• Import a graphic of a cover onto the • Extract and save the page. 8 x 10 correct-sized page. • Insert the page to the beginning of the • Make a PDF. sample chapter in question. • Crop out the new page. +HUHLVDVDPSOHFKDSWHU IURPWKLVERRN The Modern 7KLVVDPSOHFKDSWHULVFRS\ULJKWHG DQGPDGHDYDLODEOHIRUSHUVRQDOXVH Technology RQO\1RSDUWRIWKLVFKDSWHUPD\EH of UHSURGXFHGRUGLVWULEXWHGLQDQ\ Radiation IRUPRUE\DQ\PHDQVZLWKRXWWKH Oncology SULRUZULWWHQSHUPLVVLRQRI0HGLFDO 3K\VLFV3XEOLVKLQJ A Compendium for Medical Physicists and Radiation Oncologists Editor s Jacob Van Dyk The Modern Technology of Radiation Oncology A Compendium for Medical Physicists and Radiation Oncologists Jacob Van Dyk Editor Medical Physics Publishing Madison, Wisconsin © 1999 by Jacob Van Dyk. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the publisher. Printed in the United States of America First printing 1999 Library of Congress Cataloging-in-Publication Data The modern technology of radiation oncology / Jacob Van Dyk, editor. p. cm. Includes bibliographical references and index. ISBN 0-944838-38-3 (hardcover). – ISBN 0-944838-22-7 (softcover) 1. Cancer—Radiotherapy. 2. Medical physics. 3. Radiology, Medical. 4. Cancer—Radiotherapy—Equipment and supplies. I. Van Dyk, J. (Jake) [DNLM: 1. Neoplasms—radiotherapy. 2. Equipment Design. 3. Radiotherapy—instrumentation. 4. Radiotherapy—methods. 5. Technology, Radiologic. QZ 269 M6893 1999] RC271.R3M5935 1999 616.99’ 40642—dc21 DNLM/DLC for Library of Congress 99-31932 CIP ISBN 0-944838-38-3 (hardcover) ISBN 0-944838-22-7 (softcover) ISBN 978-1-930524-89-7 (2015 eBook edition) Medical Physics Publishing 4555 Helgesen Dr. Madison, WI 53718 1-800-442-5778 [email protected] www.medicalphysics.org Information given in this book is for instructional use only. Because of the possibility for human error and the poten- tial for change in the medical sciences, the reader is strongly cautioned to verify all information and procedures with an independent source before use. The editor, authors, and publisher cannot assume responsibility for the validity of all materials or for any damage or harm incurred as a result of the use of this information. ii Dedication In my personal life: To my wife Christine, and my children Tonia, Jon, Ben, and Amy, who have unwittingly sacrificed family time due to my professional commitments but who have knowingly shared their love and support. In my professional life: To Jack Cunningham who by example demonstrated that medical physics is much more than just a career. iii Contents Preface v Acknowledgments vi Contributors vii 1 Radiation Oncology Overview 1 2 Clinical Implementation of Technology and the Quality Assurance Process 19 3 Patient Immobilization 53 4 Simulators 95 5 CT Simulators 131 6 Simulator Computed Tomography 169 7 Imaging for Radiation Therapy Planning (MRI, Nuclear Medicine, Ultrasound) 191 8 Computerized Radiation Treatment Planning Systems 231 9 Kilovoltage X-rays 287 10 Cobalt-60 Teletherapy 313 11 Medical Accelerators 349 12 Beam Shaping and Intensity Modulation 437 13 Megavoltage Radiography for Treatment Verification 481 14 Radiation Oncology Information Management System 509 15 Tomotherapy 521 16 Stereotactic Irradiation 589 17 Special Techniques in Radiotherapy 641 17A Total Body Irradiation with Photon Beams 641 17B Total Skin Electron Irradiation 663 17C Intraoperative Radiation Therapy 679 18 Brachytherapy 695 19 Dose Measuring Tools 753 20 Proton Therapy 823 21 Neutron Therapy 871 22 Hyperthermia 919 22A Local Hyperthermia 919 22B Whole Body Hyperthermia 933 23 Photodynamic Therapy 941 24 Boron Neutron Capture Therapy 981 25 Monoclonal Antibody and Other Internal Emitter Therapies 1021 Acronyms 1043 Index 1049 iv Preface Radiation Oncology is a very technology intensive dis- evolving technologies and, thus, provides a compre- cipline of medicine. Complex, sophisticated equipment hensive overview. Anyone embarking on any of these is required to localize the tumor, to generate ionizing new procedures will be able to gain some basic insight radiation, and to deliver a high radiation dose to a as to what is required to make that procedure clinically three-dimensional target volume while sparing normal viable. tissues. A number of books have been written about the Nowhere can all these technologies be found in medical physics and clinical aspects of radiation oncol- one cancer therapy center. However, the staff of every ogy and treatment planning. The standard medical cancer center is involved in improving procedures by physics textbooks tend to discuss the basic concepts of either purchasing new equipment or by upgrading radiation interactions and dosimetry, and