for handling radiation therapy
equipment.
Category
Radiation Oncology
(i) Chief Radiation Oncologist
(ii) Radiation Oncologist
Medical Physics
Medical Physicist/Radiation Physicist/
Radiological Physicist
Radiological Safety
Radiological Safety Officer
Radiation Therapy Technology
(i) Chief Radiation Therapy
Technologist
(ii) Radiation Therapy Technologist
(iii) Technologist (Simulator)
(iv) Technologist (Brachytherapy)
Treatment Planning and Execution
(i) Physics Assistant
(ii) Technologist (Mould Room)
Auxiliary: Nurse,Social Worker,Dietician,
Physiotherapist, Occupational Therapist,
Psychologist,Maintenance Engineer
Staffing
One per centre
One additional, for each 400 patients treated annually. No more
than 40 patients under treatment by a single physician per day
One per Centre, for up to 500 patients
treated annually, additional in ratio of
1 per 500 patients treated annually.
One per centre
One per centre
2 per teletherapy unit up to 40 patients treated daily, 4 per
teletherapy unit up to 80 patients treated daily
2 for every 500 patients simulated annually
As needed
One per 500 patients treated annually
One per 600 patients treated annually
May be employed as per requirement
 Programme design
• Assessment and evaluation for setting radiation facility

• Assessment of national needs and country wide distribution of radiation

facility

• Assessment of institution’s clinical needs

• Basic clinical essentials

• Assessment of institution’s infrastructure & resources

• Business analysis & project planning

• Allocate a budget of 12-30 crores

Formation of an ad hoc committee
1. Oncology project consultant
2. Radiation oncologist
3. Physicist
4. Therapist
5. Engineer
6. Architect
7. Project management consultant
8. Civil contractor
9. MEP specialist
10. Structural specialist
11. Vendor project team
 Programme implementation
• Register the institute – eLORA
e licencing of radiation application

• It facilitates online submission for

I. Layout approval
II. Licence
III. Registration
IV. RSO approval of radiation facilities
Steps Purpose Regulatory form name

1 Obtaining site & lay-out approval Application for site and lay-out approval

2 Obtaining RSO approval Nominate RSO

3 Obtaining procurement permission of Application for procurement

equipment ( equipment & source )

4 Intimating receipt of equipment Equipment receipt intimation

5 Obtaining comisisonning approval of Application of commissioning

equipment ( prior permission for switching
ON beam )

6 Submission of radiation survey levels Survey report

measured around the instillation

7 Obtaining licence for operation of Application for licence

equipment
 Site identification & facility design
• Should be preferably in basement or in ground level

• Radiotherapy departments are usually located on the periphery

of the hospital complex

• The machine manufacturer’s pre-installation manual should

provide the minimum room dimensions

• Room should be large enough to allow full extension of the

couch in any direction, with room for operator to walk around it

• Principles of radiation protection to be followed

• Publication – 103 ( ICRP, 2007 )

 Structural shielding design
• NCRP Report No: 49, structural shielding design & evaluation for
medical use of x-rays & gamma rays of energies upto 10 Mev

• NCRP Report No: 51, radiation protection design guidelines for 0.1-
100 Mev particle accelerator facilities

• NCRP Report No: 79, neutron contamnation from medical electron

accelerator ( 1984 )

• NCRP Report No: 144, radiation protection for particle accelerator

facilities, in order to account for the higher energies & the
associated production of neutrons

• NCRP Report No: 151, upgrade of Report No: 49

 SHIELDING MATERIAL
• Shielding should be designed by a qualified expert to ensure that the
required degree of radiation protection is achieved

• The usual materials for radiation shielding are (normal or high

density) concrete, steel, or lead

• Concrete is usually the cheapest material as it is easier to bring to

the site and use for construction

• An on-site concrete testing should be used. In new construction,

standard concrete of density 2350 Kgm–3 should be used

• If there are space restrictions, then it may be necessary to use

higher density materials such as steel or lead
 DESIGN FACTORS
• Controlled areas
• Supervised areas

• Primary radiation
• Secondary radiation
• Leakage radiation

• Primary barrier
• Secondary barrier

• Factors required for calculation of barrier thickness are :

– Workload (W)
– Use factor (U)
– Occupancy factor (T)
 ADDITONAL CONSIDERATIONS

• For external beam therapy units extent of primary barrier will be

determined by divergence of the primary beam to outside of barrier

• The primary barrier is then extended further by 30 cm on each side

to allow for small angle scatter (also termed the plume effect).

