PHYS5401 - Medical Imaging Physics

Syllabus

Module 1           Introduction to Medical Imaging

1.1          Introduction

1.2          Medical Imaging Modalities

1.3          X-Ray Imaging Modalities

1.4          Nuclear (Molecular) Imaging Modalities

1.5          Ultrasound

1.6          Magnetic Resonance Imaging (MRI)

 

Module 2           Maths Review, Image Theories, and Image Perception and Assessment

2.1          Introduction

2.2          Spatial Resolution

2.2.1                The Spatial Domain

2.2.2                The Point Spread Function, PSF

         2.2.2.1         How does the Point Spread Function affect image quality (what we see)?

2.2.3                The Line Spread Function, LSF

2.2.4                The Edge Spread Function, ESF

2.3          Convolution

2.3.1                Relationships Between Spread Functions

2.4          The Frequency Domain

2.5          Fourier Series and the Fourier Transform

2.6          The Modulation Transfer Function, MTF(f)

2.6.1                Conceptual Description

2.6.2                Practical Measurement

2.6.3                Limiting Resolution

2.6.4                Nyquist Frequency

2.7          Image theory fundamentals

2.7.1                Linear systems theory

27.2                Linearity

2.7.3                Shift invariance or Isoplanatism

2.7.4                Sampling theory

2.8          Contrast

2.8.1                Definition

2.8.2                Contrast types

2.8.3                Optical density

2.8.4                Greyscale characteristics

2.9          Noise

2.10       Contrast-to-Noise Ratio

2.11       Signal-to-Noise Ratio

2.12       Detective quantum efficiency

2.13       Image Perception and Assessment

2.13.1             Human visual system

2.13.2             Human eye

2.13.3             Barten model

2.13.4             Perceptual linearization - Viewing conditions

2.13.5             Specifications of Observer Performance –

2.13.6             Decision outcomes

2.13.7             Specifications of Observer Performance –

2.13.8             Statistical decision theory and receiver operating characteristic methodology

2.13.9             Experimental Methodologies

2.13.10          Contrast–detail methodology

2.13.11          Forced choice experiments

2.13.12          ROC experiments

 

Module 3                           Introduction to Image Processing & Enhancement

3.1          Introduction

3.2          Image data types

3.3          Spatial resolution

3.4          Basic image processing operations

3.4.1                Histograms

3.4.2                Generating and Plotting Image Histograms

3.5          Noise

3.6          Why perform enhancement?

3.7          Spatial filtering and noise removal

3.7.1                Mean filtering

3.7.2                Gaussian filtering

3.7.3                ‘Ideal’ low pass filter

3.7.4                Median filtering

3.7.5                Image filtering techniques for medical image post-processing

3.8          Image Segmentation

3.8.1                Thresholding

3.9          Image Registration

3.9.1                Intensity-based vs feature-based image registration

3.9.2                Shape-preserving transformations

3.10       Transformation models

3.10.1             linear transformation

3.10.2             2D Rotation transformation

3.10.3             Uniform scaling transformation

3.10.4             Affine transforms

3.11       Artificial Intelligence (AI) in Medical Image Analysis

3.11.1     Deep Neural Networks (DNNs)

 

Module 4           Tomographic Reconstruction from Projections

4.1          Introduction

4.2          Simple Backprojection

4.3          Filtered Backprojection (FBP)

4.4          Iterative Reconstruction

4.5          FBP versus Iterative Reconstruction

 

Module 5           Ultrasound Imaging –Review of the physics of sound

5.1          Introduction

5.2          What is sound?

5.3          Describing Sound Waves

5.3.1                Frequency, wavelength and velocity

5.3.2                Amplitude, Pressure, Intensity and the dB scale

5.3.3                Combining Waves

5.3.4                The Doppler Effect

5.4          Interaction of sound waves with matter

5.4.1                Attenuation

5.4.2                Acoustic Impedance

5.4.3                Reflection

5.4.4                Refraction

5.4.5                Scatter

 

Module 6           Ultrasound Imaging

6.1          Introduction

6.1.1                Physical properties imaged

6.1.2                Clinical applications

6.1.3                Resolution

6.1.4                Pros / cons

6.1.5                Imaging system

6.2          Transducers

6.2.1                Basic transducer design

6.2.2                Transducer Arrays

6.3          Beam Properties and Formation

6.3.1                Near and far field

6.3.2                Side lobes and grating lobes

6.3.3                Beam formation in a linear array

6.3.4                Beam formation in a parallel (phased) array

6.4          Data Acquisition and Image Formation

6.4.1                Pulse echo

6.4.2                Display Modes

6.4.3                2D imaging

6.5          Doppler imaging

6.5.1                Continuous-Wave Doppler

6.5.2                Pulsed Doppler

6.5.3                Duplex Scanning

6.5.4                Doppler Displays

6.5.5                Colour Flow Imaging

6.5.6                Spectral Waveform

6.5.7                Power Doppler

6.6          New Developments

 

