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External beam radiotherapy
External beam radiation therapy (EBRT) is a form of radiotherapy that utilizes a high-energy collimated beam of ionizing radiation, from a source outside the body, to target and kill cancer cells. The radiotherapy beam is composed of particles, which are focussed in a particular direction of travel using collimators. Each radiotherapy beam consists of one type of particle intended for use in treatment, though most beams contain some contamination by other particle types.
Radiotherapy beams are classified by the particle they are intended to deliver, such as photons (as x-rays or gamma rays), electrons, and heavy ions; x-rays and electron beams are by far the most widely used sources for external beam radiotherapy. Orthovoltage ("superficial") X-rays are used for treating skin cancer and superficial structures. Megavoltage X-rays are used to treat deep-seated tumors (e.g. bladder, bowel, prostate, lung, or brain), whereas megavoltage electron beams are typically used to treat superficial lesions extending to a depth of approximately 5 cm. A small number of centers operate experimental and pilot programs employing beams of heavier particles, particularly protons, owing to the rapid decrease in absorbed dose beneath the depth of the target.
Teletherapy is the most common form of radiotherapy (radiation therapy). The patient sits or lies on a couch and an external source of ionizing radiation is pointed at a particular part of the body. In contrast to brachytherapy (sealed source radiotherapy) and unsealed source radiotherapy, in which the radiation source is inside the body, external beam radiotherapy directs the radiation at the tumor from outside the body.
Conventionally, the energy of diagnostic and therapeutic gamma- and X-rays is on the order of kiloelectronvolts (keV) or megaelectronvolts (MeV), and the energy of therapeutic electrons is on the order of megaelectronvolts. The beam is made up of a spectrum of energies: the maximum energy is approximately equal to the beam's maximum electric potential within a linear accelerator times the electron charge. For instance, a 1 megavolt beam will produce photons with a maximum energy around 1 MeV. In practice, the mean X-ray energy is about one-third of the maximum energy. Beam quality and hardness may be improved by X-ray filters, which improves the homogeneity of the X-ray spectrum.
Medically useful X-rays are produced when electrons are accelerated to energies at which either the photoelectric effect predominates (for diagnostic use, since the photoelectric effect offers comparatively excellent contrast with effective atomic number Z) or Compton scattering and pair production predominate (at energies above approximately 200 keV for the former and 1 MeV for the latter), for therapeutic X-ray beams. Some examples of X-ray energies used in medicine are:
Megavoltage X-rays are by far most common in radiotherapy for the treatment of a wide range of cancers. Superficial and orthovoltage X-rays have application for the treatment of cancers at or close to the skin surface. Typically, higher-energy megavoltage X-rays are chosen when it is desirable to maximize "skin-sparing" (since the relative dose to the skin is lower for such high-energy beams).
Medically useful photon beams can also be derived from a radioactive source such as iridium-192, caesium-137, or cobalt-60. (Radium-226 has also been used as such a source in the past, though has been replaced in this capacity by less harmful radioisotopes.) Such photon beams, derived from radioactive decay, are approximately monochromatic, in contrast to the continuous bremsstrahlung spectrum from a linac. These decays include the emission of gamma rays, whose energy is isotope-specific and ranges between 300 keV and 1.5 MeV.
Superficial radiation therapy machines produce low energy x-rays in the same energy range as diagnostic x-ray machines, 20–150 keV, to treat skin conditions. Orthovoltage X-ray machines produce higher energy x-rays in the range 200–500 keV. Radiation from orthovoltage x-ray machines has been called "deep" due to its greater penetrating ability, allowing it to treat tumors at depths unreachable by lower-energy "superficial" radiation. Orthovoltage units have essentially the same design as diagnostic X-ray machines and are generally limited to photon energies less than 600 keV. X-rays with energies on the order of 1 MeV are generated in Linear accelerators ("linacs"). The first use of a linac for medical radiotherapy was in 1953. Commercially available medical linacs produce X-rays and electrons with an energy range from 4 MeV up to around 25 MeV. The X-rays themselves are produced by the rapid deceleration of electrons in a target material, typically a tungsten alloy, which produces an X-ray spectrum via bremsstrahlung radiation. The shape and intensity of the beam produced by a linac may be modified or collimated by a variety of means. Thus, conventional, conformal, intensity-modulated, tomographic, and stereotactic radiotherapy are all provided using specially modified linear accelerators.
