Radiation Therapy:

Khan
Bentel
Radiation dose is often determined using the following methods:
Photographic film, TLD, Ionization chambers The width of the penumbra INCREASES with
Increased SSD, Decreased source-collimator distance, Increased source size
The point of maximum electron equilibrium is referred to as:
Dmax Wedge angle refers to
The angle at which an isodose curve at a specified depth is tilted as a result of the
A HVT is a way of expressing wedge being inserted in the beam
The quality of the beam
A guide to determining the needed electron beam energy (in MeV) is to
Dose rates in air express Multiply the maximum tumor depth in cm by 3
The dose measured without a phantom and with a buildup cap at a given distance
True or False
Dose rates Only 10-50 percent isodose lines bulge out in the penumbra region, causing great
Increase with increased field size and decrease with increased distance difficulties in matching adjacent electron fields uniformly
TRUE - Only 10-50 percent isodose lines bulge out in the penumbra region, causing
Increasing the distance from 80cm to 90cm causes the dose rate to change by great difficulties in matching adjacent electron fields uniformly
0.7901
Sol’n 1. WHO DISCOVERED X-RAYS
80^2/90^2 = 0.7901
WHEN
Percentage depth dose is dependent on WILHELM CONRAD ROENTGEN
Field size, Distance, Energy
11-8-1895
TPR - Tissue Phantom Ratio 2. WHO DICOVERED POLNIUM & RADIUM
The ratio of dose at a specified point in tissue or phantom, to the dose at the same
1898
DISTANCE in the BEAM, at a REFERENCE point.
PIERRE & MARIE CURIE
TMR - Tissue Maximum Ratio 1898
The ratio of dose at a specified point in tissue or phantom, to the dose at the same 3. _________ DEALS WITH THE CELL SENSITIVITY AT THE
POINT at the DEPTH of MAXIMUM dose. INSTANT OF THEIR DIVISION.
RADIOBIOLOGY
TAR - Tissue Air Ratio 4. WHEN IS THE BEST TIME TO DISTRIBUTE RADIATION
The ratio of dose at a specified point in a MEDIUM, to the dose at the same point in DURING CEL DIVISION BECASUE THEY ARE THE MOST
FREE SPACE. SENSITIVE
5. WHAT ARE 3 FORMS OF RADIATION PROTECTION
The TAR (tissue air ratio) at 5cm depth for 10x10cm field minus the TAR at 5cm for a TIME (DECREASE)
0x0 cm field gives the
SAR ( Scatter Air Ratio) DISTANCE (INCREASE)

In a fixed SSD (source to surface distance), the dose is routinely normalized at SHEILDING (INCREASE)
