Teletherapy Physics – session 1

Alan McWilliam

alan.mcwilliam@christie.nhs.uk

The Christie NHS

NHS Foundation Trust
 Contents
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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3. Treatment Planning Glossary (1)
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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3. Treatment Planning Glossary(1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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An X-ray beam

• Principle plane: a plane

containing the beam axis
and parallel to the face of
one or other collimator.
• Beam axis: the axis about
which the collimator rotates
• Radiation field: a plane
section through the beam
perpendicular to the beam
axis.

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3. Treatment Planning Glossary (1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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Isocentre

SAD

Isocentre

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3. Treatment Planning Glossary (1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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 The Christie NHS
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 SSD
• Source-surface distance
• Phantom depth d
max

d,depth

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3. Treatment Planning Glossary (1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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 Build up depth
electrons

X-rays

electrons

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 Build up depths

Energy Dmax (mm)

C0-60 5

4MV 10

6MV 16

8MV 20

18/20MV 30

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3. Treatment Planning Glossary (1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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 100cm

120
100
dmax 80

PDD (%)
60
Depth A 40
20
0
0 10 20 30
Depth (cm)

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3. Treatment Planning Glossary (1)

• Beam • Source to surface distance

• Collimator (SSD)
• Radiation field • Source to Axis distance
• Principal plane (SAD)
• Beam axis • Depth in phantom
• Superposed beams • Depth of maximum dose
(build-up depth)
• Iso-centre
• Percentage depth dose
• Phantom
• Beam Profile
• Tissue equivalence
• Equivalent field

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 Beam Profile

• Flat at depth – wedge, target and lateral

scatter
100
Norm alised dose (%)

80

60

40

20 dmax
At depth
0
-15 -10 -5 0 5 10 15
Position (m m )
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4. Treatment Planning Glossary (2)
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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4. Treatment Planning Glossary (2)

• Isodose line • Back Scatter Factor

• Isodose plot • Tissue Maximum Ratio
• Primary Dose • Tissue Phantom Ratio
• Scatter dose • Tissue Air Ratio
• Scatter factor • Tissue Standard Ratio
• Peak Scatter Factor

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Isodose
Plot

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• Example isodose distributions from Pinnacle

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Focal Spot
Beam
Penumbra
Inner Jaw
100

Norm alis e d dos e (%)

80

Outer Jaw 60

40

20 dmax
At depth
0
-15 -10 -5 0 5 10 15
Position (mm)

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4. Treatment Planning Glossary (2)

• Isodose line • Back Scatter Factor

• Isodose plot • Tissue Maximum Ratio
• Dose decrement line • Tissue Phantom Ratio
• Primary Dose • Tissue Air Ratio
• Scatter dose • Tissue Standard Ratio
• Scatter factor
• Peak Scatter Factor

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 Target Primary photon
Flattening filter Head-scattered
Collimators photon
Phantom-scattered
photon

Phantom

Scattered electrons
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 5. PDD Variation
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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 5. PDD variation

• PDD increases with increasing energy because of an

increase in beam penetrating power

• PDD increases with increasing SSD because of a

decreasing effect of z on the inverse square factor

• PDD increases with increasing field size because of

increased scatter contribution to points on the central axis

• PDD increases when wedge added

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 PDD variation with energy

100.0
90.0 4MV (FS = 10cm)
80.0 6MV (FS = 10cm)
70.0
8MV (FS = 10cm)
PDD (% )

60.0
20MV (FS = 10cm)
50.0
40.0
30.0
20.0
10.0
0.0
0 10 20 30 40
Depth (cm)

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 PDD variation with SSD

120.0

100.0 100

80.0 160
PDD (%)

60.0 60
40.0

20.0

0.0
0 5 10 15 20 25 30 35
Depth (mm)
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 Inverse Square
 SSD  d max 
2

INVSQ factor   
 SSD  d 

4.5
4
3.5
3
Dose

2.5
2
1.5
1
0.5
0
0 50 100 150
Distance
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 4MV PDD variation with field size

120

100 3.2 10.0

80 20.0 40.0
PDD (% )

60

40

20

0
0 5 10 15 20 25 30 35
Depth (cm)
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PDD 10cm deep variation with field size

PDD at 10 cm deep
1.200
1.150
1.100
1.050
PDD(%)

1.000
0.950
0.900
0.850
0.800
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Field Size (cm)

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Variation of PDD with field size for
two energies

(10cm deep) 5 x 5 cm 10 x10 cm 15 x 15 cm

300kV 25.0% 33.5% 40%

50 cm SSD

8MV 68.5% 71.0% 72.5%

100 cm SSD

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PDD variation with a wedge added

• The wedge preferentially attenuates the low

energy photons in the beam. This leads to
beam hardening and subsequent increase in
percentage depth dose.
• The wedge not only adds asymmetry to the
beam profile but also adds asymmetry to the
photon spectra and the photon and electron
scatter.

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 6. Surface Dose
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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 6. Surface Dose

• The surface dose is not negligible because

• Electrons are backscattered from x-ray interactions
near the surface
• Electrons are produced from x-rays scattered from the
treatment head. This is sometimes called electron
contamination

• Surface dose increases with

• Use of lead trays and blocks – increased electron
contamination
• Field size– increased electron contamination
• Beam’s angle of incidence - increased electron
backscatter and contamination

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 7. Hand calculation data
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculation data
8. Output factors
9. Heterogeneity corrections

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 7. Hand calculation data
• Central axis PDDs or
• Isocentric dose data – Tissue (Reference)
Ratios
• TAR, TSR, TPR, TMR

• Calibration factor for standard conditions

• Correction factor for treatment conditions

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 Correction factors include

To account for difference to reference conditions

• Output factor – scatter changes with area

• Elongation factors, or equivalent area
• Distance factor – inverse square
• Wedge factor – for attenuation in wedge
• Tray factor – for attenuation by a tray

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 8. Output factors
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculations
8. Output factors
9. Heterogeneity corrections

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Field size correction factor
8. Output Factors
1.2 field size correction factor(C fs ) 
4MV
Dose at d max for a field size( fs)
Dose at d max for a standard field size (10  10)
1.1 20MV

20 MV
1
8 MV
0.9 6 MV
4 MV
0.8
0.0 10.0 20.0 30.0
field size (cm)
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 Field Shape Dependence:
Equivalent Square
a
c
2 a b
c
c ab
b

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 Field Shape Dependence
3

3 Eq.Sq = 4 x Area / Perimeter

= 4 x (8x6 – 0.5 x 3 x3)
(8+6+5+ (32+32)+3)
= 184 / 26.8 174 / 26.24
8 = 6.63

Eq.sq (Rec) = 2x8x6/(8+6)

= 6.86

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 9. Heterogeneity corrections
1. X-ray beam physics - introduction
2. Electron beam physics - introduction
3. Treatment planning glossary(1)
4. Treatment planning glossary(2)
5. PDD variation
6. Surface dose
7. Hand calculations
8. Output factors
9. Heterogeneity corrections

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 9. Heterogeneity corrections
Relative Electron Densities

Water 1.0
d1 x re(1) Muscle ~1.1
Lung ~0.3
dt
d2 x re(2) Air Cavities ~0.1
Bone ~1.2-1.5

d3 x re(3)

dwe = S di x re(i)

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