What is an Accelerator ??

 Accelerator is a device which used to speed up a beam of charged

particles to near the speed of light before they collide with a target or
with another beam of particles.
• The sub-nucleus particles created by the collision as well as the
radiation emitted are detected and analyzed. Some of these machines
accelerate particles in a straight line, and we call them linear
accelerators, or linacs for short.
Other high-energy machines are based on rotating the
accelerated particles in a circular path, such as the cyclotrons and the
synchrotrons.
Applications of Accelerators
• Radiation Therapy
• Producing Medical Radioisotopes
• Electron Beam Sterilization of Medical Disposables
and Food Processing
• Nondestructive Testing (NDT)
• Ion Implantation in Semiconductor Chip Fabrication
• Processing of Polymers
• Security and Inspection Applications
Medical Linear Accelerator
• In its simplest definition, a linear accelerator (linac) is a device that
uses electromagnetic waves, in the microwave range, to accelerate
electrons.
• The highly accelerated electron can also be used to treat tumor near
the surface of the patient and when the electron is hit to the high
atomic number material (Tungsten) it produces X-rays that are used
to treat the deep down tumors.
History

In 1952, two innately talented physicists,

Namely Henry Kaplan and Ed Ginzton began
working on the concept of a linear accelerator.
In 1956, in the Stanford hospital in San Francisco,
the first linear accelerator was installed.
In 1962, a series of experiments began to see
if radiation works best with chemotherapy. Kaplan and Saul Rosenberg
worked together to improve the chances of patients' survival.
This patient, a 2-year-old boy
suffering from
retinoblastoma, was the first
to undergo X-ray treatment
from a medical linear
accelerator that Kaplan
developed with campus
physicists.
In 1994, A great invention was made at Stanford, Something called
cyberknife was introduced which narrowed down x-ray beams in a precise
manner.

First ever Cyber Knife , in 2004

In 1997, A further step was taken to advance the use of
linear accelerators by combining with intensity modulation
radiation therapy.
The result was that many thin beams of radiation
could be achieved from any desired angle.

In 2004, four-dimensional radiotherapy was implemented.

In 2007,Volumetric Modulated Arc Therapy (VMAT) was introduced.

• During the first 50 years of radiation medicine the technological
progress was aimed mainly towards:
• Development of analog imaging techniques.
• Optimization of image quality with concurrent minimization of dose.
• Ever increasing energies and beam intensities.

During the past two decades most developments in radiation

medicine were related to:
• Integration of computers in imaging
• Development of digital imaging techniques
• Incorporation of computers into therapeutic dose delivery with high energy linear
accelerators (linacs)
MAJOR COMPONENTS OF LINACS
● Power Supply
● Modulator
● RF Generation system
● Electron Gun
● Wave Guide system
● Bending Magnet
● Treatment Head
● Treatment Couch
Power Supply
• A Power supply provides Direct current (DC) power to the
modulator,which includes the pulse forming network and a switch
tube known as Hydrogen thyratron.
• High voltage pulses from the modulator section are flat-topped DC
pulses of a few microseconds in duration.
• These pulses are delivered to the magnetron and klystron
simultaneously.
Modulator
• This vital component of the Linear accelerator is usually located in the
treatment room In some Units.
• This modulator cabinet contains three major components,
1. Fan control (cooling the power-distribution system)
2.Auxiliary power distribution system (contains the emergency off
button that shuts off the power to the treatment unit)
3.Primary power-distribution system.
 RF Power Generation system
• The electrons are accelerated in the accelerating wave guide using high
power RF fields. Which are set up in accelerating wave guide by
microwave radiation.
• This Radiation is produced by microwave generators that are either
Magnetrons or Klystrons
• Elekta, Accuray linacs use Magnetron whereas Linac by varian uses
Klystron
Magnetron
• It produces microwave required for electron
Acceleration
• Functions as a high frequency oscillator.
• Peak power up to 5MV can be produced by Magnetrons
• Typical high voltage pulse of about 50kVp is a few
microseconds long and is repeated a few hundred times
per second.
• Pulse repetition frequency (PRF) differs according to
manufacturer,PRF determins the X-ray Energy from Linac.
Klystron
• It is not a generator of microwaves but acts
as a RF power amplifier.
• Driven by low power microwave oscillator.
• Peak power on the order of 7MV or higher.
• Mainly using in high energy linacs.
• It uses High DC voltage.
Injection System
• Injection system or the source of the electrons is importantly a simple electrostatic
accelerator known as an Electron gun.
• When a high voltage is given to the cathode it gets heated up under vacuum which provides
sufficient thermal energy to the electrons to draw itself out from the material and get
ejected by thermionic emission.
• The number of electrons produced depends upon the temperature of the filament which is
controlled.
 The electron gun and waveguide system are evacuated to a low
pressure to make the mean free path of electrons between atomic
collisions long compared to path in the system.

