GIAO TRNH C S LY SINH

C s sinh hoc bc xa
Phan I: M au
Phan II: C s vat ly
Phan III: Tac dng sinh hoc cua bc xa
2
M AU
CAC NG DUNG CUA BC XA TRONG Y TE
Cc c im ca bc x ion ha v ng dng ca chng:
kh nng ion ha v kch thch nguyn t
Phng php ion ha:
x tr: trung tm Ung bu TPHCM, bnh vin Ch Ry
kh trng: trung tm chiu x ti Th c
dit cn trng, to t bin: trong nng nghip, nghin cu sinh hc
kh nng m xuyn qua vt cht
Phng php ghi nhn bc x truyn qua: X quang, CT, Angio
c p dng ti khoa chn on hnh nh ca cc bnh vin
tnh cht khng phn bit v mt ha hc gia ng v phng x v
ng v bn + kh nng c ghi nhn bi h thng o c rt nhy
Phng php nh du phng x: chn on hnh nh (PET, SPECT)
v xt nghim in vitro
c p dng ti khoa y hc ht nhn mt s bnh vin
3
XA TR BANG MAY GIA TOC
4
LAP KE HOACH CHO XA TR BANG MAY GIA TOC
5
LAP KE HOACH CHO XA TR BANG MAY GIA TOC
6
CHUP ANH CAT LP NH S HO TR CUA MAY TNH
(COMPUTED TOMOGRAPHY, CT)
7
POSITRON EMISSION TOMOGRAPHY (PET) + CT
8
9
V DU VE MOT HE THONG GHI NHAN ANH CT
Slice or Axial Image
Image Recon. Computer
Data Acquisition
10
E AP DUNG BC XA THANH CONG, CAN NAM VNG
1. Cc c im ca bc x v ngun bc x (ngun
ng v, my pht tia, my gia tc)
2. C s vt l ca s tng tc gia bc x v vt cht
3. Tc dng sinh hc ca bc x
4. Phng php v thit b ghi nhn bc x
5. K thut x l v hin th nh (trong chn on hnh
nh)
Phn c s gii thiu C s vt l ca s tng tc vt
l gia bc x v vt cht vTc dng sinh hc ca
bc x.
Cc mc cn li s c cp trong cc bi ging v
cc ng dng c th ca bc x trong y t v nng
nghip.
11
C S VAT LY
CAU TAO CUA NGUYEN T
Vat chat cau tao t cac nguyen t
Moi vat chat quanh ta, ke ca c the cua chung ta, eu cau
tao t cac nguyen t (atom).
Cac nguyen t rat nho: mot cm
3
nc cha khoang 10
23
(mot
tram ngan t t) nguyen t !
Hai hay nhieu nguyen t ket hp lai thanh phan t.
Nhng ai phan t hu c nh ADN co the bao gom hang
trieu nguyen t.
Nguyen t gom mot hat nhan (nucleus) gia va cac electron
chuyen ong chung quanh
Cac electron c ky hieu la e-.
Chung la nhng hat rat nhe (khoi lng m = 9,1.10
-31kg
).
Cac electron mang ien tch am, e = - 1,6.10
-19
C.
12
CAU TAO CUA HAT NHAN
Hnh dung ve nguyen t Hnh dung ve hat nhan
Hat nhan gom cac proton va neutron
Cac proton va neutron co khoi lng xap x bang nhau va nang
hn electron khoang 2000 lan.
Cac neutron khong mang ien; ky hieu n.
Cac proton mang ien tch dng va bang vi ien tch cua
electron; ky hieu p.
Nguyen t ben vng nh lc hut ien gia cac electron va cac
proton.
So proton bang so electron, nen bnh thng nguyen t trung hoa
ve ien.
Kch thc cua hat nhan be hn cua nguyen t khoang 10.000 lan
nguyen t gan nh rong khong !
electron (e
-
)
hat nhan
proton (p)
neutron (n)
13
Tnh cht hoa hc ph thuc vao so th t nguyen t
(atomic number Z): tong so proton (hay so electron) co
trong mot nguyen t.
V du: nguyen t oxy co Z = 8; hidro co Z = 1.
oi vi hp chat, ngi ta dung khai niem nguyen t
so hieu dung (effective atomic number Z
eff
)
Tnh cht vat ly (s phong xa) ph thuc vao so khoi
(atomic mass A): tong so proton va neutron co trong hat
nhan nguyen t.
TNH CHAT CUA NGUYEN T PHU THUOC VAO
CAI G ?
14
Cac electron trong nguyen t (mang ien am) b hut bi hat nhan
(mang ien dng).
Tuy nhien chung khong ri vao nhan ma chuyen ong khong
ngng quanh nhan.
Co the hnh dung rang cac electron chuyen ong thanh tng lp
quanh nhan.
Ky hieu cac lp t trong ra ngoai la K, L, M, N, ng vi n = 1, 2,
3, 4
moi lp, ch co mot so electron toi a c phep co mat.
V du: lp K (n = 1) co toi a 2 electron
lp L (n = 2) co toi a 8 electron
lp M (n = 3) co toi a 18 electron
Noi chung, lp th n co toi a 2n
2
electron.
CAU TRUC LP CUA CAC ELECTRON TRONG
NGUYEN T
Z = 1 Z = 2 Z = 8 Z = 10
15
CAC MC NANG LNG CUA ELECTRON TRONG
NGUYEN T
The nang va nang lng lien ket
Do chu lc hut cua hat nhan, cac electron moi lp co mot
the nang tng tac vi hat nhan nhat nh.
Qui c: khi electron khong lien ket vi hat nhan, the nang
cua no bang khong; trong nguyen t, electron co the nang am.
Cac electron cac lp trong co the nang am hn cac electron
cac lp ngoai.
Tr tuyet oi cua the nang c goi la nang lng lien ket
(binding energy).
Nang lng kch thch
La nang lng can thiet e nang electron t mc thap nhat
len cac mc cao hn.
e tnh nang lng kch thch, ngi ta lay mc nang lng
thap nhat bang khong.
16
THANG NANG LNG CUA ELECTRON
Cc mc nng lng trong nguyn t hidr
NL kch thch
13,6 eV
12,75 eV
12,1 eV
10,2 eV
0 eV
The nang
0 eV
-0,85 eV
-1,5 eV
-3,4 eV
-13,6 eV
Lp
N
M
L
K
Cac nguyen to khac nhau co cac thang nang lng khac nhau, ac
trng cho nguyen to o.
Noi chung, khoang cach gia cac lp trong co o ln la keV, gia
cac lp ngoai la vai eV. Nguyen t cang nang, khoang cach nay
cang rong.
17
PHAN T, NGUYEN TO, HP CHAT
Cac electron ngoai cung c goi la cac electron hoa tr. Chung
co the lien ket vi cac electron hoa tr cua nguyen t khac e tao
thanh phan t (molecule).
Mot phan t co the gom hai hay nhieu nguyen t cung Z hay khac
Z lien ket vi nhau.
V du:
Phan t oxy gom hai nguyen t oxy, ky hieu O
2
.
Phan t nc gom hai nguyen t hiro va mot nguyen t oxy,
ky hieu H
2
O.
Phan t ADN la mot phan t hu c ln gom rat nhieu nguyen t
H, C va O.
Cac chat ma phan t cua chung cau tao bi cac nguyen t cung
loai c goi la nguyen to (element) hay n chat. Cac chat ma
phan t cua chung cau tao bi cac nguyen t khac loai c goi la
hp chat (compound).
? Phan biet nguyen to va hp chat trong cac chat sau: oxy, khong
