The document discusses various considerations for magna field irradiation (TBI) including:
1) Biological factors like repair, repopulation and fractionation that are important for TBI. Fractionation increases lung tolerance up to 175%.
2) Physical factors that must be addressed like dose calibration, scatter corrections, and ensuring dose uniformity throughout the body.
3) Methods for calculating and prescribing dose including using average or single point doses. Most protocols prescribe to the umbilicus midpoint.
4) Techniques used to achieve homogeneity like bolus, compensators and beam energies. Homogeneity of ±10% is typically achieved.
5) Determining lung dose accurately through methods like CT-based calculations or
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
Total Body Irradiation (TBI) is given
to prepare (condition) the patient’s body for bone marrow or stem cell transplant.
It is a special radio therapeutic technique
that delivers to a patient’s whole body, a
uniform dose within (+/-)10% of the
prescribed dose.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Conventional radiotherapy treatments are delivered with radiation beams that are of uniform intensity across the field (within the flatness specification limits). Wedges or compensators are used to modify the intensity profile to offset contour in irregularities and produce more uniform composite dose distributions such as in techniques using wedges. This process of changing beam intensity profile to meet the goals of a composite plan is called intensity modulation
IMRT refers to a radiation therapy technique in which nonuniform fluence is delivered to the patient from any given position of the treatment beam to optimize the composite dose distribution. The optimal fluence profiles for a given set of beam directions are determined through inverse planning. The fluence files thus generated are electronically transmitted to the linear accelerator, which is computer controlled, to deliver intensity modulated beams (IMBs) as calculated.
Dose Evaluation in the Movement Couch of the Total Body Irradiation Technique...iosrjce
IOSR Journal of Applied Physics (IOSR-JAP) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of physics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in applied physics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
Total Body Irradiation (TBI) is given
to prepare (condition) the patient’s body for bone marrow or stem cell transplant.
It is a special radio therapeutic technique
that delivers to a patient’s whole body, a
uniform dose within (+/-)10% of the
prescribed dose.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Conventional radiotherapy treatments are delivered with radiation beams that are of uniform intensity across the field (within the flatness specification limits). Wedges or compensators are used to modify the intensity profile to offset contour in irregularities and produce more uniform composite dose distributions such as in techniques using wedges. This process of changing beam intensity profile to meet the goals of a composite plan is called intensity modulation
IMRT refers to a radiation therapy technique in which nonuniform fluence is delivered to the patient from any given position of the treatment beam to optimize the composite dose distribution. The optimal fluence profiles for a given set of beam directions are determined through inverse planning. The fluence files thus generated are electronically transmitted to the linear accelerator, which is computer controlled, to deliver intensity modulated beams (IMBs) as calculated.
Dose Evaluation in the Movement Couch of the Total Body Irradiation Technique...iosrjce
IOSR Journal of Applied Physics (IOSR-JAP) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of physics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in applied physics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Comparative dosimetry of forward and inverse treatment planning for Intensity...iosrjce
IOSR Journal of Applied Physics (IOSR-JAP) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of physics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in applied physics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Brachytherapy-A Brief Review with focus on Carcinoma Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
2. Introduction
Magna field radiotherapy (TBI/HBI/TNI) is becoming increasingly
prominent and involves Dosimetric problems that are much more
pronounced than they are for conventional field sizes.
In this review,
•Biological considerations in TBI
•Physical considerations in TBI
• calculation & prescription of dose for TBI
•Techniques in TBI
• Special considerations to lung dose delivery and reduction of
dose (due to low density tissues and low tolerance to irradiation)
are outlined.
3. In principle, it difficult to obtain the dose delivery information of
magna field radiation for variety of reasons.
• Dose delivery (ranges from 5Gy in single fraction using dose
rate 50cGy/min to 14Gy in multiple fractions over a no. of days)
• Dose prescription points may vary from institute to institute
• Overall lack of Clinical evaluation
All this points raise the question: with what accuracy must the dose
be delivered?
ICRU has recommended an overall accuracy in dose delivery of 5%
But recent data indicates that 5% change in dose to lung could result
in a 20% change in the incidence of radiation pneumonitis
If the prescribed dose is well below the radiation pneumonitis and it is
sufficient for adequate tumor control, then the guideline of 5%
accuracy can be relaxed to 10 % or even 15%
4. Radiobiological Considerations
In the context of TBI as applied to Bone Marrow Transplantation,
Repair and Repopulation are the most significant of the four R’s
From the pioneer work of Elkind & Sutton, during fractionated
Radiotherapy regimen (or) continuous low dose rate exposure, both
repair of sub lethal damage and repopulation may occur between
fractions.