Electron
GUN
 WAVEGUIDE
• The waveguide is a channel directing the microwave power of the
klystron/magnetron to the Accelerating wave guide.
• Waveguides are evacuated or gas filled (Sulfur Hexaflouride)metallic
structures.
• Two types of waveguides are used in linac :
1. Radiofrequency power transmission wave guide (usually gas filled)
2. Accelerating wave guides (usually evacuated)
• For electron transmission Accelerating waveguides are used.
Structure of Accelerating waveguide
• Cylindrical uniform waveguide by Adding series of
copper discs (Irises) with circular holes at the center.
• Discs are placed at equal distance along the tube.
• Discs divide the waveguide into series
of cylindrical cavities.
Accelerating Waveguide
• Electrons are accelerated through the holes in the discs using an
oscillating electric field supplied by the radio-frequency generator
(magnetron or klystron) and modulator.
• Accelerating waveguides may be either of the traveling-wave or
standing-wave based on the time dependent variation of their
electric field
Accelerating Waveguide
Travelling Waveguide Standing Waveguide
• Waveguide length will be greater • Side coupling will reduce waveguide length
• At the end of the waveguide microwaves • At the end of the waveguide microwaves
are absorbed without any reflection or fed are reflected back to the input
back to the input • It requires high microwave peak power
than travelling wave guide
• It requires low microwave peak power
• Requires higher mean RF power (25%
• Requires lower mean RF power more)
Electron Beam Transport
• It consist of the evacuated drift tubes and bending magnets,which
are used in transporting the electron beam from the accelerating
waveguide to the X-ray target or the exit window for electron beam
therapy.
• Steering and focusing coils installed on the accelerating waveguide
are usually linked with electron transport system

Electron Gun Bending

Electron Beam magnet
Steering Coils ;

• The steering coils keep the accelerated electron pencil beam as close as
possible to the axis of the cylindrical accelerating waveguide.
• It will steer the beam towards the opening which connects the accelerating
waveguide to the target.
Focusing Coils :

• Focusing coil is to focus the accelerated pencil beam in order to minimize the
beam divergence and cross section.
• Divergence results from a small radial component of the electric field in the
accelerating waveguide and from the repulsion among electrons in the pensil
beam.
• The focusing solenoid coils are coaxial
with the accelerating waveguide.
Treatment Head
 Bending magnet.
Shielding material.
X-ray target.
Primary collimator.
Beam flattening filter and Scattering foil.
Beam monitoring devices.
Secondary collimators.
MLC and Wedge.
Field light
1. BENDING MAGNET
• Changes the direction of electron beam downward towards the isocentre.
• There are two types of bending magnets ;

90° bending (Achromatic) 270° bending (Chromatic)

• Bending magnet not only directs the beam to strike the target,but also
focuses the beam to diameter of 1mm.
• The design of magnets enables them to focus the electron of slightly
different energies on the same point on target (Achromatic behavior)
2. SHIELDING MATERIAL

• The treatment head consist of a thick shell of high-density shielding

material such as lead, tungsten, or lead-tungsten alloy.
• Shielding material is used to avoid the unnecessary irradiation to the
surrounding, patient and the radiation workers as well.
3. X-RAY TARGET

