Topic 5 . Ultrasound diagnostics. Physical basis of ultrasonography.

Parameters of
the sound vibrations. Acoustic environment. Interaction of the ultrasound & acoustic
environment.

Methods of RT:
Radiation therapy is divided into:
I. According to the type of radiation (photons, electrons, neutrons, protons, heavy nuclei):
1. X-ray therapy
2. beta- therapy
3. gamma- therapy
4. RT with high energy radiation
II. According to the location of the source of radiation:
1. distant (source is located on the distance of 3-5cm up to1-2m from surface of the
body)
2. contact (source (RPL) is placed into the tumor
III. According to the type of administration of the dose:
A. external irradiation:
close: the source of IR is located on the distance - 1,5 cm to 30 cm
distant: the source of IR is located on the distance - 30 cm to 1,5-2 m
applicatory: the source of IR is located on the distance - 0 cm to 1,5 cm, the
source of radiation is located directly on the irradiated surface, (as applicators P-
32, Tl-204 are used)
Distant RT is divided on:
1. X-ray therapy,
2. irradiation with high energy sources
X-ray therapy:
According to the location of the focus, distant X-ray therapy is divided into…
1. superficial (the pathologic focus is located on the depth of 1 сm from the skin surface)
2. medium (the pathologic focus is located on the depth of 3 сm from the skin surface)
3. deep (the pathologic focus is located deeply from the skin surface)
B. internal irradiation:
intra tissue (the source of gamma-irradiation is placed directly in the tumor)
internal radiation (per os, i/v, i/a organotropic radionuclides or labeled solutions
are injected) - incorporated elements
intracavital-(oral, uterus, rectum or artificial cavity (post operative)

Absolute contraindications for the radiation therapy:

pregnancy
Relative contraindications for the radiation therapy:
age over 70
diabetus mellitus
hypertension
chronic heart & lung diseases
These patients may not overcome such treatment
Treatment of malignant tumors may be:
 Isolated
Combined
Complex
Isolated method of malignant tumors treatment may be used as:
1. X-ray and γ-therapy,
2. combined radiation therapy
Combined radiation therapy represents:
1. external irradiation
2. contact radiation therapy
Combined treatment may be performed as…
1. pre-operative,
2. intra-operative and
3. post-operative treatment
The main purpose of the sub-operative irradiation: irradiation of the bed of the
extracted tumor and prevention of the metastasizing
Complex method of treatment means…
1. radiation therapy,
2. chemotherapy,
3. hormonal therapy and
4. surgical treatment

Radical treatment: radiation therapy with radical aim is used in case of:
Breast c-r
Oral, lip, pharyngeal c-r, larynx, head & neck tumors
Female genital system c-rs
Skin c-r
Lymphoma
Primary brain tumors
Prostatic C-r
Unresectable sarcomas
Main points of the radical therapy:
Doses should be high (approximately 60-66 Gy) divided into fractions in 30-33
procedures during 6-7 weeks
Combined therapy (chemotherapy as basic method+radiation therapy) is used with the
aim of eradication of the residual malignant cells in meningeal spaces where cytostatics
doesn’t reach) for irradiation of the:
1. skull in acute lympholeikemias,
2. small cell lung C-r
Palliative therapy by means of irradiation is performed in incurable cases (metas in
bones, esophagus C-r, lung C-r); in patients suffering from some symptoms which
radiation therapy may relieve or reduce such as:
pain (e.g. headache in case of brain metas from c-r or leikemias are very sensitive to
RT; but pain caused by direct invasion of the tumor into the skull bone is less
sensitive; liver ache is better treated with steroids)
obstruction (e.g. in case of esophagus stenosis, lung atelectasis, compression of the
v. cava superior in case of the lung c-r, compression of the ureter in case of the
 cervix uteri c-r or c-r of the urinary bladder, compression of the pyloric part of the
stomach due to lymphoma; but lymphostasis of the upper & lower extremities
caused by increased l.n. is less sensitive to the RT cause its usually complicated
with vein trombosis)
chronic bleeding (is usual in case of cervix uteri c-r, urinary bladder, larynx,
bronchial c-r, oral cavity & its relatively sensitive to RT but in case of hematuria in
hypernephroma RT doesn’t show any effect, nephrectomy is preferable)
ulceration (RT increase the QL of the patients with ulceration after breast c-r,
perineal ulceration in rectal c-r)
pathological fractures: RT may be prophylactic in case of myeloma, Ewing’s
sarcoma
neurological disorders: (e.g. metas from breast c-r into retrobulbar tissue,
paraparesis due to compression of the spinal cord (if its duration is less <24hrs) may
regress under RT;
systemic symptoms (myastenia due to thymoma is very sensitive to RT; night
sweats, hyperpyrexia, loss of mass also regress after irradiation of the
lymphomatous masses)
for decreasing of the intracranial pressure

Typical protocol for the palliative therapy: irradiation in dose of 10Gy in 1 fraction; 25
Gy for 5 fractions or 30 Gy for 10 fractions depending on the size of the field.

Learning objectives
- indications and contraindication

- types of radiotherapy

Self-control tests
1. Select the doses which are used for the treatment of non-malignant diseases.
A. single and total absorbed doses of radiation
B. single and total exposure doses of radiation
C. single and total effective doses of radiation
D. single and total equivalent doses of radiation
E. single and total tolerance doses
2. The size of single and total dose of radiation in case of non-malignant diseases
depends on…
A. acuteness of the process
B. the degree of distribution
C. the area of distribution
D. location of the process
E. histologic changes in tissue
3. Select the optimal dose of IR in case of inflammatory processes.
A. single dose – 1,0 – 3 Gy, total dose of radiation – 3 – 6 Gy.
B. single dose –0,3 – 0,7Gy, total dose of radiation -1,5 – 3 Gy.
C. single dose –0,25-0,5 Gy, total dose of radiation –1 – 1,5 Gy.
D. single dose –2 – 3 Gy, total dose of radiation –2- 3 Gy.
E. single dose –1,5 – 2 Gy, total dose of radiation –2 – 3 Gy.
4. Select the optimal dose of IR in case of chronic inflammatory processes.
A. single dose –0,3Gy, total dose of radiation – 5 Gy.
B. single dose –1 Gy, total dose of radiation -5-6 Gy.
C. single dose –0,5 Gy, total dose of radiation –6-7Gy.
D. single dose –3 Gy, total dose of radiation –6-7 Gy.
E. single dose –5 Gy, total dose of radiation –7– 8 Gy.

References
- 1. Encyclopedia of Diagnostic Imaging by Albert L. Baert (Hardcover - Feb 13,
2008)
- 2. Grainger & Allison's Diagnostic Radiology: Multiple Choice Questions by Adam
Mitchell (Paperback - Dec 12, 2003)
- 3. Radiology: PreTest Self-Assessment and Review by David M., M.D. Hovsepian
(Paperback - Jun 1, 1993)
- 4. Radiology Super Secrets (Secrets Ser) by Douglas S., M.D. Katz, Kevin R., M.D.
Math, Stuart A. Groskin, and Math Groskin Katz (Audio CD - May 1999)
- 5. Radiology Imaging: Words And Phrases by Sally C. Pitman (Paperback - Aug 30,
2005)