Radiation Oncology Physics A Handbook for Teachers and Students

by Unknown

• ISBN13: 9789201073044
• ISBN10: 9201073046
• Format: Paperback
• Copyright: 2005-09-15
• Publisher: International Atomic Energy Agency

Summary

This publication is aimed at students and teachers involved in teaching programmes in field of medical radiation physics, and it covers the basic medical physics knowledge required in the form of a syllabus for modern radiation oncology. The information will be useful to those preparing for professional certification exams in radiation oncology, medical physics, dosimetry or radiotherapy technology.

Table of Contents

Basic Radiation Physics	1	(44)
Introduction	1	(6)
Fundamental physical constants (rounded off to four significant figures)	1	(1)
Important derived physical constants and relationships	1	(2)
Physical quantities and units	3	(1)
Classification of forces in nature	4	(1)
Classification of fundamental particles	4	(1)
Classification of radiation	5	(1)
Classification of ionizing photon radiation	6	(1)
Einstein's relativistic mass, energy and momentum relationships	6	(1)
Radiation quantities and units	7	(1)
Atomic and Nuclear Structure	7	(15)
Basic definitions for atomic structure	7	(2)
Rutherford's model of the atom	9	(1)
Bohr's model of the hydrogen atom	10	(2)
Multielectron atoms	12	(2)
Nuclear structure	14	(1)
Nuclear reactions	15	(1)
Radioactivity	16	(3)
Activation of nuclides	19	(1)
Modes of radioactive decay	20	(2)
Electron Interactions	22	(4)
Electron-orbital electron interactions	23	(1)
Electron-nucleus interactions	23	(1)
Stopping power	24	(1)
Mass scattering power	25	(1)
Photon Interactions	26	(19)
Types of indirectly ionizing photon radiation	26	(1)
Photon beam attenuation	26	(2)
Types of photon interaction	28	(1)
Photoelectric effect	28	(1)
Coherent (Rayleigh) scattering	29	(1)
Compton effect (incoherent scattering)	30	(2)
Pair production	32	(2)
Photonuclear reactions	34	(1)
Contributions to attenuation coefficients	34	(2)
Relative predominance of individual effects	36	(1)
Effects following photon interactions	37	(1)
Summary of photon interactions	38	(2)
Example of photon attenuation	40	(1)
Production of vacancies in atomic shells	41	(2)
Bibliography	43	(2)
Dosimetric Principles, Quantities and Units	45	(26)
Introduction	45	(1)
Photon Fluence and Energy Fluence	45	(3)
Kerma	48	(1)
Cema	48	(1)
Absorbed Dose	49	(1)
Stopping Power	49	(5)
Relationships Between Various Dosimetric Quantities	54	(7)
Energy fluence and kerma (photons)	54	(2)
Fluence and dose (electrons)	56	(1)
Kerma and dose (charged particle equilibrium)	57	(3)
Collision kerma and exposure	60	(1)
Cavity Theory	61	(10)
Bragg-Gray cavity theory	61	(1)
Spencer-Attix cavity theory	62	(2)
Considerations in the application of cavity theory to ionization chamber calibration and dosimetry protocols	64	(2)
Large cavities in photon beams	66	(1)
Burlin cavity theory for photon beams	66	(2)
Stopping power ratios	68	(2)
Bibliography	70	(1)
Radiation Dosimeters	71	(30)
Introduction	71	(1)
Properties of Dosimeters	72	(5)
Accuracy and precision	72	(1)
Type A standard uncertainties	72	(1)
Type B standard uncertainties	73	(1)
Combined and expanded uncertainties	73	(1)
Linearity	74	(1)
Dose rate dependence	74	(1)
Energy dependence	75	(1)
Directional dependence	76	(1)
Spatial resolution and physical size	76	(1)
Readout convenience	76	(1)
Convenience of use	76	(1)
Ionization Chamber Dosimetry Systems	77	(4)
Chambers and electrometers	77	(1)
Cylindrical (thimble type) ionization chambers	78	(1)
Parallel-plate (plane-parallel) ionization chambers	79	(1)
Brachytherapy chambers	79	(1)
Extrapolation chambers	79	(2)
Film Dosimetry	81	(3)
Radiographic film	81	(3)
Radiochromic film	84	(1)
Luminescence Dosimetry	84	(5)
Thermoluminescence	85	(1)
Thermoluminescent dosimeter systems	86	(2)
Optically stimulated luminescence systems	88	(1)
Semiconductor Dosimetry	89	(2)
Silicon diode dosimetry systems	89	(1)
MOSFET dosimetry systems	90	(1)
