The ABR - Radiation Oncology

basic physics
instruments and measurements
dosimetry
radioactivity (radionuclides and physics of therapeutically employed radionuclides)
protection and safety

Categories for Radiologic Physics for Radiation Oncology

Atomic and Nuclear Structure

Bohr model of the atom

Coulombic force and electron binding energy
Electron orbits (energy levels)
Electron transitions—absorption and emission of energy
Characteristic radiation and the Auger effect

Nuclear structure
- Nucleons —protons and neutrons
- Nuclear force
- E = mc² and nuclear binding energy

Factors affecting nuclear stability
- Neutron-to-proton ratio
- Average binding energy per nucleon
- Pairing of similar nucleons in the nucleus

Nuclear nomenclature
- The four isos (isotopes, isotones, isobars, isomers)
- Shorthand representation of isotopes

Radioactive Decay

Modes of radioactive decay
- Beta (ß)
  - ß- (negative beta, negatron)
  - ß+ (positive beta, positron)
  - Electron capture
- Alpha (α)

Other decay processes
- Gamma rays
- Internal conversion

Decay schemes
- Construction and interpretation
- Examples for each decay mode

Mathematics of radioactive decay
- Units (SI Units)
- Exponential decay equation
  - Half-life
  - Decay constant
  - Mean life, average life, and effective half life
  - Simple dose calculation for implants
- Radioactive equilibrium
  - Secular equilibrium
    - Radium needles
    - ⁹⁰Sr applicators
  - Transient equilibrium
    - Nuclear medicine generators
- Counting statistics
Naturally occurring radioisotopes
Manmade radioisotopes
- Fission
- Nuclear bombardment
Decay schemes and properties for therapeutic isotopes

Properties and Production of Particulate and Electromagnetic Radiation

Particulate radiation

Mass, charge
Relativistic energy equation

Electromagnetic radiation
- Wave-particle duality
- Wave equations
- Electromagnetic spectrum
Production of radiation
- Principles
- Radioactive decay
- X-ray tube
Linear accelerators
- Operational theory of wave guides
  - Standing wave guides
  - Traveling wave guides
- Bending magnet systems
- Flattening filters
- Electron scattering foils
- Electron cones
- Targets
- Factors affecting
  - Beam energy
  - Entrance dose
  - Depth of maximum dose
  - Beam uniformity
  - Dose rate
- Monitor chamber
- Collimation systems
  - Primary and secondary collimators
  - Coupled and independent jaws (including virtual wedges)
  - Multileaf collimators
  - Other collimation systems (e.g., stereotactic systems)
  - Radiation and light fields (including field size definition)
- Mechanical and operational features
Cyclotron
Microtron
Cobalt units
Therapeutic x-ray (<300 kVp)

Interactions of Electromagnetic Radiation with Matter

Coherent scatter
Photoelectric effect
Compton effect
Pair production
Photonuclear disintegration
Relative probabilities of interactions in human tissues
- Energy dependence
- Atomic number dependence
- Electron density dependence

Interactions of Particulate Radiation with Matter

Formalism
- W value
- Specific ionization
- Linear energy transfer
- Range
- Stopping power
Types of interactions
- Heavy vs light particles
- Charged vs uncharged particles
- Elastic collisions
- Inelastic collisions
Heavy charged particles
- Inelastic collisions with electrons
- Depth dose characteristics ( Bragg peak)
Light charged particles
- Elastic and inelastic collisions with electrons
- Inelastic collisions with nuclei
Neutrons
- Elastic collisions with hydrogen nuclei
- Depth dose characteristics vs charged particles and photons
Biological implications of particle therapy

Quantification and Measurement of Dose (including SI units)

Exposure (air kerma)
Absorbed dose (kerma)
Dose equivalent
RBE dose
Calculation of absorbed dose from exposure (e.g., f factor)
Bragg-Gray cavity theory
Gas-filled detectors
- Principles of operation
- Uses
Ion chambers
- Types
- Exposure measurement
- As a Bragg-Gray cavity
- Correction factors (e.g., temperature and pressure)
- Calibration of photon and electron beams (e.g., TG 21 and TG 25)
Thermoluminescent dosimetry
Calorimetry
Film
Chemical dosimetry
Solid state diodes
Scintillation detectors
Measurement techniques

Characteristics of Photon Beams

Mathematics of exponential attenuation
- Half-value thickness
- Attenuation coefficients (linear, mass, partial, total)
- Narrow beam vs broad beam geometry
- Monoenergetic vs heteroenergetic
- Parallel vs diverging beams
Beam quality for heteroenergetic beams
- Energy distribution of accelerated electron beam
- Filtration
- Geometry
- Effective energy
- Energy spectra

