BEAM DIRECTION AND

MODIFICATION DEVICES USED IN

RADIOTHERAPY
Moderator : Mr. Robert
Presented By : Parul Sharma
 Radiations emitted by radioactive
material and x-ray targets
X-rays from
thick and
thin targets
Need for collimated radiation
• Minimum dose to the radiation workers
• Minimum dose to normal tissue
• Desired size for the treatment
Two stages of collimation
1. Master or Fixed collimation
2. Treatment or movable collimation :
• Secondary collimators (Movable jaws)
• Tertiary collimators (Multi leaf collimators)
 Master or Fixed collimation
• In case of tele curie
radioactive isotope source,
the source is placed in steel
shell filled with lead and
brought to the front of an
opening (conical hole)
through the lead shielding
for treatment .
• Depleted uranium is also
used as a shielding material
during OFF position.
• In kV range, X-ray tube is
mounted in a metal box which is
lined with lead except for the thin
window through which the useful
beam emerges.
• Lead glass is also used to make the
main body of tube allowing
radiation to escape through a thin
window of soda glass.
• In MV range, the target is shrouded
with several inches thickness of
lead and beam emerges from a
small hole.
Treatment or Movable collimation
Movable jaws (secondary collimators):
 Two movable pair of jaws (X,Y) at right
angles and are made of high Z materials.
 Provides rectangular or square field.
 The field size at skin surface is seen by
light beam falling through the opening of
jaws .
 Optical beam size is made congruent with
the radiation field size.
Beam size (beam profile)
It is the dimensions of the beam
at isocenter i.e. 100cm from the
source In LINACs.
Edge of the geometrical field is
roughly defined at 50% dose level.
Physical or useful beam is
considered between 80% or 90%
dose levels.
Penumbra
A dose transition region near the borders of the field or a region in
which dose rate changes rapidly as a function of distance from the
central axis of beam.

Transmission penumbra

Geometric penumbra

Physical penumbra
Transmission penumbra
It is caused due to variable transmission
of beam through non divergent
collimator edge.
Its extent increases with larger
collimator openings due to greater
obliquity of the rays at the edge of jaws.
 1 cm or wide strips of copper-tungsten
alloy are placed on inner surface of
jaws.
Density of this alloy is greater then
lead , thus more attenuation is
provided.
Geometric penumbra
It is due to the finite dimensions of source.
• The geometric width of the penumbra () at any
depth (d) from the surface of a patient can be
determined by considering similar triangles ABC
and DEC.

DE=
• Therefore, if AB = s, the source diameter, OM =
SDD, the source to diaphragm distance, OF = SSD,
the source to surface distance, then the penumbra
(DE) at depth d is given by
Physical penumbra

It is the spread of dose 90% 20%

distribution near the field
borders and is usually specified
by the lateral width of isodose
levels from 90% to 20% .
It is influenced by geometric
penumbra, beam energy and
lateral transport of electrons in
the tissue.
Penumbra trimmers
S
• Consists of extensible,
heavy metal bars to
attenuate the beam in
the penumbra region.
• Increase the source to C1
diaphragm distance,
reducing the geometric
penumbra. C2

• Another method is to
use secondary blocks
placed close to the
patient ( 15 – 20 cms).
SC1D < SC2D P1
P1 > P2 P2
Multi leaf collimators (tertiary collimators) :
A multileaf collimator (MLC) is a device made up of individual
"leaves" of a high atomic numbered material that can move
independently in and out of the path of a particle beam in
order to block it.
MLCs are used on linear accelerators to provide conformal
shaping of radiotherapy treatment beams for improved
treatment delivery efficiency.
Applications :
1. Less time consuming than conventional methods which
use lead blocks for shaping.
2. In arc therapy, leaves move continuously according to the
shape of tumor at particular gantry angle.
3. Achievement of beam intensity modulation using the
motion of the MLC leaves during irradiation to create a
dynamic compensating filter.
 Configuration of MLCs
1st level configurations:
• Replacement of upper jaws

• Design of ELEKTA MLCs (80, microSRS)

• Leaves move in Y-direction parallel to the rotation axis

of gantry
• Back-up collimator located beneath the leaves set to
the position of outermost leaf
• Shorter leaf dimensions and more compact treatment
head diameter
• Each leaf is 3mm wide which has a projection of 1cm at
the isocentre.
2nd level configuration :
• Replacement of lower jaws