In fact, the data indicate that when the dose is given in multiple
fractions rather than single increases the lung tolerance up to 175%
Radio biologically three measurable factors got importance in TBI such
as Fractionation Dose, Dose Rate and Total Dose
The increase in Dose fractionation results increase in therapeutic ratio
and this effect occurs optimally at dose fractions of order 2 Gy
5. LD50/30 (Dose with 95% confidence limits) is a good indication of the
survival level of bone marrow stem cells. As the dose rate decreases,
the LD50/30 increases
In addition to fractionated dose and dose rate, one has to consider
total dose, uniformity of the dose throughout the bone marrow and
body.
This is majorly depends on age of the patient, differences in
conditioning chemotherapy regimens and the delay in the actual
transplant.
Based on the all the above factors, fractionation method become
more practice in most of the hospitals instead of Single Fractionation
6. Physical Considerations
J. Van Dyk, M.Sc., F.C.C.P.M had discussed about the physical
considerations in Magna Field Irradiation Technique and suggested to
consider the no. of factors before initiating a large field radiotherapy.
Irradiation Methods:
In the first instance, a method must be devised to produce radiation
fields large enough to cover the entire target volume adequately
This is majorly depends on type of equipment available
Basic Dosimetry:
Large field treatments are usually performed under unusual
geometric conditions and hence experimental data should be
determined specifically for that geometry.
o Central Axis dose data (Solid phatom) o Dose calibrations cGy/MU
o Beam Profiles (Solid phantoms) o Buildup Characteristics (after applying
Lucite sheet, how buildup regions changes
that need to check)
o Inverse Square Law data (To check scatter
effect)
o Output Factors Sp and Sc need to measure)
7. Patient Dosimetry:
Once the basic parameters have been determined, factors specially
related to the patient must considered before dose delivery
Dose Prescription : the dose prescribed to a single point at the
patient’s midline at the levels of the pelvis
Patient Contour: to make dose uniformity through out patient’s
shape, use the tissue equivalent bolus on skin surface and use the
compensators in the beam remote from the patient surface
Dose distribution: most magna-field radiotherapy procedures are
performed with AP-PA or Lateral Opposed fields. When comes to
Co-60 radiation, Lateral beams contains larger dose variation as
compared to AP-PA. In Higher Energy radiation, this dose variation
is very less in Lateral beams
8.
9. Prescription & Calculation of dose for TBI
The use of large Total Body fields creates a unique set of problems
that stress the accuracy of technique routinely used for dose calculation
Difficulty results from the complexity of the dose distribution due to
wide variations in the dose from point to point
For this reason, it is difficult to describe the resulting dose distribution
clearly (or) to state the prescribed dose accurately
Different approaches are found to calculate and prescribe the dose to
TBI patients.
First Method:
One approach is that use the integral dose for entire body to calculate
the average dose for all points
But it fails to define the dose to specific areas such as the lungs or
other sensitive structures.
10. Second Method:
Another approach is that averaging of limited number of points
The averaging technique is aimed at modifying the delivered dose
downward when high dose areas occur and upward if low doses are
found
This mechanism guarantees that critical areas do not receive either
excessively high or low doses of radiation
This approach has some appeal such as it can be used to guard against
the large dose variations which can result when the irradiation
technique is changed
i.e. bi lateral irradiation fields has been shown considerably dose
variations from the AP/PA fields
11. Third method:
CCSG protocol prescribe the dose by using a single value
corresponding to a single point in the body i.e. the mid point at the
level of the umbilicus (intersecting point of the mid planes AP/PA and
Lateral fields)
Because of this mid point selection, this approach is independent of
the treatment technique used
Overall dose distribution is controlled within the stated limits at least
for the point specified
The main advantages by selecting Umbilicus as a dose prescription
point are:
The point is equal to half height of the patient so that central
axis of the photon beam can be made to correspond with this
point
Tissues in the vicinity of the umbilicus are close to unit density,
so that no need of any inhomogeneity corrections
12. Although, the prescription point has advantages, important problems
remain such as:
Inverse square correction
Collimator size correction factor
Estimation of scatter volume
Accuracy of TPR
Attenuation in air column
Scatter from air column
Back scatter from wall
Output changes as a function of distance and field size. To reduce this
effect of inverse square corrections & collimator size corrections, for all
patients standard distance and standard field size are to be used
13. In this approach, the scatter volume is estimated from the top of the
shoulders to the bottom of the pelvis and has lateral & AP dimensions at
the level of umbilicus.