kh, nc, ch, betong.
18
ION DNG VA ION AM
Khi mot nguyen t mat i electron hay nhan them electron, ta
noi no b ion hoa (ionized).
Khi nguyen t mat electron, no se mang ien dng: ion dng.
Cac ion dng thng tm cach gianh lay electron cua cac
nguyen t, phan t lan can no.
Khi nguyen t nhan them electron th no se mang ien am: ion
am.
Cac ion am thng tm cach nha bt electron cho cac nguyen t,
phan t lan can no.
Mot ion dng va mot electron c goi la mot cap ion (ion
pair).
Nguyen t co the b ion hoa khi b bc xa (photon, electron,
v.v..) chieu vao.
S ion hoa lam cac nguyen t, phan t b mat on nh, t
lien ket phan t
S ion hoa do bc xa lam thay oi tnh chat sinh hoc cua te bao
Bc xa gay tac dung sinh hoc len c the song.
19
S PHAT VA HAP THU BC XA CUA NGUYEN T
NH LUAT BAO TOAN NANG LNG
S phat bc xa cua nguyen t:
Khi mot electron lp trong cua nguyen t b mat, th mot
electron lp ngoai se nhanh chong nhay vao the cho.
Do electron lp ngoai co nang lng ln hn lp trong,
nen se co nang lng tha phat ra.
Phan nang lng tha c phat ra ngoai di dang mot
photon.
Nang lng cua photon ung bang hieu nang lng cua hai
mc (nh luat bao toan nang lng).
Khi electron t the nang cao E
2
nhay vao mc thap E
1
, th
photon phat ra se co nang lng
h = E
2
- E
1
.
h = 6,625.10
-34
J.s : hang so Plank; : tan so cua photon.
oi khi nang lng nay cung c phat ra di dang mot
electron, c goi la electron Auger.
20
S PHAT VA HAP THU BC XA
NH LUAT BAO TOAN NANG LNG
S kch thch
Electron cung co the nhay t mc nang lng di len mc
tren khi nhan c mot nang lng ung bang hieu hai mc
nang lng o (chang han do hap thu mot photon)
S ion hoa do bc xa
Electron cung co the b bat ra khoi nguyen t do hap thu
mot photon, neu photon co nang lng ln hn nang lng
lien ket cua electron.
Khi o, ong nang electron E
k
se bang nang lng cua
photon, tr i nang lng lien ket cua electron W
lk
(nh
luat bao toan nang lng)
E
k
= h - W
lk
21
S PHAT VA HAP THU BC XA (tt)
Hnh dung ve s phat bc xa va s ion hoa do hap thu bc xa
Do day cac mc nang lng trong nguyen t la khac nhau
cho moi loai nguyen to khac nhau, nen day nang lng cua
cac photon cung khac nhau cho moi loai nguyen t .
Cac photon o thng c goi la tia X ac trng
(characteristic X ray).
Phan tch day nang lng cua cac photon phat ra, ngi ta co
the biet nguyen to phat ra photon o la g.
V du: phep phan tch quang pho.
22
ANH HNG CUA S ION HOA VA KCH THCH EN
CAC PHAN T SINH HOC
Trong cac te bao, cac phan t hu c thng thc hien nhng chc
nang rieng biet. Mot so phan t ong nhng vai tro quan trong
trong viec duy tr s ton tai cua te bao. Khi cac phan t nay b
pha v, te bao o co the b huy hoai.
Phan t co the b pha v neu no b mat i mot hay nhieu electron.
Nguyen nhan la electron b mot tia bc xa hat vang ra, hoac b
mot phan t khac hay mot ion dng gianh lay.
(Cac ion dng thng rat them electron va chung thng gianh
electron cua cac phan t khac, ne u phan t nay khong u sc gi
cac electron lai.)
Phan t cung co the b pha v neu no nhan them mot hay nhieu
electron.
Trong te bao co rat nhieu cac phan t nc (70-80%), khi b ion
hoa, phan t nc co the b phan ly (s thuy phan do bc xa).
Qua trnh nay co the lam sinh ra nhng goc t do (radical) OH*,
H* co hoat tnh hoa hoc rat manh, cong pha cac phan t sinh hoc.
23
CAU TRUC CUA HAT NHAN NGUYEN T
Hat nhan cau tao t cac proton va neutron.
Proton va neutron c goi chung la nucleon.
Cac nucleon trong hat nhan lien ket vi nhau bang lc hat nhan.
Mat khac, cac proton ay nhau bang lc ien. Nen hat nhan co the
khong ben. Cac hat nhan co t so gia so proton va so neutron qua
ln hay qua be thng se dan dan bien oi thanh hat nhan khac.
Tng t nh nguyen t, trong hat nhan, cac nucleon cung co cac
mc nang lng gian oan. Nhng khoang cach gia cac mc nang
lng thng vao khoang MeV.
Phan loai hat nhan -- Ky hieu hat nhan.
Cac hat nhan cua cung mot nguyen to (v du oxy) luon luon co cung
so proton, nhng co the co so neutron khac nhau.
Tong so proton trong mot hat nhan c goi la so ien tch, ky hieu
la Z; tong so proton va neutron trong mot hat nhan c goi la so
khoi, ky hieu la A.
Mot hat nhan co the c ac trng bi hai so Z va A.
Ky hieu hat nhan:
A
X hay X-A. Trong o X la ky hieu cua nguyen
to tng ng vi hat nhan o. V du
60
Co, C-12 v.v..
24
CAC HAT NHAN ONG V
ONG V BEN VA ONG V KHONG BEN
Cac hat nhan co cung Z nhng khac A c goi la cac ong v
(isotope).
Mot nguyen to co the co hang chuc ong v khac nhau. V du:
O-13, O-14, O-15, O-16, O-17, O-18, O-19, O-20, O-21, O-22,
O-23, O-24.
Mot vai ong v la ben, cac ong v con lai thng la khong ben va
co the bien oi (phan ra) thanh cac hat nhan khac: cac ong v
phong xa.
Cac ong v phong xa co the co nguon goc t nhien hay c tao ra
trong cac may gia toc hoac trong lo phan ng hat nhan.
V du: O-16, O-17, O-18 la ben, con lai la cac ong v phong xa.
Khi phan ra thanh hat nhan khac, cac ong v phong xa phat ra cac
tia khong nhn thay, nhng co kha nang am xuyen qua vat chat rat
manh. Ngi ta goi ay la tia phong xa hay bc xa hat nhan (nuclear
radiation).
Hien tng nay c goi la hien tng phong xa (radioactivity).
25
CAC LOAI TIA PHONG XA
Cac qua trnh tng ng la
phan ra alpha (),
phan ra beta (), bao gom phan ra beta tr (
-
) va beta cong
(
+
) va
phan ra gamma ().
Cac phan ra va phan ra thng dan en phan ra .
V du: Ra-226 Rn-222 +
4