some of the existing equipment. This book is intended to be a guide technical aspects as related to treatment machines and for those embarking on these procedures. While the treatment planning. However, they generally do not body of each chapter is written at a level understand- address the design details of many of the practical tools able by medical physicists and radiation oncologists, that are required to prepare patients for treatment or additional detailed information for medical physicists that are used as part of the treatment process. Virtually is provided in the appendices at the end of some of the no textbook addresses the details of acceptance, com- chapters. missioning, and quality assurance of radiation therapy As the title indicates, the book is primarily equipment. intended for medical physicists and radiation oncolo- The purpose of this book is to describe the gists although it will also benefit radiation therapists details of the technology associated with radiation (radiographers) and dosimetrists, and to a lesser oncology. A special emphasis is placed on the design extent other allied professionals such as engineering of all the equipment allied with radiation treatment. In technologists, radiobiologists, and administrators. It addition, this book describes the procedures that are is intended to be both a reference text for those who required to implement this equipment into clinical ser- have been working in the field for some years as well vice (needs assessment, purchase, acceptance, and as an educational tool for those who are entering the commissioning) and, once it is in use, the quality field. It is assumed that the reader has a basic knowl- assurance that is required to keep the equipment oper- edge of medical physics as found in other standard ational at acceptable levels. In addition to describing all medical physics textbooks. the tools that are used in “standard” radiation treatment centers, this book addresses the less common or Jacob Van Dyk v Acknowledgments A sincere thank you: To Tomas Kron for seeding the concept of this book. To Jerry Battista for providing unending support, for being an excellent “sounding board,” and for reviewing a number of my chapters. To the authors and co-authors of the chapters of this book. Their contributions have given this book the quality that it is. To Ervin Podgorsak and Glenn Glasgow who graciously took on the additional challenge of providing more than one chapter. To Christina Woodward for sleuthing and resolving incomplete references. To members of the Medical Physics group at the London Regional Cancer Centre who have been consistent in their help and support. To Betsey Phelps and the staff at Medical Physics Publishing for making this book a reality. To Barb Barons for clerical support. vi Contributors* *Numbers in brackets refer to the chapter numbers Peter J. Biggs, Ph.D., D.A.B.R. [9] authored or co-authored by the contributor. Associate Professor and Radiation Biophysicist Radiation Oncology Department Jennifer S. Aldridge, M.S. [15] Massachusetts General Hospital Medical Physics Department Harvard Medical School University of Wisconsin Boston, Massachusetts, USA Madison, Wisconsin, USA Arthur L. Boyer, Ph.D., D.A.B.R., F.A.A.P.M [12] John P. Balog, Ph.D. [15] Professor and Director, Radiation Physics Medical Physics Department Stanford University School of Medicine University of Wisconsin Stanford University Madison, Wisconsin, USA Stanford, California, USA Robin B. Barnett, Ph.D., F.C.C.P.M. [8] Kenneth W. Brooks, Ph.D., D.A.B.R. [14] Supervisor, Radiation Treatment Planning District Manager and Delivery Support Varian Medical Systems Incorporated London Regional Cancer Centre Marietta, Georgia, USA Assistant Professor, Department of Oncology University of Western Ontario Paul M. Busse, M.D., Ph.D., D.A.B.R. [24] London, Ontario, Canada Associate Chairman Harvard Joint Center for Radiation Therapy Jerry J. Battista, Ph.D., F.C.C.P.M. [8] Assistant Professor of Radiation Oncology Director, Physics Research and Education Harvard Medical School London Regional Cancer Centre Boston, Massachusetts, USA Professor and Head, Division of Radiation Oncology Professor, Departments of Oncology, Medical Karen P. Doppke, M.S., D.A.B.R. [9] Biophysics and Adjunct Professor, Department of Associate in Radiation Oncology and Assistant Physics and Astronomy, University of Western Radiation Biophysicist Ontario Radiation Oncology Department London, Ontario, Canada Massachusetts General Hospital Harvard Medical School John Beatty, M.S., D.A.B.R. [9] Boston, Massachusetts, USA Associate in Radiation Oncology and Assistant in Radiation Biophysics Guang