• Since leakage radiation and scatter radiation are of different energies,

secondary barrier requirements of each are calculated separately &
compared to arrive at final secondary barrier thickness:

– If thickness of required barrier is about same for each secondary

component, one HVL is added to the larger of the two barrier
thicknesses
– If two barrier thicknesses differ by one TVL or more, larger barrier
thickness is used
 ROOM DESIGN FOR Co UNIT
60

W=70 patients/day B
5 days / week
400 cGy/patient A
E
W=70 pt/dy*5 dy/wk * D
400cGy/wk

= 1.5*105 (cGy/wk) C
 WALL (A)

For Primary beam

RF = WUT
P d2
1.5*105*1/4* 1
= 2*10-3 *(4.55)2

=9.056*105 A
Thickness of concrete required
t =TVT Log (RF)
=20.3*5.95
=120cm
 FOR OBLIQUE WALL (Wall A)
X = (3.752 + 3.752)1/2 = 5.302
RF = WT(U*αL +U*αS) 75
P d2 75.21
R.F= (10-3 +3.6*10-3 *1/4)*1.5*105 *1 X
2*10-3 *(5.3)2 Cos 45=B/H=X/75.21
=5.07*103
t =TVT log(R.F)
=20.3*3.705
=75.21
≈75 A
Cos(45) = x / 75.21
X = Cos(45) * 75.21
=53.18cm
≈ 55cm
 WIDTH

From Similar triangles

x = 35
330 80 X

SOURCE
x = (35*330)/80
= 144

Add 30 cm on both sides as extra

margins
then width=144 +60
= 204cm
≈ 200cm
 Wall B
(p=1mSv/yr for Public)

R.F= WT(U*αL +U*αS)

B
Pd 2

=1.5*105 * 1* (1*10-3 + ¼*0)

2*10-3 *(3.75)2
120
ISOCENTER
=5.33 *103 D
A

t =TVT log(R.F)
=20.3*3.725
=75.6175cm
≈75cm C
 Wall C

RF = WT(U*αL +U*αS) B
P d2
= 1.5*105 *1 (1*10-3 + ¼*0)
40*10-3 * (3.50)2
120

=3.06*102 A D

t=TVT log (R.F)

=2.48* 20.3
= 50.4 cm
≈ 50 cm C
 MAZE WALL (Wall D) AND DOOR

For maze wall

Thickness=4*TVT
=4*20.3
=81.2cm B

For door=180 cm E

D
 FOR OBLIQUE WALL(WALL E )
tan(Ф)=P/B=120/250
Ф =tan-1 (120/250)=25.6 B
Cos25=B/H
Cos25=555/H
H=612.58cm
R.F= W*(αoU+ αsU)*T x
P*d2
= 1.5*105 *[6*10-3 *0.25+10-3 ] *1
2*10-3*(6.12)2
= 5*103 D E
 CONTD……….

t=TVT log(R.F) y
y=20.3*3.69
=75.08cm

Cos(Ф)=B/H
Cos(25)=70/x
X=70/ Cos(25)
=77.26cm
 CEILING PART OF Co60 ROOM
R.F= W*U*T CEILING

Pd2
= 1.5*102 *1/4*1
2*10-3 *(3.8)2
=1.29*106

t=TVT log(R.F)
=20.3*6.11 ISOCENTER
=124.04cm
≈ 130cm
FLOOR
 WIDTH OF CELING PART OF Co60
ROOM
From similar triangles x