I-131 Xe-131 +
-
F-18 O-18 +
+
Mot so ong v phong xa cung phat neutron.
tia alpha (hat nhan heli): i vai mm trong khong kh,
tia beta: (electron hay positron): i vai met trong
khong kh,
tia gamma (photon): xuyen qua ngi de dang
26
NH LUAT PHAN RA PHONG XA
HANG SO PHAN RA
nh luat phan ra phong xa:
Neu thi iem t = 0 co N
o
hat nhan co kha nang phan ra,
th thi iem t, mot so hat nhan a b phan ra, va so hat
nhan con lai la:
N(t) = N
o
.e
-t
.
So hat nhan co kha nang phan ra se giam dan theo thi gian
theo qui luat ham mu.
c goi la hang so phan ra (decay constant), co n v la
1/giay.
Moi loai ong v phong xa co mot rieng.
27
NH LUAT PHAN RA PHONG XA
CHU KY BAN RA (HALF-LIVE)
0,00
0,25
0,50
1,0
thi gian t
N(t)/N(0)
3T
1/2
2T
1/2
T
1/2
0,125
Sau mot khoang thi gian nhat nh, so hat nhan co kha nang
phan ra giam i con mot na. Khoang thi gian o c goi la chu
ky ban ra cua loai hat nhan ang xet, va c ky hieu la T
1/2
.
28
CHU KY BAN RA CUA CAC ONG V LA RAT KHAC NHAU
T
1/2
= ln(2/) = 0,693/.
Chu ky ban ra cua cac ong v phong xa co the rat ln, hang
ngan nam, cung co the rat nho.
V du: Radium Ra-226 co T
1/2
= 1620 nam
Iot I-131 co T
1/2
= 8 ngay
Oxy O-15 co T
1/2
= 2,1 phut.
29
NGUON PHONG XA - HOAT O CUA NGUON PHONG XA
Mot nguon phong xa la mot mau vat chat co kha nang phat tia
phong xa. Cac nguon phong xa thng c s dung trong y hoc
hat nhan hay xa tr e chan oan hay ieu tr.
Hoat o cua nguon phong xa la so hat nhan phan ra t nguon
trong mot n v thi gian.
Hoat o = so phan ra/giay
A = dN(t)/dt = N
o
.e
-t
.
Can biet hoat o cua nguon e tnh c lng bc xa i qua hay
hap thu trong c the cua benh nhan.
Hoat o cua mot nguon giam dan theo thi gian theo qui luat
ham mu, giong nh N(t).
Hang so phan ra cang ln th hoat o cua nguon cang cao.
n v:
bequerel (beccren), ky hieu Bq
1 Bq = 1 phan ra/giay.
curie (Curi), ky hieu Ci
1 Ci = 3,7.10
10
Bq.
1 mCi = 10
-3
Ci; 1 Ci = 10
-6
Ci.
30
MOT SO NGUON PHONG XA DUNG TRONG Y TE
Hoat o rieng cua mot nguon: la t so gia hoat o A cua nguon
va khoi lng m cua nguon ay:
Hoat o rieng = hoat o/khoi lng cua nguon = A/m
n v: Bq/gam.
Mot so nguon phong xa ng dung trong chan oan va ieu tr
ong v Chup hnh Chu ky ban ra
Tc-99m Tim, phoi, than, 6 gi
xng, tuyen giap
Tl-201 C tim 78 gi
C-11 Nao 20 phut
In-111 Nao 67 gi
Ga-67 Khoi u 78 gi
N-13 Tim 10 phut
O-15 Nghien cu Oxy 2 phut
F-18 ong kinh 110 phut
Co-60 Xa tr 5,3 nam
I-131 Xa tr tuyen giap 8 ngay
31
BC XA ION HOA VA TNG TAC VI VAT CHAT
BC XA ION HOA (IONIZATION RADIATION) LA G ?
La tia X, tia gamma, cac chum hat (particle) nh electron,
proton, neutron, hat alpha phat ra t hat nhan eu co kha
nang ion hoa nguyen t va c goi chung la bc xa ion hoa.
Tia X c ng dung rat pho bien trong y te.
Tia X co tnh chat rat ac biet:
Chung va c xem la song ien t, va co the c xem
la chum cac hat photon, chuyen ong vi van toc rat ln (c
300.000 km/s).
Cac photon khong co khoi lng va khong mang ien.
32
BC XA ION HOA VA TNG TAC VI VAT CHAT
TIA X VA TIA GAMMA
Khi xem tia X (tia gamma) nh la song, ngi ta thng ac
trng no bi bc song hay tan so f.
Hai ai lng nay t le nghch nhau:
= c/f,
vi c 300.000 km/s la van toc cua song ien t trong chan
khong.
Nhng song ien t co bc song dai (song radio, hong
ngoai, t ngoai, v.v.. ) thng c xem la song.
Bc song cua chung co the trai dai t vai kilomet en
khoang micromet (m = 10
-6
m).
Tia X, tia gamma co bc song rat ngan va thng c xem
la chum cac hat photon.
33
34
THANG BC X IN T
35
BA AC TRNG CUA NGUON BC XA
LOAI BC XA
1. Loai bc xa (loai hat)
2. Nang lng cua cac hat trong chum
3. Hoat o cua nguon hay cng o chum bc xa
Loai hat
La tia X, electron, hat alpha, proton hay neutron v.v..
Cac hat alpha, proton c goi la cac hat nang mang ien,
electron la hat nhe mang ien.
Neutron, tia X tia gamma la cac hat khong mang ien.
Cac loai hat khac nhau tng tac vi vat chat khac nhau, the
hien LET khac nhau.
36
BA AC TRNG CUA NGUON BC XA
NANG LNG (ENERGY)
La nang lng cua moi hat trong chum bc xa.
Nang lng cang ln th hat i cang sau vao trong vat chat.
Nang lng cua cac hat thng c o bang eV (electronvon)
1 eV = 1,6.10
-19
jun.
keV (kiloelectronvon); 1 keV = 10
3
eV.
MeV (megaelectronvon hay em-i-vi); 1 MeV = 10
6
eV.
Nang lng cua photon
Photon co nang lng t le vi tan so theo cong thc
E = h = hc/,
vi h = 6,625.10
-34
J.s = 4,14.10
-15
eV.s (hang so Plank).
Cong thc tien dung e tnh nang lng E cua photon theo bc
song
E (eV) = 1,24/ (m),
trong o c tnh bang m, con E c tnh bang eV.
V du: photon cua anh sang vang, = 0,5 m co E = 2,48 eV.
37
NANG LNG CUA TIA X
Photon cua anh sang nhn thay co nang lng khoang vai
eV, c phat ra t cac lp ngoai cung cua vo nguyen t.
Tia X co nang lng khoang vai keV en vai tram keV,
c phat ra t cac lp trong cua nguyen t hay t s phat
bc xa ham.
Tia gamma co nang lng khoang MeV, c phat ra t hat
nhan nguyen t.
Tia X dung trong y te thng c chia lam 3 loai:
loai be mat (superficial radiation) co nang lng t
10 en 125 keV;
loai trung bnh (orthovoltage radiation) t 125 en
400 keV va
loai supervoltage (hay con goi megavoltage), co
nang lng tren 400 keV.
38
oi vi bc xa la cac hat co khoi lng, thng ngi ta dung
ch nang lng e ch ong nang cua no.
Mot hat mang ien tch q, khi c gia toc bi hieu ien the
U, se co ong nang
E = q.U
V du: electron (ien tch e), khi c gia toc qua hieu ien
the 100 kV, se co ong nang 100 keV.
Trong cac ng dung y hoc, khoi lng cua cac hat thng
khong b thay oi. Nhng cung co trng hp mot hat (nh
electron) b huy va bien thanh photon. Khi o nang lng cua
photon sinh ra se t le vi khoi lng m cua hat theo cong thc
Einstein
E = mc
2
.
Khi mot cap electron-positron b huy, co hai photon sinh ra,
bay ngc chieu nhau, moi photon co nang lng la 0,511
MeV, bang ung nang lng ngh cua electron/positron.
NANG LNG CUA CAC HAT CO KHOI LNG
39
PHO NANG LNG
Neu moi hat trong chum co cung nang lng, ta goi o la chum
n nang (monoenergy). Neu cac hat trong chum co nhieu nang
lng khac nhau, ta goi o la chum a nang (heteroenergy).
Nang lng cua mot chum a nang c bieu dien bang pho nang
lng (energy spectrum).
Trong cac may X quang chan oan tia X (sinh ra do s phat bc
xa ham) co pho lien tuc, nang lng trung bnh nam trong khoang
t 20 keV en 120 keV.
Cac nguon phong xa thng dung trong y te co the phat ra:
cac tia gamma co pho nang lng gian oan
tia beta (cac electron hay positron) co pho nang lng lien tuc.
Pho lien tuc cua tia beta Pho gian oan cua tia gamma
E
tb
E
max
so hat
40
CNG O (INTENSITY) CUA CHUM BC XA
La so lng hat trong chum i qua mot
n v dien tch (at vuong goc vi chum)
trong mot n v thi gian.
n v: hat/cm
2
.s.
Cac tia phong xa khi i vao c the ngi co the lam pha v
cac phan t trong te bao, dan en lam ton thng hay huy
hoai te bao.
Neu so lng te bao b huy hoai ln, th cac mo, c quan co
the b hong, dan en benh phong xa hay chet ngi.
Ta goi ay la tac dung sinh hoc cua bc xa (biological effect
