Radiation Therapy

- secondary treatment, Adjuvant treatment

- used to treat cancers

Metastases

HISTORY
1895- milestone, discovered the Xrays by Wilhelm conrad
1896- jan 1896 first cancer xray treatment by Dr. Emil Grubbe
- uses low LET( low effect, low energey1) Alpha Beta
1897- JJ thompson- announce finding of negatively charged particle( electrons) using
Plum pudding method
- shapeless mass of electrification (jelly)

Earnest Rutherford-1897
- found two types of rad from Uranium(alpha, beta particles)
Radium- products of uranium
- he discovered nucleus (nuclear model) atom has center

December 1898
Marie and Pierre Curie- discovered Radium
Paul Von Villard- discovered gamma radiation and found to be similar to Xray

Henry Bequerel
- father of radioactivity

Pierre Curie
- discovered
pizoelectric effect
- main principle on how transducers
- sound waves

Marie curie
- discovered Polonium and
Radium - product of decay of uranium
- received noble prize in physics and chemistry
- coin the term radioactivity

1902
Guido Holzknecht- able to present chromoradiometer -a device used as dosimeter

1903
Antoine henry Bequerel
- Received noble prize of physics in discovery of radioactivity
1906
Hanz Geiger, Earnest Rutherford
- Developed device count alpha particles
Walter Muller
- a device that detects alpha but still
- discovery of geiger counter

Kev per micrometer - unit of LET

5 alpha particles
Let 1
Xray 3 kev per micrometer
Unit of exposure of air- kerma(exposure)
Roentgen- grey in air
- Gya and Gyt
Alpha
Safe for diagnostic but once inhaled swallowed it is damaging

1908
Paul Von Villard
- proposed a unit of dose based on ionizinization of air(air kerma)

1913
Half value layer(HVL) was suggested as term for the Expression of quality of xray

1922
Arthur Holly Compton
- discovered compton effect
- change of wavelengths of scattered x-rays

1925
- H. Fricke and Otto Glassor
- thimble ionization chamber

1928
Roentgen- international unit of dose

1932
Earnest O Lawrence
- invented cyclotron

1933
R.J. Van de Graff
Build an electrostatic generators that produce up to 12 million volts
Radthera 500 MeV

1934
Frederic Joliot and Irene Joliot
Produce artificial radioactivity by bombarding the Al with Alpha particles
Cataract - number one deterministic (radiation induced)/ stochastic

1939
Treatment of cancer patients through using neutron beam cyclotron has began
Disadvantage of neutron- limited penetrating power

1940
Kerst - constructed betatron with which electrons were accelerated to energies of 20
million electron volts later 300 million
ev - needed for treatment of cancer

1951
First tele therapy (delivery treatment in distance) units employing cobalt 60(work horse)
were used in radthera
-used o

1952
First linear accelerator for radiotherapy ( high energy consumption)

1960
Treatment planning computers were developed
Teletherapy

1970
Invention of CT scan

RADIATION STAFF
Radiation Oncologist - professional
Physician Assistant -
Medical Physicist - physical state, QAQC
Medical dosimetrist - measure dose being receive( cumulative dose)
Rad oncology nurse
Rad therapist

Therapy- stochastic
Diagnostic - deterministic

Goals
Curative - cure cancer to extend the life( total erasure of cancer)
2 kinds of treatment
Adjuvant - addition
Neoadjuvant- doesnt go through surgery

Palliative - terminally ill

- lessen the pain

Profilactic
- prevention

Biopsy- ultrasound
Benign and malignant

Tumor Angiogenesis- formation of blood vessels connecting to the tumor

Oxygen effect/

Gold standard
Ultrasound breast
MRI
Men
Colorectal, non hadgekins, bladder HPV human populora

Women
Ovary

Carcinogen
contributor to cancers
smokers usually gets nicotine

Arsenic(lung cancer), Chromium, Mercury

Has scales fishes no mercury content

Hydrocarbons
UV rays
Benzene - leukemia

Ionizing radiation
Stochastic effects

Tumor
Benign- pushing the organs, giving pressure to organs
- differentiated
Normal size
Minimize affect
Normal m

