Study Guide

Midterm HSCI 572

March 13, 2014

1) Know the steps in the radiotherapy treatment process.
a. Diagnosis
i. Determination that patient has cancer (or other illness treatable with radiation)
ii. Staging
b. Consultation
i. First visit with radiation oncologist
ii. Determine if patient is candidate for radiation therapy
c. Treatment Selection
i. External beam
1. Treatment units
a. Linear accelerators
b. Cobalt machines (teletherapy)
c. orthovoltage x-ray machines
2. Ionizing radiation: x-rays, gamma rays, or electron beams
3. High radiation doses cover the tumor and margin for geometric error
and microscopic spread
ii. Brachytherapy
1. Puts radiation source within or close to tumor
a. Wires, seeds, or needles
b. Cesium-137, iridium-192, iodine-125 etc.
2. Common cancers treated with brachytherapy:
a. Cervix, uterus, vagina, rectum, eye, and certain head and neck
cancers
3. Others:
a. Breast, brain, skin, anal, esop
4. Types of Brachytherapy treatment
a. Intracavitary treatment
5. Containers that hold radioactive sources are put near the tumor by way
of bodycavity (unsealed sources)
6. Interstitial treatment
7. Radioactive sources are put into tumor
d. Simulation
i. Radiographic imaging (plane film x-rays)
ii. Fluoroscopic imaging (localization)
iii. In a conventional simulation, the target has been established based on
previously acquired plane film, CT data, or specifics regarding patient disease.
The field size is typically established at the time of the simulation. 2D planning
may also be performed based on the plane film x-rays.
e. Treatment planning
i. Simulation of treatment relevant parameters recorded
1. Immobilization devices used
2. Patient position
3. Optical distance indicator
4. Reference points established (need to be identified radiographically)
ii. Image transfer to planning system
iii. Virtual Simulation
iv. Contouring
1. Identification of target and margin
2. Identification of organs at risk
v. Planning
1. Optimize beam placement/dose
f. Treatment
2) Know relationship between mass and energy, convert from amu (mass) to energy
a. E=mc^2
b. 1 amu = 1.492 417 83E -10 Joule
c. 1 eV = 1.602 176 53E -19 joule
d. 1 MeV = 1.602 176 53E -13 joule
3) Know how imaging is used in radiation therapy (simulation, types of imaging)
a. Diagnostic CT vs. CT simulation
i. CT simulation is performed on a flat bed; diagnostic CT is performed on a round
bed
ii. CT simulator requires laser alignment
iii. Image quality more important for diagnostic CT; becoming more important for
CT simulation. Reliance on delineation of target increasing with conformity of
treatment plan
iv. Display accuracy (rotation) important for CT simulation
v. CT simulations requires a larger diameter gantry opening
4) Know the types of imaging that are used and why
a. CT
b. Positron Computed Tomography (PET)
i. Radio Tracer
c. Radioisotope Tracer Imaging and SPECT
d. Magnetic Resonance Imaging (MRI)
e. Ultrasound
5) Know the function of a gantry, collimator, couch, what is meant by isocenter
a. Isocenter
i. The gantry, collimator and couch all rotate about a fixed point. This fixed point
is called the isocenter.
b. The gantry rotates 360 degrees about the patient at the isocenter, thus, the beam
may enter the patient along a cross sectional plane from 360 degrees. Additionally the
couch may rotate such that non-coplanar beams may be achieved. The couch can
rotate ~ + 100 degrees, thus limiting the number of beam orientations relative to the
patient.
6) Know how a diagnostic tube is designed
7) Be able to describe how x-rays are produced
a. X-rays are produced when the electrons are suddenly decelerated upon collision with
the metal target; these x-rays are commonly called brehmsstrahlung or "braking
radiation". If the bombarding electrons have sufficient energy, they can knock an
electron out of an inner shell of the target metal atoms. Then electrons from higher
states drop down to fill the vacancy, emitting x-ray photons with precise energies
determined by the electron energy levels. These x-rays are called characteristic x-rays.
8) Know the relationship between x-ray production and energy, atomic number
a. The effective photon energy of an X-ray beam can be increased by increasing the tube
voltage.
b. The characteristic X-rays produced in the X-ray target exhibit a continuous spectrum.
c. Bremsstrahlung increases non linearly with increase in energy
9) Know the relationship between dose rate and kV, tube current and filament current
10) The definition of a Hounsfield unit and be able to calculate
a. H= (u_tissue u_water)/u_water x 1000
11) Basics of MRI and ultrasound
a. Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or
magnetic resonance tomography (MRT) is a medical imaging technique used in radiology
to investigate the anatomy and function of the body in both health and disease.
b. MRI scanners use strong magnetic fields and radiowaves to form images of the body.
c. The technique is widely used in hospitals for medical diagnosis, staging of disease and
for follow-up without exposure to ionizing radiation.
12) Know the interactions of photon with matter, relationship between atomic number, energy and
interaction cross section
a. An interaction of a high energy photon with an atomic nucleus can lead to a nuclear
reaction and the emission of one or more nucleons.