Other Dosimetry Systems	91	(3)
Alanine/electron paramagnetic resonance dosimetry system	91	(1)
Plastic scintillator dosimetry system	92	(1)
Diamond dosimeters	92	(1)
Gel dosimetry systems	93	(1)
Primary Standards	94	(3)
Primary standard for air kerma in air	95	(1)
Primary standards for absorbed dose to water	95	(1)
Ionometric standard for absorbed dose to water	96	(1)
Chemical dosimetry standard for absorbed dose to water	96	(1)
Calorimetric standard for absorbed dose to water	97	(1)
Summary of Some Commonly Used Dosimetric Systems	97	(4)
Bibliography	99	(2)
Radiation Monitoring Instruments	101	(22)
Introduction	101	(1)
Operational Quantities for Radiation Monitoring	102	(1)
Area Survey Meters	103	(10)
Ionization chambers	105	(1)
Proportional counters	105	(1)
Neutron area survey meters	105	(1)
Geiger-Muller counters	106	(1)
Scintillator detectors	107	(1)
Semiconductor detectors	107	(1)
Commonly available features of area survey meters	108	(1)
Calibration of survey meters	108	(2)
Properties of survey meters	110	(1)
Sensitivity	110	(1)
Energy dependence	110	(1)
Directional dependence	111	(1)
Dose equivalent range	111	(1)
Response time	111	(1)
Overload characteristics	111	(1)
Long term stability	112	(1)
Discrimination between different types of radiation	112	(1)
Uncertainties in area survey measurements	112	(1)
Individual Monitoring	113	(10)
Film badge	113	(2)
Thermoluminescence dosimetry badge	115	(1)
Radiophotoluminescent glass dosimetry systems	116	(1)
Optically stimulated luminescence systems	116	(1)
Direct reading personal monitors	117	(1)
Calibration of personal dosimeters	118	(1)
Properties of personal monitors	118	(1)
Sensitivity	118	(1)
Energy dependence	119	(1)
Uncertainties in personal monitoring measurements	119	(1)
Equivalent dose range	119	(1)
Directional dependence	120	(1)
Discrimination between different types of radiation	120	(1)
Bibliography	120	(3)
Treatment Machines for External Beam Radiotherapy	123	(38)
Introduction	123	(1)
X Ray Beams and X Ray Units	124	(5)
Characteristic X rays	124	(1)
Bremsstrahlung (continuous) X rays	124	(1)
X ray targets	125	(1)
Clinical X ray beams	126	(1)
X ray beam quality specifiers	127	(1)
X ray machines for radiotherapy	127	(2)
Gamma Ray Beams and Gamma Ray Units	129	(3)
Basic properties of gamma rays	129	(1)
Teletherapy machines	130	(1)
Teletherapy sources	130	(1)
Teletherapy source housing	131	(1)
Dose delivery with teletherapy machines	132	(1)
Collimator and penumbra	132	(1)
Particle Accelerators	132	(4)
Betatron	134	(1)
Cyclotron	134	(1)
Microtron	135	(1)
Linacs	136	(15)
Linac generations	137	(1)
Safety of linac installations	137	(1)
Components of modern linacs	138	(1)
Configuration of modern linacs	138	(2)
Injection system	140	(3)
Radiofrequency power generation system	143	(1)
Accelerating waveguide	143	(1)
Microwave power transmission	144	(1)
Auxiliary system	145	(1)
Electron beam transport	146	(1)
Linac treatment head	146	(1)
Production of clinical photon beams in a linac	147	(1)
Beam collimation	148	(1)
Production of clinical electron beams in a linac	149	(1)
Dose monitoring system	149	(2)
Radiotherapy with Protons, Neutrons and Heavy Ions	151	(1)
Shielding Considerations	152	(1)
COBALT-60 Teletherapy Units Versus Linacs	153	(3)
Simulators and Computed Tomography Simulators	156	(3)
Radiotherapy simulator	157	(1)
Computed tomography simulator	158	(1)
Training Requirements	159	(2)
Bibliography	160	(1)
External Photon Beams: Physical Aspects	161	(58)
Introduction	161	(1)
Quantities Used in Describing a Photon Beam	161	(5)
Photon fluence and photon fluence rate	162	(1)
Energy fluence and energy fluence rate	162	(1)
Air kerma in air	163	(1)
Exposure in air	164	(1)
Dose to small mass of medium in air	164	(2)
Photon Beam Sources	166	(1)
Inverse Square Law	167	(2)
Penetration of Photon Beams Into a Phantom or Patient	169	(3)
Surface dose	171	(1)
Buildup region	171	(1)
Depth of dose maximum Zmax	172	(1)
Exit dose	172	(1)