80/250=35/x
X=35*250/80
=109.375cm

Add 30 cm on both sides as extra margins

then width=109 +60
SOURCE
= 169cm
≈ 180cm
 OBLIQUE WALL
X = (3.552 + 32)1/2 =4.64m

R.F=(UαL+UαS)(W*T)
P*d2
R.F=(10-3 +3.6*10-3 *1/4)*1.5*105 *1 x
2*10-3 *(4.64)2
=6.61*103

t =TVT log(R.F)
=20.3*3.82
=77.66
≈75
 ROOM SHIELDING DESIGN FOR LINAC 6-MV

W=50 patients/day A C
5 days / week
400 cGy/patient
D
W = 50 pt/dy* 5 dy/wk* 400 E
cGy/wk
= 1*105 (cGy/wk)
 WALL A AND WALL C

FOR PRIMARY BEAM

R.F= (W*U*T) B
P*d2 A
R.F= 1*105 *1*(1/4)
2*10-3 *(5.9)2
=3.59*105 A
C

t =TVT log(R.F)
=34*5.555
=188.8
≈190cm
 WALL A AND WALL C
FOR SCATTERING BEAM
B
R.F=(W*U*T) B
P*d2
R.F=1*105 *10-3 *1 A
2*10-3 *(4.9)2
=2.08*103
A C
D
t =TVT log(R.F)
=34*3.318
=112.8
≈115cm
 WALL B

R.F=(UαL +UαS )(W*T)

(P*d2)
B
R.F=(10-3 *1 +0*1/4)*1*105 *1
2*10-3 *(4.65)2
=2.3*103
A

t =TVT log(R.F)
=34*3.362
=114.3
≈115cm
 WIDTH X
From Similar triangles x

375
x = 475
40 100
x = (40*475)/100 40
= 190

100
Add 30 cm on both sides as extra margins
then width=190 +60
= 250cm
≈ 250cm
 WALL D
R.F= (UαL +UαS )(W*T)

(P*d2) B

R.F= (10-3*1 +0*1/4)*1*105 *1

A
20*10-3 *(6.80)2

= 1.0813*102

D
t =TVT log(R.F)
=34*2.0339
=69.154
≈70cm
 WALL E
R.F= (UαL +UαS )(W*T)
(P*d2)

R.F= (10-3 *1 +0*1/4)*1*105 *1)

D
40*10-3 *(6.80)2
=5.40*101 E

t =TVT log(R.F)
=34*1.7329
=58.91
≈60cm
 CEILING PART OF 6 MV LINAC
CEILING
FOR PRIMARY BEAM
R.F= W*U*T
Pd2
= 1*105 *1/4*1
2*10-3 *(4.75)2
= 5.540*105

t=TVT log(R.F)
=34*5.7435
=195.27cm
≈ 200cm FLOOR
 CONTD…
FOR SCATTERING BEAM
CEILING
R.F= W*U*T
Pd2
= 1*105 *10-3 *1
2*10-3 *(3.75)2
=3.55*103

t=TVT log(R.F)
=34*3.550
=120.70cm
≈ 125cm FLOOR
 WIDTH X
From Similar triangles x

x = 350

250
40 100
x = (40*350)/100
= 140
40
Add 30 cm on both sides as extra
margins

100
then width=140 +60
= 200cm
≈ 200cm
 ROOM DESIGN FOR Ir192
BRACHYTHERAPY ROOM

Activity= 10 Ci source
RAKR= 0.111µGy.MBq-1.m2.h-1
time/pt in hrs(t)=10 min
=10/60 hr
=0.167 hr A
no of pt or trmt/wk(n)=30 pt/wk D
Workload=RAKR*A*t*n
W=0.111*10*3.7*104*0.167* 30 E
W=20.53 cGy.wk-1at 1m distance

TVT for Ir192 =13.5 cm (concrete)