Dosimetry of Photon Beams in a Homogeneous Water Phantom

Dose distributions
- Central axis percent depth dose
- Isodose curves
- Factors affecting dose distributions and penumbra
  - Beam energy or quality (including patient dose from neutrons)
  - Source size
  - SSD and SAD
  - Mayneord F factor
  - Inverse square law
  - Field size and shape
  - Equivalent square
  - Scatter effects
  - Flattening filters
  - Depth
  - Surface dose
  - Other
- Dose distributions for multiple unshaped beams
  - Open beams
  - Wedged beams
- Tissue-air ratio and backscatter factor
- Tissue-maximum ratio
- Tissue-phantom ratio
- Relationships between PDD, TAR, TMR, TPR
- Point dose and treatment time calculation methods for single unshaped fields
  - Machine output factors (e.g., absolute and relative output, head scatter, patient scatter factors)
  - Equivalent squares
  - SSD vs SAD setups
  - Beam modifier factors (e.g., wedge and tray factors)
- Dose calculation at the isocenter of a rotating beam
- Point dose and treatment time calculations for single shaped fields
  - Separation and recombination of primary and scatter radiation (e.g., Clarkson techniques)
  - Off-axis factors
  - Dose under blocks
  - Equivalent squares for shaped fields
- Isodose distributions for multiple fields, including arc therapy
- Measurement of photon dose distributions
Dosimetry of Photon Beams in a Patient
- Dose specification (eg, ICRU 50)
- Corrections for patient contour
  - Effective SSD method
  - TAR ratio method
  - Isodose shift method
- Corrections for tissue inhomogeneities
  - TAR ratio method
  - Power law method
  - Isodose shift method
  - Equivalent TAR
- Dose within and around an inhomogeneity
- Matching of adjacent fields
- Using multiple wedged fields
- Parallel opposed beams
  - Point of maximum dose
  - Uniformity, dependence upon
    - Energy
    - Separation
    - SSD
- Entrance dose and exit dose, including beam modifying devices
- Isodose distributions for multiple beams, including mixed modality and arc therapy
- Compensation
  - Missing tissue
  - Dose compensation
  - Bolus
- Off-axis factors
- Practical/simple calculation of dose
- Practical/simple 2D treatment planning
- 3D conformal treatment planning 3D conformal treatment planning Advanced Treatment Planning for EBRT, Letter G)
- Dose delivery accuracy and precision
Dosimetry of Electron Beams
- Dose distributions
  - Central axis percent depth dose
  - Isodose curves
- Factors affecting dose distributions
  - Beam quality
  - Beam spreading systems
  - SSD and SDD
    - Effective SSD techniques
    - Inverse square
  - Field size and shape
  - X-ray contamination
  - Depth
  - Surface dose
  - Inhomogeneities (e.g., CET)
  - Other
- Energy specification
  - Most probable energy
  - Mean energy
  - Energy at depth
  - Ranges (extrapolated, practical, R50)
- Choice of energy and field size
- Air gaps and oblique incidence
- Tissue inhomogeneities
- Bolus, absorbers, and spoilers
- Matching adjacent fields
- Point dose and treatment time calculations
- Field shaping techniques
- Electron arc
- Total skin electron therapy
Brachytherapy
- Historical review—role of radium
- Calculation of dose from a point source
- Calculation of dose from a line source
- Physical and dosimetric properties of commercial sealed sources and applicators
- Implant instrumentation and techniques
  - Low dose rate
  - High dose rate (including PDR)
  - Biological considerations of dose, dose rate, and fractionation
- Calibration and specification of sources
- Disseminated (unsealed sources)
- Acceptance testing and quality assurance
- Dose specification, implantation dosimetry, and dosimetry systems
  - Patterson-Parker
  - Quimby
  - Paris
  - Other
- Dose specification and dosimetry systems of intracavitary implants
Advanced Treatment Planning for EBRT
- Plane radiography and fluoroscopy for simulation
- Portal imaging
  - Film-based
  - Electronic
- Imaging for radiation therapy planning
  - CT
  - MRI
  - Ultrasound
  - Isotope imaging
- Image processing
  - Image enhancement
  - 2D and 3D visualization of volumetric data (DRRs, volume rendering)
  - Image registration
- Virtual simulation (including BEV techniques)
- Treatment planning systems
- 3D conformal treatment planning
  - Plan evaluation (DVH, NTCP, TCP, etc)
  - Dose optimization techniques
  - Noncoplanar beams
  - IMRT
- Radiosurgery
- Patient setup and alignment
Quality Assurance
- Equipment-related
  - Regulations and recommendations
  - Measurement techniques
- Patient related
  - Misadministration
    - External beam
    - Brachytherapy
- Brachytherapy source inventory
Radiation Protection and Safety
- Principles, biological effect models, personnel dose limits, rules, regulations
- Structural shielding design for external beam therapy
  - Primary barriers
  - Secondary barriers
  - Machine shielding (beam stoppers and head shielding)
  - Neutrons
- Radiation protection for brachytherapy procedures
  - Source storage and transport containers
  - Patient room
  - Special considerations for high dose rate brachytherapy
  - Special procedures and source prep rooms
  - Release of patients treated with temporary implants
- Leak testing of sealed sources
- Routine radiation surveys
- Personnel monitoring
- Protection against nonionizing radiation
- Administrative requirements
  - Radiation Safety Officer
  - Radiation Safety Committee
- Safety instructions and safety precautions
  - Sealed-source brachytherapy
  - Radiopharmaceutical therapy
Quality Management Program
- Written directive
- Identification of patient
- Plan and delivery in accordance with written directive
- Unintended deviation
  - Recordable events
  - Misadministrations
Special Topics
- Hyperthermia
- Computers
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