Medical Radiology and Radiation Safety. 2026. Vol. 71. № 5
TECHNICAL SPECIFICATIONS OF RADIOTHERAPY EQUIPMENT FOR CANCER TREATMENT
The book Technical Specifications of Radiotherapy Equipment for Cancer Treatment is a textbook intended for students and academic staff. The proposed edition is a Russian translation of a contemporary publication by the World Health Organization and the International Atomic Energy Agency. The translation was prepared at Kuban State University in 2025 under the general editorship of N. M. Bogatov, Doctor of Physical and Mathematical Sciences; A. L. Eremin, Doctor of Medical Sciences; L. R. Grigoryan, Candidate of Physical and Mathematical Sciences; M. S. Kovalenko, Candidate of Physical and Mathematical Sciences; A. V. Klenevsky; N. E. Bey; and G. D. Efremov. The textbook is intended for students enrolled in the programs “Biotechnical Systems and Technologies” and “Medical Physics” and may also be useful to practicing professionals.
The contents cover general information and technical specifications for external beam radiotherapy equipment, medical electron linear accelerators, gamma therapy units, CT simulators, treatment planning systems, oncology information systems, and patient immobilization equipment; as well as technical specifications for dosimetry and quality control equipment and radiation protection equipment. In addition, the book addresses technical specifications for orthovoltage X-ray units, brachytherapy equipment, C-arm fluoroscopy systems, and ultrasound imaging systems. Attention is also given to establishing a radiotherapy service, project management, procurement, equipment operation and life-cycle management, patient safety, and quality management. Separate chapters are devoted to the education and training of healthcare professionals in radiotherapy, the implementation of new technologies, image-guided radiotherapy and adaptive radiotherapy, hypofractionated radiotherapy, and stereotactic radiotherapy. Specialized linear accelerators, proton therapy, and ion therapy are also discussed.
The document includes a list of abbreviations, 11 appendices containing technical specifications and a corresponding list of appendices, a list of the titles of 16 figures, a list of the headings of 22 tables, and a list of abbreviations and acronyms. These lists, provided at the beginning of the textbook, give readers a useful overview of the material presented and facilitate navigation through the publication.
The sections follow a consistent structure. Each section begins with a general description, purpose, and characteristics of the relevant technical unit. This is followed by a list of standards and requirements applicable to the particular type of equipment and then by detailed technical specifications that can assist purchasers in selecting and procuring equipment.
The translation accurately reflects the content of the original publication. For example, Section 3.2 (technical specifications for linear accelerators) discusses total body irradiation (TBI) used in the treatment of patients with leukemia. A standard treatment technique involves an extended source-to-skin distance. This allows the divergent radiation beam to encompass the entire body of a patient positioned on their side or back. Recommendations are provided for designing treatment rooms so that one of the walls is located at least 4 metres from the isocentre, corresponding to a source-to-wall distance of 5 metres for a horizontal beam. This recommendation is particularly valuable for professionals learning this technique, since single-session irradiation at a low dose rate at the specified distances reduces the incidence and severity of complications compared with irradiation performed at shorter distances, at or near the isocentre.
All figures, tables, and diagrams contain labels in Russian. Images of accelerators produced by the major manufacturers, Varian and Elekta, are presented, with the principal components identified. Recommendations concerning the selection of radiation energy for accelerators to be procured are provided and substantiated. Tables present the main dosimetric characteristics of accelerator beams and may assist institutional management in equipment procurement decisions. Technical specifications are given for accelerators operating at one or several energies. The book also discusses radiation protection of personnel from short-lived neutron activation products generated in structural components of the linear accelerator head immediately after irradiation with a high-energy photon beam.
Section 3.3 addresses technical specifications, radiation safety issues, and quality assurance for cobalt-60 (⁶⁰Co) radiotherapy units, which are still used in modern radiotherapy departments, predominantly in the form of equipment manufactured in Canada and the Czech Republic. Russian-manufactured gamma therapy units have been dismantled in virtually all radiotherapy departments in Russia.