• Design of SIEMENS MLCs

(29 pairs , outer 2 pairs
having width of6.5cm and
inner 27 pairs having width
of 1cm at the isocenter)
• Leaf ends are straight and
focused on X-ray source
• Maximum speed of leaves
is 1.5cm/sec
3rd level of configuration :
• Below upper and lower jaws
• Design of VARIAN MLCs (52, 80 and
120 leaves)
• Width for mini MLCs is between 2mm
to 5mm and that for micro MLCs is
less than 2mm.
• More bulk is added to the machine
head
• Less clearance to the mechanical
isocenter
Field shaping limitations
 In Siemens MLCs , the max. extension of a leaf is 20cm to the
center of the field and an additional 10 cm across the centerline.
The maximum leaf travel is 30cm.

 In Elekta (Philips) MLCs , the maximum extension across the

centerline is 12.5cm which gives the total max. leaf travel equals to
32.5cm.

 General Electric , has the same max. extension of the leaf across the
centerline as Siemens i.e. 10cm.
 The leaves in the Varian collimator travel on a carriage to extend their
movement across the field. Distance between the most extended leaf
and the most retracted leaf on the same side can only be 14.5 cm.
• Extension of leaf across the central line in case of symmetric and
large field size is not possible . But in case of asymmetric fields ,
the Varian carriage can be moved to the field center and a leaf can
be extended 14.5 cm beyond the field center.
Attenuation
Material properties
Pure tungsten with density of 19.3g/cm3 is very brittle

tungsten alloy with varying mixtures of Ni, Fe, Cu is used

Highest density in metals ranging from 17g/cm3 to 18.5g/cm3

Hard, machinable and inexpensive

Low coefficient of expansion

Types of transmission
• Leaf transmission : reduction of dose through
the full height of leaf
• Interleaf transmission : reduction of dose along
the line between leaf sides
• Leaf end transmission : reduction of dose along
a ray passing between the ends of opposing
leaves
Transmission requirements :
 Overall transmission should be less than 5%.

 Required thickness of tungsten alloy for this

transmission is 5cm
 For transmission of 1% thickness of tungsten
alloy should be 7.5cm
Parameters of Multileaf Collimators from different
manufacturers available in 2006
Beam direction
The collimated beam should be accurately directed towards the tumor center to
reduce the unnecessary irradiation of the normal tissue. This is achieved with the
help of beam directing devices.
Devices used for beam direction
• Front and back pointer

• Pin and arc

• Isocentric mounting

• Electron applicators
Front and back pointer
Principle :
Any straight line can be defined by two points and this method requires
marking of two points on the patient surface such that the line passing
through these points will pass through the tumor center .
WORKING:
Using radiography the two points are decided such that the line joining them will
pass through the center of tumor .
Movable distance indicator is used as front pointer and designed such that its
adjustable rod lies on the central axis of the beam.
Another rod firmly attached to the head of the machine can act as a back pointer
that points towards the exit point of the beam on emerging central axis from the
patient’s body.
This rod can be moved forward or backward accordingly .

The marks are made on the patient “shell ” made of cellulose acetate sheet or
plastic which can fit accurately and easy to be put on and taken off .
This provides more accuracy and reproducibility .
 Pin and Arc
 It is another widely used aid for accurate beam direction ,mostly used where exit points may be
inaccessible to the back pointer.
Construction :
• Ruler like scale bar R connected to the x ray tube.
• Sliding frame S and arc T is attached to this frame.
• Centre of arc T of the circle lies on the central axis
at O.
• Carriage U which carries a rod/pin V which can be
clamped at any position .
• If length of V is at lowest position then its lower
end is on the central axis at O.
• d is read off by scaled rod V .
• D is measured by R .
• Angle between V and central axis is measured
using angular scale on T .
WORKING
Depth of tumor d and its center O is localized
below surface -mark M .
The pin V is withdrawn the required distance d
and its lower end is kept at M vertically above
O.
Keeping pin V at that position rest of the
equipment is rotated about O.
Central ray of the beam will always pass
through the tumor center.
At any desired angle distance D is adjusted
accordingly and can be measured using R.
Thus D is the depth of the tumor center from
the surface at any particular field which is
useful for dose computation .
Isocentric mounting
 X ray tube or tele -curie source is made
to move in arc around patient about an
axis at 100 cm from focal spot.
 treatment table is designed to rise and
fall and also to rotate around axis
vertical to the rotational axis of the
source which cut it at iso-center point.
 PRINCIPLE :
o If the tumor is placed at isocentric point
using any method central ray will always
pass through it .
PROCEDURE
 Firstly front pointer is drawn back a distance equal to the depth of the tumor
center .
 Patient on table is raised equal to that distance so that the tip of the pointer
touches the skin mark .
 In this way tumor center is placed at isocenter .

