introduction of Radiotherapy

introduction of Radiotherapy

1. ZMT 335 1 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak TOPIC 1 Introduction of Radiotherapy

2. 1.1 Introduction 1.2 Principle of Radiation Therapy 1.3 Types of Radiation Therapy 1.4 External Radiation Therapy Equipment's & Technique 1.5 Risk & Side Effect 2 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

3. 1.1 Introduction 3 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

4. What is Radiotherapy??? 4 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

5. Radiation therapy? Radiotherapy? Radiation oncology? 1.1 Introduction

6. 1.1 Introduction 8 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

7. 1.1 Introduction 9 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

8. 1.1 Introduction 10 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

9. 1.1 Introduction 11 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

10. 1.2 Principle of RT 12 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

11. 1.2 Principle of RT

12. 1.2 Principle of RT 14 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

13. 1.2 Principle of RT 15 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

14. 1.2 Principle of RT 16 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

15. 1.2 Principle of RT 17 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

16. 1.3 Types of Radiation Therapy 18 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

17. 1.3 Types of Radiation Therapy 19 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

18. 1.3.1 External Beam Therapy (EBT) 20 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

19. 1.3.1 External Beam Therapy (EBT) 21 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

20. 1.3.1 External Beam Therapy (EBT) 22 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

21. 1.3.2 Brachytherapy 23 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

22. 1.3.2 Brachytherapy 24 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

23. 1.3.2 Brachytherapy

24. 1.3.2 Brachytherapy

25. 1.3.2 Brachytherapy

26. 1.3.2 Brachytherapy

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29. Will the patient become radioactive? Will not become permanently radioactive. Patients who are given radioactive substances such as iodine, phosphorus, or strontium by mouth or into a vein will be instructed on precautions to take until their bodies no longer contain enough radioactivity to be hazardous to others. No! 1.3.2 Brachytherapy

30. 1.4 External Radiation Therapy Equipment's & Technique 32 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

31. 1.4.1 γ – Rays 34 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

32. 1. Cobalt Unit 1.4.1 γ – Rays

33. 1.4.1 γ – Rays -Co-60- RADIOSURGERY “GAMMA KNIFE” TECHNIQUE

34. 1.4.2 X – Rays 37 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

35. X-rays Single energy 4 or 6MV X-rays Dual energy 6 and 15 or 18 MV (low and high energy) Electrons 4 MeV to 21 MeV - variable Varian Accelerator Siemens Accelerator 1.4.2 X – Rays 1. LINAC EQUIPMENT

36. No more lead blocks! 1.4.2 X – Rays 2. LINAC + MLC EQUIPMENT

37. 1.2 Principle of RT 1.4.2 X – Rays 3 . LINAC + CT EQUIPMENT

38. 4. LINAC + CBCT EQUIPMENT 1.4.2 X – Rays

39. 1.4.2 X – Rays 5. TOMOTHERAPY EQUIPMENT

40. Synchrony ™ camera Linear accelerator Manipulator Image detectors X-ray sources Targeting System Robotic Delivery System 6. TOMOTHERAPY EQUIPMENT

41. 5. RESPIRATORY GATING EQUIPMENT 1.4.2 X – Rays

42. 1.4.2 X – Rays IGRT VMAT TECHNIQUE

43. High energy beam 1 moving source 5mm – 4cm target 1.4.2 X – Rays 1. RADIOSURGERY “X KNIFE” TECHNIQUE

44. 1.4.2 X – Rays 2. IMRT TECHNIQUE

45. 1.5 Risk & Side Effect 49 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

46. 1.5.1 Risk 50 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

47. 1.5.2 Side effects 51 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

48. 1.5.2 Side effects 52 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

49. Meet the Radiation Oncology Team 53 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak

50. 54 24/1/2018 Dr. Nik Noor Ashikin Bt Nik Ab Razak Radiation Oncologist The doctor who oversees the radiation therapy treatments. Medical Radiation Physicist Ensures that complex treatment plans are properly tailored for each patient. Dosimetrist Works with the radiation oncologist and medical physicist to calculate the proper dose of radiation given to the tumor. Radiation Therapist Administers the daily radiation under the doctor’s prescription and supervision. Radiation Oncology Nurse Cares for the patient and family by providing education, emotional support and tips for managing side effects.