Radiation Treatment Parameters	172	(7)
Radiation beam field size	173	(1)
Collimator factor	174	(1)
Peak scatter factor	175	(2)
Relative dose factor	177	(2)
Central Axis Depth Doses in Water: Source to Surface Distance Set-Up	179	(4)
Percentage depth dose	179	(2)
Scatter function	181	(2)
Central Axis Depth Doses in Water: Source to Axis Distance Set-Up	183	(11)
Tissue-air ratio	184	(1)
Relationship between TAR(d, AQ, hv) and PDD(d, A, f, hv)	185	(4)
Scatter-air ratio	189	(1)
Relationship between SAR(d, AQ, hv) and S(z, A, f, hv)	190	(1)
Tissue-phantom ratio and tissue-maximum ratio	190	(2)
Relationship between TMR(z, AQ, h v) and PDD(z, A, f, hv)	192	(1)
Scatter-maximum ratio	193	(1)
Off-Axis Ratios and Beam Profiles	194	(3)
Beam flatness	196	(1)
Beam symmetry	197	(1)
Isodose Distributions in Water Phantoms	197	(2)
Single Field Isodose Distributions in Patients	199	(7)
Corrections for irregular contours and oblique beam incidence	200	(1)
Effective source to surface distance method	201	(1)
Tissue-air ratio or tissue-maximum ratio method	202	(1)
Isodose shift method	202	(1)
Missing tissue compensation	202	(1)
Wedge filters	203	(1)
Bolus	203	(1)
Compensators	203	(1)
Corrections for tissue inhomogeneities	204	(1)
Model based algorithms	205	(1)
Clarkson Segmental Integration	206	(3)
Relative Dose Measurements with Ionization Chambers	209	(3)
Delivery of Dose with a Single External Beam	212	(1)
Example of Dose Calculation	213	(2)
Shutter Correction Time	215	(4)
Bibliography	216	(3)
Clinical Treatment Planning in External Photon Beam Radiotherapy	219	(54)
Introduction	219	(1)
Volume Definition	219	(3)
Gross tumour volume	220	(1)
Clinical target volume	220	(1)
Internal target volume	221	(1)
Planning target volume	221	(1)
Organ at risk	222	(1)
Dose Specification	222	(1)
Patient Data Acquisition and Simulation	223	(18)
Need for patient data	223	(1)
Nature of patient data	223	(1)
Two dimensional treatment planning	223	(1)
Three dimensional treatment planning	224	(1)
Treatment simulation	225	(1)
Patient treatment position and immobilization devices	226	(2)
Patient data requirements	228	(1)
Conventional treatment simulation	229	(1)
Simulators	229	(1)
Localization of the target volume and organs at risk	230	(1)
Determination of the treatment beam geometry	230	(1)
Acquisition of patient data	230	(1)
Computed tomography based conventional treatment simulation	230	(1)
Computed tomography based patient data acquisition	230	(2)
Determination of the treatment beam geometry	232	(1)
Computed tomography based virtual simulation	233	(1)
Computed tomography simulator	233	(1)
Virtual simulation	233	(1)
Digitally reconstructed radiographs	234	(1)
Beam's eye view	234	(1)
Virtual simulation procedure	235	(2)
Conventional simulator versus computed tomography simulator	237	(1)
Magnetic resonance imaging for treatment planning	238	(2)
Summary of simulation procedures	240	(1)
Clinical Considerations for Photon Beams	241	(15)
Isodose curves	241	(1)
Wedge filters	241	(3)
Bolus	244	(1)
Compensating filters	245	(1)
Corrections for contour irregularities	246	(1)
Isodose shift method	246	(2)
Effective attenuation coefficient method	248	(1)
Tissue-air ratio method	248	(1)
Corrections for tissue inhomogeneities	248	(1)
Tissue-air ratio method	249	(1)
Batho power law method	250	(1)
Equivalent tissue-air ratio method	250	(1)
Isodose shift method	250	(1)
Beam combinations and clinical application	251	(1)
Weighting and normalization	251	(1)
Fixed source to surface distance versus isocentric techniques	251	(1)
Parallel opposed beams	252	(1)
Multiple coplanar beams	253	(1)
Rotational techniques	254	(1)
Multiple non-coplanar beams	255	(1)
Field matching	255	(1)
Treatment Plan Evaluation	256	(8)
Isodose curves	257	(1)
Orthogonal planes and isodose surfaces	257	(1)
Dose statistics	257	(1)
Dose-volume histograms	258	(1)
Direct dose-volume histogram	259	(1)
Cumulative dose-volume histogram	259	(1)
Treatment evaluation	260	(1)
Port films	261	(1)
On-line portal imaging	262	(2)