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External beam radiotherapy AI simulator
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External beam radiotherapy
External beam radiation therapy (EBRT) is a form of radiotherapy that utilizes a high-energy collimated beam of ionizing radiation, from a source outside the body, to target and kill cancer cells. The radiotherapy beam is composed of particles, which are focussed in a particular direction of travel using collimators. Each radiotherapy beam consists of one type of particle intended for use in treatment, though most beams contain some contamination by other particle types.
Radiotherapy beams are classified by the particle they are intended to deliver, such as photons (as x-rays or gamma rays), electrons, and heavy ions; x-rays and electron beams are by far the most widely used sources for external beam radiotherapy. Orthovoltage ("superficial") X-rays are used for treating skin cancer and superficial structures. Megavoltage X-rays are used to treat deep-seated tumors (e.g. bladder, bowel, prostate, lung, or brain), whereas megavoltage electron beams are typically used to treat superficial lesions extending to a depth of approximately 5 cm. A small number of centers operate experimental and pilot programs employing beams of heavier particles, particularly protons, owing to the rapid decrease in absorbed dose beneath the depth of the target.
Teletherapy is the most common form of radiotherapy (radiation therapy). The patient sits or lies on a couch and an external source of ionizing radiation is pointed at a particular part of the body. In contrast to brachytherapy (sealed source radiotherapy) and unsealed source radiotherapy, in which the radiation source is inside the body, external beam radiotherapy directs the radiation at the tumor from outside the body.
Conventionally, the energy of diagnostic and therapeutic gamma- and X-rays is on the order of kiloelectronvolts (keV) or megaelectronvolts (MeV), and the energy of therapeutic electrons is on the order of megaelectronvolts. The beam is made up of a spectrum of energies: the maximum energy is approximately equal to the beam's maximum electric potential within a linear accelerator times the electron charge. For instance, a 1 megavolt beam will produce photons with a maximum energy around 1 MeV. In practice, the mean X-ray energy is about one-third of the maximum energy. Beam quality and hardness may be improved by X-ray filters, which improves the homogeneity of the X-ray spectrum.
Medically useful X-rays are produced when electrons are accelerated to energies at which either the photoelectric effect predominates (for diagnostic use, since the photoelectric effect offers comparatively excellent contrast with effective atomic number Z) or Compton scattering and pair production predominate (at energies above approximately 200 keV for the former and 1 MeV for the latter), for therapeutic X-ray beams. Some examples of X-ray energies used in medicine are:
Megavoltage X-rays are by far most common in radiotherapy for the treatment of a wide range of cancers. Superficial and orthovoltage X-rays have application for the treatment of cancers at or close to the skin surface. Typically, higher-energy megavoltage X-rays are chosen when it is desirable to maximize "skin-sparing" (since the relative dose to the skin is lower for such high-energy beams).
Medically useful photon beams can also be derived from a radioactive source such as iridium-192, caesium-137, or cobalt-60. (Radium-226 has also been used as such a source in the past, though has been replaced in this capacity by less harmful radioisotopes.) Such photon beams, derived from radioactive decay, are approximately monochromatic, in contrast to the continuous bremsstrahlung spectrum from a linac. These decays include the emission of gamma rays, whose energy is isotope-specific and ranges between 300 keV and 1.5 MeV.
Superficial radiation therapy machines produce low energy x-rays in the same energy range as diagnostic x-ray machines, 20–150 keV, to treat skin conditions. Orthovoltage X-ray machines produce higher energy x-rays in the range 200–500 keV. Radiation from orthovoltage x-ray machines has been called "deep" due to its greater penetrating ability, allowing it to treat tumors at depths unreachable by lower-energy "superficial" radiation. Orthovoltage units have essentially the same design as diagnostic X-ray machines and are generally limited to photon energies less than 600 keV. X-rays with energies on the order of 1 MeV are generated in Linear accelerators ("linacs"). The first use of a linac for medical radiotherapy was in 1953. Commercially available medical linacs produce X-rays and electrons with an energy range from 4 MeV up to around 25 MeV. The X-rays themselves are produced by the rapid deceleration of electrons in a target material, typically a tungsten alloy, which produces an X-ray spectrum via bremsstrahlung radiation. The shape and intensity of the beam produced by a linac may be modified or collimated by a variety of means. Thus, conventional, conformal, intensity-modulated, tomographic, and stereotactic radiotherapy are all provided using specially modified linear accelerators.