Module 7           Ultrasound Imaging –Artefacts, Safety and Quality Control

7.1          Artefacts

7.1.1                B-Mode Imaging Artefacts

7.1.2                Refraction

7.1.3                Shadowing and Enhancement

7.1.4                Reverberation

7.1.5                Mirror Image Artefacts

7.1.6                Speed Displacement

7.1.7                Side Lobes and Grating Lobes

7.1.8                Ambiguity Artefacts

7.1.9                Slice Thickness

7.2          Doppler Artefacts

7.2.1                Speed Variations across Large Vessels

7.2.2                Speed Variations Caused by Vessel Constriction

7.2.3                Aliasing

7.3          Biological Effects and Safety

7.3.1                Measures of Exposure

7.4          Biological Effects

7.4.1                Thermal Effects

7.4.2                Non-Thermal (Mechanical) Effects

7.4.3                Acoustic Cavitation

7.4.4                Acoustic Streaming

7.5          Safety Indices

7.5.1                Thermal Index (TI)

7.5.2                Mechanical Index (MI)

7.6          Quality Control

 

Module 8           Basic Principles of X-ray Imaging

8.1          Introduction

8.2          Generation of X-rays for Medical Imaging Heading

8.2.1             The X-ray Tube

8.2.2             The Anode

8.2.3             Inherent filtration

8.2.4             Added filtration

8.2.5             Compensation filters

8.2.6             Anode angle

8.2.7             The Generator

8.2.8             Tube Cooling System

8.3          Interaction of X-rays with Tissue, Attenuation and Contrast

8.3.1             Coherent Scatter

8.3.2             Compton Scatter

8.3.3             The Photoelectric Effect

8.3.4             Overall Attenuation

8.4          Radiography

8.4.1             Physical properties imaged

8.4.2             Clinical applications

8.4.3             Resolution

8.4.4             Pros / cons

8.4.5             Imaging system

8.4.6           Contrast agents

8.5          Image Receptors

8.5.1             Computed Radiography (CR)

8.5.2             Clinical applications

8.5.3             Resolution

8.5.4             Pros / cons

8.5.5             Imaging system

8.6          Image Receptors

8.6.1             Computed Radiography (CR)

8.6.2             Digital Radiography (DR)

8.6.3             Automatic Exposure Control (AEC)

8.7          Factors Affecting Image Quality and Radiation Dose

 

Module 9           Basic X-ray QC and Dosimetry

9.1          Introduction: What is Quality Control?

9.1.1             Goals of QC and QA

9.2          Disadvantages of Poor Quality Images

9.2.1             Incorrect Diagnosis

9.2.2             Risk of Repeating a Hazardous Procedure

9.2.3             Unproductive Patient Radiation

9.2.4             Patient Inconvenience

9.2.5             Increased Cost

9.3          Factors in Quality Assurance and Quality Control

9.3.1             Equipment Factors

9.3.2             Human Factors

9.3.3             Acceptance Testing

9.4          Dosimetric Quantities

9.4.1             Basic Quantities

9.4.2             Application Specific Quantities

9.4.3             Relationship to stochastic and deterministic effects

9.5          Basic X-ray Quality Control Measurements and Dose Calculation

9.5.1             Measurement of Parameters Required for Dose Calculation

9.5.2             Dose Calculation

9.6          Typical Doses and Dose Reference Levels (DRLs)

9.6.1             Typical Effective Doses

9.6.2             Diagnostic Reference Levels (DRLs)

 

Module 10        Fluoroscopy

10.1       Introduction

10.1.1          Special demands of fluoroscopy

10.1.2          Physical properties imaged

10.1.3          Clinical applications

10.1.4          Resolution

10.1.5          Pros / cons

10.1.6          Imaging system

10.2       Fluoroscopic Image Detectors

10.2.1          Conventional Vacuum Tube Image intensifier

10.2.2          Flux gain

10.2.3          Minification gain

10.2.4          Overall brightness gain

10.2.5          Pincushion distortion

10.2.6          Flat Panel Digital Fluoroscopic Detectors

10.3       Digital Fluoroscopy (DF)

10.3.1          Digital subtraction angiography (DSA)

10.3.2          Dual energy subtraction

10.3.3          Frame averaging

10.3.4          Last frame hold

10.3.5          Road mapping

10.4       Factors Affecting Image Quality and Radiation Dose

 

Module 11        Mammography

11.1       Breast cancer

11.2       Introduction – Mammography

11.2.1          Clinical applications: Breast Cancer Screening

11.2.2          Physical properties imaged

11.3       Resolution

11.3.1          Pros / cons

11.3.2          Imaging system

11.4       Mammography X-ray Equipment 

11.4.1          X-ray Tube

11.3.2          Image Detectors

11.3.3          Compression

11.3.4          Use of Grids

11.3.5          Image Display

11.5       Magnification Techniques

11.6       Factors Affecting Image Quality and Radiation Dose

 

Module 12        Basic Principles of X-ray Computed Tomography

12.1       Introduction

12.2      Gantry

12.2.1          Slip Rings

12.2.2          Generator

12.2.3          Cooling Systems

12.2.4          X-ray Source

12.2.5          Filtration

12.2.6          Collimation

12.2.7          X-Ray Detectors

12.2.8          Xenon Gas Detectors

12.2.9          Solid-State Crystal Detector

12.2.10       Stellar Detector

12.2.11       Physical properties imaged

12.2.12       Clinical applications

12.2.13       Resolution

12.2.14       Pros / cons

12.2.15       Imaging system

12.3       Gantry configuration

12.4       Data Acquisition

12.4.1          Axial / Sequential Acquisition

12.4.2          Helical acquisition

12.5       Image Display

12.6       Factors Affecting Radiation Dose and Image Quality

 