Treatment Time and Monitor Unit Calculations	264	(9)
Treatment time and monitor unit calculations for a fixed source to surface distance set-up	265	(2)
Monitor unit and treatment time calculations for isocentric set-ups	267	(3)
Normalization of dose distributions	270	(1)
Inclusion of output parameters in the dose distribution	270	(1)
Treatment time calculation for orthovoltage and cobalt-60 units	271	(1)
Bibliography	271	(2)
Electron Beams: Physical and Clinical Aspects	273	(28)
Central Axis Depth Dose Distributions in Water	273	(8)
General shape of the depth dose curve	273	(1)
Electron interactions with an absorbing medium	274	(2)
Inverse square law (virtual source position)	276	(1)
Range concept	277	(2)
Buildup region (depths between the surface and Zmax (i.e. 0 ≤ Z ≤ Zmax))	279	(1)
Dose distribution beyond Zmax (Z > Zmax)	279	(2)
Dosimetric Parameters of Electron Beams	281	(5)
Electron beam energy specification	281	(1)
Typical depth dose parameters as a function of energy	281	(1)
Percentage depth dose	282	(1)
Percentage depth doses for small electron field sizes	282	(1)
Percentage depth doses for oblique beam incidence	283	(1)
Output factors	284	(1)
Therapeutic range R90	285	(1)
Profiles and off-axis ratios	285	(1)
Flatness and symmetry	285	(1)
Clinical Considerations in Electron Beam Therapy	286	(15)
Dose specification and reporting	286	(1)
Small field sizes	287	(1)
Isodose curves	287	(2)
Field shaping	289	(1)
Electron applicators	289	(1)
Shielding and cut-outs	289	(1)
Internal shielding	290	(1)
Extended source to surface distance treatments	290	(1)
Irregular surface correction	291	(1)
Bolus	291	(1)
Inhomogeneity corrections	292	(1)
Coefficient of equivalent thickness	292	(1)
Scatter perturbation (edge) effects	293	(2)
Electron beam combinations	295	(1)
Matched (abutted) electron fields	295	(1)
Matched photon and electron fields	295	(1)
Electron arc therapy	295	(3)
Electron therapy treatment planning	298	(1)
Bibliography	299	(2)
Calibration of Photon and Electron Beams	301	(54)
Introduction	301	(7)
Calorimetry	302	(1)
Fricke dosimetry	303	(1)
Ionization chamber dosimetry	304	(1)
Mean energy expended in air per ion pair formed	304	(1)
Reference dosimetry with ionization chambers	305	(1)
Standard free air ionization chambers	305	(1)
Cavity ionization chambers	306	(1)
Phantom embedded extrapolation chambers	306	(1)
Clinical beam calibration and measurement chain	307	(1)
Dosimetry protocols	307	(1)
Ionization Chamber Based Dosimetry Systems	308	(4)
Ionization chambers	308	(1)
Electrometer and power supply	309	(1)
Phantoms	310	(2)
Chamber Signal Correction for Influence Quantities	312	(7)
Air temperature, pressure and humidity effects: kT, P	312	(1)
Chamber polarity effects: polarity correction factor kpol	313	(1)
Chamber voltage effects: recombination correction factor ksat	314	(4)
Chamber leakage currents	318	(1)
Chamber stem effects	319	(1)
Determination of Absorbed Dose Using Calibrated Ionization Chambers	319	(7)
Air kerma based protocols	320	(3)
Absorbed dose to water based protocols	323	(3)
Stopping Power Ratios	326	(2)
Stopping power ratios for electron beams	326	(1)
Stopping power ratios for photon beams	327	(1)
Mass-Energy Absorption Coefficient Ratios	328	(1)
Perturbation Correction Factors	329	(6)
Displacement perturbation factor pdis and effective point of measurement	330	(1)
Chamber wall perturbation factor pwall	331	(2)
Central electrode perturbation pcel	333	(1)
Cavity or fluence perturbation correction pcav	334	(1)
Beam Quality Specification	335	(7)
Beam quality specification for kilovoltage photon beams	336	(1)
Beam quality specification for megavoltage photon beams	337	(2)
Beam quality specification for megavoltage electron beams	339	(3)
Calibration of Megavoltage Photon and Electron Beams: Practical Aspects	342	(5)
Calibration of megavoltage photon beams based on the air kerma in air calibration coefficient NK, Co	342	(1)
