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Report About Medical Physics Prepared By: AHMED ABD ALHFEEZ AREF Under Supervision of: Dr: Timetable for Medical Physics 1. Weeks 1 to 4 : Radiation physics . (Quality assurance and calibration) (Treatment planning) 2. Weeks 5 to 7: Radiation protection and safety. 3. Week 8 to 9: Imaging physics . (Diagnostic radiology) 4. Weeks 10 to 11: Imaging physics . (nuclear medicine) 5. Weeks 12 : Radiation biology . Section One linear accelerator What is a linear accelerator? A linear accelerator is the device most commonly used for external beam radiation treatments for patient with cancer or tumor. The LINAC, with a stereo tactic frame can be used in stereo tactic radio surgery similar to that achieved using the gamma knife to targets within the brain and to treat areas outside of the brain. It delivers a uniform dose of highenergy x ray to the region of the patient's tumor. These x rays can destroy the cancer cells, while sparing the surrounding normal tissue. The LINAC uses microwave technology to accelerate electrons in a part of the accelerator called the wave guide and then allows these electrons to collide with a heavy metal target. As a result of these collision, high energy x rays are scattered from the target. The patient's radiation oncologist prescribes the appropriate treatment volume and dosage. The medical radiation physicist and the dosimeters determine how to deliver the prescribed dose and calculate the amount of time it will take the accelerator to deliver that dose. Radiation therapists operate the LINAC and give patients their daily radiation treatments. What is the linac consists of: 1- Accelerator guides or Wave guides: Depend on the linac type. 2- Electron gun. 3- Power source: Klystron or Magnetron. 4- Bending Magnets. 5- Target. 6- Flattener. 7- Monitor. 8- Collimators. What are the Accelerator guides or Wave guides do? Accelerator guides are a special types of wave guides in which electrons are accelerated. The electron in linac experiences a zero voltage at it location and positive voltage. This means that the charged particle is pulled to the accelerated. Electron Gun: Consist of cathode and anode, in cathode the electron start from rest in the filter and gain enough energy to accelerator the electron and travels to the anode. Power source: Klystron: is an amplifier of high frequency waves created by a radiofrequency driver, Klystron are required for higher energy machines. Magnetron: Generates high frequency power, Magnetrons are used in low energy accelerators. Bending Magnets: In low energy linac, standing wave accelerator guides are short enough to be aimed at the patient. X ray beam production: Once the high energy electron beam has been produced with an accelerator guide and aimed toward the patient, the electrons are available either to produce x ray or electron therapy. The electrons smash into a heavy metal target to produce x rays. X ray beam flattening filters: The electron interactions in the target produce an x ray beam with an intensity that falls off rapidly in all directions from the central ray. The intensity is so non uniform that flattening filter must used to make the radiation beam useful for clinical purposes. Photon beam collimation: The collimation is usually made of a single block of either tungsten, depleted lead, which allows less than 3% transmission of the radiation beam. Electron beam production: The electron beam has been produced from electron gun with an accelerator guide. Electron scattering foils: It is use for broadening electron beams is the use of scattering foils in the path of the electron beam. It is use to make the electron beam scatter. Some foils are uniformly thin sheets of metal (steel or AL). Electron beam collimation: After the electrons beam is scattering and monitored, the broadened electron beam is collimated to the appropriate size for treatment using a combination of the lower and upper jaws in the head and additional electron collimation known as electron cones. Monitor chamber: They must first be measured or monitored, in order to allow delivery of the prescribed amount of radiation. The device used for this purpose is called a monitor ionization chamber. Radiation safety? Patient safety is very important. During treatment the radiation therapist continuously watches the patient through a closed circuit television monitor. There is also a microphone in the treatment room so that the patient can speak to the therapist if need. Port films are checked regularly to make sure that the beam position does not vary form the original plan The linear accelerator sits in a room with concrete walls and a lead and plastic door so that the high-energy x ray and any neutrons generated do not escape but are reduced to an acceptable dose rate. The radiation therapist must turn on the accelerator form outside the treatment room. Because the accelerator only gives off radiation when it is actually turned on, the risk of accidental exposure is extremely low. Before any patient treated, the radiation therapist will check the values and results and contrast this with any patient with treatment plan, it comes from the medicinal physicist. What are Wedge Filters? 