Construction and Working of

Medical Linear Accelerator

Moderator: Mr. O Arun Singh

Presentation by: Jatinder Singh

 Medical linear accelerator

• Medical linear accelerators are cyclic

accelerators which accelerate electrons to
kinetic energies from 4 MeV to 25 MeV using
non-conservative microwave frequency.
 Linear accelerator in general
A linear particle accelerator (linac) is a type of accelerator that
greatly increases the velocity of charged subatomic particles or
ions by subjecting the charged particle to a series of oscillating
electric potentials along a linear beam line; this method of particle
acceleration was invented in 1928 by Rolf Wideroe.

The size of linac depends upon the type of particle that is being
accelerated. They range in size from a cathode ray tube to the 3.2
km long Stanford Linac at Stanford, California.
 Linear accelerator in general

Charged particle

~
 Principle of linear accelerator
Some of the earliest designs for particle accelerators, such as
the voltage multiplier and the Van de Graaff generator, used
constant electric fields created by potentials up to a million
volts. It is not easy to work with such high voltages,
however.
The principle involved in the modern linacs is a more-practical
alternative to make repeated use of weaker electric fields set
up by lower voltages and to cause the particles to pass
through these fields in a cyclic manner.
 The difference
A medical linear accelerator is different from a high
energy physics linac in the sense that:
• It is compact & small enough to be incorporated inside
hospital facilities.
• Its has only selected ranges of electron and X-ray
energies.
Components (sections) of Medical Linac

• Gantry
• Gantry stand or support
• Modulator Cabinet
• Patient support assembly or treatment couch
• Control Console
 Beam forming components
1. RF power generation system;
2. Injection system;
3. Accelerating waveguide;
4. Auxiliary system;
5. Beam transport system; and
6. Beam monitoring system and beam collimation.
RF power generation system
 Pulsed Modulator
• Modulator cabinet consist of components 5 µ sec
that supply high voltage pulses and supply
primary electric power to all areas of
machine.
• High-voltage pulses from the modulator -V

section are flat-topped DC pulses of a few

microseconds in duration.
• These pulses are delivered to the
magnetron or klystron and simultaneously time
to the electron gun.
• Pulsed microwaves produced in the
magnetron or klystron are injected into the
accelerator tube or structure via a
waveguide system.
Injection system
 The injection system
• The injection system is the source of electrons, essentially a
simple electrostatic accelerator called an electron gun.
• Two types of electron gun are in use: diode type and triode
type, both containing a heated cathode (at a negative
potential of the order of −25 kV) and a perforated grounded
anode.
• In addition, triode type gun also incorporates a grid placed
between the cathode and the anode.
• Electrons are thermionically emitted from the heated
cathode, focused into a pencil beam and accelerated toward
the perforated anode through which they drift into the
accelerating waveguide.
• The cathode material is thermionic Barium Aluminate.
The electron gun
 Magnetron
• Magnetron is a device that produces
microwaves and works as a high-power
oscillator.

• It generates microwaves of several

microsecond duration and with a repetition
rate of hundred pulses per seconds.

• The frequency of microwave within each

pulse is 3000 MHz
Magnetron
Magnetron
 Klystron
A klystron is a specialized linear-
beam vacuum tube (evacuated electron tube).
Klystrons are used as amplifiers
at microwave and radio frequencies to
produce both low-power reference signals or
high-power carrier waves for communications
and the driving force for modern particle
accelerators.
Klystron
 Buncher

• The purpose of the buncher is to

accelerate the pulsing electrons
as they come out of the electron
gun and pack them into bunches.

• To do this the buncher receives

powerful microwave radiation
from the magnetron or klystron.

• The microwaves accelerate the

electrons in somewhat the same
way that ocean waves accelerate
surfers on surfboards.
Accelerating Waveguide
 Waveguide
• Waveguides are evacuated or gas filled metallic structures of
rectangular or circular cross-section used in the transmission of
microwaves.
• Two types of waveguide are used in linacs: RF power transmission
waveguides and accelerating waveguides.
• The power transmission waveguides transmit the RF power from the
power source to the accelerating waveguide in which the electrons
are accelerated.