6. LINEAR ACCELERATOR'S WAS DEVELOPED IN _____ BY
At Dmax
WIDEROE TO ______ ______ _____
1928
In an isocentric treatment technique, the dose is routinely normalized at
At isocenter ACCELERATE HEAVY IONS
7. iSOTOPES HAVE THE SAME NUMBER OF SOURCE TO SKIN DISTANCE
PROTONS
8. COLBALT 60 HAS A HALF LIFE OF OR
5.26 YEARS
9. MAXIMUM DOSE IS ALSO KNOWN AS SOURCE TO SURFACE DISTANCE
TISSUE TOLERANCE 23. THE LARGEST FIELD SIZE ON A TREATMENT MACHINE IS
10. A ______ ______ IS CAPABLE FO DUPLICATING THE 40 * 40
GEOMETRY AND MECHANICAL MOVEMENTS OF THE 24. THE UNIT OF DOSE IS
RADATION TREATMETN MACHINE. CENTIGRAY OR GRAY
CONVENTIONAL SIM 25. ABSORBED DOSE IS IN THE
TISSUE
DOES EVERYTHING BUT TREAT 26. EXPOSED DOSE IS IN THE
11. A ______ _______ PROVIDES A 3-DIMENSIONAL ASPECT TO AIR
TREATMENT PLANNING * ALLOWS US TO SEE THE PATIENTS 27. ENERGY / 4 =
SHAPE & TUMOR* D-MAX
DETERMINES THE TRUE VOLUME, LOCATION AND VIEW THE 28. ______ IS THE ENERGY DEPOSITED AT A POINT IN A SMALL
OAR FIXED WEIGHT OF THE MATERIAL SURROUNDING THE POINT
CT SIM IN QUESTION
12. _______ IS BASICALLY OUTLINIGN ORGANS & TUMOR VOLUME DOSE
CONTOURING 29. WHAT AR 3 METHODS OF DOSE DETERMINATION
13. WHAT DIRECTION IS THE X AXIS * IONIZATION CHAMBERS
LEFT TO RIGHT
14. WHAT DIRECTION IS THE Y AXIS * TLD'S
UP & DOWN
15. WHT DIRECTION IS THE Z AXIS * PHOTOGRAPHIC FILMS
ANTERIOR TO POSTERIOR 30. ___ ___ ___ IS THE REGION BETWEEN THE SURFACE AND D-
16. WHAT DOES MLC STAND FOR MAX
MULTI-LEAF COLLIMATOR MAXIMUM ELECTRONIC BUILDUP
17. WHAT DOES IT MEAN TO ATTENUATE
IT ABSORBS AS IT GOES THROUGH THIS IS THE BUILDUP REGION IN THE PATIENT
18. 1 INCH = 31. tHE THICKNESS OF MATERIAL THAT REDUCES THE INTENSITY
2.54 CM OF THE BEAM TO HALF OF ITS ORGINAL VALUE.
19. SYMETRICAL JAWS MEAN ___________- HVT - HALF VALUE THICKNESS
JAWS MOVE AT THE SAME TIME 32. THE ___ EXPRESSES THE PENETRATION, QUALITY OR
20. ASYMETRICAL JAWS MEAN = HARDNESS OF A BEAM
INDEPENDENT MOVING JAWS HVT
21. THE DOSE DELIVERED TO A MEDIUM (PATIENT) DEPENDS ON 33. ___ ____ INCREASE WITH INCREASED FIELD SIZE AND VARIES
6 THINGS: INVERSELY WITH THE SQUARE OF THE DISTANCE
o *DEPTH OF CALCULATION POINT BELOW THE DOSE RATES
SURFACE 34. THE ABSORBED DOSE AT A GIVEN DEPTH EXPRESSED AS A
o *PETETRATING POWER OF THE BEAM PERCENTAGE OF THE ABSORBED DOSE AT A REFERENCE
o *TYPE OF TISSUE DEPTH ONTHE CENTRAL AXIS OF THE FIELD
o * SSD o PDD
o *FIELD SIZE o PERCENTAGE DEPTH DOSE
o *COLLIMATOR DESIGN 35. THE RATIO OF THE DOSE AT A GIVEN POINT IN A MEDIUM TO
22. WHAT DOES SSD STAND FOR THE DOSE AT THE SAME POINT IN FREE SPACE
 o TAR 51. THE ANGLE THROUGH WHICH AN ISODOSE CURVE IS TILTED
o TISSUE AIR RATIO AT THE CENTRAL AXIS OF THE BEAM AT A SPECIFIED DEPTH