Module 13        Nuclear Medicine: Introduction & Radionuclides

13.1       Georg Charles de Hevesy: the father of Nuclear Medicine

13.2       Introduction to Nuclear Medicine (NM)

13.2.1          γ emission

13.2.2          β- emission

13.2.3          Isomeric Transition (IT) (or γ Radioactivity)

13.2.4          Internal Conversion (IC)

13.2.5          Positron (β+) and (β+, γ) emission

13.2.6          Electron capture (EC) with X-ray and auger electron emission, and (EC,γ) emission

13.2.7          α emission

13.3       Radionuclides and Radiopharmaceuticals

13.3.1          Reactor-Produced Radioisotopes

13.3.2          Neutron Capture

13.3.3          Cyclotron-Produced Radioisotopes

13.3.4          Radiopharmaceuticals

13.3.5          Generators

13.3.6          Activity Curves for Generators

13.3.7          Characteristics of an Ideal Generators

13.3.8          Radiopharmaceuticals for Therapy Applications

133..9          Desired Properties for diagnostic radiopharmaceuticals

13.3.10       Requirements for all radiopharmaceuticals

13.3.11       GMP in Nuclear Medicine

 

Module 14        Nuclear Medicine Imaging: Detectors and Gamma Cameras

14.1       Detectors

14.2       Gas filled detectors

14.3      Semiconductor detectors

14.4       Scintillation detectors

14.5       Gamma Cameras

14.5.1          Basic Design

14.5.2          Collimator

14.5.3          Solid-State Detectors

14.6       Types of Gamma Cameras and their Clinical Uses

14.7       Imaging Performance

14.8       Quantification

14.9       DICOM

 

Module 15        Planar (2D) Imaging - Scintigraphy

15.1       Introduction: Nuclear Medicine Imaging

15.1.1          Physical properties imaged

15.2       Planar Imaging

15.3       Principles of Image Formation

15.4       Clinical applications

15.4.1          Bone Scintigraphy

15.4.2          Lung Scintigraphy

15.4.3          Cardiac Applications

15.4.4          Thyroid Monitoring

15.5       Resolution

15.6       Pros / cons

15.7       Imaging system

15.8       Quality Assurance for Gamma Cameras

15.8.1          Quality Assurance principles

 

Module 16        Single Photon Emission Computed Tomography (SPECT) and SPECT-CT

16.1       Introduction

16.2       Single-Photon Emission Computed Tomography (SPECT)

16.3       Design and Principles of Operation

16.3.1          Physical properties imaged

16.3.2          Clinical applications

16.3.3          Resolution

16.3.4          Comparison of SPECT and Planar Imaging

16.1.5          Imaging system

16.2       Practical Considerations with SPECT

16.2.1          Attenuation

16.2.2          Chang Uniform Attenuation Correction

16.2.3          Chang Non-Uniform Attenuation Correction

16.2.4          Narrow-beam and Broad-beam attenuation

16.2.5          Scatter Subtraction

16.2.6          The Partial Volume Effect (PVE)

16.2.7          Corrections in Iterative Reconstruction

16.3       Performance and QA of SPECT systems

16.3.1          Acquisition Parameters

16.3.2          SPECT flood-field uniformity

16.3.3          Correction of non-uniformity

16.3.4          Centre-of-Rotation (COR)

16.3.5          Detector Alignment

16.3.6          Attenuation Correction in SPECT

16.4       SPECT-CT

 

Module 17        Positron Emission Tomography (PET)

17.1       Introduction

17.1.1          Physical properties imaged

17.1.2          Clinical applications

17.1.3          Resolution

17.1.4          Pros / cons

17.1.5          Imaging system

17.1.6          PET Detector

17.2       Annihilation Coincidence Detection (ACD)

17.1.6          Time-of-Flight in PET Imaging

17.3      Data Acquisition

17.3.1          Types of Events

17.4       Factors Effecting Resolution & Image Quality

17.4.1          Resolution of PET Imaging

17.5       SPECT vs PET imaging

17.6       Standardised Uptake Value (SUV)

17.7       Quality Assurance for PET Scanners

17.7.1           Important principles in PET QA

17.8       PET-CT

17.9       3D Image Reconstruction for PET-CT

17.19.1         Reconstruction process

17.19.2         Analytic vs Iterative Reconstruction

17.19.2         Filtered back projection (FBP)

17.19.3         Image acquisition (forward projection)

 

Module 18        Non-imaging procedures and QC tests for Nuclear Medicine

18.1       Non-imaging procedures

18.1.1          51Cr red cell labelling procedures

18.2       Quality Control of Nuclear Medicine Instrumentation

18.2.1          Dose calibrator

18.2.2          Geiger-Mueller counter

18.2.3          Ionization chamber

18.2.4          Scintillation (gamma) cameras

18.2.5          Resolution

18.2.6          Count Rate and Dead Time

18.2.7          Field Uniformity

18.2.8          Image Display and Processing

18.2.9          PET Cameras

18.2.10       SPECT/CT and PET/CT Image Registration

18.2.11       QC for the CT component

18.3       NEMA Specifications for Performance Measurements of Scintillation Cameras

18.4       IEC International Standards

18.5       IAEA-NMQC Toolkit

18.6       Radioactive Waste Management

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Module 19        Internal radionuclide dosimetry and radionuclide therapy