Calibration of megavoltage photon beams based on the dose to water calibration coefficient NDwCo	343	(2)
Calibration of megavoltage electron beams based on the air kerma in air calibration coefficient NKCo	345	(1)
Calibration of high energy electron beams based on the dose to water calibration coefficient NDwCo	346	(1)
Kilovoltage Dosimetry	347	(5)
Specific features of kilovoltage beams	347	(1)
Air kerma based in-phantom calibration method (medium energies)	348	(1)
Air kerma based backscatter method (low and medium photon energies)	349	(2)
Air kerma in air based calibration method for very low energies	351	(1)
Absorbed dose to water based calibration method	351	(1)
Error and Uncertainty Analysis for Ionization Chamber Measurements	352	(3)
Errors and uncertainties	352	(1)
Classification of uncertainties	352	(1)
Uncertainties in the calibration chain	352	(1)
Bibliography	353	(2)
Acceptance Tests and Commissioning Measurements	355	(32)
Introduction	355	(1)
Measurement Equipment	355	(3)
Radiation survey equipment	355	(1)
Ionometric dosimetry equipment	356	(1)
Film	356	(1)
Diodes	356	(1)
Phantoms	357	(1)
Radiation field analyser and water phantom	357	(1)
Plastic phantoms	357	(1)
Acceptance Tests	358	(12)
Safety checks	359	(1)
Interlocks, warning lights and patient monitoring equipment	359	(1)
Radiation survey	359	(1)
Collimator and head leakage	360	(1)
Mechanical checks	361	(1)
Collimator axis of rotation	361	(1)
Photon collimator jaw motion	361	(1)
Congruence of light and radiation field	362	(1)
Gantry axis of rotation	363	(1)
Patient treatment table axis of rotation	363	(1)
Radiation isocentre	364	(1)
Optical distance indicator	364	(1)
Gantry angle indicators	365	(1)
Collimator field size indicators	365	(1)
Patient treatment table motions	365	(1)
Dosimetry measurements	365	(1)
Photon energy	366	(1)
Photon beam uniformity	366	(1)
Photon penumbra	366	(1)
Electron energy	367	(1)
Electron beam bremsstrahlung contamination	367	(1)
Electron beam uniformity	368	(1)
Electron penumbra	368	(1)
Monitor characteristics	368	(2)
Arc therapy	370	(1)
Commissioning	370	(14)
Photon beam measurements	370	(1)
Central axis percentage depth doses	370	(1)
Output factors	371	(2)
Blocking tray factors	373	(1)
Multileaf collimators	373	(1)
Central axis wedge transmission factors	374	(1)
Dynamic wedge	375	(1)
Transverse beam profiles/off-axis energy changes	376	(1)
Entrance dose and interface dosimetry	376	(1)
Virtual source position	377	(1)
Electron beam measurements	378	(1)
Central axis percentage depth dose	378	(2)
Output factors	380	(3)
Transverse beam profiles	383	(1)
Virtual source position	383	(1)
Time Required for Commissioning	384	(3)
Bibliography	385	(2)
Computerized Treatment Planning Systems for External Photon Beam Radiotherapy	387	(20)
Introduction	387	(1)
System Hardware	388	(2)
Treatment planning system hardware	388	(1)
Treatment planning system configurations	389	(1)
System Software and Calculation Algorithms	390	(7)
Calculation algorithms	390	(3)
Beam modifiers	393	(1)
Photon beam modifiers	393	(1)
Electron beam modifiers	394	(1)
Heterogeneity corrections	395	(1)
Image display and dose-volume histograms	395	(1)
Optimization and monitor unit calculations	396	(1)
Record and verify systems	396	(1)
Biological modelling	397	(1)
Data Acquisition and Entry	397	(3)
Machine data	397	(1)
Beam data acquisition and entry	398	(1)
Patient data	399	(1)
Commissioning and Quality Assurance	400	(4)
Errors	400	(1)
Verification	401	(1)
Spot checks	402	(1)
Normalization and beam weighting	402	(1)
Dose-volume histograms and optimization	403	(1)
Training and documentation	403	(1)
Scheduled quality assurance	403	(1)
Special Considerations	404	(3)
Bibliography	405	(2)
Quality Assurance of External Beam Radiotherapy	407	(44)
Introduction	407	(7)
Definitions	407	(1)
Quality assurance	407	(1)
Quality assurance in radiotherapy	407	(1)
Quality control	408	(1)
Quality standards	408	(1)
Need for quality assurance in radiotherapy	408	(1)
Requirements on accuracy in radiotherapy	409	(2)