Malignant- pushing and very painful, getting energy from nearby organs, invasive type
Unable to differentiate
Normal to increase mytotic rate
Normal unidentified
Life threatening
Normal to accelerate / metastasize

Local - within the organ

Distant- wide spread

Law of bergonie and tribondeau

- high metabolic rate high rad(cancer)

Isodose
Linac

Isodose planning

CLASSIFICATIONS OF NEOPLASM
Adenoma- benign
Adenocarcinoma- malignant

Pupilloma- benign
Adenopupillomacarcinoma

Leinomayoma - soft tissue

Leinocarcinoma
Carcinoma

Blastoma
Cancer Cells
- unable to count
- innate/natural
- shape: has speculations (galamay)
- nucleus: proportionate size (big small different nucleus)
- growth: out of control
- immatured cells
- doesn’t communicate
- invisible to immune cells
- blood supply: tumor angiogenesis connects in tumor
- hungry of nutrients, blood
- looks for glucose
- doesnt like oxygen
- energy efficiency: 5% only
- amount of ATP: 2 units of ATP
- environment: acidic

Normal Cells
- specifict count of WBC RBC platelet
- exact shape
- visualize round or perfect edges
- nucleus: larger and darker
- growth: incontrol and systematic
- matured cells (cell division/ cell proliferation)
- it communicates
- visible to immune cells
- angiogenesis only during repair
- oxygen
- energy efficiency: 95% only
- amount of ATP: 36 units of ATP (adenosine tryphosphate)
- environment: alkalinic

Red Blood Cell (RBC)

- In 100 days, this cells will replinish

Angiogram
- used to know if it is benign or malignant
- Put Contrast media

Arterial Phase
- enters contrast media in organ

Tumor in liver
- CM absorbs the nutrients
Thrombolysis
- “uses medications or a minimally invasive procedure to break up blood clots and prevent new
clots from forming”

Anaerobic State
- Body should be anaerobic state when doing radtherapy

Oxygen Enhancement Ratio or Oxygen Effect

- “given by the dose in hypoxia divided by the dose in air to achieve the same survival level, and
at high dose levels the value of OER for most cell types is in the range of about 2.5–3.0”
- “increased radiation resistance in the absence of oxygen in the cells”
- type of biological factor under rad bio
- high content oxygen, more radiosensitive

Prostate cancer in Men

- Bladder

Breast cancer in Women

- Lung and Bronchus, Colorectal, Uterus

Treatment of breast cancer

- Mammogram or mammography

Non-hodgkin lymphoma
- Ovarian cancer
- Men
- disease in which malignant (cancer) cells form in the lymphatic system, older male with
weakened immune system

Cervical cancer
- WOMEN
- causes HPV (human papilloma virus)

HPV
- common sexually transmitted infection

pH Levels
- ph blood: 7
- ph whole cell: 7.35-7.45

Carcinogens
- Nicotine lead to cancer of the lungs and pharynx
- “Substances that may increase your risk of developing cancer”
Example of carcinogenic chemical/substance contributor to cancer:

Benzene
- connected to Hydrocarbon
- results lung cancer and leukemia
- “Exposure to benzene increases the risk of developing leukemia and other blood disorders”
Other example:
- Arcenic, Chromium, Nickel which has high mercury content
Hydrocarbons
- Rugby, Gasoline, Epoxy
Skin cancer
- cause by UV rays

Other example from Google: Tobacco, alcohol, UV, pesticides

——- RECORDED ———

Malignant
- pushing and very painful
- will absorb nutrients from near organs

Local
- specific area

Distant
- will go to another organ

———-

Table of Specifications of RadThera

Classification of Neoplasm

II. Tissue Origin

- Glandular Epithelium, in the lining of glands
Benign
- Adenoma
- Squamous cell Papilloma

Malignant
- Adenocarcinoma
- Squamous cell carcinoma

Oma
- tumor

Smooth muscle
- medical term: Leiomyoma- tumor in smooth muscle
- root word: Leio or Leimy??