51. 1. ENERGY 2. ACTIVITY 3. EXPOSURE 4. KERMA 5. DOSE 6. ABSORBED DOSE 7. EQUIVALENT DOSE 8. EFFECTIVE DOSE 1.6 Radiation measurement

52. 1.ENERGY Basic unit for energy = joule (J) In radiation field, the units is too big. Smaller units is used; electron-Volt ( eV ). 1 eV = energy needed to transfer 1 electron using 1 volt. 1 eV = 1.062 x 10 -19 joule 1 joule = 0.624 x 10 19 eV 1.6 Radiation measurement

53. 2. ACTIVITY ACTIVITY ( A ) = Number of decays(nucleus transformation – dN ) per second ( dt ) , measured in BEQUERELS ( Bq ). A = dN / dt 1 Bequerel = 1 decay per second An older unit (non SI) is the CURIE ( Ci ) 1 Ci = 3.7 x 10 10 Bq = 37 GBq 1.6 Radiation measurement

54. 3. EXPOSURE Exposure is symbolized by X, is absolute value of total charge, dQ of the ions of one sign produced in air when all the electrons liberated by photons in air of mass dm are completely stop in air. X = dQ /dm Coulomb per kilogram (C/kg) 1R = 2.58 × 10 − 4 coulomb/kg air The average energy required to produce ion pairs in a material, is 33.85 eV per ion pair (IP) for air . Thus , for every coulomb per kilogram of exposure , air absorbs 33.85 J/kg of energy 1.6 Radiation measurement

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57. FLUENCE The fluence ,  , is the quotient of d N by d a , where d N is the number of particles incident on a sphere of cross section d A , thus  = dN / dA The unit of fluence is m -2 1.6 Radiation measurement

58. 4. KERMA The quantity kerma , K, is defined as: K= dE tr /dm where dE tr is the sum of the initial kinetic energies of all charged ionizing particles liberated by uncharged ionizing particles in a material of mass dm. Kerma in air, K a , is used for radiation protection measurement purposes. The SI unit of kerma is the joule per kilogram (J/kg), termed gray ( Gy ). 1.6 Radiation measurement

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63. 5. DOSE Used to visualized total radiation effects received by a material (biological or non-biological). Relates with the total amount of energy transferred. A few units available: Absorbed dose ( D ) Equivalent dose ( H ) Effective equivalent dose, etc. 1.6 Radiation measurement

64. 6. ABSORBED DOSE Absorbed dose is defined as the energy imparted by ionising radiation to matter of mass m in a finite volume V. ABSORBED DOSE is measured in the SI unit of the gray ( Gy ) 1 gray =1 Joule / kg An older unit (non SI) is the rad . 100 rad = 1 gray ( Gy ) 1 rad = 10 mGy 1.6 Radiation measurement

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67. 7. EQUIVALENT DOSE Gives an approximate biological effect for certain amount of irradiation dose. Different radiations have different biological effectiveness for the same amount of energy absorbed. To allow for this, each radiation type is given a radiation weighting factor, W R , (sometimes called a quality factor, Q). H = D x Q x N D = Absorbed dose; Q = Quality factor N = Multiply factor, considering other factors such as geometrical. Normally assumed = 1. 1.6 Radiation measurement

68. Tissue EQUIVALENT DOSE ( H T,R ) = AVERAGE Absorbed dose for TISSUE ( D T,R ) x Radiation weighting factor (W R ). ( H T,R ) = ( D T,R ) x (W R ) Equivalent dose is measured in the SI unit of sievert ( Sv ). An older unit (non SI) is the rem 100 rem = 1 sievert ( Sv ) 1 rem = 10 mSv . 1.6 Radiation measurement

69. radiation weighting factor   Radiation type W R --------------------------------------        X –rays 1       gammas 1        betas     1        alphas 20 fast neutrons 10 protons            5 1.6 Radiation measurement

70. 8. EFFECTIVE DOSE A summation of the tissue equivalent doses, each multiplied by the appropriate tissue weighting factor: E = ∑ w T ·H T where H T is the equivalent dose in tissue T and w T is the tissue weighting factor for tissue T. 1.6 Radiation measurement

71. Tissue weighting factors Multipliers of the equivalent dose to an organ or tissue to account for the different sensitivities to the induction of stochastic effects of radiation. Q 1.6 Radiation measurement

72. Pre-TASK 1 Direct Action & Indirect Action of radiation on DNA Watch the videos in e-learn and answer the quiz http:// ozradonc.wikidot.com/rb:radiobiology-introduction https://www.youtube.com/watch?v=tq6FDyFeCN0