oaosi2012 ‘The Physics of Low Energy Radiation T= GULMAY MEDICAL Ss —« Superficial Therapy Educational Programme The Physics of Low Energy Radiation Introduction his work relates to the physical properties of superficial and orthowoltage X-ray beams, produced by electrostatic X-ray tubes, in the energy range of 10 kVto 3 kV. The concept of using Xraybeams abnormal ti actively targ new one; equipment frst became available continued to be the most popular means of generating therapeutic advent of linear accelerators and teletherapy equipment, in the 1950's, to a reduction in the use of superficial and orthovoltage therapy eq: the relatively low cost, simplicity and low maintenance requirement for such equipment provides adequate rationale for its use in treating surface lesio those at shallow depths and in so doing, absorbs some of the clinical oncology workload. X-ray Production X-rays are produced when an orbiting electron of an atom loses. energy, either through deceleration or va the transition of the electron between the different shells of the atom, Wi sing x rays for medical purposes, the Xray tube is designed to produ focused to collide with a metal target, causing them to dec rapidly. Ifthe electrons have enough energy when they hit he target, fan inner shell of the metal theymay knock an electron out and as a result, the gap is filled by electrons from higher energy levels. The byproduct ofthis process is the production of Xrays [1]. Attenuation Processes X-rays can be used for therapeutic purposes as a result ich they affect the tissues throug! rocess by sityis reduced. This p’ which they pass; as @ beam of radiation is transmitted through a medium, its referred to as attenuation. This loss of energy can vary greatly and is dependent on 2 intial intensity of the beam before attenuation and the density of the medium through which itis passed When an X-ray beam is attenuated by tissue the energyloss is attributable to: Absorption — the energyis transferred to the surrounding tissue Scatter- the photons collide with atomic patticles of the surrounding tiss: ‘ange direction wv radprorg.uklcompanies/Gumayprint physics hint 8oaosi2012 ‘The Physics of Low Energy Radiation The type and amount of attenuation is characterised by the initial energy of the radiation beam, of which there are four main processes: Unmodified (classical) (low energy) Photoelectric absorption | Compton scatter (modified) Pair production (high energy) [2] Each process occurs ata certain point of the X-ray spectrum. For example, when using low energies (as in diagnostic radiography) photoelectric absorption makes the biggest contribution whereas in high energy therapeutic radiography the dominant attenuation process is Compton scatter [2] Clinical Application For treatment with superficial and orthovoltage therapeutic X-ray beams the dose at the skin surface is arguably the most important factor, given the rationale of treatment. X-rays at the higher end of the energy spectrum (6-10 mV) are able to penetrate into the deep tissues of the body and are therefore of use when targeting deep seated tumours. When treating superficial tumours such as skin lesions, this level of penetration is unnecessaryand would cause unwarranted dose to ‘normal tissues. Furthermore, the maximum dose would be delivered to Underlying tissues causing tumour under dosage and the potential for recurrence. [3] Kilovoltage X-ray beams can be subdivided into two energy ranges; Low energy 10 kV- 100 kVenergybeams; used for superficial therapy, where the intended treatment region is within the first, few mm ofthe dermis. In the United Kingdom code of practice [4] the low energy range is subdivided into the medium 160-300kV, low 50-160kV and very low 8-SOkV. Several methods of absolute dosimetry are used, depending upon the specific point of clinical interest. For low energy X-rays calibration is either performed at the surface of a phantom [4.5] or in-air atthe aperture of the reference applicator [4.6], whereas for medium energy X-ays the calibration is either performed at cm depth in water [4.5.6] or in-air atthe aperture of he reference applicator (4, 6 wv radprorg.uklcompanies/Gumayprint physics hintoaosi2012 ‘The Physics of Low Energy Radiation Beam Quality Specifier The attenuating properties of a kilovoltage X-ray eam are determined both by the accelerating potential and the filtration ofthe beam; thus merely stating the nominal accelerating potential is insufficient to describe the beam. The beam quality in the kilovoltage energy range is usually described by the amount of material required to attenuate the beam by50%, or the thickness of the half value layer (HVL). Commonly Aluminium is used in the low energy range and Copper is used in the medium energy range. Measurement of the HVL for each beam is necessaryin order to derive a calibration factor for the secondary standard chamber at the qualities of those beams. The HVL is defined as the thickness of absorber which reduces the air kerma rate of a narrow X-ray beam to 50% ofthe air kerma rate of an unattenuated beam. ‘The attenuating material is placed between the applicator and a small aperture; just large enough for the narrow beam to cover the measuring chamber. The chambers positioned so that scatter from the attenuating material and backscatter from material behind the chamber (floor, walls etc) are minimised. Ideally the HVL would be measured at the normal calibration distance, however, in order to minimise scatter rom the filters, the source chamber distance Is at least twice the length of the applicator, | Attenvating Narrow Material Aperture Experimental arrangement for the measurement of half value layers In reality the HVL for ionisation is being measured; however, as long as the calibration factor of the chamber varies byless than 2% over the quality range being measured, this will not significantly affect the results. Most wv radprorg.uklcompanies/Gumayprint physics hintoaosi2012 ‘The Physics of Low Energy Radiation dosimetry services only offer a calibration in terms of half value layer, although for a given HVL the dose to water calibration factor varies bya little over 2% depending on the accelerating potential and the filtration Dosimetry Equipment In the low energy klovoltage range parallel plate chambers specifically designed for low kV dosimetry should be used. The thin entrance window of these chambers is sufficient to remove electron contamination and provide full build-up conditions up to 1 mm HVL (approx50 kV). ifthe chambers are used with a beam with a greater HVL plastic folls mustbe placed in the | way ofthe beam, to ensure full build-up conditions [6]. These foils mustbe included with “ | te ionisation chamber when its callbrated. nthe medium energyrange a eingsical ion with a volume less than 1.0cm® mustbe used, whether the calibration is performed in-air cr in-phantom. Atypical chamber would be a ‘farmer’ type chamber such as an NE2571 or NE2561 Absolute Dose Calibration Low Energy Range 10 kV — 100 kV Historically many dosimetry codes of practice have used an in air calibration in terms of air kerma, where the dose to water, at the water surface is given by: water lair bain is the instrument reading in air at the reference applicator aperture, corrected for M temperature and pressure. is the air kerma calibration (in grays per scale reading) to convert the instrument NK reading atthe beam quallty, concerned to air kerma free in alr, at the reference point of the chamber. is the backscatter factor; defined as the ratio of the water collision kerma ata point Bw on the beam avis at he surface ofa full scatter water phantom, to the water collision kerma atthe same pointin the primary (incident) beam, with no phantom present is the mass energy absorption coefficient ratio, water to air, averaged over the [(uen/p)wiairjair photon spectrum in air. itis not usually possible to measure the ionisation at he aperture of an applicator because of the finite size of the chamber and its stem. Itis usually necessary to measure the ionisation as close to the aperture of the applicator as possible and correct for extra distance from the source. Care must be taken however as the inverse square law maynot apply close to an applicator, particularly at short Focus Skin Distances (FSD's). Backscatter factors varywith HVL; field size and FSD and have been calculated using Monte Carlo techniques for the purposes of dosimetry 7]. The water air mass energy absorption coefficients vary, depending on the spectrum wv radprorg.uklcompanies/Gumayprint physics hint