Course : PG Pathshala-Biophysics

Paper 06 : Radiation Biophysics

Module 29 : Linear Accelerator in Cancer Treatment
Content Writer: Dr Devesh Gupta, Dr S.N. Medical College, Jodhpur (Raj.)

OBJECTIVE:
1. INTRODUCTION
2. PRINCIPLE OF LINEAR ACCELERATOR
3. COMPONENTS OF LINEAR ACCELERATOR
4. BEAM FORMING COMPONENTS OF LINEAR ACCELERATOR
5. SUMMARY
6. REFERENCES

1. INTRODUCTION
Mainly three modalities are used to treat cancer patient. These are Radiotherapy,
Chemotherapy and surgery. Radiotherapy is classified into External Beam Radiotherapy (EBRT) and
Brachy therapy (BT). In EBRT the source of radiation is enclosed in the machine head placed outside
the patient body at some distance, while in brachy therapy radioactive source is either inside or in
close proximity to the body. To deliver radiation doses in the treatment of oncologic diseases by
EBRT mode of treatment Cobalt tele therapy machine and Linear Accelerator (Linac) are used.
Cobalt machine contains artificially made Co-60 radioactive source which emit gamma photons of
average energy 1.25 MeV. Cobalt Teletherapy machines have some limitations. Linear accelerators
are basically a type of high energy emitting X ray machine. It works in two modes, emits electrons
and photons of energies in few MeV.

2. PRINCIPLE OF LINEAR ACCELERATOR

The linear accelerator is a device that uses high electromagnetic waves to accelerate charged
particles such as electrons using linear tube. This method of particle acceleration was invented in
1928 by Rolf Wideroe. This high energy electron can itself be used for treating superficial tumors or
can be made to hit a target to produce x-rays for treating deep seated tumors.

2.1. WORKING PRINCIPLE

 A power supply provides D.C. power to Modulator that includes pulse forming network.
 High voltage pulses from Modulator are delivered to Magnetron or Klystron &
simultaneously to electron gun.
 Klystron / Magnetron produce pulsed MW that is injected into accelerator tube via
waveguide.
 At a proper instant e-s produced by an e- gun are pulse injected into accelerator guide
with an initial energy of about 50KeV.
 Electrons are acted upon by e.m. field of microwaves & are accelerated by force of
electric field & are carried along MW.
 High energy e- emerges from exit window of accelerator guide in form of pencil beam
about 3 mm. in diameter.
 These electrons are made to strike the target to produce X-rays or strike the scattering
foil to use electrons to treat superficial tumors.

3. COMPONENTS OF LINEAR ACCELERATOR

Linear Accelerator has following major components:
a) Gantry
b) Gantry stand or support
c) Modulator cabinet
d) Patient support assembly or couch
e) Control console

3.1. Gantry
It is the gantry which rotates around the patient and delivers the clinical beams from different
direction for the treatment of patient. Also gantry contains the various beam forming components to
be explained in next section.

3.2. Gantry Stand or support

It is anchored firmly to the floor and the gantry rotates on bearings in it about the horizontal
axis.
3.3. Modulator cabinet
It contains components that supply high voltage pulses & distribute primary electric power to
all areas of machine from utility connection. Pulsed power supply energizes the klystron/magnetron
& electron gun when triggered by a timing pulse from control console.
3.4. Patient Support Assembly or couch
Patient support assembly is to support patient to be treated and is provided with following
motion:
 Vertical Motion (Up – Down Motion)
 Lateral Motion (Left – Right Motion)
 Longitudinal Motion (In – Out Motion)
 Rotational Motion

Other than these motions, now a day the treatment table is also provided with 3 more degrees of
motion that are as follows:
 Yaw
 Pitch
 Roll

3.5. Control Console

Q1. Name the device that moves around

the patient to deliver radiation
beam.

Q2. Name the major components of

modulator.
It is placed outside the treatment room and is used to control the treatment unit and the
treatment. It provides status information on treatment modality, accessories in use, prescribed dose &
dose delivered, interlock status, emergency off, & other data pertinent to Linear Accelerator operation
& patient treatment.

