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Time , Dose & Fractionationrevised

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PGIMER, AIIMS
PGIMER, AIIMS
Health & MedicineTechnology
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time , dose & fractionation
INTRODUCTION ,[object Object],[object Object],[object Object],[object Object],[object Object]
RADIATION ACTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Indirect action Direct action
TUMOR LETHAL DOSE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Probability of cell death 100% A TLD %age lethal effect dose
TUMOR LETHAL DOSE ,[object Object],[object Object],[object Object]
TISSUE TOLERANCE ,[object Object],[object Object],[object Object],[object Object],[object Object]
NTT: Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Therapeutic index ,[object Object],[object Object],[object Object],[object Object],[object Object],%age lethal effect A B TCP NTCP
Radio sensitivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radio sensitivity Dose required to produce lethal effect is more than NTT. Hence therapeutic index is very low. e.g. soft tissue & bone sarcoma, melanoma etc. Muscle, Bones, Nervous system Though tumors are more sensitive, therapeutic ratio is low. NTT exceeds TLD by only small #. e.g. sq. cell. ca. & adenoca. Skin, Mesoderm organs (liver, heart, lungs…) For which therapeutic ratio is high Normal tissue tolerates doses several times magnitude of TLD. e.g. lymphoma, leukemia,seminoma,dysgerminoma Bone Marrow, Spleen, Thymus ,Lymphatic nodes,Gonads,Eye lens, Lymphocytes (exception to the RS laws) Resistant Moderately sensitive Highly radiosensitive
Factors affecting the radiosensitivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],G1 S G2 M G0  LET  LET % survivor cells M M
RADIOCURABILITY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT FACTORS ,[object Object],[object Object],[object Object],[object Object]
DOSE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTENTION OF TREATMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CHOICE OF DOSE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
TIME ,[object Object],[object Object],[object Object],[object Object]
TIME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FRACTIONATION ,[object Object],[object Object],[object Object]
HISTORICAL REVIEW ,[object Object],[object Object],[object Object]
HISTORICAL REVIEW ,[object Object],[object Object]
RADIOBIOLOGICAL RATIONALE FOR FRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIATION DAMAGE CLASSIFICATION ,[object Object],[object Object],[object Object],[object Object]
REPAIR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SLD & ITS REPAIR ,[object Object],[object Object],[object Object]
Redistribution ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Redistribution
Repopulation ,[object Object],[object Object],[object Object],[object Object]
ACCELERATED REPOPULATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reoygenation ,[object Object],[object Object]
ADV. OF FRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIATION RESPONSE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VARIOUS FRACTIONATION SCHEDULES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conventional fractionation ,[object Object],[object Object],[object Object],[object Object]
CONVENTIONAL FRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HYPERFRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object]
HYPERFRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object]
ACCELERATED TREATMENT ,[object Object],[object Object],[object Object],[object Object]
Types of accelerated fraction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACCELERATED TREATMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CHART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SPLIT-COURSE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HYPOFRACTIONATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TIME DOSE MODELS ,[object Object],[object Object]
CUBE ROOT MODEL ,[object Object],[object Object],[object Object],Dose in R Time in days A - Skin necrosis C – moist desquamation B – cure for skin carcinoma D – dry desquamation E – skin erythema A B C D E 1 3 7 10 20 2
Cohen’s ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fowler ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NSD MODEL ,[object Object],[object Object],[object Object],[object Object],[object Object]
TDF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TDF contd. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CRITICISMS OF NSD ,[object Object],[object Object],[object Object],[object Object],[object Object]
TARGET THEORY ,[object Object],[object Object]
SIMPLE TARGET THEORY ,[object Object],[object Object],[object Object],[object Object]
SIMPLE TARGET THEORY ,[object Object],[object Object],[object Object],[object Object],[object Object]
MULTITARGET THEORY ,[object Object],[object Object],[object Object],[object Object]
LINEAR QUADRATIC MODEL ,[object Object],[object Object],[object Object],[object Object]
LINEAR QUADRATIC MODEL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sparsely ionizing particles 4 8 12 Densely ionizing particles β D 2 α D α / β
LQ MODEL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIATION RESPONSE ,[object Object],[object Object],[object Object],[object Object],[object Object],acute late Cell survival dose
EXPLANATION FOR DIFF. IN SHAPE OF EARLY & LATE RESPONDING TISSUES ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
EXPLANATION FOR DIFF. IN SHAPE OF EARLY & LATE RESPONDING TISSUES ,[object Object],[object Object],[object Object]
IMPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],dose Cell survival late acute
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
 
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Time , Dose & Fractionationrevised

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  • 10. Radio sensitivity Dose required to produce lethal effect is more than NTT. Hence therapeutic index is very low. e.g. soft tissue & bone sarcoma, melanoma etc. Muscle, Bones, Nervous system Though tumors are more sensitive, therapeutic ratio is low. NTT exceeds TLD by only small #. e.g. sq. cell. ca. & adenoca. Skin, Mesoderm organs (liver, heart, lungs…) For which therapeutic ratio is high Normal tissue tolerates doses several times magnitude of TLD. e.g. lymphoma, leukemia,seminoma,dysgerminoma Bone Marrow, Spleen, Thymus ,Lymphatic nodes,Gonads,Eye lens, Lymphocytes (exception to the RS laws) Resistant Moderately sensitive Highly radiosensitive
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