The Modern Technology of Radiation Oncology, Vol 1

Author:  Jacob Van Dyk
ISBN:  9780944838389      ISBN10:  0944838383
Published:  1999 | 1072 pp | Hardcover

Price:   $ 175.95


Interactions, The Newsletter of the COMP  |  April 2000

“This rather lengthy volume (1072 pages) represents a comprehensive compendium detailing (a) the design of various technologies in radiation oncology, and (b) procedures to implement into a clinical setting, and (c) the associated quality assurance (QA) procedures to maintain the technologies at acceptable levels. The book describes the technologies that are common in most radiation oncology centers, as well as, some more specialized technologies that would be available at specific centres. There are fifty-six expert contributors to this book resulting in twenty-five distinct chapters. Because the book addresses timely issues that are not easily found in a regular literature search, the book fills a big void in the medical physics literature, and should therefore be considered an important addition to the library of any medical physicist. Furthermore, if there would be a book (in addition to Johns and Cunningham) that would fulfill most of the study requirements for the CCPM Membership and Fellowship examination in Radiation Oncology Physics, this is it.

“The first two chapters of the book are general in nature. The book starts with an overview of radiation oncology, tissue response to radiation, dose accuracy achievable and that recommended, and nicely describes the responsibilities of all professional involved with Radiation Oncology. Chapter 2 is rather unique, in that it is probably the only published book chapter that deals with general QA concepts, manufacturer’s rather enhanced QA procedures, and total quality management, in general, and in radiation oncology in particular. A list of national societies, clinical trials groups, codes of practice, guidelines and reports are also given. This chapter is especially recommended because the information contained is not usually conveniently available.

“Chapters 3 to 13 discuss basic clinical technologies of radiation oncology. These are respectively, patient immobilization techniques, projection simulators, simulator-CTs, general imaging technologies, computerized treatment planning systems, kilovoltage x-ray systems, Co- 60 teletherapy, medical accelerators, intensity modulation, and megavoltage radiography. Chapters 14 to 19 discuss more specialized techniques such as tomotherapy, stereotactic radiosurgery, total body irradiation and brachytherapy. Chapters 20-25 contains descriptions of specialized therapies that are limited to a restricted number of centers, many of which are undergoing clinic trials: proton and neutron therapy, hyperthermia and photodynamic therapies.

“There are some minor concerns with the book (Reviewers of books must find concerns to complete their tasks). They involve (1) the content and (2) the form of the book.

“For content, 1. I find that the level of detail between different chapters is not consistent. The discussion in some chapters is very detailed and this is appropriate for this type of book, while some chapters give brief overviews. Furthermore, QA worksheets or the equivalent are not available for all chapters. The same level of description and detail should be implemented throughout the book for consistency.

“For form, there are some minor issues: 1. Grey-scale images are very poor throughout the book, and not appropriate for this type and price of book. 2. Chapter headings and sub-chapter headings are in gray. This is distracting, perhaps the use of conventional bold would be more appropriate. 3. Since the book is a compilation of various contributors, and as is commonly done for books that are edited, the names of contributors should be included on the headings of each chapter page. This facilitates the task of readers when searching for authors. 4. Chapters should be re-arranged a little differently. Chapter 15 on Tomotherapy describes a very new technique that is not commercially available. It would have been more appropriately placed towards the end of the book where merging technologies are discussed rather than between chapters on radiosurgery and information systems. Chapter 19 which describes basic tools required for all radiation-delivery technologies, should have been placed immediately after Chapter 2 or Chapter 3.

“This book represents a comprehensive review of all technologies involved in conventional and state-of-the art radiation therapies, with extensive references at the end of each chapter for further study. Despite the concerns described above, it was certainly a pleasure ‘flipping’ through the pages of this superb reference compendium. It is highly recommended for all university medical libraries and for all medical physics and radiation oncology departments. It would be indispensable for graduate medical physics students, and particularly useful for the practitioner and researcher in medical physics and radiation oncology.

“For readers who wish, the following is a chapter by chapter description of the book for Chapters 3 and beyond.

“Chapter 3 contains a discussion on rationale for patient immobilization and a thorough review of immobilization techniques and assessment of motion. Chapter 4 contains a review of simulator technology and a discussion on QA and commissioning. The role, design, practical considerations, commissioning and QA of CT simulators are given in Chapter 5. This chapter also contains a comparison of the simulator, CT simulator and simulator CT. The use, specifications QA and commissioning of CT-simulators are given in Chapter 6. Overviews of Magnetic Resonance Imaging, Nuclear Medicine and Ultrasound imaging technologies are discussed in Chapter 7. Chapter 8 contains a complete discussion of computerized radiation treatment planning with reference to: implementation of dose algorithms, system design and specifications, and some practical considerations (e.g., staffing, 3D vs. 2D, etc.). There is also a detailed review of the tendering, QA and commissioning processes involved with external beams and brachytherapy. An interesting discussion on the administration of QA is given.

