Beam Modification Final

Beam Modification devices in
Radiotherapy
Moderator:
Prof. S.C. Sharma
Head Of Department
Department of Radiotherapy
PGIMER
Introduction
 Beam modification is defined as
desirable modification in the spatial
distribution of radiation, within the
patient, by insertion of any material
into the beam.
Seminar on Beam Modification Devices. Moderator : Dr. S.C. Sharma. Department of Radio
Types of beam modification
 There are four main types of beam modification:
 Shielding:
Shielding To eliminate radiation dose to some
special parts of the zone at which the beam is
directed.
 Compensation:
Compensation To allow normal dose distribution
data to be applied to the treated zone, when the
beam enters a or obliquely through the body or
where different types of tissues are present.
 Wedge filtration:
filtration Where a special tilt in isodose
curves is obtained.
 Flattening:
Flattening Where the spatial distribution of the
natural beam is altered by reducing the central
exposure rate relative to the peripheral.
Problem in beam modification
 Radiation reaching any point,
is made up of primary and
scattered photons.
 Any introduction of the
modification devices results in
alteration of dose distribution,
due to these two phenomena.
 The phenomena scattering
results in an “blurring” of the
effect of the beam
modification.
 Scattering is more in
kilovoltage radiation than in
megavoltage radiation therapy.
Types of beam modification
devices
 Field blocking  Wedge filters.
and shaping  Beam flattening
devices:
 Shielding blocks.
filters.
 Custom blocks.  Bolus
 Asymmetrical jaws.  Breast cone.
 Multileaf
collimators.  Penumbra
 Compensators. trimmers.
 Beam spoilers  Electron beam
modification
Shielding
 Since radiation attenuation is exponential
and because of scattering, complete
shielding can never be achieved.
 The aims of shielding are:
 To protect critical organs.
 Avoid unnecessary irradiation to surrounding
normal tissue.
 Matching adjacent fields.
Shielding
 An idea shielding material should
have the following
characteristics:
 High atomic number.
number
 High-density.
High-density
 Easily available.
available
 Inexpensive.
Inexpensive
 The choice of the shielding
material is also dictated by the
type of beam being used!!
 The most commonly used
shielding material for photons is
lead.
Shielding
 The thickness used depends upon the energy of the radiation.
 For practical purposes, the shielding material which reduces beam
transmission to 5% of its original is considered acceptable.
 The term half value-layer is a convenient expression for the
attenuation produced by any material. Half-value layer is defined
as the thickness of material, which will reduce the intensity of the
primary beam by 50%.
 The number of HVL (n) required is given by the following
expression:
1/2n = 5% or 0.05
Thus, 2n = 1/0.05 = 20
OR, n log 2 = log 20.
n = 4.32
 The relationship holds true, only for mono energetic x-ray
beams.
 Practically thickness of lead between 4.5 - 5 half-value layers
results in 5% or less of primary beam transmission.
Shielding
The higher scatter
Beam
contribution to the overall
Required
energy
dose results in lower lead
dosage adjacent to the thickness
shielded area in kilovoltage
radiation. 4 MV 6.0 cm
100%
6 MV 6.5 cm
Lesser amount10 of MV 7.0 cm

scattered radiation with
250 KV megavoltage radiation60
means that theCo (1.25 5.0 cm
50%
attenuation producedMeV)
by
shielding is also more.
4 MV
Shielding
 In kilovoltage radiation shielding is
readily achieved by placing sheets of
lead on the surface directly.
 This is necessary, because of the lower
penetrating power of the beam.
 In megavoltage radiation,
 Thicker blocks used.
 Placed higher up in shadow trays (15
-20 cm).
 Avoids increase in skin dose due to
electron scatter.
 Also impossible to place the heavy block
on the body !!
Custom blocks
 Material used for custom
locking is known as the Cadmium, Bismuth,
Tin, 10.00%
Lipowitz metal or 13.30%
50.00%
Cerrobend.
 Melting point 70°C.
 Density 9.4 g /cm3 at 20°C
(83% of lead).
Lead,
 1.21 times thicker blocks 26.70%
necessary to produce the
same attenuation.
 Most commonly thickness Bismuth Lead
of 7.5 cms used. Tin Cadmium
Custom blocks
Step 2: Electrically heated Step 3: Cavities in