• The pencil electron beams strikes on the

X-ray target to produce photons.
• X-ray target used is transmission type target.
• It is made of Tungsten due to its high atomic
number (Z=74) and High melting point 3370°C.
4. PRIMARY COLLIMATOR

• The treatment beam is first collimated by a fixed primary

collimator located immediately beyond the X-ray target.
• It defines the largest available circular field size and is
essentially a conical opening projecting into a tungsten
shielding block.
• It is designed to attenuate the primary x-ray beam
intensity to less than 0.1% of the initial value
• In the case of X-rays, the collimated beam then passes
through the flattening filter.
• In the electron mode, the filter is moved out of the way.
5. FLATTENING FILTER

• The photon dose distribution produced by a linac is strongly forward peaked.

• Modifies the narrow, non-uniform photon beam at the
isocenter into a clinically useful beam through a
combination of attenuation at the center of the beam
and scatter into the periphery beam.

FLATTENING FILTER
• It is made up of Pb, Tungsten.
• Carroesel is a device in the treatment head which helps
in the movement of flattening filters of different energies
and Scattering foil as well.
• Carroesel helps to move flattening filter away from the
beam in FFF (Flattening filter free) mode either.

Structure of Flattening filter

Structure of Carroesel
 6.SCATTERING FOILS

• In the electron mode of linac operation , the beam instead of

striking the target , is made to strike an electron scattering foil to
spread the beam as well as get a uniform electron
fluence across the treatment field.
• It consist of a thin metallic foil, usually made of lead.
7. BEAM MONITORING DEVICE

• The flattened X-ray beam or the electron beam is incident on the Beam
monitoring devices.
• The dose delivered to the patient, Dose rate and field symmetry are
measured and controlled by the monitoring system.
• The chambers are usually transmission type.It consist of two flat parallel
plate type ionization chambers .
• Here the first chamber is the Primary dosimeter, it measure and stops the
radiation when the required dose is delivered.
• The other chamber is the backup one it stops the radiation when primary
chambers fails.
• The monitor chambers in the treatment head are usually sealed so that
their response is not influenced by temperature and pressure of the outside
air.
8.SECONDARY COLLIMATOR

• It consist of four blocks, two forming the upper and two forming the lower.
• Provide rectangular or square field (up to 40x40cm ) at the linac isocenter.
• This collimators are able to rotate about their axis and this degree of freedom
is referred to as collimator rotation.
• Usually made of lead or tungsten.

Set-up A with collimator Rotation Set-up B with shielding blocks

9.WEDGES

• These are the beam modifying devices.

• It causes a progressive decrease in the intensity
across the beam, resulting in a tilt of the isodose
curves from their normal positions.
• Degree of tilting depends on slope of wedge.
• Wedge angles used are: 15,30,45 & 60
• Usually made of dense material such as
lead or steel.
• Mainly there are 3 types of wedges;
1.Physical wedges
2.Motorized wedges
3.Dynamic wedges

• wedges mounted in the treatment head and

are moved into the field for part of the time to create
the wedge beam profile desired .
• Single 60 motorized wedge generates desired angle
from 0 to 60
10. MULTILEAF COLLIMATOR (MLC)

• Group of collimating leaves that can be driven automatically,

independent to each other to generate a field of any shape.
• Made up of tungsten alloy.
• The number of leaves in commercial MLC’s are steadily increasing
• Each leaves is controlled by computer controlled motors
• Perpetual modulation of MLC plays vital role in VMAT/Rapid Arc
and IMRT by allowing complex shaped fields can be
generated in sequence.
• At Medanta we have,

Agility MLC on Elekta’s Linacs

160 Leaves
5mm width
65mm/s leaf speed
15cm maximum overtravel.

Binary MLC on Accuray’s Tomotherapy

64 leaves
6.25 mm width
20 msec open –close time.
11.FIELD LIGHT

• It is a field localizing device, used to display the position of the radiation field
on the patient skin.
• A high accuracy bulb is placed at 45° angle with the Mercury mirror placed in
the space between the chambers and the jaw projects a light beam as if
emitting from X-ray focal spot.
• Thus the light field is congruent with
the radiation field.
Lasers

• The accuracy of the laser guides in determining isocenter position.