Accidents in radiotherapy	411	(3)
Managing a Quality Assurance Programme	414	(4)
Multidisciplinary radiotherapy team	414	(2)
Quality system/comprehensive quality assurance programme	416	(2)
Quality Assurance Programme for Equipment	418	(15)
Structure of an equipment quality assurance programme	418	(1)
Equipment specification	419	(1)
Acceptance	419	(1)
Commissioning	420	(1)
Quality control	420	(1)
Uncertainties, tolerances and action levels	421	(2)
Quality assurance programme for cobalt-60 teletherapy machines	423	(2)
Quality assurance programme for linacs	425	(1)
Quality assurance programme for treatment simulators	425	(4)
Quality assurance programme for computed tomography scanners and computed tomography simulation	429	(1)
Quality assurance programme for treatment planning systems	430	(1)
Quality assurance programme for test equipment	431	(2)
Treatment Delivery	433	(12)
Patient charts	433	(1)
Portal imaging	434	(2)
Portal imaging techniques	436	(3)
Future developments in portal imaging	439	(1)
In vivo dose measurements	439	(1)
In vivo dose measurement techniques	440	(3)
Use of electronic portal imaging systems for in vivo dosimetry	443	(1)
Record and verify systems	443	(2)
Quality Audit	445	(6)
Definition	445	(1)
Practical quality audit modalities	446	(1)
Postal audit with mailed dosimeters	446	(1)
Quality audit visits	446	(1)
What should be reviewed in a quality audit visit?	447	(1)
Bibliography	448	(3)
Brachytherapy: Physical and Clinical Aspects	451	(34)
Introduction	451	(4)
Photon Source Characteristics	455	(5)
Practical considerations	455	(1)
Physical characteristics of some photon emitting brachytherapy sources	456	(1)
Mechanical source characteristics	456	(1)
Source specification	457	(1)
Specification of γ ray sources	457	(2)
Specification of β ray sources	459	(1)
Clinical Use and Dosimetry Systems	460	(7)
Gynaecology	460	(1)
Types of source	460	(1)
Dose specification	460	(1)
Source arrangement	460	(1)
Applicators	461	(1)
Rectal and bladder dose monitoring	461	(1)
Interstitial brachytherapy	461	(1)
Patterson-Parker system	461	(1)
Quimby system	462	(1)
Paris system	462	(1)
Remote afterloading systems	463	(1)
Permanent prostate implants	464	(1)
Choice of radionuclide for prostate implants	465	(1)
Planning technique: ultrasound or computed tomography	465	(1)
Preplanning, seed placement and dose distributions	465	(1)
Post-implant dose distributions and evaluation	465	(1)
Eye plaques	466	(1)
Intravascular brachytherapy	466	(1)
Dose Specification and Reporting	467	(1)
Intracavitary treatments	467	(1)
Interstitial treatments	467	(1)
Dose Distributions Around Sources	468	(7)
AAPM TG 43 algorithm	468	(3)
Other calculation methods for point sources	471	(2)
Linear sources	473	(1)
Unfiltered line source in air	473	(1)
Filtered line source in air	474	(1)
Filtered line source in water	475	(1)
Dose Calculation Procedures	475	(4)
Manual dose calculations	475	(1)
Manual summation of doses	475	(1)
Precalculated dose distributions (atlases)	475	(1)
Computerized treatment planning	476	(1)
Source localization	476	(1)
Dose calculation	476	(1)
Dose distribution display	476	(1)
Optimization of dose distribution	477	(1)
Calculation of treatment time	477	(1)
Use of Patterson-Parker tables	477	(1)
Choice of reference points	478	(1)
Decay corrections	478	(1)
Commissioning of Brachytherapy Computer Treatment Planning Systems	479	(1)
Check of the reconstruction procedure	479	(1)
Check of consistency between quantities and units	479	(1)
Computer versus manual dose calculation for a single source	479	(1)
Check of decay corrections	479	(1)
Source Commissioning	480	(1)
Wipe tests	480	(1)
Autoradiography and uniformity checks of activity	480	(1)
Calibration chain	480	(1)
Quality Assurance	481	(2)
Constancy check of a calibrated dosimeter	481	(1)
Regular checks of sources and applicators	481	(1)
Mechanical properties	481	(1)
Source strength	481	(1)
Wipe tests	482	(1)
Checks of source positioning with afterloading devices	482	(1)