19.1       Internal radionuclide dosimetry

19.1.1          Introduction

19.1.2          The MIRD scheme for internal dosimetry

19.1.3          Description of terms

19.1.4          Doses from diagnostic studies

19.1.5          Radionuclide therapy dosimetry

19.2       Radionuclide therapy

19.3       Dose Limits to Radiation Workers and Others

19.3.1          Occupational exposure

19.3.2          Hospital workers

19.3.3          Risk of radioiodine treatment to a foetus

19.3.4          Exposure for the general public

 

Module 20        Nuclear Magnetic Resonance (NMR) – Basic  Principles and Physics

20.1       Introduction

20.2       The History of MRI

20.3       Magnetism

20.3.1          Nuclear magnetic characteristics

20.3.2          Magnetic Susceptibility

20.3.3          Diamagnetism, Paramagnetism, and Ferromagnetism

20.3.4          Radio Frequency Pulse

20.3.5          Radio Frequency Pulse

20.3.6          Resonance

20.3.7          Rotating Frame of Reference

20.3.8          T1, T2, and T2*

20.3.9          TR, TE, and Tissue Contrast

 

Module 21        Tissue Contrast: Some Clinical Applications

21.1       Introduction

21.2       T2 Characteristics

21.3       T1 Characteristics

 

Module 22        Pulse Sequences:  Part I (Saturation, Partial Saturation, Inversion Recovery)

22.1       Introduction

22.2       Saturation

22.2.1          Partial Saturation Pulse Sequence

22.2.2          Saturation Recovery Pulse Sequence

22.2.3          Inversion Recovery Pulse Sequence

22.2.4          Null Point

22.2.5          Clinical Applications of Inversion Recovery

22.2.6          Magnitude Reconstruction

22.2.7          Fat Suppression: STIR Imaging

 

Module 23        Pulse Sequences: Part II (Spin Echo)

23.1       Introduction

23.2       Spin-Echo Pulse Diagram

23.3       Analogy

23.4       Symmetric Echoes

23.5       Asymmetric Echoes

23.6       Tissue Contrast

 

Module 24        Image Construction: Part I (Slice Selection)

24.1       Introduction

24.2       How to Select a Slice

24.3       Slice Thickness

24.4       Cross-Talk

24.5       How to Change the Slice Thickness

24.6       Slice-Select Gradient

 

Module 25        Image Construction: Part II (Spatial Encoding)

25.1       Introduction

25.2       Frequency Encoding

25.2.1          Back Projections

25.2.2          2DFT: 2-Dimensional Digital

25.3       Phase Encoding

 

Module 26        Advanced MRI Imaging, Image Quality, Artefacts, and Safety in MRI

26.1       Factors affecting image quality

26.1.1          Resolution

26.1.2          Contrast

26.1.3          SNR

26.1.4          Effects of flow on signal

26.3       Artefacts

26.3.1          DC offset and quadrature ghost

26.3.2          RF noise

26.3.3          Magnetic field inhomogeneity

26.3.4          Gradient

26.3.5          Susceptibility

26.3.6          RF Inhomogeneity

26.3.7          Motion

26.3.8          Flow

26.3.9          Chemical shift

26.3.10       Partial volume

26.3.11       Wrap around

26.3.12       Gibbs ringing

26.4       Common MR contrast agents

26.5       Clinical applications of different sequences

26.5.1          Metabolic

26.5.2          Anatomic

26.5.3          Flow imaging

26.5.4          Cardiac measurements

26.6       Magnetic resonance spectroscopy

26.7       Diffusion Tensor Imaging (DTI)

26.8       Basic Principles of Diffusion

26.8.1          Brownian Motion

26.8.2          The nature of diffusion

26.8.3          Isotropic Diffusion

26.8.4          Anisotropic Diffusion

26.9       Magnetic Resonance Diffusion-Weighted Imaging

26.9.1          Diffusion-Weighted Imaging

26.9.2          Stejskal-Tanner Sequence

26.9.3          Diffusion Tensor Imaging

26.9.4          Quantitative Parameters of the Diffusion Tensor

26.9.5          Trace and Mean Diffusivity

26.9.6          Fractional Anisotropy

26.10    Post-Processing of DTI Data

26.10.1       Quality of DTI Data

26.10.2       Diffusion Tensor Masks

26.10.3       Visualization of DTI Parameters

26.11    Tractography

26.11.1       Limitations

26.11.2       Tract-Based Spatial Statistics

26.12    Functional Magnetic Resonance Imaging (fMRI)

26.12.1       Application of fMRI?

26.13    MR angiography (MRA)

26.14    MRI Quality Assurance (QA)

26.15    Field Uniformity

26.16    Safety, standards and environmental aspects

26.16.1       Introduction:

26.16.2       How safe is MRI?

26.16.3       Room shielding

26.17    Mechanisms of EM Radiation Interaction and Biological Effects

26.18    Safety Procedures

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PHYS5402 - Radiation Biology and Protection

Syllabus

Preface

The Role of Radiation Biology

History

Module 1   Review of Radiation and Human Biology
1.1Radiation
1.2Ionising radiation
1.3Radiation interactions with matter
1.3.1  Photons