 Any number of desired beam can be directed towards center of tumor

keeping central axis passing through the tumor center at every angle.
 The depth of the tumor from the skin surface at every angle can be
measured using the movement of front pointer.
Electron applicator

• To stop insignificant e- scatter by

delineating the field sharply close to
the patient
• To achieve a flat beam over required
widths of field
• Final layer defines field size lies b/w 0-5
cm from the patient surface
• Low Z material like Al, plastics etc. are
used to minimize x-ray contamination
• First layer towards machine head defines the
maximum field size and final layer (near
patient surface ) defines treatment field.
• Successive sections from the topmost layer
are made for collimation that absorb
scattered e-
• Frame is provided at final section in which
different sized(irregular) cut outs can be
positioned according to the required field
shape
• Some manufactures provide continuously
variable e- trimmers that attach to the head
and provide more flexibility in varying field
shape with the reduced need for cut outs.
Modifying the beam
• Alterations to the natural beam because its spatial distribution renders it
unsuitable for radiotherapy
• Eliminate the radiation dose at some special parts of the zone at which the
beam is directed
• Alterations to enable normal distribution data to be applied to the treated
zone when the beam enters the body obliquely or it passes through different
types of tissue
• Alterations to produce special spatial distributions for particular types of
treatment
Beam flattening
• There is more scattered radiation in the center,
 partly because the beam edge is always farther from the focal spot
than is the center and
 partly because there may be a greater exposure rate along the
central axis than to either side due to the natural spatial distribution
of radiation

In both cases the rate at the center is greater than the rate out
towards the beam edge
Flattening Filter
• ‘Beam-flattening' filter which reduces the central exposure rate relative to that near the edge of
the beam, to give, as nearly as possible, a constant rate across the beam .
• To achieve this result the filter must be thickest at the center and taper off to nothing towards the
edge
• Copper or aluminium is usually used in making these filters.
• It does not alter the central axis percentage depth dose values. Accurate positioning of the filter is
more important than the choice of material.
Flattening in KV energy beams
• They produced 'flat' isodose curves over a range of depths of about 5 or 6 cm, but not
over the wide depth range .
• To equalize the centre and edge rates , only primary radiations are altered.

• The primary contribution has to be overcompensated to make beam flat at a particular

depth.
• ‘Hot spots' of radiation near the beam
edges and the surface because of much
greater change of scattered radiation
associated with the kilovoltage beams
at the different depths.
In the filter:
• Photons are absorbed -- reduced efficiency Flattening in MV beams
• Photons are scattered -- increased contamination
radiation
• Neutrons are produced – increased contamination
radiation
• In general, the average energy of the beam is
somewhat lower for the peripheral areas compared
with the central part of the beam. This change in
quality across the beam causes the flatness to change
with depth, also the changes the distribution of
radiation scatter as the depth increases.
• Possible to achieve flatness to within of the central axis
dose value .
• Beam flatness is usually specified at a 10-cm depth. This
degree of flatness should extend over the central area
bounded by at least 80% of the field dimensions .
Shielding
• To attenuate the beam at a particular region .
• Used to protect some delicate organs which have low tolerance to radiation .
Material :
• High Z material
• High density
• Easily available , inexpensive

 Complete protection can never be afforded

 Reduced dose to the sensitive or important tissues

• This strip (F) can be sufficiently thick so that practically no primary radiation passes through it .
• The point T will not go un-irradiated because of scattered radiation from the irradiated zones
on either side

Easy to achieve with MV radiations than KV radiations

because of more scattered dose in kV range
HVL
• HALF-VALUE LAYER is defined as the thickness of material, required to
attenuate the intensity of the primary beam to half of its original value.
Beam Required
• Intensity of a beam after travelling a distance x in a homogenous
quality lead
medium I = I0 e-μx thickness
For HVL , I = ½ I0 and x= HVL
Therefore , HVL= 0.693/μ Co60 5.5 cm
• Aim of shielding is reduction to 5% or less
4 MV 6.0 cm
1/2 = 5% or 0.05
n