1- There are situations in radiotherapy when it is required to treat a tumor from one side on the patient only and it is necessary to use more than one field. As example is the tumor of the middle ear for which two angled beams make the treatment. This method gives a very inhomogeneous dose distribution over the region common to both fields This is done by using which filters which turn the isdose curve through an angle. In normal distributions, the isodose curve usually cut the central axis of the beam at right angle. The value of angle depends o the designer of the wedge filter. Thus, the propose at this time of beam modification is to change the radiation distribution from normal which is symmetrical about the central axis of the beam into a distribution where the dose falls steadily from one side of the beam to the other side. This is done by using a filter which is thicker at on end and tapers to nothing at the other end as shown : Wedge filters have been used to both kV and MV beams but there main value is which MV radiation due to there being less scattering. The material used for wedge filter is unimportant specially MV rang since there is no question of Harding of the beam. Weight for weight, almost all materials attenuates radiation to the same extent. Al, Copper or lead are almost used but have the advantage of giving thinner filter. What is the Block? Shielding blocks used to be commonly made of lead. The thickness of lead required to provide adequate protection of the shielded areas depends on the beam quality and allowed transmission through the block. A primary beam transmission of 5 % through the block is considered acceptable for most clinical situation. The thickness of lead required for shielding increases substantially. The lead blocks are then placed above the patient supported in the beam on a transparent plastic tray, called the shadow tray. Gives the recommended lead shields thicknesses for various quality beams. Medium Melting Alloy: (MMA) On average approximately 20 pounds of 95co (LMPA= Low Melting Point Alloy). MMA is needed per patient. This is toxic and hazardous waste. Do not throw it into the garbage as details are: 1- 52 % Bismuth. 2- 32 % Lead. 3- 15 % Tin. 4- 10 % Cadmium What is the Multi-leaf Collimator? Multi-leaf collimator (MLC) for a photon beams consists of a large number of collimating blocks or leaves that can be driven automatically, independent of each other, to generate a field of any shape. The thickness of the leaves along the beam direction is sufficient to provide acceptably low beam transmission. The width of each leaf is usually about 1 cm as projected at the isocenter. The field edges are, therefore, formed stepwise, 1 cm wide. The MLC device contains 120 leaves on it (60 on each side). With the central 20 cm comprised of 0.5 cm wide leaves and the outer 10 cm for each direction comprised of 1 cm under leaves. Standard radiotherapy involves geometrical beams forming a box around the tumor, whilst conformal radiotherapy uses three-dimensional planning, and the volume of radiation therapy given to the tumor is irregular and 'conforms' to the correct area. A major component of modern linear accelerators which assists this technique is the multi-leaf collimator (MLC). The tumor is positioned under the collimator's centre using fixed laser measurement equipment, and the photon beam is modulated with series of leaf pairs, according to the tumor's volume and profile. The leaves travel on moveable carriages and move independently into the beam focus in order to block off radiation. An MLC also provides the automated shaping capability needed for treating patients with dynamic Intensity Modulated Radiation Therapy (IMRT). By virtually eliminating heavy custom blocks which existed in linear accelerators prior to MLC, valuable time is saved, dose distribution is improved and patient throughput is increased with existing equipment. The Steps of QA in linear accelerators daily 1. We are checking all parts of linac. 2. We are checking the display (Field size, Collimator angle, Couch and gantry by the holder (Manual Control). 3. Should be change the Couch to up or down to reach 100 cm between the couch and the source by press the SSD and optical (Field size 10x10 cm2). 4. Must be sure of the distance between the source and couch by rangefinder at 100 cm. 5. The best place paper on the couch to display SSD and cross wire on paper and move collimator into left and right to see the point of the center. 6. Put the phantom laser on the couch and make (Switch on) laser to see line of the laser corresponding on the line at the phantom (Right, left, sagittal and overhead). 7. Lock the water temp, water pressure and water level. 