• Isocenter is a virtual point where the central axis of the Gantry,Collimator
and Couch meets.
• 2 side lasers,sagittal and ceiling lasers are mounted on walls of LINAC Unit.
• Tolerence of Laser position is 2mm.
Treatment Couch

• Treatment table is a mechanically movable motor driven couch.

• It can move the patient Lateral (X) ,longitudinal (Y) ,vertical (Z)
• Provides Isocentric rotation.
• Hexapod can be mounted on Treatment couch.
• Hand pendent conatins switches can be
used to access movement of table,
Gantry , Couch,Collimator jaws (field size),SSD etc..
Accessories and Systems used with LINAC

• Electronic Portal Imaging device (EPID)

• Cone Beam CT (CBCT) / On Board Imaging.
• HEXAPOD
• Active Breathing Co-ordinator
• Electron Applicators
• Treatment and Verification system
• Treatment Planning system
Electronic Portal Imaging Device

• EPID uses flat panel array of solid state detectors based on amorphous silicon
(a-Si) technology.
• It is compact & easier to mount on a retractable arm for
positioning in or out of the field.
• A scintillator converts the MV X-ray beams which come out
of treatment head into visible photons, The light is detected
by an array of photodiodes implanted on th panel,
thus real time image is displayed.
• iViewGT system is being used to operate EPID on Elekta.
Cone Beam CT

• CT scans acquired with detectors imbedded in a flat panel instead of a circular

ring is known as CBCT.
• Planar projections images are obtained from multiple directions as the source
with opposing detector panel rotates around the patient through 180° or
more.
• These multidirectional images provide sufficient information to reconstruct
patient anatomy in 3D, including cross-sectional , sagittal and coronal planes.
Electron Applicators

• In electron-beam mode, a well defined electron

beam passing through the thin window of the
accelerator vacuum system is transported
through a scattering foil system in order to
broaden the beam.
• Electrons undergo significant scattering in the
air between the scattering foils and the patient.
• It is therefore necessary to collimate the beam with
an applicator attached to the treatment head.
• The electron applicator currently in use constructed of light-weight fiberglass
and aluminum.
HEXAPOD

• Is a unique fully robotic patient positioning system with six degrees

of freedom to correct for any misalignments detected by X-ray
volume imaging (XVI) or portal imaging.
• x, y, z, pitch, roll and yaw can be achieved with submillimeter 6D
conformal positioning accuracy.
Treatment record and Verification system

• Electronic medical record (EMR) and practice management system.

• All patient information is collected and accessible , from the Simulation
through treatment, so you can deliver the best possible care for every
patient.
• Simplify the management of complex treatments techniques, QA and
patient’s notes with automated and customizable workflows.

 MOSAIQ by Elekta
 Precision by Accuray
 ARIA by Varian
 ARIA User Interface

MOSAIQ User Interface

Treatment Planning system
• These computerized system are used to generate beam shapes and dose
distributions with the intent to maximize tumor control and minimize normal
tissue complications.
• Definition of irradiation parameters Dose calculation, Plan evaluation,
Optimization, Dose prescription and determination of monitor units are
performed at TPS.
• MONACO by Elekta, Precision by Accuray and ECLIPSE by Varian are widely
used TPS systems.
 Care and Usage

• The way a linear accelerator is cared for, and how often its used, can also
determine its useful life.
• Proper maintenance, like adhering to scheduled Preventative Maintenance
Inspections (PMI) , can uncover small problems before they become bigger.
• Another chief consideration is the linear accelerators usage, often measured
in beam hours or filament hours.
• Newer technologies like VMAT (volumetric arc therapy) require much more
use of “beam on” time and can reduce the lifespan of a linear accelerator
• The X-ray produced are almost 1 percent of the electron energy which is
striking on a target, rest of the energy (99%) is converted into heat.