Step 1: Outline of
wire pivoting around a the styrofoam block
the treatment field
point (simulating the being used to cast
being traced on
source) cutting the the Cerrobend
radiograph using a
styrofoam block blocks.
Styrofoam cutting
device.
Custom blocks
 Shielding blocks can be of
two types:
 Positive blocks, where
the central area is
blocked.
 Negative blocks, where
the peripheral area is
blocked.
 The term diverging block
means that the block
follows the geometric
divergence of the beam.
 This minimises the block
transmission penumbra.
Independent Jaws
 Used when we want to block of
the part of the field without
changing the position of the
isocenter.
 Independently movable jaws,
allows us to shield a part of the
field, and this can be used for
“beam splitting”.
 Here beam is blocked off at the
central axis to remove the
divergence.
 Use of independent jaws and
other beam blocking devices
results in the shift of the
isodose curves.
 This is due to the elimination of
photon and electrons scatter from
the blocked part of the field.
Independent Jaws
 Independent jaws can be used to produce
dynamic wedges also.
 Generated electronically by creating
wedged beam profiles through the dynamic
motion of an independent jaw within the
treatment field.
 In cobalt machines and older linear
accelerators, where fixed jaws were
present, half beam blocking was used to
for beam splitting.
Multileaf Collimators
 Multileaf collimators are a bank of large
number of collimating blocks or leaves
 Can be moved automatically independent
of each other to generate a field of any
shape.
 40 pairs of leaves or more having a width
of 1 cm on less (projected at the
isocenter).
 Thickness = 6 – 7.5 cm
 Made of a tungsten alloy.
 Density of 17 - 18.5 g/cm3.
 Primary x-ray transmission:
 Through the leaves < 2%.
 Interleaf transmission < 3%.
 For the jaws 1%
 Cerrobend blocks 3.5% .
 MLC systems may have double focus or
single focus leaves.
 The latter are shaped to match the radiation
beam along the Y axis only as the upper
end is narrower than the lower.
 Single focus leaves are also rounded at
the ends.
 This can lead to significant beam
transmission (20%) when the leaves abut
each other.
 Both designs are to ensure a sharp beam
cut off at the edge.
 In order to allow fast interleaf movement, Beam
while reducing radiation transmission a
tongue and groove design is often used.
 This design in turn leads to some under
dosing in the region of the tongue (17 – Tongue
25%).
 The degree of conformity between
the planned field boundary and the
boundary created by the MLC
depends upon:
 Projected leaf width.
 Shape of target volume.
 Angle of collimator rotation.
 RCI = Treated Volume (inside 95%
isodose curve) / PTV
 The direction of motion of the
leaves should be parallel with the
direction in which the target volume
has the smallest cross-section.
 The advantages are:
 The disadvantages are:
 Time for shaping and
 Island blocking is not
possible.
inserting of custom blocks is
not required.
 Because the physical
penumbra is larger than that
 The hardening of beam, produced by Cerrobend
scattered radiation, and blocks treatment of smaller
increase in skin doses and fields is difficult, as is the
doses outside the field, as shielding of critical structures,
seen with physical near the field.
compensators is avoided.  The jagged boundary of the
field makes matching difficult.
 Automation of reshaping
and modulation of beam
 Practically smaller fields are
used because MLC carriages
intensity in IMRT. and secondary jaws don’t
 MLCs can also be used to as move during IMRT delivery
dynamic wedges and making matching of fields
electronic compensators necessary.
(2D).
Compensators
Notice the reduction in
the hot spot
 A beam modifying device
which evens out the skin
surface contours, while
retaining the skin-sparing
advantage.
 It allows normal depth dose
data to be used for such
irregular surfaces.
 Compensators can also be
used for
 To compensate for tissue
heterogeneity. This was first
used by Ellis, and is primarily
used in total body
irradiation.
 To compensate for dose
irregularities arising due to
reduced scatter near the field