8. Sure from audiovisual (mike and camera) and the light of the room. 9. Inter locks the door and beam off. 10. Put the detector on the couch to dosimatric measurement. 11. Dosimatric measurements of:[a] Electron beam with applicator . [b] Photon beam without applicator . Section Two Radiation safety officer: A radiation safety officer (RSO) it must important for radiation safety, he will have the responsibility of implementing the radiation protection program. Radiation exposures can a rise in two ways: A great part of the body may be exposed to radiation from an external source. A certain organ may be exposed to radiation from radioactive materials which have been injected or inhaled and retained by body. Protections thus consist of keeping both the amounts of exposure to external radiation and quantities of radioactive material, which may inter the body to safe levels, which do not cause harmful effects. Radiation monitoring : For area monitoring, the portable battery operated survey meters are used. For recording doses received by radiation workers, film badges and TLD (Thermoluminscent Dosimeters) are widely used for this propose. Ion chamber it like survey meters but it use electronic screen and it is using different unit. How can we control of contamination? In planning work with RAI (Radioactive Isotope), it is necessary to remember the following points: The minimum quantity of radioactive material just enough for the propose should be use. Preference should be given to radioactive material of short half-lives, low energies and low toxicity. A max distance should be kept between the radioactive source and the worker. The time spent near the radioactive source should be kept to a minimum. Shielding should be used where necessary to reduce the dose rates to safe levels. How can we disposal the radioactive waste? Radioactive waste disposal from analytical, here the amount of radioactivity in use is small in mCi level Therefore, waste disposal is sample: Gaseous waste: release to the atmosphere. Liquid waste: discharge to sewers. Solid waste: burial. The Physical Units: What is Rontgen? Is the unit of expose in the cgs old system, the quantity is a measure of ionization produced I air by photons. Define the Rontgen? The rontagen is the amount of X and gamma rays that produces a given amount of ionization in each unit of air. 1R= 2.58 x 10-4 C/kg air What is Gray? Is the unit of absorbed dose in SI system. Define the Gray? The Gary is radiation-absorbed dose of 1 J/kg. 1Gy=1J/kg What is rad? Is the unit of absorbed dose in cgs old system. Define the rad? The rad is defined as 100 ergs/g of tissue 1 rad= 99 ergs/g 100 rad =1Gy What is rem? Is the unit of dose equivalent in cgs old system. Define the rem? A unit that reflects the biologic response and that could be used to compare effects of different radiation would be extremely useful to ward this end. 100 rem=1Sv What is sievert? Is the unit of dose equivalent in SI system. Define the sievert? The equivalent dose is a measure of the absorbed dose in a tissue, taking into consideration the radiation weighting factor, 1 for x rays, 10 for imaging some neutron. What is x unit? Is the unit of is a measure of the photon flux and the unit of expose in the SI system. Define the x unit? The x unit defined that quantity of x or gamma radiation that produces in air. 1 x unit =1 C/kg in air. 1 x unit = 3881 R. What is Ci? Is the unit of activity radiation in cgs old system. 1Ci = 3.7 x 1016 BqS What is Bq? Is the unit of activity radiation in SI system. Radiation Safety Ion Chambers Instrument 451 Ion Chamber Survey Meter Family 451 P Pressurized Ion Chamber Survey Meter 451B Ion Chamber Survey Meter with Beta Slide 451 EXL -SoftwareAssistant for Excel 470A Ion Chamber Survey Meter GM & Scintillation Instruments and Probes "Identifier" Multi Channel analyzer Complete radiation safety protection 190 Digital Survey Meter with extern probe 190 Digital survey Meter with internal GM-detector 190 with Neutron Probe "Identifier" Multi Channel Analyser Mod 190 Selections of probes Section three Production of x rays X ray discovered by roentgen in 1895 while studying cathode rays in a gas discharge tube. He observed that another type of radiation was produced which could be detected outside the tube. The x ray tube: The tube consists of a glass envelope which has been evacuated to high vacuum. At one end is a cathode (e-) and at the other an anode (e+), both hermetically sealed in the tube. The cathode is a tungsten filament which when heated emits electrons, a phenomenon known as thermionic emission. The anode consists of a thick copper rod at the end of which is placed a small piece of tungsten target. When a high voltage is applied between the anode and the cathode, the electrons emitted from the filament are accelerated the anode and achieve high velocities before striking the target. The anode: The choice of tungsten as the target material in conventional X ray tubes is based on the criteria that the target must have high atomic number and high melting point. The efficiency of x ray production depends on the atomic number, and for that reason, tungsten with Z=74 is a good target material. Which has a melting point of 3370Co. efficient removal of heat from the target is an important requirement for the anode design. Some of tubes use thick copper anode to the outside of the tube where it is cooled by water or oil. The heat generated in the rotating anode is radiated to the oil reservoir surrounding the tube. The cathode: The cathode consists of: 1- Wire filament. 