36. THE RATIO OF DOSE AT A SPECIFIED POINTIN TISSUE OR IN A IS THE ____ ____
PHANTOM TO THE DOSE AT THE SAME DISTANCE IN THE WEDGE ANGLE
BEAM AT A REFERNCE DEPTH, USUALLY 5CM. 52. WHERE THE BEAMS COME TOGETHER OR ANY AREA THAT
o TPR GETS MORE THAN 100% OF THE DOSE IS CALLED A
o TISSUE PHANTOM RATIO HOT SPOT
37. THE RATIO OF THE DOSE AT A SPECIFIED POINT IN TISSUE 53. AN ACCURATE METHOD OF CALCULATING THE CHANGE IN
OR INA PHANTOM TO THE DOSE AT THE SAME POINTWHEN IT %DD FOR SMALL FIELDS, THERE THE SCATTER COMPONENT
IS AT THE DEPTH OF MAXIMUM DOSE IS SMALL IS THE ________
o TMR MAYNOERD F FACTOR
o TISSUE MAXIMUM RATIO 54. THE INCREASE OF %DD WITH INCREASED DISTANCE CAN BE
38. THE RATIO OF SCATTERED DOSE AT A GIVEN POINT IN A DETERMINED USING THE ______________
MEDIUM TO DOSE IN AIR AT THAT SAME POINT MAYNOERD F FACTOR
o SAR 55. WITH ELECTRONS THE ENERGY (MeV) SHOULD BE 3X THE
o SCATTERED AIR RATIO ______________
39. THE RATIO OF THE SCATTERED DOSE AT A DESIGNATED MAXIMUM DEPTH OF THE TUMOR
POINT N A PHANTOM TO THE EFFECTIVE PRIMARY DOSE AT
THE SAME POINT AT THE REFERENCE DEPTH OF MAXIMUM EX: A 3 CM TX DEPTH OF THE TUMOR A 9MeV ELECTRON
DOSE BEAM SHOULD BE USED
o SMR 56. ELECTRON ENERGY DETERMINATION
o SCATTERED MAXIMUM RATIO
40. TH REGION NEAR THE EDGE OF THE FIELD MARGIN WHERE 90% MULTIPLE THE DEPTH OF THE TUMOR BY _____
THE DOSE FALLS OFF RAPIDLY IS CALLED THE 4
PENUMBRA 57. ELECTRON ENERGY DETERMINATION
41. ________ HAS THE LARGEST PNEUMBRA
COBALT 60 80% MUTIPLE THE DEPTH OF THE TUMOR BY
42. JUST THE X AND Y DIMENSIONS IS CONSIDERED 3
2-D 58. ELECTRON ENERGY DETERMINATION
43. X, Y, AND Z IS CONSIDERED
3-D RULE OF THUMB
44. X,Y,Z & RESPIRATORY GATING IS CONSIDERED MULTIPLY THE DEPTH OF THE TUMOR BY
4-D 3
45. RT,T STANDS FOR 59. ENERGY DIVIDED BY 4 =
REGISTERED TECHNOLIGIST, RADIATION THERAPY D MAX
46. TREATMENT MACHINES ARE CALIBRATED AT 60. TISSUE EQUIVELENT MATERIAL TO RAISE DOSE TO THE
100 CM SKINS SURFACE IS CALLED
47. SSD + DEPTH = BOLUS
o SAD 61. A ____ ____ DROPS THE PENETRATION ABILITY OF THE BEAM
o SOURCE TO AXIS DISTANCE BEAM SPOILER
48. EPI STANDS FOR 62. RADIOACTIVITY WAS DISCOVERED BY ___________
ELECTRONIC PORTAL IMAGING HENRI BECQUEREL
49. OBI STANDS FOR 63. ____ _____ WAS THE ONLY MEASURE OD DOSE BY WHICH
ON BOARD IMAGING THE EARLIER PIONEER COULD ESTIMATE THE NECESSARY
50. WEDGES ARE ALSO KNOWN AS LENGTH OF THE TREATMENTS
FILTERS ERYTHEMA DOSE
64. THAT ONE COULD ACHEIVE THE SAME TUMOR RESPONSE 78. NOTE
WITH LESS INJURY TO NORMAL TISSUE BY FRACTIONATING
THE DOSE WAS DISCOVERED BY LINEAR ACCELERATORS WERE FIRST DEVELOPED
HENRI COUTARD AND CLAUDE REGUARD FOLLOWING WORLD WAR II
