Linear Accelerators

Chapter 7 W/L
Chapter 9 S/S

Radiation Therapy Equipment

Low-energy machines: Uses x-rays generated at voltages up to

300kVp
Grenz rays
10-15kVp
Treatment of inflammatory disorders (Langerhans cells), Bowens disease,
patchystage mycosis fungoides, herpes simplex

Contact therapy
Superficial skin lesions
Endocavitary treatments for curative intent (rectal)
hemangiomas

Superficial equipment
50-150kVp
Skin cancer and tumors no deeper than 0.5 cm

Orthovoltage machines
150-500kVp
Skin, mouth, and cervical carcinoma
Experience limitation in the treatment of lesions deeper than 2 to 3 cm.

Limitations of
Low Energy Machines

Can not reach deep-seated tumors with an

adequate dosage of radiation.
Do not spare skin and normal tissues.

Central Axis Depth Dose

Central axis depth dose and physical penumbra are
related to beam quality.
The central axis depth dose distribution for a specific
beam depends on the energy.
Isodose curve: a line representing various points of
similar value in a beam along the central axis and
elsewhere
The depth of an isodose curve increases with beam quality
The absorbed dose in the medium outside the primary beam is
greater for low-energy beams than for those of a higher energy.
Limited scatter outside the field for megavoltage beams occurs
because of predominantly forward scattering of the beam.

Linear Accelerator
Treatment machine that uses high-frequency
electromagnetic waves to accelerate charged particles
such as electrons to high energies via a linear tube.
Charged particles travel in straight lines as they gain
energy from an alternating electromagnetic field.
Higher energy beams can be generated with greater skin
sparing, field edges are more sharply defined with less
penumbra and computer technology shapes the
treatment beam and personnel receive less exposure to
radiation leakage.

History

1948: A working 1MV linear accelerator was installed at the Fermi

Institute in Chicago.
Mile long waveguide ran under University Boulevard at the University of
Chicago.

1948: the British Ministry of Health brought together the three main
groups in England who were working on the linac.
Medical Research Council
Atomic Energy Research Establishment
Metropolitan Vickers Electric Company

1952: linac installed at Hammersmith Hospital in London, first

treatment in 1953 with an 8MV beam.
1956: first clinically used in the US at the Stanford University
Hospital.
1961: The first 100 cm SAD fully isocentric linear accelerator was
manufactured and installed in the US.

Accelerator Generations

Early Accelerators (1953-1961):

Extremely large and bulky
Limited gantry motion

Second Generations (1962-1982):

360 degree rotational
Allow treatment to a patent from any gantry angle
Improvement in accuracy and dose delivery

Third generation accelerators:

Improved accelerator guide
Magnet systems
Beam-modifying systems to provide wide ranges of beam energy, dose
rate, field size
Operating modes with improved beam characteristics
Highly reliable
Compact design
May include: dual photon energies, multileaf collimation, several
electron energies & electronic portal verification systems

Components

Modulator cabinet
Console
Drive Stand
Klystron
Waveguide
Circulator
Water-cooling system

Gantry
Electron gun
Accelerator structure
Treatment head
Bending magnet
Flattening filter
Scattering foil

Treatment couch
Other accessories

Modulator Cabinet
Modulator cabinet: contains components that distribute
and monitor primary electrical power and high-voltage
pulses to the magnetron or klystron
Located in the treatment room
Three major components:
The fan control: automatically turns the fans off and on as the
need arises for cooling the power distribution
Auxiliary power-distribution system: contains the emergency off
button that shuts off the power to the treatment unit.
Primary power-distribution system

Console
Console electronic cabinet: provides a
central location for monitoring and
controlling the linac
Take the form of a digital display, push button
panel or video display terminal (VDT)
All interlocks must be satisfied for the
machine to allow the beam to be started
Provides a digital display for prescribe dose
(monitor units), mechanical beam parameters
such as collimator setting or gantry angle

Drive Stand
Drive Stand: a stand containing the apparatus
that drives the linear accelerator
Open on both sides with swinging doors for easy
access to gauges, valves, tanks, and buttons
Klystron/Magnetron: power source used to generate
electromagnetic waves for the accelerator guides
Waveguide: hollow tube-like structure that guide the
electromagnetic waves from the magnetron to the
accelerating guide where electrons are accelerated
Circulator: directs the RF energy into the waveguide
and prevents any reflected microwaves from returning
to the klystron
Water-cooling system: allows many components in
the gantry and drive stand to operate at a constant
temperature

Klystron
Klystron: A linear beam microwave
amplifier requiring an external oscillator or
radiofrequency (RF) source driver
A form of radiowave amplifier, multiplies the
amount of introduced radiowaves greatly.
Electron tube that is used to provide
microwave power to accelerate electrons
Microwave frequencies needed for linear
accelerator operation are about three billion
cycles per second

Magnetron
Magnetron: device that provides high-frequency
microwave power that is used to accelerate the
electrons in the accelerating waveguide.
Electrons are emitted from the cathode and
spiral in the perpendicular magnetic field. The
interaction of the spiraling electrons with the
cavities in the anode creates the high-frequency
EM waves.
oscillator and amplifier used in low-energy

Gantry
Gantry: responsible for directing the
photon (x-ray) energy or electron beam at
a patients tumor.
Electron gun: produce electrons and injects
them into the accelerator structure
Accelerator structure: a special type of
wave guide in which electrons are
accelerated.
Treatment head: components designed to
shape and monitor the treatment beam

Accelerator Structure
Microwave power (produced in the klyston) is transported to the

accelerator stricture in which corrugations are used to slow up the

waves synchronous with the flowing electrons. After the flowing
electrons leave the accelerator structure, they are directed toward
the target (for photon production) or scattering foil (for electron
production) located in the treatment head.