of radiation).
Cng o cang ln, tac dung huy hoai cua tia phong xa cang
manh.
41
CAC TNG TAC GIA BC XA VA VAT CHAT
Khi i bc xa i vao vat chat, chung co the va cham vi cac
electron cua vo nguyen t.
Neu hat co nang lng u ln, chung co the lam ban electron ra
khoi nguyen t: s ion hoa (ionization).
Neu hat co nang lng khong ln lam, chung co the lam
electron trong nguyen t nhay t mc nang lng thap len mc
nang lng cao hn:s kch thch (excitation).
Cac electron co nang lng khoang tren 1 MeV, khi i gan hat
nhan nguyen t co the b uon cong qu ao va phat ra tia X: bc
xa ham (Bremstrahlung). Khi o electron cung b mat nang
lng.
Neu hat co nang lng cao hn na, no co the tng tac vi hat
nhan va gay ra phan ng hat nhan.
ac biet neutron khong the gay ion hoa trc tiep, nhng de dang
gay phan ng hat nhan, lam ban ra cac manh v hat nhan. Cac
manh v nay co kha nang gay ion hoa rat manh. Do o neutron
la bc xa gay ion hoa gian tiep, nhng rat nguy hiem.
42
S TRUYEN NANG LNG THONG QUA KCH
THCH VA ION HOA
Trong ng dung y te, tng tac chu yeu gia bc xa va
nguyen t la s ion hoa va kch thch.
Do s tng tac nay, bc xa b mat dan nang lng: Nang
lng cua hat c truyen cho vat chat.
Cac electron xuat hien do s ion hoa (cac electron th cap)
co the c truyen nang lng u ln e tiep tuc ion hoa cac
nguyen t khac.
Vay khi mot hat i vao vat chat, no co the lam cho nhieu
nguyen t lan can nhau b ion hoa.
So cap ion xuat hien t le vi nang lng vat chat hap thu.
43
HE SO TRUYEN NANG LNG TUYEN TNH LET
Lng nang lng ma hat truyen cho vat chat (do ion hoa va kch
thch) tren mot n v chieu dai cua quang ng i cua hat c
goi la LET (linear energy transfer).
Cac hat p, co LET > 3,5 keV/m. Chung c goi la cac hat co
LET cao.
Photon va electron noi chung c goi la cac hat co LET be.
Bc xa co LET cang cao th gay tac dung sinh hoc cang manh.
(a) (b)
Mat o ion hoa gay bi
proton (a) ln hn nhieu so
vi electron (b).
LET trong mi trng nc
Tia X 250 kVp 2 keV/m
Tia X 3 MeV 0.3 keV/m
Tia gamma cobalt-60 0.3 keV/m
Electron 1 keV 12.3 keV/m
Electron 10 keV 2.3 keV/m
Electron 1 MeV 0.25 keV/m
Neutrons 14 MeV 12 keV/m
Hat nang mang ien 100-200 keV/m
44
BC XA HAM
Cac hat nhe mang ien nh electron khi i gan hat nhan co
the b hut bi hat nhan, do o qu ao cua hat b uon cong
ong nang cua hat b giam i (b ham).
nang lng mat i bien thanh nang lng tia X phat ra:
bc xa ham (Bremstrahlung).
ng dung: tao ra tia X dung trong X quang chan oan.
Xac suat xay ra s phat bc xa ham cang ln khi:
nang lng cua electron cang ln
khi so ien tch cua moi trng Z cang ln.
e tao ra tia X bang bc xa ham, anod trong ong tia X
c lam bang tungsten (kim loai nang).
Pho bc xa ham: pho lien tuc + cac nh bc xa ac trng.
bc xa ham bc xa ac trng
45
LIEU HAP THU (ABSORBED DOSE)
S ion hoa va s kch thch la nhng nguyen nhan ban au dan en
s huy hoai te bao, tc gay nen tac dung sinh hoc.
Nang lng hap thu trong mot n v khoi lng vat chat cang ln
th tac dung sinh hoc cang cao.
Tac dung sinh hoc cua tia phong xa c o bang lieu hap thu
(absorbed dose, goi tat la dose): o la lng nang lng hap thu
trong mot kilogam vat chat.
n v cua lieu hap thu la Gray (viet tat Gy)
1 Gy = 1 Joule/kg;
1 cGy (centigray) = 0,01 Gy.
Lieu hap thu trong mot n v thi gian c goi la suat lieu hap
thu (dose rate). n v thng dung la cGy/min hay cGy/s.
Lieu hap thu phu thuoc vao loai bc xa (photon, electron hay
neutron); vao nang lng cua hat (may keV hay may MeV); cung
nh vao tnh chat cua moi trng ma hat i vao (xng, tht, v.v..).
o so cap ion xuat hien trong moi trng co the tnh c lieu hap
thu.
46
LIEU CHIEU (EXPOSURE)
Trong X quang, ngi ta cung con dung lieu chieu (exposure).
Lieu chieu ch c dung cho bc xa la photon co nang lng
di 3 MeV.
Theo nh ngha, lieu chieu la lng ien tch xuat hien trong
mot n v khoi lng khong kh khi c chieu.
n v cua lieu chieu trong he SI la C/kg. Ngoai ra, ngi ta
cung con dung n v rnghen, ky hieu R.
1R = 2,58.10
-4
C/kg khong kh.
1 C/kg = 3876 R.
Do ien tch cua moi cap ion la e = 1,6.10
-19
C, mot lieu chieu
co gia tr bang 1 C/kg se tao ra trong khong kh
1 (C/kg) / 1,6.10
-19
(C) = 6,25.1018 cap ion/kg.
oi vi khong kh, t lieu chieu, ngi ta co the tnh ra lieu
hap thu va ngc lai.
47
S SUY GIAM CUA CHUM PHOTON
KHI I QUA VAT CHAT
Cho mot chum tia X song song i qua mot lp vat chat,
mot so photon se b hap thu hay tan xa ra khoi chum.
Do o so hat trong chum se giam dan.
oi vi chum n nang E gia N(0) va N(x) co quan he:
N(x) = N(0).e
-.x
N(0)
N(x)
x
S suy giam cua chum photon la ket qua cua ba loai tng
tac chnh: hieu ng quang ien, tan xa Compton va s sinh
cap.
48
HE SO SUY GIAM TUYEN TNH
(muy) c goi la he so suy giam tuyen tnh (linear
attenuation coefficient) cua lp vat chat oi vi chum photon
o. cang ln th s suy giam cang nhanh.
n v thng dung cua la cm
-1
.
o ln cua phu thuoc:
nang lng E cua chum photon;
nguyen t so Z cua cac nguyen to cau tao nen moi trng va
mat o cua moi trng truyen: t le vi khoi lng rieng
cua vat lieu. Vat lieu co khoi lng rieng cang ln th he so
suy giam tuyen tnh cang ln.
V du:
Xng co kha nang lam suy giam chum photon manh nhat,
sau o en cac c bap. Phoi ngi cha nhieu kh nen khong
lam chum tia X suy yeu ang ke.
Ch co he so suy giam rat ln nen thng c dung lam vat
lieu che chan photon.
49
HIEU NG QUANG IEN
Hien tng:
1) Mot photon c hap thu hoan toan
va mot electron (goi la quang electron)
c bt ra khoi nguyen t.
2) Mot electron t lp tren se nhanh
chong nhay vao cho trong do quang
electron e lai, mot tia X ac trng phat
ra.
ac iem:
1) Xac suat xay ra ln nhat oi vi cac electron t lp K.
2) ong nang cua quang electron la E
k
= h E
b
, trong o h
la nang lng cua photon, E
b
la nang lng lien ket cua
electron.
3) Nang lng cua tia X ac trng xap x bang nang lng
lien ket E
lk
. Thng tia X ac trng nay se b hap thu trong
lan can nguyen t b ion hoa, do no gay ra mot hieu ng
quang ien khac.
50
HIEU NG QUANG IEN (tt)
Hieu ng quang ien la mot trong nhng nguyen nhan chnh lam
suy giam chum photon nang lng thap.
He so suy giam tuyen tnh do hieu ng quang ien c ky hieu
la . T so gia va khoi lng rieng cua moi trng la he so
suy giam khoi /.
Noi chung, he so suy giam khoi giam khi nang lng h cua
photon tang. Nhng co nhng iem nhay vot khi nang lng cua
photon bang nang lng lien ket cua electron trong nguyen t.
/
Nang lng photon h
He so suy giam khoi tang nhanh khi so
th t nguyen t Z tang.
Vay: hieu ng quang ien xay ra chu yeu
oi vi cac tia X hay tia co
nang lng tng oi thap
trong vat chat co Z ln.
Trong xng, hieu ng quang ien xay
nhieu hn trong mo mem.
51
HIEU NG COMPTON
Hieu ng Compton la nguyen nhan chnh lam suy giam
chum photon co nang lng nam trong vung t 100 keV
en 10 MeV.
Hien tng:
Photon truyen mot phan nang lng cho electron va b lech
khoi phng chuyen ong.
electron b bt khoi nguyen t (ion hoa).
Sau o se co bc xa ac trng phat ra.