65. THE MANCHESTER SYSTEM OF RADIUM DISTRIBUTION WAS 79. _____ _____ PRODUCE HIGH ENERGY BEAMS BY
DEVELOPED BY ACCELRATING CHARGED PARTICLES IN A LINEAR TUBE
RALSTON PATERSON AND HERBERT PARKER LINEAR ACCELERATOR
66. THE _________ IS USED TO MEASURE QUALITY OF X-RAYS 80. WHEN USING ELECTRONS WHY ARE CONES THAT EXTEND
AND WAS INTRODUCED BY BENEIST COLOSE TO THE PATIENTS SKIN USED
PENETROMETER BECAUSE ELECTRONS SCATTER READILY
67. IN 1928 THE _____ WAS INTERNATIONALLY ACCEPTED AS A 81. WHAT DOES A COLIMATOR DO?
UNIT OF MEASUREMENT FOR X-RAYS AND GAMMA RAYS DEFINE THE BEAM
ROENTGEN 82. THE PHOTON BEAM FROMA LINEAR ACCELERATOR IS
68. THE _____ AS A UNIT OF ABSORBED DOSE WAS INTERCEPTED BY iONIZATION CHAMBERS AND A ____ _____
RECOMMENDED BY THE ICRU IN 1953 FLATTENING FILTER
RAD 83. WHAT REDUCED THE DOSE RATE IN THE CENTER OF THE
69. ARTIFICAL RADIOACTIVITY WAS DISCOVERED IN UNFILTERED BEAM
1934 A FLATTENING FILTER
70. ARTIFICAL RADIOACTIVITY WAS DISCOVERED BY 84. THE FIRST COLBALT 60 MACHINE WAS INTRODUCED DURING
IRENE CURIE & FREDERIC JOLIOT THE
71. NOTE; 1950'S
THE USE OF BETATRONS INRADIATION THERAPY BECAME 85. THE HALF LIFE OF A COBALT-60 SOURCE IS
UNPOPULAR PRIMARLY BECUASE THEY PRODUCED LOW 5.26 YEARS
DOSE RATES AND LIMITED FIELD SIZES 86. THE AVERAGE ENERGY OF A COBALT-60 BEAM IS
72. RADIATION THERAPY UNITS OPERATING ATAPPROXIAMATELY 1.2 MeV
50 TO 120 kVp ARE REFERRED TO AS 87. NOTE
SUPERFICIAL UNTIS
73. THE ___ ____ ____ IS THE THICKNESS OF A GIVEN MATERIAL THE PENUMBRA OF A LINEAR ACCELERATOR BEAM IS
THAT, WHEN INTRODUCED INTO THE PATH OF THE BEAM SMALLER THAN THAT OF A COLBALT 60 MACHINE
REDUCES THE INTENSITY OF THE BEAM TO ONE HALF ITS 88. THE ______ IS THE POINT AROUND WHICH THE SOURCE OF
ORGINAL VALUE THE BEAM ROTATES
HALF VALUE THICKNESS (HVT) ISOCENTER
74. NOTE 89. THE SECONDARY COLLIMATOR OF A LINEAR ACCELERATOR
IS LARGELY RESPONSIBLE FOR
INSERTION OF ALUMINUM, COPPER, AND TIN FILTERS INTO THE SHARPNESS OF THE BEAM EDGES
THE X-RAY BEAM CAUSES LOW ENERGY X-RAYS TO BE 90. SIMULATORS ARE PRIMARLY USED TO
ABSORBED DUPLICATES THE GEOMETRY OF THERAPY MACHINES
75. ________ XRAYS USUALLY OPERATE AT 50 - 70 CM OF 91. 1 Gy IS THE SAME AS
SOURCE-SURFACE DISTANCE (SSD) 100 cGy
ORTHOVOLTAGE 92. THE POINT OF MAXIMUM ELECTRON EQUILIBRIUM IS
76. ________ X-RAYS UNITS USUALLY OPERATE IN TE RANGE IN REFERRED TO AS
150 T0 500 kVp D-MAX
ORTHOVOLTAGE 93. A HVT IS A WAY OF EXPRESSING THE ______ OF THE BEAM
77. __________ X-RAY BEAMS ARE GENERALLY MORE QUALITY
PENETRATING THAN SUPERFICIAL BEAMS
ORTHOVOLTAGE
94. ______ _____ IN AIR EXPRESS THE DOSE MEASURED o PTV
WITHOUT A PHANTOM AND WITH A BUILDUP CAP AT A GIVEN o PLANNING TARGET VOLUME
DISTANCE 107. WHAT IS DOSE NORMALIZATION?