Amplification that occurs in the accelerator structure is in the

closed ended, precision crafted copper cavities where the
electrical power provides momentum to the low-level electron
stream mixed with the microwaves. Alternating positive and
negative electric charge accelerates the electrons toward the
treatment head, the negative voltage repels electrons while
the positive voltage attracts then, thereby pushing and pulling
the electrons along.
Charged particles experience the equivalent of a small
voltage multiple times, ending up with a large amount of
kinetic energy

Accelerator Structure

Length varies depending on the beam energy of the linac, as more

cavities are used, higher energy is derived
Traveling wave: an electromagnetic wave travels to the right along
with the electron, the electron is continuously accelerated as it
moves
Limitation: the electron and the electric field must move at the same
velocity
Irises: washer shaped metal discs that provide resistance to the travel of
the electromagnetic waves.
As the electron increases in energy and velocity, the need for irises is
reduced, so irises are increasingly far apart and have increasingly wider
openings.

Standing wave: microwave power is joined into the structure by

side-coupling cavities, rather than through the beam aperture,
provides a shorter accelerating tube
Makes use of the concept if interference
More efficient, more costly

Treatment head
Treatment head: components designed to shape and
monitor the treatment beam
Bending magnet: direct the electrons vertically toward the
patient
X-ray target:
Primary collimator: designed to limit the maximum field size
Beam flattening filter: shaped the x-ray beam in its cross
sectional dimension
Ion chamber: monitors the beam for its symmetry in the rightleft and inferior-superior direction
Secondary collimators: upper and lower collimator jaws
Field light: outlines the dimensions of the radiation field as it
appears on the patient, allows accurate positioning of the
radiation field in relationship to skim marks or other reference
points

Bending Magnet
Bending magnet: bends the electron beam through a
right angle, so it ends up pointed at the patient
90 degree magnets (chromatic) have the property that any
energy spread results in spatial dispersion of the beam.
Electrons are bent in proportion with their energy, the lower energy
electrons are bent more, the higher energy electrons less
Results in a beam that is spread from side to side according to
energy
Energy sensitive, act as energy differentiators

270 degree magnets (achromatic) designed to eliminate spatial

dispersion
So not significantly disperse the different electron energies in the
beam.

Flattening Filter
Flattening filter: (lead, steel, copper etc.)
Modifies the narrow, non-uniform photon beam at the isocenter
into a clinically useful beam through a combination of attenuation
of the center of the beam and scatter into the periphery of the
beam
Measured in percent at a particular depth in a phantom (10 cm)
Must be carefully positioned in the beam or the beam hitting the
patient will be non-uniform, resulting in hot and cold spots

Flatness: a wide beam that is nearly uniform in intensity

from one side to the other (+/- 6%)
Symmetry: the measure of intensity difference between
its opposite sides (+/- 4%)
Causes include the use of a wedge, misalignment of the
flattening filter, and misdirection of the electron beam before
hitting the target.

Scattering foil
Scattering foil: thin metal sheets provide
electrons with which they can scatter,
expanding the useful size of the beam
Other accessories

Monitor Chambers
Electron and photon beams must first be
measured or monitored in order to allow
delivery of the prescribed amount of
radiation.

Treatment Couch
Treatment couch: mounted on a rotational axis
around the isocenter
Also called patient support assembly (PSA)
Move mechanically in a horizontal and lengthwise
direction- must be smooth and accurate allowing for
precise and exact positioning of the isocenter during
treatment positioning
Support up to 450 lbs
Range in width from 45-50 cm
Racket-like frame should be periodically tightened to
provide more patient support and reduce the amount
of sag during treatment positioning.

Multimodality Treatment
Multimodality treatment units offer several
advantages:
Dual photon energies- they can provide
backup for other treatment units that may
experience down-time
Patients can be treated with multiple beam
energies on the same treatment unit

New Technologies
Three-dimensional conformal therapy (3D-CRT): the
field shape and beam angle change as the gantry moves
around the patient
Images from CT scanners are transferred to treatment planning
computers, where normal tissues and tumor volumes are defined
forward planning process: beam arrangement are tested by trial
and error

Intensity Modulated radiation therapy (IMRT):

beneficial in escalating the dose to the tumor volume and
reducing the dose to normal tissue
inverse treatment planning: the radiation oncologist selects
dose parameters for normal tissues and the target volume and
the computer back calculates the desired dose distribution and
beam arrangements
Adjusts the intensity of radiation beam across the field with the
aid of MLC moving in and out of the beam portal under precise
computer guidance.

Additional Advances
Independent collimators (dual asymmetrical
jaws): provide increased flexibility in treatment
planning
MLCs allow an increased number of treatment
fields without the use of heavy Cerrobend
blocking
Dynamic wedge: computerized shaping of the
treatment field
Electronic portal imaging: provides feedback on
single-event setup accuracy or observation of
treatment in near real-time

Additional Advances
Verification and record devices:
Allow incorrect setup parameters to be corrected
before the machine is turned on
Provide data in computer assisted setup
Recording of patient data
Allowing for data transfer from the simulator or
treatment planning computer
Assisting with quality control

Stereotactic radiation therapy: involves the

aiming and delivery of a well defined narrow
beam to extremely hard to reach places

Interlocks
Designed to protect the patient, staff members
and equipment from hazards
Patient protection interlocks, including beam
energy, beam symmetry, dose, and dose-rate
monitoring, prevent radiation and mechanical
hazards to the patient
Emergency off buttons terminate irradiation and
machine functions require a complete warm-up
procedure before the treatment machine can
produce an electron or photon beam

High-energy Machines
High-energy machines
Van de Graaff generator
Betatron: particles travel in a circular pattern
Cyclotron: the particles travel in a spiral
pattern
Linear accelerator
Cobalt unit