Radiation monitoring around patients	482	(1)
Quality management programme	482	(1)
Brachytherapy Versus External Beam Radiotherapy	483	(2)
Bibliography	483	(2)
Basic Radiobiology	485	(20)
Introduction	485	(1)
Classification of Radiations in Radiobiology	486	(1)
Cell Cycle and Cell Death	487	(1)
Irradiation of Cells	488	(1)
Direct action in cell damage by radiation	488	(1)
Indirect action in cell damage by radiation	488	(1)
Fate of irradiated cells	489	(1)
Type of Radiation Damage	489	(3)
Timescale	489	(1)
Classification of radiation damage	490	(1)
Somatic and genetic effects	490	(1)
Stochastic and deterministic (non-stochastic) effects	491	(1)
Acute versus late tissue or organ effects	491	(1)
Total body radiation response	491	(1)
Foetal irradiation	492	(1)
Cell Survival Curves	492	(2)
Dose Response Curves	494	(2)
Measurement of Radiation Damage in Tissue	496	(1)
Normal and Tumour Cells: Therapeutic Ratio	497	(1)
Oxygen Effect	498	(2)
Relative Biological Effectiveness	500	(1)
Dose Rate and Fractionation	501	(2)
Radioprotectors and Radiosensitizers	503	(2)
Bibliography	504	(1)
Special Procedures and Techniques in Radiotherapy	505	(44)
Introduction	505	(1)
Stereotactic Irradiation	506	(10)
Physical and clinical requirements for radiosurgery	506	(1)
Diseases treated with stereotactic irradiation	507	(1)
Equipment used for stereotactic radiosurgery	507	(1)
Historical development	508	(1)
Radiosurgical techniques	509	(1)
Gamma Knife	509	(1)
Linac based radiosurgery	509	(2)
Miniature linac on robotic arm	511	(1)
Uncertainty in radiosurgical dose delivery	512	(1)
Dose prescription and dose fractionation	513	(1)
Commissioning of radiosurgical equipment	514	(1)
Quality assurance in radiosurgery	514	(1)
Gamma Knife versus linac based radiosurgery	515	(1)
Frameless stereotaxy	516	(1)
Total Body Irradiation	516	(6)
Clinical total body irradiation categories	516	(1)
Diseases treated with total body irradiation	517	(1)
Technical aspects of total body irradiation	517	(1)
Total body irradiation techniques	518	(1)
Dose prescription point	519	(1)
Commissioning of total body irradiation procedure	519	(2)
Test of total body irradiation dosimetry protocol	521	(1)
Quality assurance in total body irradiation	521	(1)
Total Skin Electron Irradiation	522	(5)
Physical and clinical requirements for total skin electron irradiation	523	(1)
Current total skin electron irradiation techniques	523	(1)
Selection of total skin electron irradiation technique	524	(1)
Dose calibration point	525	(1)
Skin dose rate at the dose prescription point	525	(1)
Commissioning of the total skin electron irradiation procedure	525	(1)
Measurement of clinical total skin electron irradiation dose distributions	526	(1)
Quality assurance in total skin electron irradiation	526	(1)
Intraoperative Radiotherapy	527	(2)
Physical and clinical requirements for intraoperative radiotherapy	527	(1)
Intraoperative radiotherapy radiation modalities and techniques	527	(1)
Commissioning of an intraoperative radiotherapy programme	528	(1)
Quality assurance in intraoperative radiotherapy	528	(1)
Endocavitary Rectal Irradiation	529	(2)
Physical and clinical requirements for endorectal irradiation	529	(1)
Endorectal treatment technique	530	(1)
Quality assurance in endorectal treatments	531	(1)
Conformal Radiotherapy	531	(7)
Basic aspects of conformal radiotherapy	531	(1)
Multileaf collimators	532	(1)
Acceptance testing of multileaf collimators	533	(1)
Commissioning of multileaf collimators	534	(1)
Quality assurance programme for multileaf collimators	534	(1)
Intensity modulated radiotherapy	534	(1)
Commissioning of intensity modulated radiotherapy systems	535	(2)
Quality assurance for intensity modulated radiotherapy systems	537	(1)
Dose verification for intensity modulated radiotherapy treatment plans	537	(1)
Image Guided Radiotherapy	538	(6)
Cone beam computed tomography	539	(1)
Computed tomography Primatom	540	(1)
Tomotherapy	541	(1)
BAT system	542	(1)