● The electrons are accelerated in the accelerating waveguide by means of an

energy transfer from the high power RF fields, which are set up in the
accelerating waveguide and are produced by the RF power generators.
● The simplest kind of accelerating waveguide is obtained from a cylindrical
uniform waveguide by adding a series of discs (irises) with circular holes at
the centre, placed at equal distances along the tube.
These discs divide the waveguide into a series of cylindrical cavities that
form the basic structure of the accelerating waveguide in a linac.
Waveguide
B

A
Cutaway view of a standing wave accelerating waveguide for a 6
MV linac. The accelerating cavities are on the central axis; the
coupling cavities are off-side. The electron gun is on the left, the
target on the right, both permanently embedded.
Travelling wave structure
 Standing Wave Accelerator

(a) Standing wave acc.

(b) Standing Waves

(c) Side coupled cavities

Electron energy and electron beam current
Difference between Standing and Travelling wave linac

TRAVELING WAVE STANDING WAVE

Microwave enters on gun side. Microwave can enter from any where
along accelerator structure.

MW is absorbed in a resistive load. Acc. st.is terminated with a

conducting disc for reflection

Hence only one advancing incident Hence two waves incident & reflected
wave wave

No cavity can be moved out as they Cavity with no E field can be moved
provide E field in direction of out to side i.e. side coupling
propagation i.e. no side coupling
 Circulator or Isolator
• The isolator consist of a special waveguide
containing ferrite material.
• It has the properties of a ceramic in that it has
sufficiently high resistance to permit the passage of
microwave, while it also has ferromagnetic
properties.
• It allows the waveguide to pass through it in only one
direction which can be either the direction of
microwave or its opposite.
The auxiliary system
 The vacuum system
• The minimum vacuum condition required for the for the
operation of the syatme is determined by the fact that the
electrons being accelerated should not be deflected by
collisions with gas atoms.
• The mean free path b/w collisions with gas atoms needs
to be long compared to the length of the acc. waveguide,
• This length is typically 1-3 m.
• The maximum gas pressure to meet this condition is 10-5
torr ( where 1 torr = 1mm Hg).
Beam Transport System
 Beam Transport System
• Acc. wave guide are long & are
mounted parallel to gantry rotation
axis.
• To make e- beam strike target
bending magnets are used.
• Three types of banding system have
been developed :-
– 90° bending
– 270° (achromatic) bending
– 112.5° (slalom) bending
• The 270° bending is achromatic in
sense that e- of variable energy will
enter the beam defining system at
same point & in same direction.
• For 90° bending magnet system
energy, position & direction of e-
entering bending system needs to be
accurately regulated
Beam Transport System
Treatment head
 Treatment Head
The important components found in a typical head of a
fourth or fifth generation linac include:

 Several retractable X ray targets.

 Flattening filters and electron scattering foils (also called
scattering filters);
 Primary and adjustable secondary collimators;
 Dual transmission ionization chambers;
 A field defining light and a range finder;
 Optional MLC.
 X-ray targets
• The target used in medical linacs for MV beam is
transmission type of target.
• The mean photon energy is greater for thin
target but x-ray output is less.
• For thin target there will unwanted flux of e - on
pt. side of target that can be absorbed in low Z
on back of target e.g. carbon with minimal x-ray
production.
• Experiments on radiation quality & output
produced by different targets concluded that for
e- energy upto 10MeV a thick tungsten target
gave good x-ray output &beam penetration, while
for higher e- energies thick Al target should be
used.
Photon and Electron Modes
 Flattening Filter
• High energy X-rays emerging from target
are forward-peaked in intensity along
beam central axis & of progressively less
intensity away from it.
• To make intensity uniform across beam a
conical metal absorber called flattening
filter is placed in beam path.
• High Z filter if used would soften the
beam due to pair production.
• Al flattening filters are used in low energy
linacs & copper or steel in high energy
linacs because Al filter would be large
enough to be accommodated in
treatment head of high energy linac.
 Collimators
• The primary collimator defines a maximum circular field, which is
then further truncated with an adjustable rectangular collimator
consisting of two upper and two lower independent jaws and
producing rectangular and square fields with a maximum dimension
of 40 × 40 cm2 at the linac isocentre.
• The IEC recommends that the transmission of the primary X ray
beam through the rectangular collimator should not exceed 2% of
the open beam value.
 Dose monitoring system
• Most common dose monitors are transmission I.C. permanently embedded in
linac treatment head b/w flattening filter or scattering foil & photon beam
secondary collimator.
• Sealed parallel plate I.C. are used to make their response independent of ambient
temp. & pressure.
• For pt . Safety two I.C. are used, one serving as check on another, with
completely independent biasing power supplies & readout electrometers.
• During pt. treatment if primary chamber fails the secondary chamber will
terminate irradiation with additional dose of few percent above prescribed dose .
• In event of simultaneous failure of both chambers timer will shut the machine
down with minimal overdose to patient.
 Multileaf Collimators
• MLCs are a relatively recent addition to linac dose
delivery technology.
• In principle, the idea behind an MLC is simple; however,
building a reliable MLC system presents a substantial
technological challenge.
• The number of leaves in commercial MLCs is steadily
increasing, and models with 120 leaves (60 pairs)
covering fields up to 40 × 40 cm2 and requiring 120
individually computer controlled motors and control
circuits are currently available.
• MLCs are becoming invaluable in supplying intensity
modulated fields in conformal radiotherapy, either in the
step and shoot mode or in a continuous dynamic mode.
 Bending Magnet