1.3.2  Photoelectric effect

1.3.3  Compton effect

1.3.4  Pair production

1.3.5  Electrons

1.3.6  Neutrons

1.4Human Biology
1.4.1    Introduction on Human Radiation Response

1.4.2    Human Radiation Response

1.4.3    Human Responses to Ionizing Radiation

1.4.4    Composition of the Body

1.4.5    Cell Theory

1.4.6    Molecular Composition

1.4.7    The Human Cell

1.4.8    Cell Function

1.4.9    Cell Proliferation

1.4.10 Mitosis

1.4.11 Meiosis

1.4.12 Tissues and Organs

 

Module 2   The Effect of Radiation on DNA
2.1Introduction
2.2DNA: the target
2.3Direct and Indirect Action of Radiation
2.4Cellular response to ionising radiation
2.4.1  SSB and DSB damage

2.4.2  Consequence of DNA damage

2.4.3  The major pathways of DNA repair

 

Module 3    The Cell Cycle and Mechanisms of Cell Death
3.1 The cell cycle and cellular radiosensitivity
3.2Cell Death
3.3Tumour cell death

Module 4   Quantifying Cell Death
4.1 Introduction
4.2Measuring loss of reproductive ability in cells
4.2.1 Clonogenic assay

4.3Target theory
4.3.1 Single hit single target theory

4.3.2 Single hit multiple target theory

4.3.3 Introduction to the Linear Quadratic model

4.4Cell survival curves

Module 5   Characterization of Radiation Damage
5.1Characterisation of radiation damage
5.1.1  Lethal damage

5.1.2  Sublethal damage (SLD)

5.1.3  Potentially lethal damage (PLD)

5.1.4  Non-lethal damage

5.1.5  Summary

 

Module 6   LET and RBE
6.1Linear energy transfer (LET)
6.2Relative biological effectiveness (RBE)
6.2.1                Definition

6.2.2                RBE as a function of LET

 

Module 7   Tumour Biology
7.1Normal cells versus malignant cells
7.1.1                Self—sufficiency in growth signals

7.1.2                Insensitivity to antigrowth signals

7.1.3                Evasion of apoptosis

7.1.4                Unlimited replicative potential

7.1.5                Sustained angiogenesis

7.1.6                Tissue invasion and metastasis

7.2Tumour growth characteristics
7.2.1                Tumour kinetic parameters

7.2.2                Tumour composition and characteristics of tumour cells

7.3Tumour angiogenesis
7.3.1                Early research

7.3.2                Characteristics of tumour vasculature

 

Module 8     Factors influencing local tumour control– the 5 Rs
8.1Tumour behaviour during radiotherapy
8.2The 5 Rs of radiobiology
8.2.1                Repair

8.2.2                Repopulation

8.2.3                Redistribution

8.2.4                Reoxygenation

8.2.5                Radiosensitivity

 

Module 9     The Effect of Oxygen
9.1Introduction
9.1.1                The oxygen ‘fixation’ hypothesis

9.2Hypoxia Definitions
9.3 Oxygen Enhancement Ratio (OER)
9.3.1                OER as a function of LET

9.4 Methods to detect (measure) tumour hypoxia
9.5 Methods to overcome tumour hypoxia

Module 10     Normal Tissue Response to Radiation
10.1Radiation response and tolerance of normal tissue: early versus late effects
10.2Functional sub—units (FSU)
10.3Clinical response of normal tissue
10.3.1             Skin

10.3.2             The hematopoietic system

10.3.3             Lung

10.3.4             Spinal cord

10.4Volume effects in normal tissues
10.5Bystander effect and adaptive response
10.5.1             Bystander effect

10.5.2             Adaptive response

10.5.3  Conflicting phenomena at low—doses:

10.6Medical dictionary

Module 11     Predictive assays and disease staging
11.1Introduction
11.2Predictive assays
11.2.1  Predictive assays for tumour response

11.2.2  Predictive assays for normal tissue response

11.3Disease staging
11.4Glossary — tumour volume

Module 12     Modelling in Radiobiology
12.1Introduction
12.2Administered dose
12.2.1             Dose response curves

12.2.2             Dose volume histograms

12.2.3             In vivo dosimetry

12.3Tumour control vs. healthy cell damage
12.3.1             NTCP

12.3.2             TCP

 

Module 13     Fractionation – the LQ Approach
13.1Introduction
13.2Linear Quadratic Model
13.3Surviving Fraction at 2 Gy
13.4Biologically effective doses (BED) in radiotherapy
13.4.1             Continuous Hyperfractionated Accelerated Radiation Therapy (CHART)

 

Module 14    Specialized Radiotherapy Treatments
14.1Introduction
14.2Radiobiology in specialized radiotherapy treatments
14.2.1             Stereotactic Radiosurgery (SRS) and stereotactic radiation treatment (SRT)

14.2.2             Brachytherapy

14.3Adjuvant therapies in the treatment of cancer
Chemotherapy

Hyperthermia

 

Module 15     Health Effects of Exposure to Ionising Radiation
15.1Introduction
15.2Deterministic and stochastic effects of radiation
15.2.1 Deterministic effects

15.2.2 Stochastic effects

15.3Detriment
15.4Probability of Carcinogenesis from Low—Level Exposure
15.4.1             Types of study

15.4.2             Dose-­‐Response Models

15.4.3             Measures of Risk

15.4.4             Assignment of Causation

15.4.5             Statistical methods

15.4.6             Probability of Causation

15.5Mutagenesis Risk from Low—Level Exposure
15.6High—Level Exposure
15.7References

