“There is no safe amount of radiation.

Even small amounts do harm”

–linus paulIng

RADIATION THERAPY
AN OVERVIEW
UNDERSTANDING RADIATION THERAPY

RADIATION
The propagation of energy from a radiative source to another medium.

RADIATION THERAPY
Therapeutic dose of ionizing radiation
 HISTORY
• 1895: Discovery of X-rays by Wilhelm Conrad Roentgen (Germany)

• 1895: Use of X-rays in breast cancer by Emil Grubbe (Chicago, USA)

• 1896: Use of X-rays in nasopharyngeal cancer and in pain palliation by Voigt J.

Ärztlicher Verein (Germany)

• 1896: Use of X-rays in the treatment of gastric cancer by Despeignes (France)

HISTORY

• 1934: 23% cure rate in head and neck cancer (Henri Coutard)

• 1994: The first clinical IMRT treatment (USA)

• 2001: FDA approval of robotic radiosurgery

• 2003: The first use of image-guided radiation therapy (IGRT) technology

 RADIATION PHYSICS

• Atom - smallest unit of element

• Photon- smallest unit of electromagnetic radiation

• Ionizing (high-energy) radiation has the ability to remove electrons from atoms
INTERACTION OF RADIATION

Major Types:

• Photo electric effect

• Comptom effect

• Pair Production
PHOTO ELECTRIC EFFECT
• Radiation knocks an electron from an inner atomic orbit.

• Basic interaction in diagnostic radiology.

 COMPTON EFFECT

• Mechanism for the absorption of ionizing radiation in radiotherapy.

• Absorption of incoming radiation is the same for bone and soft tissues
 PAIR PRODUCTION

• Photon transforms into an electron and a positron near a nucleus.

• Threshold photon energy level for pair production is 1.02 MeV

• Why the sky is blue? : Coherent Effect

RADIATION UNITS

• Radioactivity. This is the transition of an unstable nucleus to a steady state through the emission of
particulate or electromagnetic radiation from the nucleus.

• Curie (Ci). This is an activity of 3.7×1010 disintegrations per second.

• Becquerel (Bq). This is an activity of one disintegration per second.

• 1 Ci=33.7×1010Bq
• 1 Bq=2.7×10−11 Ci
RADIATION UNITS
• Kerma (kinetic energy released in the medium).
This is the sum of the initial kinetic energies of all of the charged particles liberated by uncharged ionizing
radiation (neutrons, protons) in a sample of matter divided by the mass of the sample.

• Absorbed Dose:

• Exposure:
This is the amount of ionization produced by photons in air. Since it is impossible to directly measure the
absorbed dose in tissue, the measurement of radiation is performed in air
 RADITHERAPY GENERATORS
• Kilovoltage X-rays - skin cancers and superficial tumors.

• megavoltage X-rays - deeply seated tumors.

• Cobalt 60 Teletherapy Unit

• Linear Accelerator (Linac)

 MEASUREMENT OF IONIZING RADIATION

• Maximum allowable dose - 20 mSv per year

• Normal Population – 1mSv Per Year

RADIOBIOLOGY- BASICS

• Phases of Cell Cycle –

The most radiosensitive stages during the cell cycle are the early G2 and M stages

• Features of Cancer cells: Clonal origin, Immortality, Genetic instability, Loss of contact inhibition,
Continuous increase in proliferation, Metastasis.

• Direct effect of Radiation : The direct ionization of atoms in DNA molecules is the result of energy
absorption via the photoelectric effect and Compton interactions.

• Indirect effect of Radiation : formation of free radicals by energy transfer from radiation, and the
resulting molecular damage caused by the interactions of these free radicals with DNA
 RADIOBIOLOGY
• Target Tissue
 RADIOBIOLOGY

• Process of DNA Breakdown

• Target Theory
RADIOBIOLOGY
• LQ model:
• Douglas and Fowler in 1972
• cell death due to ionizing radiation has two components

• Cellular damage due to radiation

RADIOBIOLOGY
• Factors Affecting Cell Survival Curve
RADIOBIOLOGY
• Tissue & Organ response to Radiation
RADIOBIOLOGY

• Tumor response to Radiation

• Therapeutic Index: Tumor control probability (TCP) relation to the normal tissue complication probability (NTCP)
for different doses

The TCP is a function of the The NTCP is a

total dose, fraction dose, function of the total
irradiated volume including dose, fraction dose,
the whole tumor, and fraction number and
treatment reproducibility the volume of tissue
exposed to the
radiation
FRACTIONATION
• One Time Total Dose = Serious adverse effects.

• 5R’s of Radiotherapy – Basis of Fractionation

• Repopulation
• Repair
• Redistribution (= reassortment)
• Reoxygenation
• Radio sensitivity (intrinsic radio sensitivity)
FRACTIONATION
FRACTIONATION