e
-
(h, p)
(h)
e
-
(E
k
)

52
HIEU NG COMPTON
ac iem:
Xay ra chu yeu khi photon co nang lng rat ln so vi nang
lng lien ket cua electron trong nguyen t.
ong nang cua electron xap x bang hieu nang lng cua
photon trc va sau khi va cham:
E
k
= h - h.
ong nang E
k
va h co o ln phu thuoc vao goc tan xa
cua photon: cang ln th ong nang E
k
cua electron cang
ln. E
k
co gia tr cc ai khi = 180
o
. Khi o h' cua photon
sau tan xa la be nhat.
He so suy giam tuyen tnh ky hieu la , he so suy giam khoi
/.
/ khong phu thuoc vao Z, nhng t le mat o electron trong
moi trng tang.
Lieu hap thu do hieu ng Compton gay ra trong xng va mo
mem xap x bang nhau.
53
S SINH CAP (PAIR PRODUCTION)
Trong s sinh cap, mot photon c hap thu trong vung gan hat
nhan va mot cap electron-positron xuat hien.
Electron va positron phat ra thng co nang lng u cao e co
the gay bc xa ham. Bc xa ham nay thng thoat i khoi vung
vat chat nho.
Cac positron cung co kha nang gay ra s ion hoa va kch thch nh
electron. Nhng khi chuyen ong cham lai positron se b huy vi
mot electron va phat ra hai photon, moi photon co nang lng
0,511 MeV. Vay s huy cap luon luon i kem sau s sinh cap.
electron
Photon en
positron
S sinh cap S huy cap
Bc xa ham
Ch xay ra neu nang lng cua photon vt qua hai lan nang lng
ngh cua electron (2 x 0,511 = 1,022 MeV). Khi o phan nang lng
bien thanh ong nang cua electron va positron la
E
k
= (h -1,022 MeV).
Xac suat xay ra s sinh cap tang theo nang lng cua photon va
theo so th t nguyen t cua chat hap thu.
54
SO SANH CAC LOAI TNG TAC
Trong vung nang lng 100 keV 10 MeV hieu ng Compton ong
vai tro chu yeu.
h = 26 keV, 50% electron xuat hien do HQ, 50% do Compton;
h = 100 keV, 99% electron la do Compton, con lai do quang ien;
h = 10 MeV, 77% electron la do Compton, con lai do tao cap.
0,01 0,1 1 10 100
20
40
60
80
100
Tao cap
Quang ien
Compton
X
a
c