Module 16     Radiation Protection Quantities and Units
16.1Introduction
16.2Absorbed dose
16.3Radiation weighting factors
16.4Equivalent dose
16.5Tissue weighting factors
16.6Effective dose

Module 17    Introduction to Radiation Protection - Dose Limits
17.1Introduction
17.2International Bodies
17.3Internationally recommended dose limits
17.4Australian dose limits
17.4.1             Schedule 1 - Dose limits and maximum permissible exposure levels

17.5United States dose limits
17.6Occupational Exposure

Module 18     Shielding Calculations in Medical Radiation Equipment Installation
18.1Introduction
18.2Limiting exposure
18.3Shielding Design Considerations of High Energy Therapy Machines
18.3.1             Doors

18.3.2             Neutrons

18.4Estimating the Barrier Thickness
18.4.1             Primary Radiation Barrier

18.4.2             Secondary Radiation Barrier for Leakage Radiation

18.4.3             Secondary Radiation Barrier for Scattered Radiation

18.4.4             TVL calculation method

18.4.5             Doors and Mazes

18.5Radiological Survey

Module 19    Personnel Protection and Radiation Monitoring
19.1Introduction
19.2Protection of Workers and Patients
19.3Film Badges
19.4Pocket Dosimeters
19.5Storage Phosphor Badges (TLD and OSL)
19.5.1             TLDs for personnel monitoring

19.5.2             Optically Stimulated Luminescence

19.6Biological dosimetry
19.6.1             Short term methods

19.6.2             Long term methods

 

Module 20    Radiation Accidents and Incidents
20.1Introduction
20.2Accident: Chernobyl
20.3Accident: Fukushima—Daiichi
20.4Other Incidents and Accidents

Module 21    WA Radiation Protection Legislation
21.1The Need for Legislation
21.2Australian Radiation Protection
21.3Western Australian Legislation
21.4WA Radiation Safety Act 1975
21.4.1   Application of Act and exemptions

21.5WA Radiation Safety (Qualifications) Regulations 1980
21.6WA Radiation Safety (Transport of Radioactive Substances) Regulations 2002
21.7WA Radiation Safety (General) Regulations 1983
21.8The future harmonisation of radiation safety in Australia

Module 22    WA Radiation Safety Regulations
22.1Part I — Preliminary
22.2Part II — General precautions and requirements relating to radiation safety
22.3Part III — Radioactive substances
22.4Part IV — Irradiating apparatus
22.5Part V — Electronic products
22.6Part VI — General
22.7Schedule I
22.7.1             References

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PHYS5403 - Radiotherapy Physics

Syllabus

Module 1    Review of Radiation Physics
1.1    Introduction to Radiation Oncology Physics
1.2    Different uses of radiotherapy 
1.3    Review of physical quantities and units 
1.4    Radiation and radioactivity
1.4.1  Classification of radiation
1.4.2. Radioactivity
1.5    Interaction of ionizing radiation with matter
1.6    Electron Interactions
1.7    Attenuation of radiation

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Module 2    Radiobiological Basis for Radiotherapy
2.1    Introduction: cancer
2.2    Biology of cells and their response to radiation
2.2.1  Quality of radiation deposited in cell
2.2.2  Effects of radiation on biological tissues
2.3    Measurement of radiation damage
2.4    TCP, NTCP and therapeutic ratio
2.5    Oxygen
2.6    Fractionation in radiotherapy

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Module 3    Calibration Protocols
3.1    History
3.2    Introduction
3.3    Calibration Protocols
3.3.1  Historical Perspective
3.3.2 Radiation Treatment Parameters
3.3.3 Inverse square law
3.3.4 KERMA
3.3.5 ABSORBED DOSE
3.3.6  Air kerma in air method (TRS-277): A Primary standard
3.3.7  The Australasian Protocol
3.3.8  Absorbed dose determination in external beam radiotherapy (TRS-398)
3.3.9 Measurement of Dose Distribution
3.3.9.1  Beam Profiles
3.3.9.2. Depth Dose Curves (penetration of photon beams into a phantom or patient)
3.3.9.3. Buildup region
3.3.9.4. Depth of dose maximum zmax
3.3.9.5. Exit dose
3.3.9.6. Isodose Charts
3.3.10 Penetration of Photon Beams into a Phantom or Patient
3.3.11 Surface dose

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Module 4    Radiotherapy Treatment Machines I: Overview
4.1    Overview
4.2    Historical introduction
4.3    X-ray generators
4.4    Bremsstrahlung
4.4.1 Heat
4.5    Thin-target and thick-target bremsstrahlung radiation
4.6    The continuous spectrum emitted by thick targets
4.7    Gamma ray beams and gamma ray units
4.7.1     Introduction
4.7.2     Construction of a 60Co Teletherapy Unit
4.7.3     Generation of a beam by a 60Co unit
4.7.4     Radiotherapy in Low and Middle Income Countries
4.8    Choice of Radiation Beam and Prescribed Target Dose

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Module 5    Radiotherapy Treatment Machines II: Particle Accelerators
5.1    Introduction
5.1.1 Particle Accelerators in Medicine
5.2    High energy (megavoltage) machines – design considerations
5.3    Betatron
5.4    Cyclotron