Compensators
 The dimension and shape of a

compensator must be adjusted to h'
account for :
 Beam divergence. d
 Linear attenuation coefficients of
the filter material and soft tissue. h
 Reduction in scatter at various
depths due to the compensating
filters, when it is placed at the
distance away from the skin.
 To compensate for these factors a 1
tissue compensator is always has an
attenuation less than that required
for primary radiation.
h’/h
 As the distance between the skin and
compensator increases the
Seminar on Beam Modification Devices. Moderator : d
Dr. S.C. Sharma. Department of Radio
thickness ratio (h’/h) decreases.
Compensators
 The thickness ratio depends on:
 Compensator to surface distance.
 Thickness of the missing tissue.
 Field size.
 Depth.
 Beam quality.
 Of these, the distance is the most important factor
when d is ≤ 20 cm.
 Therefore, a fixed value of thickness ratio (τ) is
used for most compensator work (~ 0.7).
 The formula used for calculation of compensator
thickness is given by: TD x (τ/ρc), where TD is the
tissue deficit and ρc is the density of the
compensator.
Compensators
Two-dimensional
compensators
 Used when proper mould
room facilities are not
available.
 Thickness varies, along a
single dimension only.
 Can be constructed using
thin sheets of lead, lucite or
aluminum. This results in
production of a laminated
filter.
Compensators
Three-dimensional
compensators
 3-D compensators are
designed to measure tissue
deficits in both transverse
and longitudinal cross
sections.
 Various devices are used to
drive a pantographic cutting
unit.
 Cavity is produced in the
Styrofoam block are then
used to cast compensator
filters. Seminar on Beam Modification Devices. Moderator : Dr. S.C. Sharma. Department of Radio
 Medium density materials are
Compensators
Compensating wedges: Set up
 Compensating wedges are
 At the filter-surface
distance calculated not
useful where the contour less than 20 cm.
can be approximated with  Nominal SSD measured
a straight line for an from a plane
oblique beam. perpendicular to beam
axis touching the highest
 Three important point in the contour.
differences between  In SAD technique the
compensating wedges and depth of the isocenter is
wedge filters are: measured from the same
elevated point only.
 Standard isodose
curves, can be used
 No wedge transmission
factors are required.
 Partial field
compensation can be
done.
Beam Spoilers
 Special beam modification
device where shadow trays
made from Lucite are kept at 100%
a certain distance from the
skin.
% depth dose
 Based on the principle that
relative surface dose D=5
D = 10
increases when the surface to D = 20
tray distance is reduced. D = 40
 First used by Doppke to
increase dose to superficial D = Tray to surface
neck nodes in head and neck distance
cancers using 10 MV photon
beams. .4 .8 1.2
Depth (cm)
Wedge Filters
 A beam modifying device,
which causes a
progressive decrease in
intensity across the beam,
resulting in tilting the
isodose curves from their
normal positions.
 Degree of the tilt depends  The sloping surface is
upon the slope of the made either straight or
wedge filter. sigmoid in shade.
 Material: tungsten or steel.  A sigmoid shape produces
 Usually wedges are a straighter isodose curve.
mounted at a distance of  Mounted on trays which are
15 centimeters from the mounted on to the head of
skin surface. the gantry.
Wedge filters
Y
 Types of wedge systems:
 Individualized wedge .
 Universal wedge.
 Dynamic wedges
X
 Virtual wedges
This area will have
 Pseudo wedges a hot spot.
 The two dimensions of
wedges are important – “X”
or width and “Y” or length.
 All wedges are aligned so
that the central axis of the
beam is at the central axis of X
the wedge.
 If the X dimension ofBeamfield
Seminar on is Devices. Moderator : Dr. S.C. Sharma. Department of Radio
Modification
longer then we can’t use the

Wedge Filters
 Individual wedges
are useful in Cobalt
beams
 Using bigger
wedges than
 The wedge
necessary will systems available
reduce output of are:
the machine →  6W ( x 15)
increased  8W ( x 15)
treatment time.  10W ( x 15)
 The width (W) of  All systems have
the wedge is fixed the following four