2- Circuit to provide filament current. 3- Negatively charged focusing cup. The function of the cathode cup is to direct the electron to the anode so that they strike the target in the well defined area, the focal spot. Since size of focal spot depends on filament size. The glass envelope: The glass envelope surrounding the components of the X ray tube is evacuated to prevent the electrons form interaction with gas molecules before they reach the x ray target. Shield: Some stationary anodes are hooded by a copper and tungsten shield to prevent stray electron from striking the walls of the tube. For that the copper shield absorbs the unwanted x ray. Computed tomography (CT) Overview: Computed tomography (CT) scans are completed with the use of a x-ray beam rotating through a 360o angle and computer production of images. These scans allow for cross-sectional views of body organs and tissues. In it’s basic form, a rotating x ray beam emits ionizing radiation of a defined thickness which is used to irradiate the patient from numerous projection. Detectors located on the opposite side of the patient to the beam, register the amount of radiation that has penetrated the patient. kV and mA: The kV is a reflection of the energy level of the x ray beam. Higher energy levels offer greater penetration through the patient allowing a greater number of photons to reach the detectors. The mA relates directly to the number of photons emitted in the x ray beam and is therefore inversely proportional to the quantum noise. There include collimation and matrix. Some note’s: Increase mA decrease quantum noise increase in contrast resolution. Higher mA higher patient dose higher tube load. Increase kV decrease in quantum noise greater penetration. Higher kV higher dose to patient may reduce tissue differences. Usually we use 120kV and 250mA for a normal patient and 140kV and 300mA for fat patient and 80kV and 200mA for baby or kids. Brain scans can detect tumors, and strokes. The introduction of CT scanning, especially spiral CT, has helped reduce the need for more invasive procedures. Body scans. CT scans of the body will often be used to observe abdominal organs, such as the liver, kidneys, adrenal glands, spleen, and lymph nodes Aorta scans. CT scans can focus on the thoracic or abdominal aorta to locate aneurysms and other possible aortic diseases. Chest scans. CT scans of the chest are useful in distinguishing tumors and in detailing accumulation of fluid in chest infections. Radiation safety: Pregnant women or those who could possibly be pregnant should not have a CT scan unless the risk of non diagnosis exceeds the radiation risk. Pregnant patients should particularly avoid full body or abdominal scans. For many CT examinations patient may be asked to sign contrast agent (orally, rectally or via injection).Intravenous, oral and rectally are pharmaceutical agents liquids and are sometime referred to as dyes or pigment contrast is used to make specific organs. There are four types of contrast agent used in CT: Via intravenous injection. Orally Rectally A much less common type of contrast used in CT is for special lung and brain imaging. Sometimes it is necessary to not be drinking anything for hour to several hour exam (fasting).The preparation times varies depending on the actual exam as well imaging center’s requirement. If a contrast medium is administered, the patient may be asked to fast from about four to six hours prior to the procedure. Patients will usually be given a gown (like a typical hospital gown) to be worn during the procedure. All metal and jewelry should be removed to avoid artifacts on the film. CT equipment: A CT scan may be performed in a hospital or outpatient imaging center. Although the equipment looks large. The patient is asked to lie narrow table, that slides into the center of the scanner. The scanner looks like a ring and is round in the middle, which allows the x-ray beam to rotate 360o around the patient. The scanner section may also be tilted slightly to allow for certain cross-sectional angles. CT procedure: It is most important to tell the patient that “do not move” while the CT is scanning so the scanning picture wont be corrupted. In some studies, such as abdomen CTs, the patient will be asked to hold his or her breath during image capture. Following the procedure, films of the images are usually printed for the radiologist and referring physician to review. A radiologist can also interpret CT exams on a special