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Module 6    Radiotherapy Treatment Machines III: Linacs
6.1    Medical linear accelerator: Principle of operation
6.2    Structure of medical linear accelerators
6.3    Medical linear accelerator: generators
6.3.1 The electron gun (injection system)
   6.3.2  RF power generation system
6.4    Medical linear accelerator: Accelerating structure
6.4.1  Accelerating waveguide
6.4.2  Steering coils
6.5    Medical linear accelerator: Beam delivery system
6.5.1 Auxiliary systems
6.5.2 Beam transport system
6.5.3 Treatment head
6.5.4 X-ray target
6.5.5 Flattening filter
6.5.6 Beam monitoring system
6.5.7 Beam collimation
6.5.8 Primary or fixed collimator
6.5.9 Secondary collimator (Jaws)
6.5.10 Multileaf collimators
6.6    Production of clinical electron beams in a linac
6.6.1 Field shaping
6.7    Safety in beam delivery

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Module 7     Specification and Acceptance Testing of a Linear Accelerator
7.1     Accelerator specifications and machine-selection criteria
7.2    Measurement Equipment
7.2.1 Radiation survey equipment
7.2.2 Ionometric dosimetry equipment
7.2.3 Other dosimetric detectors (film, diodes)
7.2.4 Phantoms 
7.3    Acceptance Tests
7.3.1 Acceptance Tests of Radiotherapy Equipment: Characteristics
7.3.2 Safety checks
7.4    Radiation Survey
7.5    Leakage Tests
7.5.1 Collimator and head leakage
7.5.2 Mechanical Checks
7.5.2.1 Collimator axis of rotation
7.5.2.2 Photon collimator jaw motion
7.5.2.3 Congruence of light and radiation field
7.5.2.4 Gantry and couch axis of rotations
7.5.2.5 Radiation isocentre
7.5.2.6 Optical distance indicator
7.5.2.7 Gantry angle indicators
7.5.2.8 Collimator field size indicators
7.5.2.9 Patient treatment table motions
7.5.3    Dosimetry Measurements for Radiation Beam Performance
7.5.3.1 Photon energy
7.5.3.2 Photon beam uniformity
7.5.3.3 Photon penumbra
7.5.3.4 Electron energy
7.5.3.5 Electron beam bremsstrahlung contamination
7.5.3.6 Electron beam uniformity
7.5.3.7 Monitor characteristics
7.5.3.8 Arc therapy

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Module 8    Commissioning of a Linear Accelerator
8.1    Introduction
8.2    Characterising the beam
8.2.1 Central axis percentage depth doses (PDDs)
8.2.2 Transverse beam profiles
8.2.3 Wedge Profile Data
8.2.4 Output factors
8.2.5 Blocking tray factors and other attenuation factors
8.2.6 Central axis percentage depth doses values
8.2.6.1 Penumbra
8.2.6.2 Output factor
8.2.6.3 Leakage

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Module 9    Beam Data Acquisition
9.1    Beam data acquisition system (BDAS)
9.1.1 Water phantom
9.1.2 Field and reference probes
9.1.3 Electrometer and controller
9.1.4 Computer
9.1.5 Equipment required
9.2    Data collection program
9.2.1 BDAS Parameters Which can Affect Data
9.2.2 Procedure
9.2.3 Responsibility

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Module 10    Quality Assurance of Treatment Machines
10.1     Introduction
10.1.1 Definitions
10.2     Legal obligations
10.3     Secondary standard equipment
10.3.1 Ionisation chamber
10.3.2 Measuring assembly (electrometer)
10.3.3 Portable stability check source
10.4     Transfer of secondary standard to field instruments
10.4.1 Cross-calibration of field ionization chambers
10.5     Method of calibration of superficial X-ray therapy treatment (SXRT) and deep X-ray therapy treatment (DXRT)
10.6     Method of calibration of high energy machines
10.7     Quality assurance tests on radiotherapy treatment machines

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Module 11     Treatment Planning Techniques: Planning Computer& Beam Models
11.1     Background & History 
11.2     Introduction
11.2.1 Principal hardware components of a Treatment Planning (TP) system
11.2.2 TP hardware systems can be classified into
11.2.3 Software of a TP system includes components
11.3     Treatment planning algorithms – beam models
11.4     Photon Dose Calculation: Algorithmic Methods
11.5    Kernel Based Algorithms
11.6    Ray Tracing
11.7    Pencil Beam
11.8    Steps in computing pencil beam dose
11.9    Convolution / Superposition Algorithms
11.10    Steps in computing convolution/superposition dose
11.11    Boltzmann Transport Equation
11.12    Steps in computing Boltzmann Transport Equation dose (Acuros)
11.13    Monte Carlo (MC)
11.14    Steps in computing Monte Carlo Dose
11.15    Techniques for accelerating Monte Carlo calculations
11.16    Calculation in a heterogeneous medium
11.17     TAR planning tools (power law and equivalent)
11.18     Use of CT in radiotherapy treatment planning
11.19     Quality assurance in Treatment planning

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Module 12    Treatment Planning Techniques: Monte Carlo and Superposition /Convolution Models
12.1     Introduction
12.2     The Monte Carlo simulation process
12.3     Sampling using random numbers
12.4     Example Monte Carlo system
12.5     Theory of superposition
12.6     Comparison with experimental results (limitations of model-based algorithms)
12.7     Benchmarking Photon Dose Calculations
12.8     Summary