6 MV 6.5 cm
Thus, 2n = 1/0.05 = 20
10 MV 7.0 cm
OR, n log 2 = log 20.
25 MV 7.0 cm
n = 4.32
The relationship holds true, only for mono energetic x-ray beams .
Compensators
• Where the beam enters the patient obliquely or
through a curved surface compensation is used.
• More radiation will reach P and Q respectively than
would be indicated by any isodose chart since to
reach those points the beam has suffered less
attenuation
• Primary radiation reaching P and Q will be the same
provided that A’C’ equals AC and D’E’ equals DE
respectively.
• Advantageous to place the compensator at
position II because it does not affect the skin
sparing effect in high energy beams .
Designing of compensators
Three separate stages
1. Replacement of the missing tissue area with a series of
square-section sticks, each having an end section of
15mm2
2. This series is displaced at some distance from the patient
surface towards source. Thus the required end section
area of each stick would be
x= mm
3. Replacement of the unit density material of sticks with
another dense material like aluminium or brass . The
length of the sticks now required will be less to provide
the same attenuation.
• The required thickness of a tissue-equivalent compensator along a ray divided by the
missing tissue thickness along the same ray may be called the density ratio or thickness
ratio (τ = h′/h)
• If, for given irradiation conditions, τ is chosen for a certain compensation depth, the
compensator overcompensates at shallower depths and undercompensates at greater
depths.
• An average value of 0.7 for τ may be used for all irradiation conditions provided d greater
than or equal to 20 cm
• The thickness ratio is used to calculate compensator thickness (tc ) at a given point in the
field
tc = TD · (τ /ρc)
where , TD is the tissue deficit at the point considered
ρc is the density of the compensator material.
Compensators in TBI
• The compensators are usually designed in three pieces: one for the lower
extremities, one for the head and neck region, and one for the lungs.
• The first step in designing tissue compensators is to determine the tissue deficit
(TD),
TD=Lref −L+(1−ρlung )Llung
where Lref is the lateral separation at the umbilicus
L is the lateral separation at that particular anatomical location,
Llung is the separation of the lung determined from the anterior
radiograph
ρlung is the density of the lung 0.25 g/cm3
• The compensator thickness, Lc, is determined using the following equation :

Lc =

τ is the thickness ratio

is the density of the compensating material
K is the off axis correction factor that accounts for both the

decreases in beam intensity away from the central axis and

effective scattering field size for the various locations
is the broad-beam linear attenuation coefficient in tissue
Wedges

In treatment planning the wedge filter is used for two purposes:

1. To compensate for surface obliquity off axis
2. To enable a uniform distribution of dose to be produced when beams are
arranged at angles
1. To compensate for surface obliquity off axis by increasing the dose at the region of tissue
excess and reducing the dose at the region of tissue deficiency, relative to the central axis.
2. Deliberately to alter the dose gradient in the patient to enable a uniform
distribution of dose to be produced when beams are arranged at angles to each other.
Hinge angle(φ) : angle between the central
rays of the two intersecting fields .

 To satisfy the condition required for uniform

dosage, i.e., parallel isodose curves, the wedge
isodose angle(θ) and hinge angle(φ) are related
as :

θ = 90 – φ/2
 To produce a high dose zone which is clinically
acceptable, it is not necessary for the isodose
curves to be strictly parallel.

 With any 'wedge' filter there is a small range of

'hinge angle‘ values for which satisfactorily
uniform distributions are obtained.
 Wedges

