Medical Physics

3.

Physics of Radiation Therapy

3.1.

Principles of Radiation Oncology

3.1.1.

Therapeutic Ratio Concepts

3.1.1.1.

Tumor Control Probability (TCP)

3.1.1.1.1.

Dose-Response Relationships

3.1.1.1.2.

Sigmoid Curve Characteristics

3.1.1.2.

Normal Tissue Complication Probability (NTCP)

3.1.1.2.1.

Tolerance Doses

3.1.1.2.2.

3.1.1.3.

Therapeutic Window Optimization

3.1.2.

Radiobiology Fundamentals

3.1.2.1.

Cell Survival Curves

3.1.2.1.1.

Linear-Quadratic Model

3.1.2.1.2.

Alpha/Beta Ratios

3.1.2.1.3.

Survival Fraction Calculations

3.1.2.2.

Fractionation Principles

3.1.2.2.1.

Conventional Fractionation

3.1.2.2.2.

Hypofractionation

3.1.2.2.3.

Hyperfractionation

3.1.2.2.4.

Biologically Effective Dose (BED)

3.1.2.3.

Radiosensitivity Factors

3.1.2.3.1.

Intrinsic Radiosensitivity

3.1.2.3.2.

Cell Cycle Effects

3.1.2.3.3.

Oxygen Enhancement Ratio

3.1.2.4.

Four Rs of Radiobiology

3.1.2.4.1.

Repair of Sublethal Damage

3.1.2.4.2.

Redistribution in Cell Cycle

3.1.2.4.3.

3.1.2.4.4.

3.2.

External Beam Radiotherapy Equipment

3.2.1.

Medical Linear Accelerators (LINACs)

3.2.1.1.

Accelerator Components

3.2.1.1.1.

3.2.1.1.2.

Accelerating Waveguide

3.2.1.1.3.

Magnetron or Klystron

3.2.1.1.4.

Electron Path and Steering

3.2.1.2.

Treatment Head Components

3.2.1.2.1.

Target and Flattening Filter

3.2.1.2.2.

Primary Collimator

3.2.1.2.3.

Monitor Chambers

3.2.1.2.4.

Secondary Collimation System

3.2.1.3.

Photon Beam Production

3.2.1.3.1.

Bremsstrahlung Target Interaction

3.2.1.3.2.

Beam Flattening

3.2.1.3.3.

Energy Selection

3.2.1.4.

Electron Beam Production

3.2.1.4.1.

Electron Path Modification

3.2.1.4.2.

Scattering Foils

3.2.1.4.3.

Electron Applicators

3.2.2.

Cobalt-60 Teletherapy Units

3.2.2.1.

Source Characteristics

3.2.2.1.1.

Gamma Ray Energies

3.2.2.1.2.

Source Activity and Decay

3.2.2.2.

3.2.2.2.1.

3.2.2.2.2.

Collimation System

3.2.2.2.3.

Treatment Head Rotation

3.2.2.3.

Source Replacement Procedures

3.2.2.4.

Dosimetric Characteristics

3.3.

Photon Beam Dosimetry

3.3.1.

Beam Characterization

3.3.1.1.

Central Axis Depth Dose

3.3.1.1.1.

Percentage Depth Dose (PDD)

3.3.1.1.2.

Tissue-Air Ratio (TAR)

3.3.1.1.3.

Tissue-Phantom Ratio (TPR)

3.3.1.1.4.

Tissue-Maximum Ratio (TMR)

3.3.1.2.

Off-Axis Dose Profiles

3.3.1.2.1.

3.3.1.2.2.

3.3.1.2.3.

Penumbra Characteristics

3.3.1.3.

3.3.1.3.1.

Field Size Dependence

3.3.1.3.2.

Collimator Scatter Factor

3.3.1.3.3.

Phantom Scatter Factor

3.3.2.

Beam Modification Devices

3.3.2.1.

Collimation Systems

3.3.2.1.1.

Fixed Collimators

3.3.2.1.2.

Adjustable Collimators

3.3.2.1.3.

Multileaf Collimators (MLCs)

3.3.2.1.3.1.

Leaf Design Parameters

3.3.2.1.3.2.

Leaf Positioning Accuracy

3.3.2.1.3.3.

Leakage and Transmission

3.3.2.2.

Beam Shaping Devices

3.3.2.2.1.

Physical Wedges

3.3.2.2.1.1.

3.3.2.2.1.2.

3.3.2.2.2.

3.3.2.2.2.1.

Jaw Movement Patterns

3.3.2.2.2.2.

Dose Rate Modulation

3.3.2.2.3.

3.3.2.2.3.1.

Design Principles

3.3.2.2.3.2.