computer screen. The procedure time will vary in length depending on the area being imaged. Average study times are from 30 to 60 minutes. Contrast agents: Contrast agents are often used in CT exams and in other radiology procedures to illuminate certain details of anatomy which may not be easily seen. Some contrasts are natural, such as air or water. Other times, a water contrast agent is administered for specific diagnostic purposes. The patient may drink this contrast. Oral and rectal contrast are usually given when examining the abdomen or cells, and not given when scanning the brain or chest. Iodine is the most widely used intravenous contrast agent and is given through an intravenous needle. Results: Normal findings on a CT exam show bone, the most dense tissue, as white areas. Tissues and fat will show as various shades of gray, and fluids will be gray or black. Air will also look black. Intravenous, oral, and rectal contrast appears as white areas. The radiologist can determine if tissues and organs appear normal by the sensitivity of the gray shadows. In CT, the images that can cut through a section of tissue or organ provide three-dimensional viewing for the radiologist and referring physician. What is observed? In the chest for example, the patient will be asked to hold his or her breath during image capture. It is very important to tell the patient that "do not move" while the CT is scanning and injecting the patient through the VEINS during the test for take clear image to see an organ. KV use: The set kV depends on the patient age, normally using 120-140 KV for old men or adult's patient and 80 for babies. Higher KV higher dose to patient and more scatter which may reduce differences in tissue visible. Section Four Nuclear Medicine Introduction: Nuclear Medicine is used mainly to allow visualization of organs and regions within organs that can not be seen on conventional x ray images. Especially tumors may stand out on nuclear medicine images. It is a different process from x ray, CT and MRI all of which are looking at the anatomy of the body. Gamma Camera: The gamma camera has a large crystal detector and used to detect the gamma rays from the radiopharmaceutical and to build them up into image there are two heads of gamma camera. Each head has a metal collimator roughly analogous to lens followed by a NaI (TL) crystal. The crystal detects the emitted radiation signal and converts that signal into faint light or pulses of light. These pulses are amplified by photo multiplier tubes and passed to a computer that works out where the original gamma ray comes from. It can also rotate around the patient to produce series of images. Gamma Camera Image: The nuclear medicine image can either be in gray scale (black & white) for instance in a bone scan or they can be color coded to clearly show functional activity like in a cardiac study. What we are do morning daily in nuclear medicine? 1- Elution: First, we taking 2 tubes (vacuum tube, cerium tube or pharmaceutical) and put both of them in generator. The generator is using Radio isotope it is Tc99, when the saline passes through in to the vacuum tube we get the Tc99m radioactivity. 2 -Radioisotopes: The main radioisotope we use is Technetium-99m (Tc99m). This emits a gamma ray of energy 140 KeV with a half life of 6 hours. It is ideal for our purposes as it combines good imaging characteristics with a low radiation dose to the patient. It is produced from a generator containing its parent isotope Molybdenum 99 (Mo99). 3 –Dose calibrator: It is machine is use to measure the radioactive isotope for example , for normal patient 900 MBq - 1000 MBq, for children 500 MBq - 600 MBq. But when we want to scan the thyroid we get 185 MBq – 250 MBq . Radiopharmaceuticals: A large number of radiopharmaceuticals are used in Nuclear Medicine. Most are known by abbreviations. The most common are MDP for bone scans, MAA for lung scans, PYP for heart scans and DTPA for kidney scans. All are prepared in the department's radio pharmacy. Section Five In this section I already toke all subjects as follow: 1- Introduction to biology part1: Cell structure , cell cycle and cell division . 2- Introduction to biology part 2: DNA RNA protein 3- The physics and chemistry of radiation absorption . 4- Cell survival curves. 5- DNA strand breaks and chromosomal aberrations . 6- Repair of radiation damage and the dose-rate effect. 7- The oxygen effect and reoxygenation. 8- Linear energy transfer and relative biological effectiveness. X ray interaction with matter? 1-Coherent scattering: In coherent scattering, incoming photon are absorbed by the atomic electron. Usually the electron in the outer most shell. When then radiates the energy of the photon in a slightly different direction. Since the electron of the atoms are not excited to higher level Z and not ionized. 