Physical Non-physical
wedges wedges

Manually Motorized Dynamic/Virtual Enhanced

handled wedge wedge wedge Dynamic wedge

Individualized Universal
wedge wedge
Physical wedge
• A wedge-shaped absorber that causes a progressive decrease in the intensity across the beam,
resulting in a tilt of the isodose curves from their normal positions.
• The sloping surface is made either straight or sigmoid in shape; the latter design is used to
produce straighter isodose curves.
• Made of a dense material, such as lead or steel
Manually handled wedges Motorized wedge
• Are mounted on a transparent plastic tray or a • Is placed in the field internally i.e., an
frame that can be inserted in the designated internal motor slides the wedge into
slot in the head of the machine . position.
• A set of wedges is usually employed on each • Consist of a single large wedge i.e. 600
megavoltage machine covering the angles 15, • Placed above the secondary collimating jaws
30, 45 and 60 °. .
• Placed at least 50 cm from the isocenter
• So that it does not destroy the skin-sparing
effect of the megavoltage photon beam
 Individualized wedge
• Requires a separate wedge for each beam
width, optimally designed to minimize the
loss of beam output.
• Thin end of the wedge is aligned with the
border of the light field
• Preferred for use in cobalt teletherapy due
to constant output.
Universal wedge
• A single wedge serves for all beam widths.
•
Fixed centrally in the beam, while the field
can be opened to any size.
• Useful for linear accelerator beams where
the output is not fixed and can be varied.
Dosimetric effects
• Decrease in the dose output due to attenuation is characterized by the wedge
output factor or simply wedge factor, defined as the ratio of doses without and
with the wedge, at a point in phantom along the central axis of the beam.
[setup conditions : (10 X 10)cm field size , measurement depth is 10cm , dose
2

calculation at depth of maximum dose ]

• Attenuation in the lower X-ray energies in the megavoltage beams causes
‘ Beam hardening ‘that alters the central axis depth dose values at large depths .
Non physical wedge
• An electronic filter that generates a tilted dose distribution profile similar to a
physical wedge
• By moving one of the collimating jaws from one end of the field to the other.

• Include Varian’s Enhanced Dynamic Wedge, Siemens’ Virtual Wedge .

Advantages :
• Automation of treatment delivery

• Less peripheral dose compared to the physical wedge filter

Disadvantages :
• Greater dosimetric complexity in the acquisition of commissioning data

• Difficulties in MU calculations for various field sizes and configurations.

Dynamic wedges
• Kijewski et al.1 first proposed the idea of using dynamic jaws to generate dose
distributions equivalent to those produced by physical wedges.
• Dynamic wedge works on the basis of STT i.e. Segmented Treatment Table which
governs the position of jaws w.r.t. the number of delivered monitor units.
• The dynamic wedge STT specifies the moving jaw position in equally spaced steps
as a function of the cumulative fractional dose .
• Wedge factor is not smooth with changing field size . Thus, STTs for each available
energy, field size, and wedge angle are needed and stored within the accelerator’s
computer system
• In the initial release 128 different STTs were stored for each available photon
energy.
Enhanced dynamic wedge
• Works on the same principle of STT .
• The effective wedge factor is a smooth, continuous function of the field size so One
reference STT is needed per photon energy known as Golden STT.
• Golden STT corresponds to the full field width of 30 cm and a wedge angle of 60° .
• STT for all other field sizes and wedge angles can be derived from this Golden STT.

STTΘ = (1- ).STT 0

0
+ .STT 60
0

• The resulting STT is then truncated to the actual field

The EDWF is defined as the ratio of the EDW field output
size and normalized so that the final dose is the total
to the open field output for the same field dimension
at dose delivered at center
the geometric the end of
of the
thetreatment
field in phantom
EDWF= =
Beam Spoiler
• A low atomic-number material , like lucite
shadow tray is placed at some distance
from the skin surface . It will increase the
scattered radiation and decreases the width
of build up region .

• Effect of Lucite shadow tray on dose buildup for 10-MV x-rays. Percent depth–dose distribution is
plotted for various tray to surface distances (d). 10-MV x-rays, tray thickness = 1.5 g/cm2, field size
=15 × 15 cm2, source to surface distance = 100 cm, and source to diaphragm distance = 50 cm
Modification in electron beam
Scattering foil
• Beam modifying device used in electron beam
therapy
NEED:
• To spread the thin beam of electrons(3mm in
diameter) to cover the treatment volume
• To get uniform electron fluence over the
treatment volume
• Mostly used material for making scattering foil
is lead
• Thickness should be such that mostly electrons
are scattered
Lead cutouts
•
Thickness of lead required :
Lead cutouts : lead cutouts are used to restrict the
thickness
electron fields of leaddesired
to the required
areato stopisthe
which primary
to be
electrons has been investigated by Giarratano et
treated.
al. (1975),
• Lead who concluded that a lead thickness
cut out can be manufactured from commercially
in
millimeters
available sheetsequal
of leadto the most probable electron
energy at the surface (in MeV) divided by two is
• Placed directly on the patient’s surface to define the
treatment areaadequate to provide shielding
An extra millimeter
• Produces a field with sharp edges
of lead can be added to provide an additional
• Should be considered for small fields, low electron
margin of safety.
energies and when
e.g. For critical
20Mev, areas lie directly
thickness adjacent
of Pb = to
desired field.
= 11 mm
Isodose distribution at the edge of lead cutout

Angles α and β which

represent the angles of
maximum and minimum
dose changes,
respectively.