Material Selection

3.3.2.2.4.

Bolus Materials

3.3.2.2.4.1.

Tissue Equivalence

3.3.2.2.4.2.

Clinical Applications

3.3.3.

Field Shaping and Dose Distribution

3.3.3.1.

Isodose Curve Analysis

3.3.3.2.

Field Junction Techniques

3.3.3.3.

Multiple Field Arrangements

3.3.3.3.1.

Parallel Opposed Fields

3.3.3.3.2.

Three-Field Techniques

3.3.3.3.3.

Four-Field Box Techniques

3.4.

Electron Beam Therapy

3.4.1.

Electron Beam Physics

3.4.1.1.

Energy Selection Criteria

3.4.1.2.

Depth Dose Characteristics

3.4.1.2.1.

Therapeutic Range

3.4.1.2.2.

Practical Range

3.4.1.2.3.

Bremsstrahlung Tail

3.4.1.3.

Lateral Dose Profiles

3.4.1.4.

Field Size Effects

3.4.2.

Electron Beam Delivery

3.4.2.1.

Applicator Systems

3.4.2.1.1.

Standard Applicators

3.4.2.1.2.

3.4.2.1.3.

Internal Shielding

3.4.2.2.

Bolus Applications

3.4.2.3.

Abutment Techniques

3.4.3.

Clinical Applications

3.4.3.1.

Superficial Lesions

3.4.3.2.

Boost Treatments

3.4.3.3.

Total Body Irradiation

3.5.

Particle Therapy

3.5.1.

3.5.1.1.

Physical Principles

3.5.1.1.1.

Proton Interactions in Tissue

3.5.1.1.2.

Bragg Peak Characteristics

3.5.1.1.3.

Range-Energy Relationships

3.5.1.2.

Beam Delivery Systems

3.5.1.2.1.

Passive Scattering

3.5.1.2.2.

Pencil Beam Scanning

3.5.1.2.3.

Uniform Scanning

3.5.1.3.

Treatment Planning Considerations

3.5.1.3.1.

Range Uncertainties

3.5.1.3.2.

Relative Biological Effectiveness (RBE)

3.5.1.4.

Facility Requirements

3.5.1.4.1.

Cyclotron or Synchrotron

3.5.1.4.2.

Beam Transport Systems

3.5.1.4.3.

3.5.2.

Heavy Ion Therapy

3.5.2.1.

Carbon Ion Properties

3.5.2.2.

Enhanced Biological Effectiveness

3.5.2.3.

Fragmentation Effects

3.5.2.4.

Clinical Applications

3.6.

Treatment Planning Systems

3.6.1.

Patient Data Acquisition

3.6.1.1.

3.6.1.1.1.

Immobilization Devices

3.6.1.1.2.

Contrast Protocols

3.6.1.1.3.

Image Quality Requirements

3.6.1.2.

Multi-Modality Imaging

3.6.1.2.1.

MRI Integration

3.6.1.2.2.

PET Integration

3.6.1.2.3.

Image Registration

3.6.2.

Treatment Planning Software

3.6.2.1.

Anatomy Definition

3.6.2.1.1.

Target Volume Delineation

3.6.2.1.1.1.

Gross Tumor Volume (GTV)

3.6.2.1.1.2.

Clinical Target Volume (CTV)

3.6.2.1.1.3.

Planning Target Volume (PTV)

3.6.2.1.2.

Organs at Risk (OAR) Contouring

3.6.2.2.

Beam Arrangement

3.6.2.2.1.

Beam Angle Selection

3.6.2.2.2.

Isocenter Placement

3.6.2.2.3.

3.6.3.

Dose Calculation Algorithms

3.6.3.1.

Pencil Beam Algorithms

3.6.3.1.1.

Convolution Methods

3.6.3.1.2.

Superposition Algorithms

3.6.3.2.

Monte Carlo Methods

3.6.3.2.1.

Particle Transport Simulation

3.6.3.2.2.

Variance Reduction Techniques

3.6.3.3.

Grid-Based Boltzmann Equation Solvers

3.6.4.

Plan Evaluation Tools

3.6.4.1.

Dose Volume Histograms (DVHs)

3.6.4.1.1.

3.6.4.1.2.

Differential DVH

3.6.4.1.3.

DVH Analysis Parameters

3.6.4.2.

Isodose Distribution Analysis

3.6.4.3.

Dose Statistics

3.6.4.4.

Plan Comparison Methods

3.7.

Advanced Treatment Techniques

3.7.1.

Intensity-Modulated Radiation Therapy (IMRT)

3.7.1.1.

Inverse Planning Process

3.7.1.1.1.

Objective Functions

3.7.1.1.2.