DOSE RATES IT THE DOSE AT SOME POINT THATS BEEN "FORCED" TO
95. ____ _____ INCREASE WITH INCREASED FIELD SIZE AND 100%
DECREASE WITH INCREASE DISTANCE 108. PHOTON ISODOSE CURVES USED IN
DOSE RATES DOSECALCULATION ON A PATIENT USUALLY REQUIRE THE
96. IN A FIXED SSD TECHNIQUE THE DOSE IS ROUTINELY FOLLOWING CORRECTIONS
NORMALIZED OBLIQUE INCIDENCE & SURFACE IRREGULARITIES
AT D-MAX 109. ELECTON ISODOSE CURVES USED IN DOSE
97. THE WIDTH OF THE _______ INCREASES WITH INCREASED SD, CALCULATION ON A PATIENT USUALLY REQUIRE
DECREASED SOURCE TO DISTANCE SOURCE-COLLIMATOR CORRECTIONS FOR BEAM OBLIQUITY AND SURFACE
DISTANCE & INCREASED SOURCE SIZE IRREGULARITIES
PNEUMBRA 110. THE MAXIMUM DOSE FROMA SINGLE 6-MV PHOTON
98. THE DOSE IN THE SUPERFICIAL REGION GRADUALLY BEAM OCCURS AT APPROXIMATELY
INCREASES, OR BUILD UP, UNTL IT REACHES A CERTIAN 1.5cm
DEPTH AND THEN FLLS OFF DUE TO THE INCREASING 111. THE DEPTH OF MAXIMUM DOSE (D-MAX) FOR ANY
THICKNESS PHOTON BEAM ENERGY IS REDUCED BY
BUILD UP REGION LARGER FIELD SIZE AND OBLIQUE INCIDENCE
99. WHAT IS THIS CALLED 112. A SHEET OF LUCITE PLACED IN THE BEAM TO REDUCE
THE DEPTH OF D-MAX IS A
IF THE TUMOR IS NOT SITUATED AT MID-DEPTH, ITS USALLY BEAM SPOILER
BENEFICIAL TO DELIVER A HIGHER DOSE FROMTHE FIELD 113. TREATMENT FIELDS SHOULD ALWAYS BE SHAPED SO
WHERE THE TUMOR IS SHALLOWER THAT THE BEAM EDGE CROSSES __________ TO THE SPINAL
WEIGHTING CORD
100. WHAT IS USED TO ALTER THE DOSE DISTRIBUTION? PERPENDICULAR
WEDGE ANGLE 114. LONGER OR SHORTER
101. THE WEDGE ANGLE NEEDED DEPENDS ONTHE ______
ANGLE IN PORT FILMS OF PARALEL OPPOSED ISOCENTRIC FIELDS
HINGE OF A LUNG TUMOR, THE ANTERIOR FILED WILL APPEAR TO
102. _____ _____ IS THE ANGLE SEPERATING THE 2 INCLUDE A _______- SEGMENT OF THE SPINAL CORD THAN
CENTRAL AXES THE POSTERIOR FIELD
HINGE ANGLE LONGER
103. WHAT DOES ICRU STAND FOR 115. WHAT CAN YOU USE TO MINIMIZE THE GAP BETWEEN
INTERNATIONAL COMMISSION OF RADIATION UNITS AND TWO ADJACENT FIELDS
MEASUREMENTS A HALF BEAM BLOCK
104. WHAT IS THE GROSS PALPABLE EXTENT AND 116. NOTE
LOCATION OF MALIGNANT GROWTH
o GTV WHEN ADJACENT AREAS MUST BE TREATED, IT IS BEST TO
o GROSS TUMOR VOLUME CALCULATE THE GAP NECESSARY BETWEEN THE FIELDS TO
105. WHAT IS THE TISSUE VOLUME THAT CONTAINS THE PREVENT AN OVERLAP
GTV AND SUBCLINICAL MICROSCOPIC MALIGNANT DISEASE 117. IN AN ISOCENTRIC TREATMENT TECHNIQUE IT IS
o CTV ROUTINE TO NORMALIZE THE DOSE
o CLINICAL TARGET VOLUME AT ISOCENTER
106. WHAT CONTAINS THE TUMOR AND ADJACENT 118. THE 20% ISODOSE LINE CURVE OUT AND THE 90%
TISSUES CURVE CONSTRICTS IN AN _____ BEAM
 ELECTRON
119. WHEN PARALLEL OPPOSED 6-MV PHOTON BEAMS ARE
USED IN A 20-CM THICK PATIENT, THE MAXIMUM DOSE WILL
OCCUR AT
THE ENTRANCE/EXIT OF EACH FIELD
KHAN SUMMARY
Part 1: Basic Physics
Electron has a negative unit charge (1.602 × 10−19 C)
An atom represented in such a manner is also called a nuclide (AZX)
1 amu = 1.66 × 10−27 kg
electron volt (eV) is defined as the kinetic energy acquired by an electron in
passing through a potential difference of 1 V
1 eV = 1 V × 1.602 × 10−19 C = 1.602 × 10−19 J
In the case of tungsten (Z = 74), the electrons in the K, L, and M shells have
binding energies of about 69,500, 11,000, and 2,500 eV, respectively.
