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Physical and Biological Background of Radiosurgery

Article information

J Korean Med Assoc. 2008;51(1):16-26
Publication date (electronic) : 2008 January 31
doi : https://doi.org/10.5124/jkma.2008.51.1.16
Tae Suk Suh, PhD1, Il Han Kim2
1Department of Biomedical Engineering, The Catholic University College of Medicine, Korea. suhsanta@catholic.ac.kr
2Department of Radiation Oncology, Seoul National University College of Medicine, Korea. ihkim@snu.ac.kr

Abstract

Radiosurgery is a highly precise form of radiation therapy for the treatment of vascular lesions, certain primary or metastatic neoplasms, or functional disorders. Either intracranial or extracranial, which are inaccessible or unsuitable for surgical or other management. As the basis of radiation physics for radiosurgery, this article introduces radiation history, the method of radiation production, interaction mode of radiations with human, transfer of radiation energy to the tissue, and dose planning to generate a desirable dose distribution on the target site. Biologically, the goal of radiosurgery is to cause a precise damage only to the limited tissue within the target volume without exceeding the acceptable rate of complications. As the therapeutic ratio is a function of the volume irradiated, the total dose and dose per fraction used, and the level of acceptable risk, radiation oncologists or practitioners should consider various radiobiologic factors when using radiosurgery to obtain the maximum therapeutic ratio.

Keywords: Radiosurgery; Fractionated stereotactic radiotherapy (FSRT); Radiobiology; Therapeutic ratio

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Article information Continued

Copyright © 2008 Korean Medical Association

Figure 1

Figure 1

Schematic diagram illustrating parts of radiation physics involved in radiosurgery. In order to understand the principle of radiosurgery four parts of radiation physics principles are involved in the radiosurgery procedure: radiation production; interaction with matter; dose deposition; and dose planning.

Figure 2

Figure 2

Classification of electromagnetic radiation.

Figure 3

Figure 3

Schematic diagram illustrating the interaction mode from X or γ-ray. X or γ-ray interact with the absorber to produce high speed electrons by three important mechanisms known as the photoelectric effect, Compton scattering, and pair production. The high speed electron produces a track along which ionization and excitation of atoms occur, and molecular bonds are broken, resulting in chemical change and finally producing biological damage.

Figure 4

Figure 4

Comparison of dose distribution for three different radiations (Co-60 γ-ray, 6MV X-ray, proton). If the target is located in deep seated area in the patient, γ-rays and x-rays would be unsatisfactory since they deposit more dose outside the target region than within it. By contrast, the single proton beam deposits more dose to the target than to the normal tissues along its entry path (10).

Figure 5

Figure 5

Tumor control probability (TCP) and normal tissue complication probability (NTCP).

Table 1

Tolerance dose (TD5/5-TD50/5) to whole-organ irradiation

Table 1

TD5/5 = TD of 5% toxicity in 5 yrs

TD50/5 = TD of 50% toxicity in 5 yrs

Table 2

Normal tissue tolerance to therapeutic irradiation

Table 2

Table 3

Kjellberg's dose prescription recommendation for single fraction radiosurgery using proton beam derived from the 1% dose-volume isoeffect line for brain necrosis

Table 3