4. BEAM FORMING COMPONENTS OF LINEAR ACCELERATOR

The major beam forming components are as follows:
a) Injection System/Electron Gun
b) Microwave Power Source/RF Power Source
c) Waveguide
d) Auxiliary System
e) Beam Transport System
f) Treatment Head

4.1. Injection System/Electron gun

 The injection system is a source of electrons and is known as electron gun.
 Two types of electron guns are used in medical Linear Accelerators namely:
a) Diode Type
b) 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.
 Electrons are thermionically emitted from the heated cathode, focused into a pencil beam
by a curved focusing electrode and accelerated towards the perforated anode through
which they drift to enter the accelerating waveguide.
 The electrostatic fields used to accelerate the electrons in the diode gun are supplied
directly from the pulsed modulator in the form of a negative pulse delivered to the
cathode of the gun.
 In a triode gun, however, the cathode is held at a static negative potential. The grid of the
triode gun is normally held sufficiently negative w.r.t to the cathode to cut off the current
to the anode. The injection of electrons into the accelerating waveguide is then controlled
by voltage pulses, which are applied to the grid and must be synchronized with the pulses
applied to the microwave generator.
4.2. Microwave Power Source/RF Power Source
For the operation of Linear Accelerator there are two RF power source available:
a) Magnetron
b) Klystron

4.2.1. Magnetron
 It is a device that produces microwaves and acts as a high power oscillator that extracts
microwave energy from electrons by means of slow wave resonant structure in strong
magnetic field.
 Magnetrons are used for lower energy Linear Accelerators of energy upto 6MeV.

4.2.2. Klystron
 Unlike magnetron it is not an RF oscillator, but is an RF amplifier. It requires an RF
input signal to excite it that then it amplifies.
 Klystrons are used for higher energy Linear Accelerators of energy greater than 6MeV.

4.3. Waveguide
Waveguides are evacuated or gas filled metallic structures of rectangular or circular cross
section used for transmission of microwaves. There are two types of waveguide that are being used in
Linear Accelerators for different purposes and are as follows:
a) RF Power Transmission Waveguide
b) Accelerating Waveguide

4.3.1. RF Power Transmission Waveguide

RF power transmission waveguide transmit the RF power from RF power source (magnetron or
klystron) to accelerating waveguide. The waveguide is either evacuated or filled with a dielectric gas
Freon or sulphur hexafluoride (SF6) to twice the atmospheric pressure.

4.3.3. Accelerating Waveguide

In this the electrons are accelerated by means of an energy transfer from high power RF field
which are set up in the accelerating waveguide and produced by RF power generators. The waveguide
is evacuated to allow free propagation of electrons and are categorized as follows:
a) Travelling Waveguide
b) Standing Waveguide

4.4. Auxiliary System

The system consists of several components that do not take part directly in electron acceleration
but make the acceleration possible and Linear Accelerator viable for its operation. The Linear
Accelerator auxiliary system consists of following components:
a) Vacuum system
b) Pressure system
c) Cooling system

4.4.1. Vacuum system

 It provides vacuum for operation of e- gun, accelerator guide & bending magnet
system.Without vacuum e- gun would burn out just like a light bulb filament exposed to
air.
 Accelerated e-s would collide with air molecule deflecting them & reducing their energy,
pencil like e- beam would be diffused & broken up.
 A vacuum pumping system producing a vacuum pressure of ~10-6 torr in the accelerating
waveguide and the RF generator.

4.4.2. Pressure system

 It pressurizes waveguide with dielectric Freon & SF6 to prevent electrical breakdown
from high power MW electric fields.
4.4.3. Cooling system
 Establishes operating temperature of sensitive components & operates primarily to
remove residual heat dissipated in other components.
 Temperature control is particularly critical for accelerator waveguide Otherwise cavities
will change dimension slightly resulting in detuning & impairment of their acceleration
capabilities.

4.5. Beam Transport System

The beam transport system includes two components:
a) Bending Magnets
b) Beam Steering and Focusing Coil.