To calculate the total scatter volume, CCSG followed two procedures
such as
The entire scatter volume is considered as unit density
the volume is exactly centered around the central axis of the field
14. After measured with Modular Plastic Phantom, CCSG had concluded
that
Change in the amount of scatter material behind the chamber
doesn’t produce a significant change in detector reading
Low density tissues at distances greater than about 15cm from the
chamber do not change the measured dose relative to the condition
where a scattering volume is made up entirely of unit density
material
CCSG found that correction methods used for extending the PDD’s to
other SSD are sufficiently rigorous for the TBI situation
CCSG protocol recommends to determine the PDD’s, TAR’s and TPR’s
using a phantom that more closely correspond to the actual irradiation
conditions
Although TAR & TPR are independent of distance, the problems
associated with the finite size of the scattering volume must be
addressed
Finally, CCSG recommends to calibrate the treatment unit at standard
extended distance using maximum field
15. Techniques of Magna Irradiation:
TBI technique is depends on a lot of variables such as
Machine type and energy
Dose prescription parameters (dose, no. of fractions,
dose/fraction and dose rate)
Patient position
Therapy room constraints ( distance & Field size)
Beam modifiers (Bolus and Compensators)
Brenda Shank, M.D, PhD ., had surveyed about TBI treatment
techniques in seven representative institutes and found that remarkable
dose homogeneity throughout patient including at the Skin surface
within 10% by using Bolus and Compensators for energies ranging from
1.25MeV (Tele cobalt Machine) to 10MV (Linear Accelerator)
16. Homogeneity and Methods used to achieve
Institution
Beam
Energy
Patient
Position
Bolus Compensators Homogeneity
University of California 1.25MeV AP/PA
- -
89 – 121%
Johns Hospital 1.25MeV AP/PA
- -
80 – 110%
Fred Hutchinson
cancer Research center
1.25MeV AP/PA
- -
87 – 111%
Children Hospital 6MV AP/PA
- -
-
University of
Minnesota
10MV Laterals 0.95cm Lucite
( to increase
skin dose)
Al ; all except
abdomen and
pelvis
94 – 102%
City of Hope Hospital 10MV AP/PA Face : 0.6cm
Lucite
Rest : 0.8cm
tissue eq.
blanket
Pb; calf, foot
and neck
96 – 103%
Memorial Sloan-
kettering cancer center
10MV AP/PA 1 cm Lexan - 89 – 115%
17. Lung Dose Determination
One of the major complications of large field radiotherapy is radiation
Pneumonitis. (infection in Lung)
It is imperative that the dose to lung be precisely controlled to ensure
that the probability of minimal occurrence
The below steps are followed to calculate lung dose and to reduce
radiation Pneumonitis
First step : Determination of inhomogeneity correction by using any of
below methods
Linear Attenuation Method
Effective Attenuation method (ICRU)
Generalized Batho method
Equivalent TAR method
18. Considerations : Depth from surface – 12.5cm
Lung depth – 9.0cm
Method of Calculation Dose correction factors
Linear attenuation method (3.5% /cm) 1.32
1.31
1.04
1.17
Effective attenuation method (ICRU)
Generalized Batho
Equivalent TAR
12%
Variation in lung dose calculations for 50 x 60 cm2 cobalt -60 fields using
different calculation methods
19. Second step: Obtaining patient specific density & geometry of lung
and dose determination by using any of below methods
CT data and Pixel based dose calculations
(accurate 3% )
CT data for contours and average density data
(accuracy 5%)
Transmission measurements
Lateral radiographs
Nomo graph relating dose correction factor and
patient thickness (large errors occurs in diseased
lung)
In a study evaluating response of lung to radiation absorbed dose, CT
scans were performed on 23 patients for dose calculation
20. When the dose correction factors for the middle of lung were plotted
as a function of patient thickness, 80% of the data points fell within
1.5% of a straight line.
The maximum dose deviation for normal lungs was 3.5% ; diseased
lungs showed much larger deviations
Higher energy data were derived by converting those dose corrections
to an equivalent t depth and then determining the dose correction
factor for higher energy.
Why it is increasing with patient thickness increase (inhomogeneity of
patient thickness)
Patient Thickness
(cm)
Lung dose correction factor
Co – 60 6 MV 25 MV
12 1.04 1.04 1.02
16 1.09 1.09 1.06
20 1.14 1.13 1.09
24 1.19 1.17 1.12
28 1.24 1.21 1.14
21. Third step : Reduction of lung dose to avoid probability of lung
complications
By use of lung compensators (causes under dose)
Constant thickness lung attenuators (dose variation
throughout lung volume occurs)
Lung blocks for part of treatment (dose variation
throughout lung volume occurs)
Brenda Shank, M.D, PhD ., suggested multiple ways to decrease lung
damage which include:
Lowering TBI dose
Patient Positioning ( by using Arms as absorber)
Partial lung blocking
Using higher beam energies
Increasing fractionation
Using a low dose rate
22. References:
1. Symposium on Magna-Field Irradiation: Rationale, Technique,
Results ; Giulio J. D’ Angio, M.D
2. Radiobiological considerations in Magna Field Irradiation ; Richard G.
Evans, PhD., M.D
3. Magna Field Irradiation ; Physical Considerations ; J. Van Dyk, M.Sc.,
F.C.C.P.M
4. Calculation & Prescription of Dose for Total Body Irradiation ; J. M.
Glavin, D.Sc
5. Techniques of Magna Field Irradiation ; Brenda Shank, M.D., PhD.,