 WALL A
R.F= W*U*T
Pd2
= 20.53*1*1
2*10-3 *(2.45)2 B
= 1.710*103

t= TVT log(R.F)
A
= 13.5*3.232
= 43.64cm
≈ 45cm
 WALL B

R.F= W*U*T
B
Pd2
= 20.53*1*1
2*10-3 *(3.4)2
= 8.879*102
A
t=TVT log(R.F)
=13.5*2.948
=39.80cm
≈ 40cm
 WALL C
R.F= W*U*T
Pd2 B
= 20.53*1*1
2*10-3 *(5∙15)2
= 3∙87*102

D C
t= TVT log(R.F)
= 13.5*2∙587
= 34∙93cm
≈ 35cm
 WALL D
R.F= W*U*T 200

Pd2 A
= 20.53*1*1
40*10-3 *(2∙3)2
= 9∙70*101

t= TVT log(R.F) D C
= 13.5*1∙986
= 26∙82cm
≈ 30cm
 WALL E
R.F = W*U*T
Pd2
= 20.53*1*1
A D
40*10-3 *(2.3)2
= 9.702*101
E
t= TVT log(R.F)
= 13.5*1.9868
= 26.82cm
≈ 30cm
 CEILING FOR HDR
R.F= W*U*T CEILING
Pd2
= 20.53*1*1
2*10-3 *(2.45)2
= 1.710*103

t= TVT log(R.F)
= 13.5*3.232
= 43.64cm
FLOOR
≈ 45cm
 ROOM DESIGN FOR Co60 BRACHYTHERAPY
ROOM
Activity=2 Ci source
RAKR=0.308µGy.MBq-1.m2.h-1 B
time/pt in hrs(t)=10 min
=10/60 hr
A D C
=0.167 hr
no of pt or trmt/wk(n)=30 pt/wk

Workload=RAKR*A*t*n
E
W=0.308*2*3.7*104*0.167* 30
W=11.41 cGy.wk-1at 1m distance

TVT =20.3 cm (concrete)

 WALL A
R.F= W*U*T
Pd2
B
= 11.41*1*1
2*10-3 *(2.6)2
= 8.439*102

t= TVT log(R.F) A C
D
= 20.3*2.9262
= 59.40cm
≈ 60cm
 WALL B
R.F= W*U*T
Pd2
= 11.41*1*1 B
2*10-3 *(3.55)2
= 4.591*102

A C
t= TVT log(R.F) D
A
= 20.3*2.6619
= 54.03cm
≈ 55cm
 WALL C
R.F= W*U*T
Pd2
B
= 11.41*1*1
2*10-3 *(4∙35)2
= 3.01*102

t= TVT log(R.F) A C
D
= 20.3*2∙478
= 50∙31 cm
≈ 50cm
 WALL D
R.F= W*U*T
Pd2
B
= 11.41*1*1
2*10-3 *(2∙35)2
= 5.165*101

t= TVT log(R.F) A C
D
= 20.3* 1∙712
= 34.766cm
≈ 35cm
 WALL E
R.F= W*U*T
Pd2
= 11.41*1*1
40*10-3 *(2.35)2 A D
= 5.165*101

t= TVT log(R.F) E
= 20.3*1.7130
= 34.77cm
≈ 35cm
 CEILING FOR HDR
R.F= W*U*T CEILING
Pd2
= 11.41*1*1
2*10-3 *(2.6)2
= 8.439*102

t= TVT log(R.F)
= 20.3*2.9262
= 59.40cm
≈ 60cm
FLOOR
 TELETHERAPY ROOM: DESIGN
 A ‘fail safe interlock’ to switch off radiation
beam (i e return source to shielded position) if
door is opened during treatment

 Restart of irradiation should require both

closing of door & activation of a switch at
control console

 A sign which indicates the room is a radiation

area and/or contains radioactive materials

 A visible light at the door which shows if the

source is on red for source on & green for
source off

 There should be a battery operated scatter

radiation detector inside the room which
shows when the source is on
 Viewing system either of
 Mirror & glass door arrangement / Lead glass
 Two CCTV - Two cameras are recommended
one 15° off & another above the gantry
rotation axis for optimum patient viewing