This heat needs to be cooled and is achieved by Cooling system consist

of water chiller.

• Air-conditioning and humidity control in the treatment room with a

certain number of air volume replacements per hour is required for proper
functioning
 Safety
• The facility should be prepared and equipped to deal with any
emergency situation such as unwanted Radiation exposure, Fire and
other accidents.
• To minimise hazards due to high voltage, caution sign boards with
danger signs and visual indication should be put up near such locations
• Audio visual communication between the treatment room and control
room.
LINACS AT HOUSE
 Elekta’s Synergy and Infinity
YEAR OF INSTALLATION SYNERGY – 2009
INFINITY - 2010
ENERGY (X-RAY) 4MV, 6MV and 15 MV
ENERGY (ELECTRON) 4-22Mev
DOSE RATE (Maximum) 1400 MU/m (FFF), 600 MU/m (FF)

IMAGING XVI (CBCT) , iViewGT (EPID)

MLC 160 LEAVES (AGILITY MLC)

MLC SPEED 65mm/s

MLC THICKNESS 5mm
FIELD SIZE (max) 40cm*40cm

MICROWAVE SOURCE MAGNETRON

 ELEKTA SYNERGY is equipped with HEXAPOD Evo RT system

Accuray’s Tomotherapy-H
• A fusion of Radiotherapy Linac with Computered Tomography.
• It is armed to provide Helical treatments which is boon for large sized PTVs.
• Flat couch provided allows automatic translation during treatment,is
calliberated by IEC
• 6MV FFF
• Integrated MVCT system (3.5 MV)
Accuray’s Tomotherapy-H
• A fusion of Radiotherapy Linac with Computered Tomography.
• It is armed to provide Helical treatments which is boon for large sized PTVs.
• Flat couch provided allows automatic translation during treatment, is
calliberated by IEC
• 6MV FFF
• Integrated MVCT system (3.5 MV)
YEAR OF INSTALLATION 2015
ENERGY 6MV FFF

DOSE RATE 865 MU/minute

IMAGING C-TRUE (3.5 MV)

MLC 64 BINARY LEAVES

MLC THICKNESS 0.625 MM

MLC SPEED (OPEN TO CLOSE) 20 ms

FIELD SIZE (MAX) 5CM*40CM

GANTRY ROTATION (MAX) 6 rpm

Tomotherapy Linear Accelerator
YEAR OF INSTALLATION 2015
ENERGY 6MV FFF

DOSE RATE 865 MU/minute

IMAGING C-TRUE (3.5 MV)

MLC 64 BINARY LEAVES

MLC THICKNESS 0.625 MM

MLC SPEED (OPEN TO CLOSE) 20 ms

FIELD SIZE (MAX) 5CM*40CM

GANTRY ROTATION (MAX) 6 rpm

Accuray’s Cyberknife VSI

• Sub-milimetre accuracy treatment anywhere in

the body, with continual image guidance.
• 6D Robotic Arm-Mounted Linac.
• Enables the delivery of a large number of
non-isocentric ,non-coplanar beams individually
directed at unique points within the intented target.
• 6MV FFF
• 1000 MU/Minute
Accuray’s Cyberknife VSI

• Sub-milimetre accuracy treatment anywhere in

the body, with continual image guidance.
• 6D Robotic Arm-Mounted Linac.
• Enables the delivery of a large number of
non-isocentric ,non-coplanar beams individually
directed at unique points within the intented target.
• 6MV FFF
• 1000 MU/Minute
CK’S Linear Accelerator
THE FUTURE OF LINAC
Treat cancer with a FLASH

PHASER (Pluridirectional high-energy agile scanning electronic radiotherapy)

Rapid (<1s)freeze-motion dose

delivery – Highest precision
Dragon LINAC
300x higher dose rate
50Gy/Second
 FLASH RT biological advantage
Thank You
For Your Attention