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Conventional Linear Accelerators
A linear accelerator (LINAC) is the device frequently used for external beam radiation treatments for patients with cancer. Linear accelerator machines produce radiation that is referred to as high energy X-ray.The radiation therapy works by focusing high-energy gamma ray or electron beams onto cancer cells. The radiation destroys the cancer cells which are more affected than non-cancerous tissues. Linear accelerators are, as a rule, multi-modality ionizing radiation generators with associated imaging devices, used for delivery of exterior beam radiotherapy.
The following characteristics are included in linear accelerators: multileaf collimator (MLC) for beam shaping, capability to deliver intensity modulated radiotherapy (IMRT) and a 3D image guidance system (IGRT). The linear accelerator also provides an electronic portal imaging system for imaging treatment beams.
Optional/additional features may be incorporated into the linear accelerators, including: arc-based IMRT Delivery, total body irradiation, high-dose rate electrons, etc.
Although linear accelerators are expensive, their usability and longevity makes them relatively cost-effective compared with the other treatment alternatives.
The operation of linear accelerators should be according to the existing standards and regulations which include: standard guidelines for radio therapy room design, IEC standards, radiation regulations, etc.
Technical Considerations
The technology used is fundamentally the same for all linear accelerators. Recent linear accelerators are planned to facilitate intensity- modulated radiotherapy (IMRT), which is a dynamic delivery method which allows good control of the three-dimensional dose distribution: the distributed beam instead of being flat, modifies the intensity at several points within the beam.
There are 3 types of linear accelerator IMRT delivery techniques:
• Step and shoot method: this method consists of delivering a series of different shape fields formed by the MLC to build up a variable intensity pattern. The irradiation is stopped between each field.
• Dynamic MLC methods: the MLC leaves move across the field at variable speeds, but the radiation remains unvarying.
• Arc therapy methods: the radiation runs continuously and the gantry collimators and MLC leaves move continuously. The dose rate also varies during the delivery. Treatments are delivered in an arc (or sometimes in two arcs). This is arguably the best choice for IMRT.
The linear accelerators’ three-dimensional imaging systems can be operated in three distinctive ways:
1. Applying diagnostic x-ray cone beam, in plain or orthogonal to the linear accelerators’ high energy beam.
2. Using the high-energy treatment cone beam of the linear accelerator.
3. Using a CT machine combined with the linear accelerator.
Recording and Verification Systems
In contemporary radiotherapy units, the linear accelerators are operated using record and verify systems, which efficiently deliver and record the treatments.
These systems are typically connected to the general information network, which record many functions, including: booking and scheduling, recording of patient notes, recording costs, image handling etc.
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