Optimization Algorithms

3.7.1.1.3.

Constraint Handling

3.7.1.2.

Delivery Methods

3.7.1.2.1.

Step-and-Shoot IMRT

3.7.1.2.2.

Dynamic MLC IMRT

3.7.1.2.3.

3.7.1.3.

Quality Assurance Requirements

3.7.1.3.1.

Fluence Map Verification

3.7.1.3.2.

Dose Distribution Verification

3.7.2.

Volumetric Modulated Arc Therapy (VMAT)

3.7.2.1.

Arc Delivery Principles

3.7.2.1.1.

Gantry Rotation

3.7.2.1.2.

3.7.2.1.3.

Dose Rate Modulation

3.7.2.2.

Planning Considerations

3.7.2.2.1.

Arc Arrangement

3.7.2.2.2.

Optimization Constraints

3.7.2.3.

Delivery Efficiency

3.7.3.

Stereotactic Techniques

3.7.3.1.

Stereotactic Radiosurgery (SRS)

3.7.3.1.1.

Frame-Based Systems

3.7.3.1.2.

Frameless Systems

3.7.3.1.3.

Image Guidance Requirements

3.7.3.1.4.

Single Fraction Delivery

3.7.3.2.

Stereotactic Body Radiation Therapy (SBRT)

3.7.3.2.1.

Hypofractionation Schedules

3.7.3.2.2.

Motion Management

3.7.3.2.2.1.

Respiratory Gating

3.7.3.2.2.2.

Breath Hold Techniques

3.7.3.2.2.3.

Tracking Systems

3.7.3.2.3.

Target Localization

3.7.4.

Image-Guided Radiation Therapy (IGRT)

3.7.4.1.

Imaging Modalities

3.7.4.1.1.

3.7.4.1.2.

Cone Beam CT (CBCT)

3.7.4.1.3.

Ultrasound Guidance

3.7.4.1.4.

Implanted Markers

3.7.4.2.

Registration Techniques

3.7.4.2.1.

Rigid Registration

3.7.4.2.2.

Deformable Registration

3.7.4.3.

Correction Strategies

3.7.4.3.1.

Setup Error Correction

3.7.4.3.2.

Adaptive Planning

3.8.

3.8.1.

Radioactive Source Characteristics

3.8.1.1.

Source Types and Designs

3.8.1.1.1.

3.8.1.1.2.

Source Encapsulation

3.8.1.2.

Radionuclides for Brachytherapy

3.8.1.2.1.

3.8.1.2.2.

3.8.1.2.3.

3.8.1.2.4.

3.8.1.3.

Source Strength Specification

3.8.1.3.1.

Air Kerma Strength

3.8.1.3.2.

Apparent Activity

3.8.1.3.3.

Reference Air Kerma Rate

3.8.2.

Dose Rate Classifications

3.8.2.1.

Low-Dose-Rate (LDR) Brachytherapy

3.8.2.1.1.

Permanent Implants

3.8.2.1.2.

Temporary Implants

3.8.2.1.3.

Dose Rate Ranges

3.8.2.2.

High-Dose-Rate (HDR) Brachytherapy

3.8.2.2.1.

Remote Afterloading

3.8.2.2.2.

Treatment Delivery

3.8.2.2.3.

Fractionation Schemes

3.8.2.3.

Pulsed-Dose-Rate (PDR) Brachytherapy

3.8.2.3.1.

Pulse Characteristics

3.8.2.3.2.

Biological Considerations

3.8.3.

Application Techniques

3.8.3.1.

Interstitial Brachytherapy

3.8.3.1.1.

Needle Placement Techniques

3.8.3.1.2.

Seed Implantation

3.8.3.1.3.

Template-Based Approaches

3.8.3.2.

Intracavitary Brachytherapy

3.8.3.2.1.

Gynecological Applications

3.8.3.2.2.

Applicator Design

3.8.3.2.3.

Optimization Methods

3.8.3.3.

Surface Applicators

3.8.3.3.1.

Mold Techniques

3.8.3.3.2.

Contact Therapy

3.8.4.

Dosimetry and Treatment Planning

3.8.4.1.

Dose Calculation Formalisms

3.8.4.1.1.

TG-43 Formalism

3.8.4.1.2.

Point Source Approximation

3.8.4.1.3.

Line Source Approximation

3.8.4.2.

Treatment Planning Systems

3.8.4.2.1.

3.8.4.2.2.

Optimization Algorithms

3.8.4.2.3.

Dose Volume Analysis

3.8.4.3.

Quality Assurance

3.8.4.3.1.

Source Calibration

3.8.4.3.2.

Treatment Plan Verification

3.8.4.3.3.

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4. Radiation Protection and Dosimetry