(a) strong nuclear force - responsible for holding the nucleons together in
the nucleus; short range; comes into play when the distance between the
nucleons becomes smaller than the nuclear diameter (~10−15 m)
(b) electromagnetic force - force between charged nucleons, quite strong,
but it is repulsive and tends to disrupt the nucleus’
(c) weak nuclear force - much weaker and appears in certain types of
radioactive decay (e.g., b decay)
(d) gravitational force - involved in the nucleus, very weak and can be
ignored
in 1925, de Broglie introduced a hypothesis concerning the dual nature of
matter
There are two classes of particles: fermions and bosons.
Fermion is a general name given to a particle of matter or antimatter that is
characterized by spin in odd half integer quantum units of angular
momentum (1/2, 3/2, 5/2,…).
Boson is a general name for any particle with a spin of an integer number (0,
1, 2,…).
The fundamental particles of matter (fermions) are of two kinds: quarks and
leptons. There are six types of each, as listed below:
• Quarks: up (u), down (d), charm (c), strange (s), top (t), and bottom (b);
• Leptons: electron (e), electron neutrino (νe ), muon (µ), muon neutrino
(νµ), tau (τ), and tau neutrino (ντ ).
Besides the above 12 elementary particles of matter, there are 12
corresponding elementary particles of antimatter. This follows the principle
discovered by Paul Dirac (1928) which states that for every particle of
matter there must be another particle of antimatter with the same mass but
opposite charge. So there are six antiquarks and six antileptons.
Quarks are the building blocks of heavier particles, called hadrons
(neutrons, protons, mesons, etc.).
For example, it takes three quarks (u, u, d) to make a proton and three
quarks (u, d, d) to make a neutron. These quarks are held together by field
particles called gluons, the messenger particles of the strong nuclear force.
The class of particles called the messenger particles are the carriers of force
in a force field according to the quantum electrodynamics (QED) theory.
These particles of force are not material particles but quanta of the field.
Thus, the force between any two interacting matter particles is transmitted
by the messenger particles traveling at the speed of light, which is the speed
with which all photons travel.
There are 13 messenger particles or bosons that mediate the four forces of
nature. They are listed below:
Electromagnetism photon (γ)
Strong force eight gluons
Weak force W+, W−, Zo
Gravity graviton (not yet detected)
Radioactivity, first discovered by Antonio Henri Becquerel in 1896, is a
phenomenon in which radiation is given off by the nuclei of the elements.
The process of radioactive decay or disintegration is a statistical
phenomenon.
The number of disintegrations per unit time is referred to as the activity of a
radioactive material
The mean or average life is the average lifetime of a radioactive atom
before it decays. It is the sum of the lifetimes of all the individual nuclei
divided by the total number of nuclei involved
The activity per unit mass of a radionuclide is termed the specific activity.
There are a total of 118 elements known today. Of these, the first 92 occur
naturally

It appears that as the number of particles inside the nucleus increases, the
forces that keep the particles together become less effective and, therefore,
the chances of particle emission are increased

All naturally occurring radioactive elements have been grouped into three
series: the uranium series, the actinium series, and the thorium series
The uranium series originates with 238U having a half-life of 4.51 × 109
years and goes through a series of transformations involving the emission of
a and b particles. g rays are also produced as a result of some of these
transformations. The actinium series starts from 235U with a half-life of 7.13
× 108 years and the thorium series begins with 232Th with half-life of 1.39 ×
1010 years. All the series terminate at the stable isotopes of lead with mass
numbers 206, 207, and 208, respectively

Clinical Radiation Generators: