TELETHERAPY

AGENDA
Introduction
Building confidence
Engaging the audience
Visual aids
Final tips & takeaways

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TELETHERAPY
MACHINES
• Treatment machines incorporating
with ionizing radiation source that is
basically used in cancer treatment.
• “tele” – refers to distance (distant)
EXAMPLES OF
TELETHERAPY
MACHINES
• Grenz Rays Machine
• Contact therapy machine
• Orthovoltage machine
• Superficial machine
• Orthovoltage machine
• Super voltage machine
• Mega voltage machine
GRENZ RAYS
• Treatment machines incorporating
gamma ray source for use in
external beam
• Inherent filtration is 0.1 mm Al
• 1923- Gustav Bucky constructed x-
ray tube with lithium borate
window (lindermann glass)
• Grenz rays= low energy x-rays
having an energy of 10 to 15 kVp
• Grenz means “boarder”
• The recommended fractionation involving
approximately 200 (R) per session at weekly
intervals total to 800 to 1000 (R).
• Grenz rays are especially effective for
treatment of inflammatory disorder involving
Langerhan’s cell
• Grenz rays have yielded positive results for:
• Bowen’s disease
• Patch-stage mycosis fungoides
• Herpex simplex

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 CONTACT THERAPY
OR ENDOCAVITARY
• It operates at potentials of 40 to 50 kVp and
facilitates irradiation of accessible lesions at very
short source to the surface of the skin.
• It operates at 2 mA.
• 0.5 to 1.0 mm Al filter.
• This quality of radiation is useful for tumors not
deeper than 1 mm
• Fractionated doses of 300 to 500 R and total doses
ranging from 1200 to 1500 R.
 SUPERFICIAL
MACHINES
• Radiation therapy units operating in the
approximate range of 50 to 120 kVp.
• Addition of filters typically Aluminum
(1-6 mm) used to harden the beam.
• 5 to 8 mA
ORTHOVOLTAGE
MACHINE
• Ranges from 150 to 500 kVp are
preferred to as orthovoltage units.
• Copper is usually used as filters
and sometimes tin with addition to
aluminium.
• Aluminium is placed distal to copper in the path of
the beam to remove soft secondary radiation
produced when the beam strikes by copper.
• HVL of 1 to 4 mm copper
• Orthovoltage units can use external/ del regato
cones to collimate the beam.
• Copper on the other hand is added distal to the tin
filter in the path of the beam to remove soft
secondary radiation.
• SSD of 50 to 70 cm and can be used without a
cone.

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SUPERVOLTAGE
THERAPY MACHINE
• X-ray therapy in the range of 500 to
1000 kVp.
• Maybe referred to as high voltage
therapy.
 MEGAVOLTAGE
THERAPY UNIT
• X-ray beams of energy 1 MV or greater
can be classified as megavoltage beams.
• Examples:
Linear Accelerator
Cobalt-60 Machine
Cesium – 137 Machine
COBALT-60 MACHINE
including beam
collimator and source
a radioactive source; a source housing,
movement
mechanism;

stand in isocentric
machines or a
a patient support
a gantry and housing support
assembly;
assembly in stand-
alone machines;

and a machine
console.
COBALT-60 SOURCE

The most widely used

teletherapy source uses diameter of the cylindrical
60Co radionuclides teletherapy source is
contained inside a between 1 and 2 cm; the
cylindrical stainless-steel height of the cylinder is
capsule and sealed by about 2.5 cm
welding.
• Typical source activities are of the order of
5000–10 000 Ci (185–370 TBq).
• Teletherapy sources are usually replaced
within one half-life after they are installed;
however, financial considerations often result
in longer source usage
• The 60Co radionuclides
SOURCE HOUSING
• The housing for the teletherapy
source is called the source head:
steel shell with lead
mechanism
two methods are in use for moving the
source from the “beam off” into the
“beam on” position and back:
(i) a source on a sliding drawer and
(ii) a source on a rotating cylinder
Dose • The prescribed target dose is delivered
delivery with the help of two treatment timers:
with • Primary
teletherapy • Secondary timer
machines
 • Collimators of teletherapy
Collimator machines provide square and
and rectangular radiation fields
penumbra typically ranging from 5 × 5 to 35
× 35 cm2 at 80 cm from the
source.
 LINEAR ACCELERATOR
• Machines that produce high electron beams
using high frequency electromagnetic waves.

• Developed by Wideroe in 1928 to accelerate

heavy ions like protons.

• Electron linear accelerators were developed first

during late 1940’s and early 1950’s by Fry,
Ginzton and Chodorow.

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GENERATIONS OF
LINEAR
ACCELERATORS

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FIRST
GENERATION

• Low energy photons (4–8 MV)

• straight-through beam;
• fixed flattening filter;
• external wedges;
• symmetric jaws;
• single transmission ionization
chamber;
• isocentric mounting

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SECOND
GENERATION

• Medium energy photons (10–

15 MV) and electrons: bent
beam;
• movable target and flattening
filter;
• scattering foils;
• dual transmission ionization
chamber;
• electron cones
• Can rotate 360 degrees 26
THIRD
GENERATION
• High energy photons (18–25 MV)
and electrons:
• dual photon energy and multiple
electron energies;
• achromatic bending magnet;
• dual scattering foils or scanned
electron pencil beam;
• motorized wedge;
• asymmetric or independent
collimator jaws
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FOURTH
GENERATION
• High energy photons and
electrons:
• computer controlled
operation;
• dynamic wedge;
• electronic portal imaging
device (EPID);
• multileaf collimator (MLC).

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 FIFTH
GENERATION
• High energy photons and
electrons:
• photon beam intensity
modulation with MLC;
• full dynamic conformal dose
delivery with intensity
modulated beams produced
with an MLC

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 Linacs are usually mounted isocentrically and
the operational systems are distributed over
Components five major and distinct sections of the
of modern machine, the:
LINACS ● Gantry;
● Gantry stand or support;
● Modulator cabinet;
● Patient support assembly
● Control console
• The main beam forming components of a modern medical LINAC are
usually grouped into six classes:
• (i) Injection system;
• (ii) RF power generation system;
• (iii) Accelerating waveguide;
• (iv) Auxiliary system;
• (v) Beam transport system;
• (vi) Beam collimation and beam monitoring system
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 Injection system

• The injection system is the source of electrons; it is essentially a simple

electrostatic accelerator called an electron gun.
• Two types of electron gun are in use as sources of electrons in medical linacs:
• Diode type;
• Triode type.
• Both electron gun types contain a heated filament cathode and a perforated
grounded anode; in addition, the triode electron gun also incorporates a grid

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Radiofrequency power generation
system
• The microwave radiation used in the accelerating waveguide
to accelerate electrons to the desired kinetic energy is
produced by the RF power generation system, which consists
of two major components:
• An RF power source;
• pulsed modulator

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• The RF power source is either a magnetron or a klystron. Both
are devices that use electron acceleration and deceleration in a
vacuum for the production of high power RF fields.
• Both types use a thermionic emission of electrons from a
heated cathode and accelerate the electrons towards an
anode in a pulsed electrostatic field; however, their design
principles are completely different

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 Accelerating waveguide

• Waveguides are evacuated or gas filled metallic structures of

rectangular or circular cross-section used in the transmission of
microwaves.
• Two types of waveguide are used in linacs:
• RF power transmission waveguides and
• accelerating waveguides.
• The power transmission waveguides transmit the RF power from the
power source to the accelerating waveguide in which the electrons
are accelerated
 Microwave power transmission

• The microwave power produced by the RF generator is carried

to the accelerating waveguide through rectangular uniform S
band waveguides that are either evacuated or, more
commonly, pressurized with a dielectric gas (Freon or sulphur
hexafluoride, SF6) to twice the atmospheric pressure.
 Auxiliary system

• The auxiliary system consists of several services that are not

directly involved with electron acceleration yet make the
acceleration possible and the LINAC viable for clinical operation.
• vacuum pumping system
• water cooling system used for cooling the accelerating guide, target, circulator and RF
generator;
• An optional air pressure system for pneumatic movement of the target and other beam shaping
components;
• Shielding against leakage radiation
 Electron beam transport

• In low energy LINAC the target is embedded in the

accelerating waveguide and no beam transport between the
accelerating waveguide and target is required.

• Bending magnets are used in linacs operating at energies

above 6 MeV, where the accelerating waveguides are too
long for straight-through mounting.
• The accelerating waveguide is usually
mounted parallel to the gantry rotation
axis and the electron beam must be bent
to make it strike the X ray target or be
able to exit through the beam exit
window. Three systems for electron
bending have been developed:
• 90º bending;
• 270º bending (achromatic);
• 112.5º (slalom) bending.

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• The important components found in a typical head of a fourth or fifth
generation LINAC include: —
• Several retractable X ray targets;
• Flattening filters and electron scattering foils (also called scattering
filters);
• Primary and adjustable secondary collimators;
• Dual transmission ionization chambers
• A field defining light and a range finder;
• Optional retractable wedges;
Target

• It is the transmission type

target because as the kinetic
energy of electrons increases,
the direction of the x-ray
emission becomes increasingly
forward in which the electrons
bombard to the target from the
one side and the x-ray beam is
obtained on the other side.
 Beam Flattening Filter (x-ray
beam mode)
• It is used to make the beam intensity
uniform across the filed since the
electron produce in the linear accelerator
is in the megavoltage range and the x-ray
intensity is peaked in a forward direction.
• The filter is usually made of lead.
Tungsten, uranium steel, aluminium or
combination has been suggested and
used.
 Scattering foil (Electron Mode)

• Scattering foil (Electron

Mode)
• It is used to scattered
the pencil thin
electron beam
• Usually made up of
tin.
Beam collimation

• In a typical modern medical LINAC, the photon beam

collimation is achieved with two or three collimator
devices:
• A primary collimator;
• Secondary movable beam defining collimators;
• An MLC (optional)
In addition to the primary and
secondary collimators, clinical
electron beams also rely on
electron beam applicators
(cones) for beam collimation.
 The primary collimator

• defines the largest available

circular field size and is a
conical opening machined
into a tungsten shielding
block.
 Secondary beam defining collimators

• consist of four blocks, two

forming the upper and two
forming the lower jaws of the
collimator. They can provide
rectangular or square fields at
the linac isocentre, with sides of
the order of few millimetres up
to 40 cm.
 Asymmetric jaws

• provide asymmetric fields,

most commonly one half
or three-quarter blocked
fields in which one or two
beam edges, respectively,
are coincident with the
beam central axis
 Multi-Leaf Collimators

• In principle, the idea behind an

MLC is simple; however, building a
reliable MLC system presents a
substantial technological
challenge.
Dose monitoring system

• Transmission ionization chambers

• sealed ionization chambers
• customary position: between the flattening filter or
scattering foil and the photon beam secondary
collimator.
 The main requirements for the ionization
chamber monitors are as follows:

• Chambers must have a minimal effect on clinical photon

and electron radiation beams;
• Chamber response should be independent of ambient
temperature and pressure
• Chambers should be operated under saturation
conditions.
 SHIELDING CONSIDERATION

• Primary and secondary Barriers

• Superficial and orthovoltage X ray therapy rooms are
shielded either with ordinary concrete (2.35 g/cm3 ) or
lead. In this energy range the photoelectric effect is the
predominant mode of photon interaction with matter,
making the use of lead very efficient for shielding
purposes

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• Megavoltage treatment rooms (often referred to as
bunkers or vaults because of the large barrier thickness
required for shielding) are most commonly shielded
with ordinary concrete so as to minimize construction
costs.
• The Compton effect is the predominant mode of
photon interaction with shielding material in this
energy range
• Modulator
• It is the power source of the accelerator
• It transforms the alternating current to direct current which is needed by the
components of the stand.
• Modulator Cabinet
• This important component of the linear accelerator is usually located in the
treatment room and is the noisiest part of the ensemble. In some systems, the
modulator cabinet contains three major components
• Fan control
• Auxiliary power-distribution system, and power distribution system.
Console

• Brain of the accelerator

• It has the controlling circuit boards and tuning
capacitors used for output and steering
adjustment
• Daily operations are control from the console.
Treatment couch

• Is not part of the

radiation delivery
system. However , it is
the main factor in the
gantry installation and
the patient set up.
• Area in which the patient is positioned to received
their radiation treatment.
• Many tabletops support up to 160 kgs and range in
width from 45 to 50 cm.
• Some manufacturers offer the same indexed carbon
fiber couch top for their simulator and treatment
units.
 Energy range of Linear
Accelerators
ENERGY RANGE FEATURES

Low 4 to 6 MV; x-rays

Medium 8 to 12 MV; x-rays and electrons

High 15 to 35 MV; x-rays, electrons,

and special features.
VAN DE GRAAF
GENERATOR
• The machine that was first
particle accelerator that
can accelerate electrons
up to 2 MV
• Developed by R.J Vaan de
Graaf in 1931
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 BETATRON
• Developed by Kerst in 1941.
• Machine in which electrons are accelerated in
circular orbit via changing the magnetic fields.
• The accelerating tube is shaped like a
doughnut by an injector at an instant that the
alternating current cycle begins.
• The electrons can be extracted from tis orbit
to produce an electron beam
• Replaced by LINAC
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• The electrons are accelerated
by the electric field induced in
the doughnut shape by the
changing magnetic flux in the
magnet; they are kept in a
circular orbit by the magnetic
field present
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Cyclotron

• It was developed in 1930 by Ernest

Rutherford for accelerating ions of kinetic
energy of few MeV.
• It was used for basic nuclear medicine
research.
 ….

In cyclotron, the particles

are accelerated along a
spiral trajectory guided
inside two evacuated half
cylindrical electrodes
(referred to as DEES)

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Microtron

• An electron accelerator which combines the

principles of both linear accelerator and the
cyclotron.
• In microtron, the electrons are accelerated
by oscillating electric field of single
microwave cavity.
THANK YOU