b. Because they have no charge, they can penetrate nucleus at low energies
13) Know attenuation coefficients, mass energy transfer coefficient, mass energy absorption coeff,
etc.
a. = Linear Attenuation Coeff.
b. / = Linear Attenuation per Density
c. _tr/= Energy Transferred per Density
d. _en/= Energy Absorbed per Density
14) Know how number of electrons per gram are calculated
a. Number of electrons per gram = (avogadro's number)/atomic mass x atomic number
b. Number of Atoms = g/(X g/mol) x Avogadro's Number
15) Know the components of a linear accelerator and how photons are produced
a. Electron gun
i. Cathode filament provides electrons by thermionic emission.
b. Waveguide
i. Transfers microwave power to the accelerator structure.
c. Accelerator structure
i. Series of disks through which electron accelerates
d. Circulator
i. Device placed between the microwave source and accelerator structure to
protect microwave source from damage.
e. Magnetron/Klystron (what is the difference?)
i. Klystron is microwave amplifier and magnetron is microwave generator
f. Bending magnet
i. Typically 270 degrees, designed to focus electrons on target after they exit
accelerator structure
g. Target
i. Tungsten or tungsten alloy, produces photons
h. Monitor chambers
i. Ion chambers designed to monitor dose; shuts off beam after specified MUs
have been delivered.
16) Know the basic design for cyclotrons, betatrons, microtrons, Gamma Knife, Cyberknife,
Tomotherapy
a. Principle of betatron:
i. Electron in changing magnetic field accelerates in circular orbit
ii. Pulse of electrons injected into evacuated doughnut at start of AC cycle
iii. As magnetic field increases, electrons continuously experience acceleration and
spin with increasing velocity
iv. By end of first quarter of cycle, electrons have made several thousand
revolutions
v. Spiral out, strike target, produce x-rays
vi. 4-40 MV energies
vii. Limited by low dose rate
b. Cyclotron
i. Used for particle therapy protons and neutrons
ii. Protons directly accelerated
iii. Deuterons (proton + neutron) accelerated for neutron generation, proton
removed by process called stripping
iv. Used in the production of radionuclides
c. Tomotherapy
i. a type of radiation therapy in which the radiation is delivered slice-by-slice
(hence the use of the Greek prefix tomo-, which means "slice"). This method of
delivery differs from other forms of external beam radiation therapy in which
the entire tumor volume is irradiated at one time.
17) Be able to calculate geometric penumbra
a. Edge of the radiation beam where dose rate changes rapidly, usually defined as the
length of the beam where intensity is between 80% and 20%
b. Geometric Penumbra
i.
ii.
c. Gamma Knife
i. Dedicated unit for brain tumors
ii. Designed by neurosurgeon, Lars Leksell in 1967
iii. Contains 201 Cobalt 60 sources of approximately 30 Ci each, placed in a circular
array.
iv. 201 sources converge on a single point
v. Sources do not move
vi. Patient immobilized
1. Helmet attached to skull
2. Fixed onto couch apparatus
vii. An ablative dose of radiation is delivered to the tumor in one treatment session,
while surrounding brain tissues are relatively spared.
18) Know the dose distributions of beams as a function of beam energy
19) Know the relationships between beam energy and depth.
a. Assuming depth increases with energy for the most part
20) Know how a free air ion chamber is designed.
a. This is a chamber freely open to atmosphere, where the fill gas is ambient air. The
domestic smoke detector is a good example of this, where a natural flow of air through
the chamber is necessary so that smoke particles can be detected by the change in ion
current. Other examples are applications where the ions are created outside the
chamber but are carried in by a forced flow of air or gas.
21) Know the definitions of exposure, absorbed dose
a. Exposure
i. Defined as dQ/dm where dQ is the total charge of the ions of one sign produced
in air when all the electrons (negatrons and positrons) liberated by photons in
(dry) air of mass dm are completely stopped in air.
ii. the ionization equivalent of the collision kerma in air
b. Absorbed Dose
i. The quotient d-epsilon/dm where d-epsilon is the mean energy by ionizing
radiation to material of mass dm
ii. A fundamental dose quantity D representing the mean energy imparted to
matter per unit mass by ionizing radiation (Other way of stating it)
22) Be able to graph KERMA and absorbed dose
a.
23) Basis for Bragg Gray cavity theory
a. Bragg Gray cavity theory states that the ionization that is produced in a cavity is related
to the absorbed dose in the surrounding medium
24) Difference between TG-21 and TG-51 protocols
a. The fundamental difference between the TG-21 protocol and the TG-51 protocol is that
the TG-21 protocol is based on exposure for Co60 and TG51 is based on dose in water.
b. TG-51 is based on an absorbed dose to water standard and calibration factor (N(D,W))
while the TG-21 protocol is based on an exposure (or air kerma) standard and
calibration factor (N(x)).
25) Explain factors used in TG-21 and TG-51 protocols
26) Correction factors for TG-51 protocol
27) Definition of PDD, TAR, Sc, Sp, OAR, TMR, Mayneord F
a.
fs
depth
d
depth
d
depth
Dose
Dose
TAR
Dose
Dose
TMR
Dose
Dose
PDD