ExacTrac ultrasonic module	542	(1)
CyberKnife	543	(1)
Adaptive Radiotherapy	544	(1)
Respiratory Gated Radiotherapy	544	(1)
Positron Emission Tomography/Computed Tomography Scanners and Positron Emission Tomography/Computed Tomography Image Fusion	545	(4)
Bibliography	548	(1)
Radiation Protection and Safety in Radiotherapy	549	(62)
Introduction	549	(1)
Radiation Effects	550	(1)
Deterministic effects	550	(1)
Stochastic effects	550	(1)
Effects on the embryo and foetus	551	(1)
International Consensus and Radiation Safety Standards	551	(1)
Types of Radiation Exposure	552	(2)
Quantities and Units Used in Radiation Protection	554	(5)
Physical quantities	554	(1)
Radiation protection quantities	554	(1)
Organ dose	555	(1)
Equivalent dose	555	(1)
Effective dose	556	(1)
Committed dose	557	(1)
Collective dose	558	(1)
Operational quantities	558	(1)
Ambient dose equivalent	558	(1)
Directional dose equivalent	558	(1)
Personal dose equivalent	559	(1)
Basic Framework of Radiation Protection	559	(1)
Governmental Regulation and National Infrastructure	560	(1)
Scope of the Basic Safety Standards	561	(1)
Responsibilities for Implementation of Basic Safety Standards Requirements	562	(1)
Safety in the Design of Radiation Sources and Equipment	562	(8)
Equipment	563	(2)
Sealed sources	565	(2)
Safety in the design of facilities and ancillary equipment	567	(1)
Manual brachytherapy	567	(2)
Remote control brachytherapy and external beam radiotherapy	569	(1)
Safety Associated with Acceptance Tests, Commissioning and Operation	570	(5)
Safe operation of external beam radiotherapy	572	(1)
Safe operation of brachytherapy	572	(2)
Safe operation of manual brachytherapy	574	(1)
Safe operation of remote control afterloading brachytherapy	575	(1)
Security of Sources	575	(2)
Occupational Exposure	577	(6)
Responsibilities and conditions of service	577	(1)
Use of dose constraints in radiotherapy	577	(1)
Investigation levels for staff exposure in radiotherapy	578	(1)
Pregnant workers	578	(1)
Classification of areas	579	(1)
Local rules and supervision	579	(1)
Protective equipment and tools	580	(1)
Individual monitoring and exposure assessment	580	(1)
Monitoring of the workplace	581	(1)
Health surveillance	581	(1)
Records	582	(1)
Medical Exposure	583	(8)
Responsibilities for medical exposure	583	(1)
Justification of medical exposure	584	(1)
Optimization of exposure and protection	584	(1)
Calibration of radiotherapy sources and machines	585	(2)
Clinical dosimetry	587	(1)
Quality assurance for medical exposure	587	(2)
Constraints for comforters and visitors	589	(1)
Discharge of patients	589	(1)
Investigation of accidental medical exposure	590	(1)
Public Exposure	591	(1)
Responsibilities	591	(1)
Access control for visitors	591	(1)
Radioactive waste and sources no longer in use	591	(1)
Monitoring of public exposure	592	(1)
Potential Exposure and Emergency Plans	592	(4)
Potential exposure and safety assessment	592	(1)
Mitigation of consequences: emergency plans	593	(1)
Lost source	593	(1)
Stuck source	594	(1)
Contamination	595	(1)
Off-site accidents	595	(1)
Patient accidental exposure	595	(1)
General Shielding Calculations	596	(4)
Step one: Design dose in occupied areas (annual dose and weekly dose)	597	(1)
Step two: Calculation of the radiation field (air kerma in air) in the occupied area without shielding	598	(1)
Step three: Attenuation by shielding barriers	599	(1)
Typical Linac Installation	600	(6)
Workload	600	(2)
Calculation of the primary barrier transmission factor	602	(1)
Calculation of the scatter barrier transmission factor	603	(1)
Calculation of the leakage barrier transmission factor	603	(1)
Determination of barrier thickness	604	(1)
Consideration of neutron production in a high energy linac	605	(1)
Door of a linac room	605	(1)
Other considerations	606	(1)
Shielding Design for Brachytherapy Facilities	606	(5)
Bibliography	607	(4)
International Organizations	611	(2)
Abbreviations	613	(6)
Symbols	619	(8)
Bibliography	627	(12)
Index	639