Wedge Filters
 Universal
wedges are
designed so that
the same wedge
can be used with  The x
all field sizes. dimension is 20
 This is useful as cm and the y is
it saves time. 30 cm. (except
 However not 60°)
suitable for  Wedge angles
cobalt beams used are: 60°,
because of
Wedge filters
 The wedge isodose
angle (θ) is the
complement of the
angle through which
the isodose curve is
tilted with respect to θ
the central ray of the
beam at any specified
depth.
 This depth is important
because the angle will
decrease with
increasing depth.
 The choice of the
reference depth Seminar on Beam Modification Devices. Moderator : Dr. S.C. Sharma. Department of Radio
varies:
Wedge filters
 The presence of the wedge decreases output of
the machine.
 WTF = Dose with the wedge/ Dose without the
wedge (at a point in the phantom, along the
central axis of the beam).
 Usually measured at a suitable depth below the
Dmax usually 5 -10 cms! This minimises the error in
calculation of PDD.
 The resultant reduction in output results in an
increase in the treatment time.
 In some isodose charts used in cobalt machines
the wedge transmission factor is already
incorporated, and no further correction is
necessary.
 Use of wedge will result in a preferential
hardeningSeminar
(attenuation ofDevices.
on Beam Modification lowModerator
energy beams)
: Dr. S.C. - of Radio
Sharma. Department
more pronounced in case of linear accelerators.

Wedge filters - Design
This angle is the wedge angle.
A B C D E
% DD at each point is
calculated and tabulated
A B C D E
Non wedge 40 55 67 68 62
isodose
Wedge isodose 35 39 43 76 105
Ratio (W: NW) .87 .71 .79 1.1 1.7
Transmission - .38 .42 .66 1