4.5.1. Bending Magnets

Ideally, the accelerating waveguide would be mounted with its axis parallel to the central axis
of the radiation beam. However, except for low energy Linear Accelerators (E≤ 6 MeV), the resulting
height of the Linear Accelerator would be prohibitive. Thus it becomes necessary to mount the
accelerating waveguide approximately at right angles to the direction of the radiation beam. This
requires the electron beam to be bent for its further use which is achieved using bending magnets.
Three systems of electron bending have been developed. These are:
a) 90 ˚ Bending (Non – Achromatic)
b) 270 ˚ Bending (Achromatic)
c) 112.5 ˚ Bending (Slalom)

4.5.2. Beam Steering and Focusing Coils

Beam steering and focusing coils are used to constrain (focus) the electron beam close to the
central axis of waveguide otherwise the mutual repulsion cause the electron beam to diverge. This
will result in reduced beam current and in addition to this would damage the guide structure.
Q1. What is electron gun and how does it
work?

Q2. What is the basic difference between

magnetron and klystron?

Q3. What is accelerating waveguide?

Q4. What is the purpose of steering and

focusing coils?

4.6. Treatment Head

The beam transport system will result in a narrow pencil electron beam which is of little use for
treatment. In order to generate beam useful for treatment, the narrow pencil electron beam is brought
in treatment head where clinical photon and electron beams are produced.
The treatment head contains various components that influence the production, shaping,
localizing and monitoring of clinical photon and electron beams.
a) X – Ray Target
b) Flattening Filter
c) Scattering Foil
d) Field Defining Light
e) Beam Collimation
f) Transmission Ionization Chambers
g) Electron Applicator

4.6.1. X – Ray Target

A transmission type target of high atomic number metal, usually tungsten or copper – tungsten
laminate is used. Photon beams are generated by bremsstrahlung from a high energy electron beam
striking this target. Efficiency of x-ray production ↑ with ↑ in e- energy. Hence target heating is not a
serious problem & can be cooled by cold water flowing through a copper block into which target is
fitted.

4.6.2. Flattening Filter

The bremsstrahlung generated when high energy electron strikes the target is forwardly peaked.
To make the beam intensity uniform across the field, a flattening filter is inserted in the beam. The
filter is usually made of lead, although tungsten, uranium, steel, aluminum or a combination.
Al flattening filters are used in low energy LINEAR ACCELERATORs & copper or steel in
high energy LINEAR ACCELERATORs because Al filter would be large enough to be
accommodated in treatment head of high energy LINEAR ACCELERATOR.
Nowadays in some special cases flattening filter free (FFF) beams are also used for patient
treatment.

4.6.3. Scattering Foil

To widen the narrow pencil electron beam scattering foil is used. Scattering foils are thin foils
of high atomic number metal. It not only widens the electron beam but also gives flatter beam across
the treatment field.

4.6.4. Field Defining Light

The FS definition is provided by light localizing system in treatment head. It consists of mirror
& light source and are located in space b/w chambers & jaws. It projects light beam as if emitting
from x-ray focal spot. A range finder light projects a numerical scale on patient surface to define SSD.

4.6.5. Beam Collimation

Beam collimation is achieved by two or three collimator devices:
a) Primary collimator
b) Secondary moveable collimator
c) Multi Leaf Collimators (optional)
4.6.5.1. Primary collimator
The primary collimator defines the largest available circular field size and is a conical
opening machined into a tungsten shielding block, with the sides of the conical opening projecting on
to edges of the target on one end of the block and on to the flattening filter on the other end.

4.6.5.2. Secondary collimator

The 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
Linear Accelerator isocentre, with sides of the order of few millimetres up to 40 cm.

4.6.5.3. Multi Leaf Collimators (MLCs)

Conventional collimators are only able to constrain the radiation field to rectangular or square
field. In order to provide more flexibility, multileaf collimators (MLCs) have been introduced. Unlike
single metal block, MLCs have up to 60 pairs of leaves that can move independently thus providing
irregular field shaping. In addition to providing irregular field MLCs are becoming invaluable in
delivering intensity modulated radiation therapy as well as in Stereotactic Radiotherapy and Radio
Surgery.
4.6.6. Transmission Ionization Chambers
 The dose monitors are transmission I.C. permanently embedded in LINEAR
ACCELERATOR treatment head b/w flattening filter or scattering foil & photon beam
secondary collimator.
 Sealed parallel plate I.C. are used to make their response independent of ambient
temperature & pressure.
 For safety two I.C. are used, one serving check on another, with completely independent
biasing power supplies & readout electrometers.
 In event of simultaneous failure of both chambers timer will shut the machine down with
minimal overdose to patient.
 The flattened x – ray beam or electron beam strikes these ionization chambers. This
system aims at delivering precise and uniform radiation dose and serves following
purposes:
o Monitoring and control of dose delivery whether in x-ray or electron beam mode.
o Dose rate monitoring.
o Beam uniformity or symmetry and flatness monitoring.
o Automatic treatment termination control if any of the above should lie outside acceptable
tolerance.