2-Photoelectric effect: Result in transfer of the total energy of photon to inner electron of an atom of absorbed medium. The electron ejected from the atom with kinetic energy Ek=hv-Eb Where: hv=the energy of photon. Eb= the binding energy of ejected electron. For example: Incoming high energy photon interacts with inner electron k shell and transfers all energy in the electron and ejected from the atom and left positive charge due to hole. In this case the outer electron fills in the hole or electron L shell fill to k shell, M shell fill to L shell. The probability of photoelectric interaction depends on the atomic number of the absorbed material as well as on the energy of the x ray. 3-Compton Effect: In the Compton which energy is both absorbed and scattered. Incoming photon interact or knock the electron out of atom, left the positive charge ion and the energy of the photon is transferred to free electron in this medium. Incoming photon knock the electron given us two directions: 1-compton electron. 2-compton scattering. The scattering photon has reduced energy that is directly related to its angle of scatter φ. The Compton electron is set into motion with kinetic energy equal to the energy transferred by the incident photon. Less any binding energy the most be overcome in ejecting the electron from its atom. The direction of the Compton electron angle θ. Both φ and θ tend to decrease with increasing energy of the incident photon. Δλ=2.4x10-12 (1-cos θ) λ'=λ+Δλ Where: Δλ=Wavelength in nanometer o the x ray. λ= The incident photon. λ'= The scattered photon. 4-Pair production: If the energy of the photon is greater than 1.02Mev or 10Mev the photon may intact with matter through the mechanism of pair production. The incoming photon interacts with the electron field of the nucleus .the photon interacts strongly with the electron magnetic field of atomic nucleus. And give all energy in the process of creating a pair consisting: 1-Negative electron (e-). 2-Posstive electron (e+). These two particles go to difference directions. Because two particles created have rest mass energies 1.02Mev that means 0.511 Mev for each particle. Thus, the threshold energy for the pair production process is 1.02mev. The photon energy increase of this threshold is shared between the particles as kinetic energy. Annihilation Radiation: When the positron comes to rest because losing its energy, it combines with free electron .the two particles are thus annihilated, producing two photon, each having 0.511 Mev energy and the two photon ejected in opposite direction. 5-Photodisgration: Photodisgration occur when photon have enough energy to eject nuclear particle when they are absorbed by nuclear.Photodisgartion I interactions also can be used to measure the energy photon in high energy X ray beam. Electron interaction with mater? 1- Characteristic Radiation: Electron may interaction with many different types of particles as an electron travels it makes many such collisions every time it interact. It either given its energy to another electron in an elastic interaction and inelastic collision sometime along amount of energy is transferred in a collision. In fact, in some interaction enough energy is given to change the energy state of the electron that way hit. In this case an electron in lower shell can be excited to higher shell level in atom and loosely bound to nuclear and has higher potential energy. This process called Excitation. Sometimes enough energy is given to the electron to remove it totally from the atom. This called Ionization. Electron incident on the target also produce characteristic x rays. Electron incident on the target also produce characteristic x rays. An electron , with kinetic energy Eo may interact with the atoms of the target by ejecting an orbital electron, such as a K,L or M electron, leaving the atom ionized. The electron will recede from the collision with energy Eo-ΔE Where: ΔE= The energy given to the orbital electron. Eo= Kinetic energy. ΔE is spent in overcoming the binding energy of the electron and the rest is carried by the ejected electron. When a vacancy is created in an orbit, an outer orbital electron will fall down to fill that vacancy. The energy is radiated in the form of electromagnetic radiation. This is called characteristic radiation. With high Z targets and transition involving inner shells such as K,L and M the Characteristic radiations emitted are of high enough energies to be considered in the X ray of electromagnetic spectrum. 2-Bremsstrahlung: Bremsstrahlung is the result of collision between a high speed electron and nucleus. The electron while passing near a nucleus may be deflected from its path by the action of coulomb forces of attraction and lose energy as bremsstrahlung. Phenomenon predicted by Maxwell’s general theory of electromagnetic radiation. In bremsstrahlung production the maximum energy of the X ray equals the kinetic energy of the incoming electron. As the kinetic energy of the electron increase. The direction of x ray emissions becomes increasingly forward. The energy loss per atom by electrons depends on the square of the atomic number Z2.