s
u
a
t

t

n
g

o
i

(
%
)
Nang lng tia X (MeV)
Xac suat tng oi cua cac qua trnh tng tac trong nc
55
SO SANH CAC LOAI TNG TAC
Lieu hap thu trong xng va trong cac mo mem
Hieu ng quang ien: lieu hap thu trong xng ln gap 6 lan
lieu hap thu trong mo mem.
Hieu ng Compton: lieu hap thu trong xng xap x bang lieu
hap thu trong cac mo mem.
Hieu ng sinh cap: lieu hap thu trong xng ln gap 2 lan lieu
hap thu trong cac mo mem.
Tam quan trong cua tng loai tng tac oi vi mo mem
Nang lng cua photon
< 50 keV HQ la quan trong
60 keV en 90 keV H Q va H Compton quan trong
nh nhau
200 keV en 3 MeV Ch co H Comptom
5 MeV en 10 MeV H tao cap bat au xuat hien
50 MeV en 100 MeV H tao cap la quan trong nhat
56
LIEU HAP THU TRONG CAC TRNG HP
Mot ong tia X hoat ong nang lng cc ai E
o
se phat ra
cac photon co nang lng trung bnh khoang E
o
/3.
tia X t mot ong tia X hoat ong ien the 60-140 kV se
b hap thu manh trong xng so vi trong mo mem
thch hp e phan biet mo va xng.
tia X t mot ong tia X hoat ong ien the 200-250 kV se
b hap thu trong xng nhieu hn trong mo mem mot t.
Tia t nguon Cs-137 (E