II. Local Spread

Benign
- will grow but its function is by giving pressure to organs
- very rare moving to other areas of distant organs
- example: tumor in brain moabot sa breast
- well-differentiated (can identify the shape and size)
Malignant
- giving pressure is
- undifferentiated (can’t identify the exact shape and size of a malignant tumor)

Local Specific Area

Distal
- will move further to another area

Law of Bergonie and Tribondeau

- principle helps prove that cancer cells may be treated with radiation

II. Mytotic Activity

Benign
- normal
Malignant
- normal to increase mytotic rate, very high metabolic rate

*Cells with high metabolic rate are more radiosensitive

*Principle: Law of Bergonie and Tribondeau- cancer cells can be treated with radiation

IV. Effects on host or origin:

Benign
- Little effect
- example: small tumor in uterus will not affect too much unless it is growing

Malignant
- Life threatening: cancer cells are hungry of nutrients

V. Reproduction:
Benign
- Normal
Malignant
- Normal to Accelerate
- Tumor will metastasized

Table of Specifications (TOS)

Classification of Neoplasms

Medical term when inside the glands:

Benign Tumor
- Adenoma
Malignant Tumor
- Adenocarcinoma

Squamous:
Benign
- Papilloma
Malignant
- Squamosal Carcinoma

Malignant disease when it comes to Hematopoietic

- Leukemia

Malignant when Neural

- Blastoma

Lymphoreticular
Benign
- neuroma

❌
✅
Gastroectomy
Gastrectomy
- if vowel follows in the suffix, combining letter “O” should be excluded

NET:
Fractionation
- each individual treatment dose
Protraction
- the time period that the total treatment dose is to be given

4 Ways of Occurence when tumor appears LTTA

1. Local Invasion - if breast , breast only
2. Through lymphatic vessels - local spread in Lymphatic System
3. Through blood vessels - cancer cells can stay within blood vessel (ex leukemia)
4. Across Cavities - cancer cells can metastasize in abdomen or pelvic cavity
Staging of Cancer
Stage 1
- tumor is confine to organ of origin

Stage 2
- naabots local lymph nodes

Stage 3
- distant node invaded, not only in local but will go through far (external galli)
- distant lymph nodes

Stage 4
- blood borne metastasis is present
- all over the body
- through the flow of blood, through the river of your soul, miracles

Intermittent fasting - safer from cancer

(TNM System) Tumor, Nodes, Metastasis

TUMOR
- Local extension of tumor
- Primary Tumor
- How Large

NODES
-

METASTASIS
- How large of spread

Reticulosis - Malignant

Carcinoma
- largest and most group of cancer which is applied to malignant cyst to arrising in surface tissue
- 1st division of cancer
- spread: commonly to regional lymph nodes and also via the blood to lungs, liver, brain etc

Sarcoma
- 2nd division of cancer
- greek word: flesh
- spread: usually blood borne to lungs

Reticulosis
- 3rd division of cancer
- osis: abnormal condition
- reticule: pertaining to RBC
- immature RBC: reticulocyte
- wide spread, which include blood forming like bone marrow, lymph nodes, spleen, thymus,
parts of liver
- spread: endocrine-exocrine

Types of Radiation Therapy Treatment/Rad Oncology

Treatment

1. Evaluation
- before treatment, evaluation and assessment is done by radiation oncology nurse

3 Factors assessing patient during radiation therapy PHA

1. Patient’s State of Disease - status
2. History of previous medical interventions
3. Availability of other forms of treatment - if there are other option aside from radiation oncology

Ways of methods of outlining treatment portals (Path of Radiation) ITDS

1. Indelible Ink - apply directly in skin in the form of tattoo
2. Tattoo - edges of the treatment field, years of treatment
3. Dye Visible in Black Light - tattoo is visible when light is off, months of treatment
4. Simulation Machine - practice of treatment, px placed in treatment area, smaller than other
treatment, uses MRI-like machine, not safe for px who is claustrophobic; SIMULATORS-
machine duplicating geometrical aspect of tumor, outlines field or draw type field of treatment

2 Types of treatment techniques in Radiotherapy

a. Fixed SAD Technique
- source to access distance
- concentrated and uniformly distributed to the center known as isocentric technique since
gantry move 360* while px is in position
- better than fixed SSD
- px is stationary, gantry rotating

“SAD (source-access distance) is the distance from the source to the isocenter”
“gantry moves around the patient”