ratio
mm Pb - 15.2 13.6 6.5 0
Wedge filters
 Wedged fields are generally used
for relatively superficial tumors.
 Beams are usually directed from
the same side of the patient.
 The broad edges of the wedges
should be aligned together.
 The wedge angle choosen φ
depends on the angle between the
central rays of the two beams also  Thus the 2 factors on which the
called the “hinge angle”(φ). wedge angle is choosen are:
 Wedges:  The hinge angle.
 Reduce the hot spots at the  The wedge separation.
surface  The wedge angle that will make the
 Rapid dose falloff beyond the isodose curves parallel to each other
region of overlap. and the hinge angle bisector is
 The overlap region is also called obtained using the equation.
the “plateau region”.
Θ = 90 – φ / 2
Wedge filters
Problem Solution
A different value of wedge angle is A small range of hinge angles can be
required for different beam angles covered by a given wedge angle producing
significant variation(±5%).
The body contour can be more Compensators may be used to overcome the
curved as a result, the isodose deficit or a different wedge angle can be
curves are not obtained in the used, so that part acts as a compensator.
manner desired.
Wedge filters
 Dynamic wedges or  Virtual wedges or dynamic
“motorized wedges” as they enhanced wedges are moving
were called once had a 60° jaws that are moved by
wedge mounted in the computer control to create
treatment head itself. wedge beam profiles.
 This wedge was moved into  However use has not resulted
the field for part of the time to in significant improvement
create the wedge beam profile over conventional wedges.
desired.  Fixed jaws can be used to
produce pseudo wedges
where part of the treatment
field requiring greater dose
would be irradiated using
smaller field sizes.
Flattening filters
 A beam flattening filter reduces the
central exposure rate relative to that
near the edge of the beam.
 Used for Linear accelerators.
 Due to the lower scatter the isodose
curves are exhibit “forward peaking”.
 The filter is designed so that the thickest
part is in the centre.
 Material: copper or aluminium.
 Penetrating power should not increase
as this will alter the per cent depth-dose
as well as reduce the flattening.
 In cobalt beams point source is not used
so flattening is not required.
Flattening filters
 The beam flatness is specified at 10 centimeters.
 The extent of flatness should be ± 3% along the
central axis of the beam at 10 centimeters.
 Should cover 80% or more of the field, or reach
close or than one centimeter from the edge.
 There is usually over flattening of isodoses, near
the surface. This results in production of “horns” or
hot spots.
 No point parallel to the surface should receive a
dose > 107% of the central axis dose.
 Because of the thinner outer rim, the average beam
energy is lower at the periphery as compared to the
centre
Bolus
 A tissue equivalent material used to reduce
the depth of the maximum dose (Dmax).
 Better called a “build-up bolus”.
 A bolus can be used in place of a
compensator for kilovoltage radiation to
even out the skin surface contours.
 In megavoltage radiation bolus is primarily
used to bring up the buildup zone near the
skin in treating superficial skin lesions.
Bolus
 The thickness of the bolus used varies
according to the energy of the radiation.
 In megavoltage radiation:
 Co60 : 2 - 3 mm
 6 MV : 7- 8 mm
 10 MV : 12 - 14 mm
 25 MV: 18 - 20 mm
 Properties of an ideal bolus:
 Same electron density and atomic number.
 Pliable to conform to surface.
Bolus
 Commonly used materials are:
 Cotton soaked with water.
 Paraffin wax.
 Other materials that have been used:
 Mix- D (wax, polyethylene, mag oxide)
 Temex rubber (rubber)
 Lincolnshire bolus (sugar and mag carbonate in form
of spheres)
 Spiers Bolus (rice flour and soda bicarb)
 Superflab.
 Superstuff.
 Elastogel. Seminar on Beam Modification Devices. Moderator : Dr. S.C. Sharma. Department of Radio
Breast Cone
 A beam modifying and directing device used
for a tangential fields therapy.
 Advantages:
 Directs being to the central axis of the area of
interest, where a tangential beam is applied to
a curved surface.
 Helps position, the patient with an accurate
SSD.
 Endplate provides compensation, enhances
surface dose and presses down the tissue.
 Effective shielding of lungs.
Penumbra trimmers
 Refers to the region at the edge of the beam where the dose-rate
changes rapidly as a function of distance from the beam axis.
 Types:
 Transmission penumbra: Transmission through the edge of the
collimator block.
 Geometrical penumbra : Finite size of the source.
 Physical penumbra: Lateral distance between to specified isodose
curves at a specific depth (90% & 20% at Dmax).
 Takes scattered radiation into account.
 Penumbra width depends upon:
 Source diameter.
 SSD.
 Depth below skin.
 Source to diaphragm distance (inversely)
Penumbra trimmers
A B
SDD
O
 Consists of extensible,
heavy metal bars to
attenuate the beam in M
E
the penumbra region.
SSD
 Increase the source to
diaphragm distance,
reducing the geometric N C D
penumbra. d P
 Another method is to
1. CD/ AB = MN/ OM
use secondary blocks
placed close to the 2. CD/ AB = SSD + d – SDD / SDD
patient ( 15 – 20 cms). 3. P = AB ( SSD + d – SDD)/ SDD
Electron beams
 Electron field shaping is done using lead cutouts.
 For a low-energy electrons (<10 MeV), sheets of
lead, less than 6 mm thickness are used.
 The lead sheet can be placed directly on the skin
surface.
 Shields can also be supported at the end of the
treatment cone if too heavy at the cost of greater
inaccuracies.
 Design is easier, because the size is same as that
of the field on the patients skin.
Electron Beam
 To avoid variation in output and electron
scatter, jaws cannot be used to collimate
electron beams.
 An electron beam cone is therefore used to
provide the collimation.
 A primary collimator is provided close to
source – defines the maximum field size.
 A secondary collimator, near the patient
defines the treatment field.
Direct / Internal Shielding
 Used for electron beam
shielding.
 A lead shield can be placed
where shielding of structures wax lead Dental filling
against backscatter electrons
is required.
 A tissue equivalent material
is coated over the lead shield
like wax/ dental acrylic/
aluminum.
 Example of areas requiring
these techniques are the
buccal mucosa and eye lids. Tissue to be shielded
Scattering foil
 A device to widen the thin pencil beam
(3 mm) of electrons.
 Metallic plates of tin, lead or aluminium
are used.
 Disadvantages: Primary foil
 Beam attenuation.
 Generation of bremsstrahlung radiation. Secondary foil
 Advantages:
 Less prone to mechanical errors.
 Less expensive.
 Requires less instrumentation.
 Nowadays dual foil systems are used, Electron
which compare well with scanning beam cone
systems.
Conclusion
 Beam modification increases the conformity
allowing a higher, dose delivery to the target
while sparing more of normal tissue
However the price of this
simultaneously.
 It thus fulfils the basic aim of radiotherapy.
accuracy is an eternal
vigilance.
vigilance

Beam Modification Final

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Beam Modification devices in

Lesser amount10 of MV 7.0 cm

Step 2: Electrically heated Step 3: Cavities in

reduced scatter near the field

 The dimension and shape of a

longer then we can’t use the

the wedge is fixed the following four

more pronounced in case of linear accelerators.

Ratio (W: NW) .87 .71 .79 1.1 1.7

Transmission - .38 .42 .66 1

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