= 661 keV) hay t nguon Co-60

(E

1,25 MeV), cho cung lieu hap thu nh nhau trong

xng va mo mem.
Tia X phat ra t mot may gia toc hoat ong 5-20 MeV
cung b hap thu trong xng nhieu hn trong mo mem mot
t.
57
THONG TIN VE BC XA T NGUON ONG V
Rat hiem trng hp bc xa phat ra t mot nguon ong v
phong xa ch gom mot loai bc xa (hat , electron, positron,
hay ) va ch co mot nang lng; ma thong thng co nhieu
loai hat va co nhieu nang lng khac nhau.
Khi o, ben canh hoat o cua nguon, ta con can phai biet co
bao nhieu loai bc xa phat ra, moi loai co cng o
(intensity) va nang lng trung bnh bang bao nhieu.
Thong tin nay c mo ta tom tat trong cac s o phan ra
hay c cho bang bang.
Co the tm thay thong tin nay tai cac website nh:
http://ie.lbl.gov/ , hay http://cswww.in2p3.fr/amdc hoac
trong tap tin Table of Nuclear Moments. D lieu ve hat nhan
Co-60 trong v du di ay c truy cap t website
http://www.nndc.bnl.gov/nudat2/index.jsp.
58
THONG TIN VE BC XA T NGUON ONG V
S o phan ra cua Cobalt 60
59
THONG TIN VE BC XA T NGUON ONG V
Beta-:
Energy (keV) End-point energy (keV) Intensity (%) Dose (MeV/Bq-s)
95.77 15 318.2 5 99.88 % 3 0.09566 15
625.87 21 1491.4 5 0.12 % 3 0.00075 19
Mean beta- energy: 96.41 keV 24, total beta- intensity: 100.00 % 4, mean beta- dose: 0.09641 MeV/Bq-s 25
Electrons:
Energy (keV) Intensity (%) Dose ( MeV/Bq-s )
Auger L 0.84 0.0366 % 12 3.08E-7 10
Auger K 6.54 0.0154 % 5 1.01E-6 3
CE K 338.81 7 3.77E-5 % 23 1.28E-7 8
CE L 346.13 7 3.81E-6 % 23 1.32E-8 8
CE K 817.77 3 2.4E-6 % 4 1.9E-8 3
CE L 825.09 3 2.2E-7 % 3 1.84E-9 22
CE K 1164.895 3 0.0151 % 7 0.000176 8
CE K 1324.159 4 0.0115 % 5 0.000152 7
CE K 2150.24 3 5.4E-8 % 9 1.16E-9 20
CE L 2157.56 3 5.2E-9 % 9 1.11E-10 19
CE K 2497.359 5 1.6E-10 % 3 3.9E-12 8
CE L 2504.684 5 1.5E-11 % 3 3.8E-13 8
Gamma and X-ray radiation:
Energy (keV) Intensity (%) Dose ( MeV/Bq-s )
XR l 0.85 0.000310 % 18 2.64E-9 15
XR k2 7.461 0.00325 % 19 2.42E-7 14
XR k1 7.478 0.0064 % 4 4.8E-7 3
XR k3 8.265 0.000394 % 23 3.26E-8 19
XR k1 8.265 0.00077 % 4 6.3E-8 4
347.14 7 0.0075 % 4 2.60E-5 14
826.10 3 0.0076 % 8 6.3E-5 7
1173.228 3 99.85 % 3 1.1715 4
1332.492 4 99.9826 % 6 1.332260 9
2158.57 3 0.00120 % 20 2.6E-5 4
2505.692 5 2.0E-6 % 4 5.0E-8 10
Phan II
Tac dung sinh hoc cua bc xa
0. M au
1. Cau tao te bao cua c the ngi - cau tao cua te bao
2. C che tng tac gia bc xa vi c the ngi
3. Phan loai cac hieu ng bc xa
4. Cac yeu to anh hng en tac dung sinh hoc cua bc xa
5. Quan he gia lieu va ap ng bc xa
61
0. M u
Vic hiu bit cc tc dng sinh hc ca bc x l cn thit trong hai lnh vc:
1. An ton bc x: nhm bo v con ngi khi nhng tc hi ca bc x
2. X tr: nhm s dng bc x mt cch hp l tiu dit t bo nguy hi cho c
th.
Trong an ton bc x, ngi ta thng gp:
liu hp th thng l rt thp, khong mGy/nm v
nhiu loi bc x khc nhau (gamma, neutron, ht nng mang in, v.v..) c
LET khc nhau.
Cn trong x tr, thng th
liu kh cao, khong vi chc Gy, c chiu trong vng 1 thng v
bc x thng c dng l tia X v electron, c LET xp x bng nhau
Sau khi hc xong chng ny, sinh vin cn nm c:
Chui qu trnh xy ra t khi bc x i vo c th cho n nhng biu hin
lm sng
Nhng yu t vt l v sinh hc nh hng n tc dng sinh hc ca bc x
Quan h liu-p ng bc x v ng cong liu-sng st.
62
1. Cau tao te bao cua c the ngi
C the con ngi cau tao t cac c quan (organ) nh
tim, phoi, nao
Cac c quan cau tao t cac mo (tissue) nh mo m, da
xng...
Cac mo cau tao t cac te bao (cell).
Te bao la n v song c ban.
Kch thc te bao: khoang 50 micromet
Trong c the ngi co khoang 10
13
-10
14
te bao.
Tng tac gia bc xa va c the song se gay nen
nhng thay oi trong te bao lam chet te bao hay
gay ot bien hoat ong bat bnh thng, chang
han phat trien nhanh chong mot cach hon loan va
dan en ung th.
63
Cau tao cua te bao
Te bao gom co mot nhan (nuclear) gia, mot chat long bao
quanh goi la bao tng (cytoplasma). Boc quanh bao tng la mot
mang goi la mang te bao (membrane). Moi bo phan thc hien
nhng chc nang rieng re.
+ Mang te bao lam nhiem vu trao oi chat vi moi trng ngoai
+ Bao tng la ni xay ra cac phan ng hoa hoc, be gay cac
phan t phc tap thanh cac phan t n gian va lay nang lng
nhiet toa ra (d hoa: catabolism), tong hp cac phan t can
thiet cho te bao (anabolism).
+ Trong nhan co ADN (deoxyribonucleic acid) la mot ai phan
t hu c cha cac thong tin quan trong e thc hien s tong
hp cac chat.
+ ADN cung cha thong tin can thiet e ieu khien viec phan
chia te bao.
Tac dung sinh hoc chnh cua bc xa la s pha hong ADN cua
te bao.
64
Cau tao cua te bao
Mang te bao
Nhan te bao
Bao tng
vo ng xoa n ke p
no i base
65
Chu ky cua te bao
Cac te bao co thi gian song nhat nh. Cac te bao khac
nhau co thi gian song khac nhau.
Cac te bao cung co kha nang phan chia e tao thanh te
bao mi.
Cac giai oan cua mot chu ky te bao:
+ M (phan chia te bao: mitosis)
+ G1 (chuan b tong hp: 1st growth)
+ S (tong hp: synthetic)
+ G2 (tang trng: 2nd growth)
66
2. C che tng tac gia bc xa vi c the ngi
1. Giai on vt l (10
-16
s 10
-13
s)
Tng tac au tien: bc xa ion hoa va kch thch cac
nguyen t trong te bao.
So lng nguyen t b ion hoa/kch thch trong mot n
v khoi lng vat chat t le vi lieu hap thu tai o.
Hieu ng trc tiep: kch thch hay ion hoa trc tip phan t
ADN.
Hieu ng gian tiep: ion hoa hay kch thch cac phan t
nc lan can ADN.
Te bao cha khoang 90% la nc, va ADN ch
chiem 1% khoi lng te bao, nen s ion hoa va
kch thch xay ra chu yeu oi vi phan t nc.
(C mi phn t ADN c 1,2.10
7
phn t nc.)
67
CAC HIEU NG GIAN TIEP VA TRC TIEP
Nhng bc xa co kha nang ion hoa manh tao ra tren ng
i cua chung mot vet ion hoa am, do o neu no i bang qua
mot ADN th co the gay nen hieu ng trc tiep tai nhieu cho
tren ADN.
oi vi cac bc xa co LET ln, nh tia alpha, th cac
thng ton cua ADN chu yeu la do cac hieu ng trc tiep
gay nen.
oi vi cac bc xa co LET be (kha nang ion hoa be), nh
electron, photon, th hieu ng trc tiep gay nen khoang
1/3 tong so cac thng ton cua ADN; va cac hieu ng
gian tiep gay nen khoang 2/3 tong so cac thng ton cua
ADN.
68
Cac hieu ng gian tiep va trc tiep
69
2. Giai on ha l (10
-13
s 10
-2
s)
S hnh thnh cc gc t do
S ion ha v kch thch c th dn n:
bin phn t nc thnh mt ion dng : H
2
O + HOH
+
+ e