 The unit should be air conditioned and well ventilated and should
be at at least 2m height from floor

 The conduit should be 20 to 30 cm above the floor and inclined at

200 to 450 having diameter of 8 to 10 cm if in secondary shield and
diameter of 3cm diameter if in primary shield

 The room door should be marked for the radioactive materials &
there should be an indication of how to contact the responsible
radiation safety individual in the event of emergency
 NEUTRON PROTECTION
 Considered for LINACs operating above 10 MV

 Concrete has high water content – TVL for photo neutrons half that of the
photons – additional shielding not needed

 Neutron capture produces secondary photons (capture photons):

– Average capture photon energy is 3.6 MeV
– Max energy is 8.0 MeV

 Doors of linacs may require shielding against x-rays & neutrons scattered
through maze

 Neutrons are thermalized & absorbed with a layer of about 12cm of

borated polyethylene in the door, which is followed by 2.5cm of lead to
absorb gamma rays produced by neutron capture reactions in boron nuclei
 Purchase of equipment
• Equipment needed to perform EBRT
 Imaging
 Treatment planning
 Treatment delivery
 Quality assurance
 Radiation safety
 EBRT delivery
Cobalt-60
LINAC
 LINAC selection
• A systematic review of clinical needs & type of patient who
will be treated
• A careful review of deliverables, functionality, technical &
physical specification & cost of all commercially available
linacs
• Review of available space, available funds, available or
needed support staff & available in house
• Evaluation of future upgrades, warranties & maintenance
contracts
• Evaluation of the quality of the manufacturer’s service &
technical support
• Final recommendation for the LINAC
 FDA approved medical LINACS

• VARIAN

• ELEKTA

• SIEMENS
 ELECTA products (Stockholm, Sweden)
• Versa HD – 3 times the dose rate while maintaining increased
precision
• Axesse-SRS/SBRT combined with full featured versatility
• Infinity – the Agility 160 leaf multi-leaf MLC is introduced for
even more beam precision
• SynergyS- SRS and SBRT
• Synergy- IGRT, CBCT & VMAT its XVI,KV imaging device
• Precise -3D & IMRT treatments
• Compact – designed for simplicity and high volume
throughput
• SL series ( 15,18,25,75/5)- original Electa design with basic
 VARIAN products ( Palo alto, California USA)
• Edge- Varian’s integrated solution for SRS & SBRT

• TrueBeam STx-combines BrainLab hardware and software

• TrueBeam-3 photon energies, and the 120 leaf HD-MLC for

SRS/SBRT

• Trilogy-essentially a 21iX, with a higher dose rate for SRS/SBRT

• Clinac 21/2300c/cd- Dual photon high energy accelerator with

electrons. Can deliver 3D and IMRT treatments with precision

• Clinac 600c/cd/ex-a 6MV photon with no electrons. Upgradable to

MLC, IMRT and portal imaging
 ACCURAY products ( Sunnyvale, California, USA )

 Cyberknife (G4, G5, VSI & M6)- the first and only non-evasive
robotic surgery designed linear accelerator specializing in SRS/SBRT

 Tomotherapy ( Hi-ART,HD,H SERIES, Direct & Helical)-leading

technology that combines a 6MV LINAC with CT imaging capabilities
allowing daily precision for 3D and IMRT treatment delivery
 SIEMENS products ( Erlangen, Germany)
• Artiste –most advanced LINAC of Siemens, 160 leaf MLC, IMRT
and MV CBCT for IGRT ( i.e.Mvision)