max
max
100

b. PDD Percent Depth Dose
c. TMR - Tissue Maximum Ratio
d. TAR Tissue Air Ratio
e. OAR Off Axis Ratio
f. Sc and Sp are in the tables
28) Basic equation for calculating MUs
a.
29) Performing a simple calculation
30) Be able to describe the different types of radioactive decay and use decay formula. Understand
concept and application of half-life, mean life.
a. Half Life
i. The term half-life (T1/2) of a radioactive substance is defined as the time
required for either the activity or the number of radioactive atoms to decay to
half the initial value
ii. T_1/2= ln(2)/ Activity
b. Average Life
i. T_a= 1/Activity
c. Relationship
i. T_a= 1.44 T_1/2
31) Know basic design of cylindrical chamber, parallel plate chamber, extrapolation chamber and for
what types of measurements are they optimal
a. Parallel Plate
i. An ionization chamber measures the charge from the number of ion pairs
created within a gas caused by incident radiation. It consists of a gas-filled
chamber with two electrodes; known as anode and cathode. The electrodes
may be in the form of parallel plates or a cylinder arrangement with a coaxially
located internal anode wire.
ii. A voltage potential is applied between the electrodes to create an electric field
in the fill gas. When gas between the electrodes is ionized by incident ionizing
radiation, Ion-pairs are created and the resultant positive ions and dissociated
electrons move to the electrodes of the opposite polarity under the influence of
the electric field. This generates an ionization current which is measured by an
electrometer circuit.
iii. Each ion pair created deposits or removes a small electric charge to or from an
electrode, such that the accumulated charge is proportional to the number of
ion pairs created, and hence the radiation dose.
iv. Widely used for the detection and measurement of certain types of ionizing
radiation; X-rays, gamma rays and beta particles.
v. Parallel-plate chambers are similar to the extrapolation chambers except for the
variable electrode spacing. The electrode spacing of the parallel-plate chambers
is small (~2 mm) but fixed
b. Extrapolation Chamber
i. Used for special dosimetry (e.g., the measurement of dose in the superficial
layers of a medium and the dosimetry of electrons and particles).
32) Be able to describe the basic function of diodes, TLDs and film
a. TLD- Thermoluminescent Dosimeter
i. Many crystalline materials exhibit the phenomenon of thermoluminescence.
When such a crystal is irradiated, a very minute fraction of the absorbed energy
is stored in the crystal lattice. Some of this energy can be recovered later as
visible light if the material is heated. This phenomenon of the release of visible
photons by thermal means is known as thermoluminescence (TL).
ii. The irradiated material is placed in a heater cup or planchet, where it is heated
for a reproducible heating cycle. The emitted light is measured by a
photomultiplier tube (PMT), which converts light into an electrical current. The
current is then amplified and measured by a recorder or a counter.
iii. Simplified Theory of Thermoluminescent Dosimetry
1. In an individual atom, electrons occupy discrete energy levels. In a
crystal lattice, on the other hand, electronic energy levels are perturbed
by mutual interactions between atoms and give rise to energy bands:
the allowed energy bands and the forbidden energy bands. In
addition, the presence of impurities in the crystal creates energy traps
in the forbidden region, providing metastable states for the electrons.
When the material is irradiated, some of the electrons in the valence
band (ground state) receive sufficient energy to be raised to the
conduction band. The vacancy thus created in the valence band is called
a positive hole. The electron and the hole move independently through
their respective bands until they recombine (electron returning to the
ground state) or until they fall into a trap (metastable state). If there is
instantaneous emission of light owing to these transitions, the
phenomenon is called fluorescence. If an electron in the trap requires
energy to get out of the trap and fall to the valence band, the emission
of light in this case is called phosphorescence (delayed fluorescence). If
phosphorescence at room temperature is very slow, but can be speeded
up significantly with a moderate amount of heating (~300C), the
phenomenon is called thermoluminescence.