Waveguide

Focal Spot
e- gun

Carrousel

Ion
Chamber

Energy
Switch
Jaws

MLCs
 Linac Configurations
• Depending upon the energy of microwave
generator and size of the waveguide the linac
can be configured in various ways.
 Non bending tube linacs

Straight-through beam design; the electron gun and target are permanently
embedded into the accelerating waveguide; machine produces only x rays
with energies of 4–6 MV; the rf-power generator is mounted in the gantry.
 Beam bending Linacs - I

Accelerating waveguide is in the gantry parallel to the isocenter axis;

electrons are brought to the movable target through a beam transport
system; the rf-power generator is located in the gantry stand; machine can
produce megavoltage x rays as well as electrons.
 Beam bending Linacs - II

Accelerating waveguide and rf-power generator are located in the gantry stand;
electrons are brought to the movable target through a beam transport system;
machine can produce megavoltage x rays as well as electrons
 History of Medical Linac
• 1952: Henry Kaplan and Edward Ginzton begin building a medical linear accelerator.
• 1956: The first medical linear accelerator in the Western Hemisphere is installed at
Stanford Hospital in San Francisco.
• 1959: Stanford medical school and hospital move to the Palo Alto campus, bringing the
medical linear accelerator.
• 1962: Kaplan and Saul Rosenberg begin trials using the linear accelerator with
chemotherapy to treat Hodgkin's disease, an approach that dramatically improves patient
survival.
• 1994: First use of the CyberKnife, invented at Stanford, which uses sophisticated
computerized imaging to aim a narrow X-ray beam precisely.
• 1997: Stanford pioneers the use of intensity-modulated radiation therapy, which
combines precise imaging with linear accelerators that deliver hundreds of thin beams of
radiation from any angle.
• 2004: Implementation of four-dimensional radiotherapy, which accounts for the motion
of breathing during imaging and radiation delivery.
ADVANTAGES OF LINAC OVER Co-
60
• Build-up depth is more for linac as compared to Co-
60.
• Electron therapy is possible with linac.
• Linac with MLCs can be used for conformal therapy
i.e. leaves of MLC can be confirmed to shape of
tumor electronically.
• IMRT can be delivered with dynamic movement of
leaves.
• Linac are available with Dual energy photon beam so
energy can be selected as per requirement.
• Since dose rate is high more patients can be treated in
less time.
• No need to change source.
DISADVANTAGES OF LINAC OVER
Co-60
• Output may vary due to voltage fluctuations.
• Requires more electrical backup.
• More liable to breakdown because of complicated
electronic circuits.
• Cost of production is very high.
• Requires proper maintenance.
• Total life is less (max, 15yr.)
• Requires daily dosimetric checks e.g. output
constancy is checked daily before treating patients.
Although there are certain drawbacks associated with use of medical linacs
but these machines are getting rich popularity due to their versatile utilities
in radiotherapy, so it will not be a wonder if linacs totally substitute the Co-
60 machines.
Thanks for your
attention!