• Oncor-MV based IGRT

• Prismus- BeamView portal with IMRT

• Mevatron ( MD, KD, Mev 6740)- one or two photon energies

for 3D conformal RT
 Machine specification & purchase agreement

• Product data & specification sheets

• Any special requirement can then be added as an addendum

 Accelerator installation
• It is the work of vendor

• Takes around 45 days from shipment arrival at port to final

acceptance test
 Radiation survey
• Preliminary radiation survey of the treatment facility
• The exposure levels outside the room will not exceed permissible limits
• A formal radiation protection survey is carried out including
 The measurement of head leakage
 Area survey
 Tests of interlocks
 Warning lights
 Emergency switches
 A radiation survey in both controlled and uncontrolled areas

• A full radiation survey including the photon and neutron leakage

measurements will still have to be completed to comply with regulatory
requirements after a full calibration.
• The preliminary survey is done to assure the safety of individuals during
the acceptance testing and commissioning.
 Acceptance testing
• Are the procedures set up by the company to demonstrate that the
product meet the specification contained in its brochures & satisfies the
legal requirements of equipment safety

• As a general rule, acceptable testing is required on any pieces of

equipment that is used in conjunction with patient’s treatments

• Any deviation or addition stipulated in the bid specification are then

addressed to complete the acceptance testing process

• Is done by physicist to ensure that the machine meets the product

specification & the purchase agreement

• Conducted according to the acceptance testing procedures agreed on

between the manufacturer’s representative & the facility physicist
 Each facility should have the necessary equipment for acceptance
testing .This includes
1. A 3D water phantom scanner with computer interface
2. Ion chamber
3. Electrometer x-ray film
4. Film laser scanner
5. Precision level

 Each machine comes with the functional performance test values

performed in test cells in the factory

 These are helpful for comparison driving acceptance testing

Dose monitoring system IEC REPORT 977

• Reproducibility 0.5%
• Proportionality (> 1 Gy/ < 1 Gy) ± 2% / ± 2 cGy
• Dependence on gantry angle ± 1.5%
• Dependence on rotation of the gantry (moving) ± 2%

Stability of Calibration
• 10,000 cGy delivery 2%
• One day ± 1%
• One week ± 1%
• Stability in moving beam therapy, preset versus delivered
 Terminate irradiation by gantry angle; dose: 5%
 Terminate irradiation by dose monitor system; angle: 3°
 Depth absorbed dose characteristics

 X Radiation
• Deviation from stated value ± 3%, ± 3 mm*

 Electron Radiation
• Depth of maximum absorbed dose ³ 0.1 cm
• Practical range / depth of 80% absorbed dose ≤ 1.6
• Deviation from stated value ± 3% ± 2 mm*
• Stability of penetrative quality, electrons, variation with gantry angle
and dose rate + 1%, + 2 mm*
 UNIFORMITY OF RADIATION FIELDS

 X Radiation  Electron Radiation

• Flatness (max/min ratio) • Flatness (shape of isodose contours)
 5 ´ 5 to30 ´ 30 cm 106%  80% contour to geometric edge, at
 to maximum square 110% base depth - 15 mm
 90% contour to geometric
• Stability of flatness with angular position of edge/corner at S - 10 / 20 mm
gantry and beam limiting system
 < 30 MeV 3% • Symmetry (ratio of symmetrical points)
 > 30 MeV 4% - 105%

• Symmetry (ratio of symmetrical points) 103% • Maximum ratio of absorbed dose at 0.5
mm depth to absorbed dose on axis at
S - 109%
• Maximum ratio of absorbed dose (at dmax)
 5 ´ 5 to 30 ´ 30 cm 107%
 to maximum square 109%

• Wedge filtered X ray fields

 Wedge factor ± 2%
 Wedge angle ± 2°
 PENUMBRA
INDICATION OF RADIATION FIELDS

 X Radiation  Electron Radiation

• Numerical field indication (% is of field • Numerical field indication 2 mm

size) 3 mm, 1.5%*
• Light field indication, edges 2 mm
• Greater than 20 ´ 20 cm to maximum
square 5 mm, 1.5% • Geometry of X ray beam limiting systems
± 0.5°
• Light field indication, edges (% is of field
size)
• Illuminance and penumbra of light field
 At normal treatment distance, 5 ´ 5 cm to
 Average illuminance 40 lux
20 cm ´ 20 cm 2 mm, 1%
 Edge contrast ratio 4
 At 1.5 ´ normal treatment distance, 5 ´ 5
cm to 20 ´ 20 cm 2 mm, 2%
 Center: NTD / 1.5 ´ NTD 2 / 4 mm