“Tendering, physical and clinical commissioning and QA processes for kilovoltage x-ray therapy are given in Chapter 9. Chapter 10 describes the design of Co-60 units and the associated shielding requirements. Specification, commissioning and QA procedures are discussed with emphasis on some special topics (i.e., issues associated with penumbra, beam energy and dose uniformity, etc.).

“Chapter 11 presents a very complete description of medical accelerators, which would be recommended for graduated students in medical physics. The description involves: an overview of megavoltage accelerators, the design of the various components comprising a megavoltage linacs, a description of the photon and electron beams from linacs, and an outline of shielding considerations and design for medical linacs. Detailed specification, tendering, installation and acceptance issues are discussed. The commissioning of x-rays and electrons and subsequent calibration are also given, as well as QA and safety considerations. The chapter contains an Appendix offering a mathematical description of microwave propagation, phase/wave velocity of electrons, and capture conditions; and a discussion of pulsed operation and target/flattening filters.

“Chapter 12 discusses wedges (internal, dynamic) and missing tissue compensators, and in particular, fan-beam modulation with a commercial system (MIMiC and Peacock from Nomos Corp.) And cone-beam modulation. The appendix outlines calculations for internal and dynamic wedge dosimetry, velocity and areal modulation, etc. Chapter 13 contains a general discussion of portal films and electronic portal imaging devices. Also discussed are overviews of image registration procedures and clinical use of megavoltage imaging. Chapter 14 discusses rather a recent addition to clinical radiation oncology: information systems management with special consideration of clinical operations.

“Chapters on specialized techniques then follow. Chapter 15 presents Tomotherapy with discussion on processes (optimization, image reconstruction, dose/treatment verification, etc.) data acquisition and control, dosimetry (detectors and phantom) and clinical considerations. The clinical discussion involves conformal and conformal avoidance radiotherapy and it’s potential application; and installation and shielding of the system. All aspects of Stereotactic Irradiation are then discussed in Chapter 16 with reference to various forms of Gamma units and Linacs. This involves, among others, discussion of ancillary equipment and techniques, radiation protection issues, treatment plan evaluations, QA and commissioning issues and analysis of various options. Special Techniques then follow with three sub-chapters in Chapter 17: Total body photon irradiation, Total skin electron irradiation and Intraoperative radiation therapy. In each subchapter is discussed relevant to each technique, physical and clinical requirement, diseases treated, current treatment application, selection of options, commissioning and associated QA procedures.

“Chapter 18 covers Brachytherapy. A discussion of program design is followed by a comparison of radionuclides used in the field. Manual, remote after loading and intravascular brachytherapy is discussed with respect to features, commissioning and QA procedures. Chapter 19 contains a discussion on considerations for dose measurements, and various phantom materials. This is followed by descriptions of every possible radiation detector that can be used in the field.

“The remaining Chapters 20 to 25 contain descriptions of specialized therapies that are limited to a restricted number of centers, many of which are undergoing clinical trials. Chapters 20 and 21 are entitled Proton Therapy and Neutron Therapy, respectively. The chapter on Proton Therapy describes the equipment (e.g., accelerators, modulation, gantries, verification, etc.), and the facilities (e.g., shielding, computer network, dosimetry laboratory, calibration, etc.) required in this type of therapy. This is followed by a comprehensive discussion of purchase considerations, specifications and acceptance testing, calibration and commissioning, and a timetable for recommended QA procedures. The chapter on Neutron Therapy contains discussion on the reactions and cyclotrons used for fast neutron therapy. This is followed by discussion of specifications of the beam itself, patient dose monitoring and regulatory requirements. There are also discussions on purchase requirements, various acceptances and commissioning procedures, QA and preventive maintenance procedures.

“A general description of Hyperthermia technology follows in Chapter 22A. The methodology of Total Hyperthermia is briefly presented in Chapter 22B. The principles and applications of Photodynamic Therapy are introduced in Chapter 23. This chapter also contains a discussion of light sources and delivery, and of dosimetry. QA, commissioning and safety considerations are then discussed with reference to spectral, power, irradiance and fluence considerations. A discussion on Boron Neutron Capture Therapy is presented in Chapter 24. Neutron interactions and approaches to neutron beam design are introduced. This is followed by a discussion of various criteria for beam evaluation and for beam control and monitoring. Computational microdosimetry, treatment planning, and current clinical experience are then discussed. The final Chapter 25 contains a discussion on Monoclonal Antibodies and Other Internal Emitter Therapies. This includes a general overview of the use of internal emitter therapy processes, the QA for the production of the associated radiopharmaceuticals and the process of selecting the appropriate patient for the therapy. This is followed by a discussion of procedures to estimate the activity and the absorbed dose in the patient.”

B.G. Fallone

Cross Cancer Institute

University of Alberta

Edmonton, Canada