Both α and β decrease

with increasing beam
energy since electron
scatter becomes more
forward directed as the
beam energy increases.
Cerrobend
• Wood's metal, also known as Lipowitz's alloy, Bendalloy,
Pewtalloy and MCP 158
• Alloy of 50% bismuth, 26.7% lead, 13.3% tin, and 10% cadmium by
weight.
• Low melting point 700C
• Density of 9.3g/cm3 i.e. 1.2 times less than lead
Required thickness of cerrobend for electron shielding :
Difference in the isodose
• Have been studied by Purdy et al. (1980).
curves for a 6-MeV, 3×3-cm 2

electron field when a Cerrobend insert is placed

• Since low melting point alloy has approximately 82% of the density
10 cm above the skin surface to define the field as
of lead 20% additional thickness needs to be employed for
adequate shielding.opposed to lead blocking placed directly on the skin
surface
e.g. For 20 MeV , the thickness of cerrobend required is 13mm.
Internal shielding
• Need to be used to protect underlying sensitive
structures • The amount of electron backscatter that would be
produced by placement of a shield made solely of lead
• Commonly when using fields to treat the lip,
would produce an increase in dose of approximately 50%
at the lead–tissue interface.
buccal mucosa and eyelid lesions
• Reduction of the increased dose due to backscatter from
• Important considerations for adequate shield the lead surface can be accomplished by applying a
thickness
coating of low-Z material ( dental acrylic or aluminium )
--the electrons
• backscattered from
Followed by 2 HVL ofthe leadboxing
dental surface doto
wax not
thedangerously
surface of
lead facing the beam . increase dose at the interface
• For
--high dose edge 6 MeV , 1 HVL of wax is 3.5mm approx.
effects
• In case of eye Internal shields placed under the eyelid to
• 1cm of muscle is required to decrease every 2MeV energy of electrons, and 1mm of lead (plus 1
protect the underlying eye, tungsten is used
mm for safety) -- high density 17.3 g/cm3 than lead
• E.g. if 9 MeV of electrons are used to treat the buccal mucosa of11.34g/cm
thickness3
1 cm ,
-- low Z (74) than lead (82) gives low
Energy of electrons after penetrating 1cm of tissue = 7MeV amount of backscatter
Required thickness of lead to shield these electrons = 3.5 + 1 = 4.5mm
Bolus
(a) preserves both the
• To increase the dose on the skin surface, shape of the original
• To replace missing tissue due to surface isodose curves and the
irregularities magnitude of the
• As compensating material to shape the coverage delivered dose.
of the radiation to conform as closely as possible (b) produces not only a
to the target volume while sparing normal tissue significant change in the
• Materials used as bolus material :- paraffin wax, shape of the isodose
polystyrene, acrylic (PMMA), Lincolnshire curves but also a large
bolus(87% sugar and 13% MgCO3), Super Stuff, decrease in the overall
Super-flab , Super-flex and solid sheets of
thermo-plastics . delivered dose to the skin
surface and at depth
Conclusion
• The high energy radiations which are being used for treatment of cancer are
generally very harmful but with proper protection using efficient methods of
beam collimation, beam direction and modification , we can use these harmful
radiations for our benefits.
• As no method is 100% efficient , yet we have achieved our goals with high
precision but there is still need for advancements in these techniques to achieve
better results.
References
• Khan’s The Physics of Radiation Therapy – F.M. Khan , J.P. Gibbons
• Fundamental Physics of Radiology – W.J. Meredith , J.B. Massey
• Technical Basis of Radiation Therapy – C.A. Perez
• Handbook of Radiotherapy Physics – P. Mayles , J.C. Rosenwald
• Practical Radiotherapy Physics and Equipment – P. Cherry , A. Duxbury