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Module 13    Patient Treatment Planning
13.1     The process of radiation therapy and definitions related to patient planning
13.1.1 Target volume definition
13.2     Patient data acquisition
13.3     X-ray simulator
13.4     CT simulator
13.5     Imaging Moving Anatomy
13.6     Four-dimensional Computed Tomography Scanning
13.7     Cone-Beam Computed Tomography
13.8     Treatment planning room
13.9     Mould room
13.10    Conclusion

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Module 14     Treatment Delivery Techniques: Photon Single Beam
14.1     Introduction 
14.2     Direct patient dose calculations
14.2.1 In-Vivo Dosimetry
14.2.2 Purpose of In-Vivo Dosimetry
14.2.3 In-Vivo Dosimeters
14.3     Methodology
14.4     Skin Dose Measurements
14.5     Entrance Dose Measurements
14.6     Exit Dose Measurements
14.7     Alteration of isodose curves by contour shape and tissue inhomogeneities
14.7.1 Single field isodose distributions in patients
14.7.2 Corrections for contour irregularities
14.7.3 Corrections for tissue inhomogeneities
14.8     Beam modifying devices
14.8.1 Wedge Filters
14.8.2 Compensating filters (Tissue Compensation)
14.8.3 Bolus/energy degraders
14.9      Energy absorption in tissue and integral dose
14.10     Multiple Beam Combinations
14.10.1 Objectives
14.10.2 Introduction
14.10.3 Weighting and normalization
14.10.4 Fixed source to surface distance versus isocentric techniques
14.11     Patient dose distribution using opposing pairs of beams and combinations of opposing pairs
14.12     Prediction of dose distribution for angled field, wedge pairs, three field technique and rotation therapy
14.13     Rotational techniques

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Module 15    Photon Treatment Delivery: Conformal Radiotherapy 1
15.1     Introduction 
15.2     Principles of conformal radiotherapy
15.3     Implementation of CFRT and IMRT
15.4     Intensity modulated radiotherapy (IMRT)
15.5     Wedges
15.5.1  Physical Wedges
15.5.2  Flying Wedges
15.5.3  Dynamic Wedges
15.6     Multi leaf collimators
15.7     Dose accuracy and uncertainty, quality assurance

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Module 16     Photon Treatment Delivery: Conformal Radiotherapy 2
16.1     Introduction to modern conformal radiotherapy techniques
16.1.1  Volumetric Intensity Modulated Arc Therapy (VMAT)
16.1.2  Tomotherapy and Real-time tracking

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Module 17    Treatment Planning & Delivery for Electron Therapy
17.1    Introduction 
17.2    Physical aspects of the electron beam
17.2.1  Output Calibration
17.2.2 Central axis Depth Dose Curves
17.2.3 Absorbed dose build-up
17.2.4 Isodose distribution
17.3    Field shaping
17.4    Bolus
17.5    Treatment planning
17.6    Electron arc therapy
17.7    Whole body electron irradiation (Total Skin Irradiation)

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Module 18     Treatment Delivery Verification
18.1     Equipment Used in External Beam Radiotherapy: A summary
18.2     Introduction
18.2.1  Accidents in radiotherapy
18.3     Checking the patient chart
18.4     Radiation therapy plan checks
18.5     Structure of an equipment quality assurance program
18.6     Machine operation
18.7     Portal imaging
18.7.1  Electronic Portal Imaging Devices EPIDs (MV imagers)
18.7.2  Why are EPIDs important?
18.7.3  Imager calibration
18.7.4  Applications of EPIDs
18.8     In-vivo measurements 
18.9     Gel dosimetry
18.10     Record and verify system
18.11     Implementation of the record and verify system
18.12     Biological modelling
18.13    Radiotherapy Treatment Side-Effects

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Module 19     Special Techniques in Radiotherapy 1
19.1     Introduction
19.2     Superficial and Orthovoltage
19.3     Intra-operative radiotherapy
19.3.1 Orthovoltage X-rays
19.3.2 Superficial X-rays
19.4     Stereotactic Radiotherapy
19.5     Stereotactic Body Radiation Therapy
19.5.1 History
19.5.2 SBRT/ SABR
19.6     Total body irradiation
19.7     Flattening filter free beams
19.8     Image-Guided Radiation Therapy (IGRT)
19.8.1 ExacTrac/Novalis Body System
19.9     Respiratory Gating
19.9.1 Four-dimensional Computed Tomography
19.10     CyberKnife
19.11     Tomotherapy
19.12     A Hybrid Linac MRI System (MR-Linac)
19.12.1 Benefits of MRI
19.12.2 FLASH radiotherapy: Aims to reduce radiotherapy toxicity

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Module 20    Special Techniques in Radiotherapy 2
20.1     Introduction
20.2     Proton beam therapy
20.3     Light and Heavy Ion Therapy
20.4     Neutron generators
20.5     Unsealed Sources

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Module 21    Principles of Brachytherapy I
21.1     Introduction
21.2     Overview of brachytherapy
21.3     Brachytherapy compared to EBRT
21.4     Sources and applicators (LDR, PDR, HDR)
21.5     Radiation protection and patient monitoring
21.6     LDR seeds
21.7     Brachytherapy for breast cancer

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Module 22    Principles of Brachytherapy II
22.1     Introduction
22.2     Principles of brachytherapy dosimetry
22.3     Dose prescription and reporting in brachytherapy
22.3.1 Intracavitary treatments
22.3.2 Interstitial treatments
22.4     Brachytherapy planning
22.5     Calculation of actual treatment dose and dose optimization
22.6     Source storage and transportation