• Reproducibility: Numerical field, light field

edge 2 mm
 INDICATION OF RADIATION BEAM AXIS

• Entry, X radiation (NTD + 25 cm) ± 2mm

• Entry, electron radiation (NTD + 25 cm) ± 4 mm
• Exit, X radiation (NTD –to+ 50 cm) ± 3 mm
ISOCENTER

• Displacement of X ray beam axis ± 2 mm

• Displacement of indication of isocenter ± 2 mm
• Indication of distance along radiation beam axis from isocenter ± 2 mm
ZERO POSITION OF ROTATIONAL SCALES
• Gantry, beam limiting device, table, table top ± 0.5°

CONGRUENCE OF OPPOSED RADIATION FIELDS AT ISOCENTER

1 mm

MOVEMENTS OF THE PATIENT TABLE

• Horizontal displacement for 20 cm vertical change 2 mm
• Displacement of rotation axis from isocenter 2 mm
• Angle between table and table top rotation axes 0.5°
• Table height: 30 kg, retracted; 135 kg, extended 5 mm
• Table top lateral tilt from horizontal 0.5°
• Deviation of table top height with lateral displacement 5 mm
 Commissioning
 Comprehensive measurements of dosimetric parameter
 Entry of beam data into a treatment planning system
 Development of operational procedures
 Training of all concerned with the operation of the accelerator

• Quality of your treatment beams for life-time of the machine

• That signature means you are stuck with the machine for next 10-
15 years
• Commissioning is to bring the medical linear accelerator into
clinical use
• Machine specific data are acquired and operational procedures
are defined. ( TG 45 AAPM )
• This commissioning data is standard data and is feed into and
used by treatment planning system, to produce patient
specific dosimetry

• It is vitally important that collected data are of highest quality

to avoid patient treatment errors

• This standard data from commissioning is used as a baseline

or reference data for periodical quality assurance

• Physicist must avoid the pressure to initiate clinical

treatments as soon as the acceptance testing is finished

• Rushing into clinical implementation without completing

proper commissioning can potentially cause harm to the
patients
• Therefore, an appropriate time that is based on the projected use
of the machine must be set aside for this activity

• It is imperative that the physicist must have proper

instrumentation to collect all necessary data

• It is very unlikely that there will be no delays, and an overhead of

50% of the time specified should be allowed for unforeseen
circumstances, breakdowns and adjustments that have to be
made as a result of measurements

• Newly released equipment is likely to have more such problems,

and in this case an overhead of 100% should be allowed
 Quality assurance
• Institutions should carry out their program at the
recommended frequency to maintain conformity with the
national standards

• All QA measurements must be entered in log books

 Conclusion
• Setting a new radiation facility is a tedious job

• Each and every step has many challenges

• Great care and diligence should be exercised in each and

every step

• The time commitment and money can be substantials, and

errors and oversights can be costly

• No compromise must be made on any aspect of the process

THANK YOU
 International atomic energy agency
• The International Atomic Energy Agency is the world's central
intergovernmental forum for scientific and technical co-operation in the
nuclear field.

• It works for the safe, secure and peaceful uses of nuclear science and
technology, contributing to international peace and security and the United
Nations' Sustainable Development Goals.

• The IAEA was created in 1957 in response to the deep fears and expectations
generated by the discoveries and diverse uses of nuclear technology.

• The IAEA established PACT in 2004, with the goal of ensuring the integration
of radiotherapy in comprehensive cancer control and of engaging with other
international organizations such as the World Health Organization (WHO) to
address cancer control in a comprehensive way.