Factors affecting precise dose distribution delivery received by tumor: REFDW

1. rotation pattern
2. energy of the beam
3. field size
4. depth of isocenter
5. weighing of the beam

b. Fixed SSD technique

- source to skin distance or source to skin surface distance
- patient is moved to adjust SSD
- only reference is skin marks
- difficult to perform if tumor is in abdominal or thoracic cavity
- px is moving
“SSD (source-skin distance) is the distance from the source to the patient's skin”
“you may have to move the patient”
“patient may have to be adjusted to make sure the SSD stays accurate”

Radiation Therapy
- tumor not just the organ

Introduced treatment or designed by medical physicist or radiation oncology

SAD= SSD + 1/2 of the patient thickness

PDD= % Depth Dose

TAR= Tissue Air Ratio
TMR = Tissue Maximum Ratio
TPR= Tissue Phantom Ratio
BSF= Back Scatter Factor

Isodose Planning or Distribution- uniform dose distribution

Phantom
- materials capable of absorbing radiation or how humans absorb radiation

Types of Phantom WSAS

1. water phantom
2. solid dry phantom
3. Alderson Rando phantom
4. solid water phantom

Isodose Curve
- Line passing through point of equal dose drawn at a regular intervals of absorb dose

Isodose Chart

Aim of Radiation Therapy

- main goal is reducing deterministic effect of radiation
- maximized the dose received by the tumor nandrolone
- minimize dose to surrounding tissue

2 types of field sizes

- geometrical field size- projection on the plane, shape
- physical field size- intersection on the surface within 50% isodose curve

3 Devices used for dose determination in radthera ITP

1. Ionization Chamber
2. (TLD) Thermoluminescent Dosimeters
3. Photographic films

Accelerators/ equipment used

Betatron by Kerst 1940-1941
- Produces electrons and x ray beam
- Orbital motion of magnetic beam
Cyclotron- produced radionuclides/ radioisotopes and neutron beam
Linear Accelerator (LINAC) commonly used machine
- Electron and x ray beam
- Travels into straight line
-
Major components of LINAC
1. Drive Stand- contains apparatus
- Other sources, kryston( gives electron, tungsten)travels to a straight line
magnetron
- Wave guides - hollow tubular structures that guides, contains copper cells
- Circulator- directs RF energy into wave guides
- Provides microwave power
- Irises - small holes that allow to travel
- Cooling system- composed of water
Parts of Drive Stand
Klystron
Wave guides
Circulator
Cooling system

2. Gantry - composed of
Electron gun- produces electron and injects them into accelerator structure
Accelerator structure-
Beam stopper
Treatment head parts/ process

3. Control console- planning, control, monitor

4. Treatment couch- patient support assembly
 Parts of treatment head
1. Bending magnets- guides the electron in a curve motion
2. XRay target- second part, produces primary beam in a cone motion
3. Primary collimator - shapes x ray beam and limits maximum field size
4. Beam flattering - fourth part of treatment head, flattens x ray beam, aka filter scattering foil
5. Ion chamber- 1,2,3
6. Secondary collimator- multi lift collimator
7. Slots for wedges, blocks and compensation aka tray

3 kinds
- Primary decimeter- measures radiation and terminates the beam when required dose is
delivered.
- 2nd Acts backup
- 3rd Uses 7 electrodes to monitor different sections of radiation field

1939

2 divisions of Radiotherapy
1. EVRT

3 kinds of EVRT machines

Superficial - operates around 50-120 kVp only
Kilovoltage- operates around 150-500 kVp
- Filters made of copper, tin and aluminum
- Combined the copper, tin and aluminum it's called thereous
Megavoltage- high chance of skin sparring(example is second degree)
- 500 up

2 types of megavoltage
Isotopic machine- cobalt 60, kilovoltage
Cesium 137- much lower than cobalt60 with ssd of 20-60
- HVL of Cesium 137 HVL 30 years, 0.662 mega electron volts
-

2. Brachytherapy - sealed source radiotherapy

- Uses radioactive material sealed source
- Inserted in organ of interest
- Example uranium and radium

3 types of Brachytherapy
Interstitial- implanted into the tumor
Intracavitary- around/within cavities
- Applied into body cavities
- Example cancer of cervix, vagina
Intraluminal- inserted to organs that is tube shaped