Section 3.4 is devoted to CT simulators. It emphasizes the need for a large CT simulator bore to accommodate patients positioned using immobilization devices, as well as the need for a flat carbon-fibre tabletop with identical indexing for all types of radiotherapy immobilization systems and indexing compatible with the linear accelerators and/or cobalt-60 teletherapy units used in the radiotherapy department. These two features distinguish CT simulators and CT scanners intended for radiotherapy from diagnostic CT scanners. Relevant standards and technical specifications for the procurement of simulators for radiotherapy are provided. It would be advisable to rename Section 3.6 “Technical Specifications for External Beam Radiotherapy Treatment Planning Systems.” Section 3.8 addresses the main characteristics and specifications of immobilization devices, while Section 3.9 provides technical specifications for the mould room, where individualized equipment and accessories for the radiotherapy of cancer patients are manufactured.
Section 3.10 presents technical specifications for dosimetric quality-control equipment used with electron linear accelerators and gamma therapy units. This includes reference dosimetry equipment and equipment for relative dosimetry, such as radiochromic film and electronic two-dimensional detector arrays. The list also includes dosimetric equipment for in vivo dosimetry and various tools for verifying the performance of imaging, optical, and mechanical components of treatment and simulation equipment. Relevant standards and specification tables are provided.
Section 3.11 provides technical specifications for radiation protection equipment. For electron linear accelerators producing photon beams of 10 MV or higher, access to a neutron survey meter is required. In such cases, neutron dose measurements must be performed at the entrance to the treatment room during commissioning and subsequently as required. Section 3.12 is devoted to X-ray equipment.
Section 4 contains technical specifications for brachytherapy equipment, including specifications for automatic source afterloading systems, C-arm fluoroscopy units, ultrasound imaging systems, dosimetry and quality-control equipment, and radiation protection equipment.
Section 5 addresses the complex issues involved in establishing a radiotherapy service, including project development and implementation, equipment procurement and life-cycle management, and the training of healthcare professionals for radiotherapy. Importantly, Section 5.3 discusses radiation incident reporting and learning systems, which are used to report and analyse deviations from the intended treatment plan and prescribed dose in clinical practice and serve as tools for quality improvement, safety, and education. Radiation incidents in radiotherapy include not only overdoses but also underdoses and any geometric errors, such as delivering the correct dose to the wrong location. It should be noted that insufficient or minimal attention is currently paid to these issues in radiotherapy departments in the Russian Federation, which is unacceptable.
Section 6 considers new radiotherapy technologies and methodologies, including electronic brachytherapy (the replacement of sealed ⁶⁰Co and ¹⁹²Ir radioactive sources with miniature X-ray tubes for brachytherapy), image-guided radiotherapy, adaptive radiotherapy, hypofractionated radiotherapy, and stereotactic irradiation. Section 6.5 discusses specialized linear accelerators, including accelerators mounted on robotic manipulators, gimbal-mounted systems, systems with enclosed gantries, MRI-integrated accelerators, systems employing divergent beams, accelerators with gyroscopic motion, and PET-integrated accelerators.
Section 6.6 is devoted to proton and light-ion therapy. At present, there are 79 operational proton therapy centres worldwide, concentrated mainly in China, Japan, the United States, and Europe. China, Japan, and Europe have 13 facilities using carbon-ion beams. The advantage of proton and light-ion therapy lies in reducing the radiation dose delivered to surrounding healthy tissues while providing opportunities for dose escalation. The resources required to establish and maintain proton or light-ion therapy centres are substantially greater than those required for linear accelerator facilities with comparable patient throughput. At present, these methods are not considered cost-effective. However, this situation may change in the future as technologies continue to develop.
The translation has been carefully edited and is written in professional language. Each chapter provides numerous references to relevant standards and literature associated with the section under discussion, which is extremely valuable in itself. The consistent structure of the sections facilitates comprehension and retention of the information. Appropriate attention is given to equipment quality assurance programmes throughout all the sections of the document. The textbook brings together and systematically organizes a substantial amount of specialized and up-to-date information compiled by a large team of physicists and physicians.
The authors and translators have carried out an extensive and conscientious body of work and have produced an excellent textbook that will be highly useful both to beginners and to experienced professionals working in the field of radiation oncology and radiotherapy.
Doctor of Biological Sciences, Professor
I. M. Lebedenko