4.6.7. Electron Applicator

Since electron scatter readily, the beam collimation must be achieved close to the patient
surface. In order to achieve this goal, auxiliary electron applicators are used with x-ray collimators
wide open. These applicators are constructed of low atomic number to minimize the x-ray
contamination.

5. SUMMARY:

Linear accelerator is very useful machine in the treatment of cancer by teletherapy mode of
treatment. High energy X rays of the order of 2 MeV to 15 MeV cannot be achieved by
applying high voltage source. High energy electrons and photons in the out-put of linear
accelerator are achieved by using combination of Klystron or Magnetron as microwave source,
electron gun and waveguide. Flattening filter makes the radiation dose profile near uniform
while primary and secondary collimator reduces the penumbra at the edges of the field. Small
focal spot, large source to skin distance (SSD), high energy output and use of MLC etc are few
reasons which leads to many advantages of Linac over Cobalt Tele Therapy. These are:-
 High dose rate.
 Higher PDD hence good for deep seated tumors.
 For Co-60 source size is 1.5cm & for linac Focal spot size 2.5-3mm. Sharp beam with
less penumbra as focal spot size is small.
 Small FS for precision therapy possible.
 Large fields can be treated as max. FS on linac is 40x40cm2 while on Co-60 max. FS is
35x35cm2.
 No chances of accidental exposure. e.g. sometimes source struck i.e. it does not move
back to safe position.
 Electron therapy possible with linac.
 Linac with MLCs can be used for conformal therapy i.e. leaves of MLC can be
confirmed to shape of tumor electronically.
 IMRT can be delivered with dynamic movement of leaves.
 Linac are available with Dual energy photon beam so energy can be selected as per
requirement.
 Since dose rate is high more patient can be treated in less time.
 No need to change source.
5.1. Production of Clinical Photon Beams
The clinical photon beam emanating from Linear Accelerator is produced as a result of
interaction of high energy narrow electron beam with a high atomic number x-ray target. This beam
is then either made uniform (flattened) using flattening filter or left as it is i.e. un-flattened to have
Flattening Filter Free beam (used nowadays for stereotactic radiotherapy). After this, the beam is
collimated firstly using fixed primary collimator which then strikes the transmission ionization
chamber aiming at delivering precise and uniform radiation dose. The beam is further collimated
using secondary jaws to provide rectangular or square field. Depending on the treatment type, MLCs
are used either to provide static irregular shape field as used in conformal treatment or to deliver
intensity modulated treatment.

5.2. Production of Clinical Electron Beams

The narrow electron beam exiting the beam transport system is of little use for treatment and
hence it is made to spread using scattering foil and removing the x-ray target and flattening filter from
the beam. Similar to photon beams the electron beam is also collimated before it is made to strike the
scattering foil, this is then made to strike the transmission ionization chambers. Due to scattering
nature of electrons the secondary collimators alone are not used to define the electron field instead an
auxiliary collimation system of low atomic number metal (electron applicator) is used with widely
opened secondary jaws. This electron applicator helps in defining the electron field close to patient
surface.

6. Summary

 High dose rate.

 Higher PDD hence good for deep seated tumors.

 For Co-60 source size is 1.5cm & for linac Focal spot size 2.5-3mm. Sharp beam with less
penumbra as focal spot size is small.

 Small FS for precision therapy possible.

 Large fields can be treated as max. FS on linac is 40x40cm2 while on Co-60 max. FS is
35x35cm2.

 No chances of accidental exposure. e.g. sometimes source struck i.e. it does not move back to
safe position.

 Electron therapy possible with linac.

 Linac with MLCs can be used for conformal therapy i.e. leaves of MLC can be confirmed to
shape of tumor electronically.

 IMRT can be delivered with dynamic movement of leaves.

 Linac are available with Dual energy photon beam so energy can be selected as per
requirement.

 Since dose rate is high more patient can be treated in less time

 No need to change source.