(s thu
phn do bc x), qu trnh ny li c th dn n
bin phn t nc thnh mt ion m: H
2
O + e

HOH

Cac ion HOH

+
va HOH

khong ben vng lam va co the b tach

thanh cac phan t nho hn
HOH
+
H
+
+ OH

hay
HOH

OH

+ H

OH

v H

c gi l cc goc t do (free radical) hydroxyl: la nhng

phan t khong mang ien, nhng co mot electron hoa tr le, do o thng
tm cach gianh lay hidro cua cac phan t khac.
Trong trng hp mt gc t do OH

cao, chng c th kt hp
to ra hydrogen peroxide
OH

+ OH

= H
2
O
2
(nc oxy gi)
Hydrogen peroxide l mt cht rt c i vi t bo!
70
Thi gian sng ca cc gc t do
Cac goc t do co thi gian song ch khoang vai micro giay (10
6
s)
nen khong the i xa c. Do o chung ch co the pha hoai cac
ADN nam trong pham vi ban knh khoang 10 nm quanh cho phan
t nc b ion hoa, khoang bang ng knh cua th cua nhiem sac
the.
Thi gian song cua cac goc hydroxyl co the c keo dai khi co
mat oxy. Ngc lai, mot so phan t khac co the thu hut cac goc
nay va lam giam tac dung sinh hoc cua chung.
Tac dung gian tiep tng manh khi co mat oxy: LET b, tng 2-3
ln
Tac dung trc tiep t phu thuoc vao oxy: LET ln, tng t
71
Tac dung cua cac goc t do len ADN
Cac goc t do khuech tan ra chung quanh vung chung hnh
thanh;
Tap trung quanh nhng phan t nc hay tng tac vi cac
phan t sinh hoc;
Thng th cac goc t do gianh lay cac nguyen t hidro cua
cac phan t sinh hoc, chang han lay hidro cua cau noi hidro
trong ADN.
Lam thay oi cau truc hoa hoc cua cac phan t sinh hoc.
72
Ton thng cua ADN
t mot nhanh
So lng t mot nhanh tang t le bnh phng lieu hap
thu
t hai nhanh
So lng t hai nhanh tang t le lieu hap thu
oi vi bc xa co LET be, t le gia ton thng 1 nhanh
va hai nhanh la 20:1.
Cho en nay ngi ta thay viec t mot nhanh va hai
nhanh ch do bc xa ion hoa gay nen, con tia t ngoai ch
co kha nang gay nen s ton thng base.
Do tac dung trc tiep hay gian tiep, ADN co the chu cac ton thng
sau: t mot nhanh, t hai nhanh, ton thng base, noi gia cac
phan t trong ADN, noi gia ADN va protein, ton thng boi.
73
Ton thng cua ADN
Ton thng base: lam thay oi base hay thay oi lien ket
gia cac base.
+ S ton thng cua base co the dan ti viec t moi lien
ket hidro gia hai base, hay lam bien oi cau truc hoa
hoc cua base, lam mat mot base, lam ghep vao mot base
khong ung hay noi hai base nam oi dien va cheo nhau
cheo (cross linking).
+ Mot dang ac biet cua sai hong base la s nh trung hoa
hai base (base dimerization): hai base cung pha noi nhau.
Noi gia cac phan t trong ADN
Noi gia ADN va protein
Ton thng boi (bulky lession): nhieu moi noi oi va base b
t hong trong mot khu vc nho: Thuoc loai ton thng gay
t vong (lethal damage). Khong sa cha c.
74
Ton thng cua ADN
Mot lieu khoang 3 Gy co the gay nen hang tram ngan cap ion
trong moi te bao b chieu.
Khi o moi te bao se co nhieu ngan cho t gay tren chuoi xoan
n va co khoang 100 cho t tren chuoi xoan kep, dan en cai
chet cua khoang 90% te bao b chieu.
Loi tn thng S tn thng trn mi t bo ng
vi 1 Gy (LET b)
t nhnh n 1 000
Tn thng base 500
t nhnh i 40
Ni gia DNA v protein 150
75
3. Giai oan hoa sinh
Qua trnh sa cha ton thng cua ADN
Qua trnh hoa sinh keo dai t 10
-2
s en nhieu gi.
a. C che t bao ve va t sa cha
Trong bao tng co nhng chat co the trung hoa cac goc t
do trc khi chung kp cong pha ADN hay cac bao quan.
Te bao co kha nang nhan biet nhng bien oi phan t cua
ADN va co the sa cha lai chung bang nhng qua trnh ieu
khien bi enzym.
C che nay thc hien viec sa cha nhng thay oi ve cau
truc va thong tin cua te bao gay bi bc xa, e cho te bao
sau khi b chieu bi mot lieu khong cao lam, co the hoi phuc
tr lai.
Hieu qua hoat ong cua cac c che bao ve va sa cha phu
thuoc vao giai on cua te bao trong chu ky, vao lng nang
lng hien co cua te bao, vao nhiet o, vao mat o cua cac
enzym sa cha cung nh mat o cua cac chat bao ve co mat
trong bao tng.
76
Qua trnh sa cha
Mot so cong viec sa cha co the c tien hanh ngay sau khi xuat hien
cac ton thng va co the ket thuc trong vong vai phut hay vai gi.
Mot so sa cha can co nang lng anh sang, c goi la sa cha quang
(photorepair).
Cac loai sa cha con lai s du ng nang lng d tr trong te bao va
khong can anh sang.
Neu s sa cha xay ra trc khi nhan oi ADN va trc khi phan bao,
th ngi ta goi la s sa cha trc nhan oi. Neu ton thng cua ADN
xay ra ngay trc hay trong khi nhan oi ADN va khong kp sa cha
trc phase mitose, th se dien ra qua trnh sa cha sau nhan oi.
Sa cha trc nhan oi hieu qua hn sa cha sau nhan oi.
Neu qua trnh phan bao xay ra cang nhanh, th thi gian e sa cha
trc nhan oi cang be, khi o s sa cha cang kem hieu qua.
Cac te bao co toc o phan bao cang cao th cang nhay oi vi bc xa.
Te bao ung th co toc o phan bao cao, ngoai ra bo may sa cha
cung b nhng sai sot, do o chung nhay vi bc xa hn te bao lanh.
77
4. Qua trnh sinh hoc
T mc te bao en mc mo T vai gi en nhieu nam
S roi loan nhiem sac the (NST)
Neu ton thng do bc xa gay nen tren ADN la u ln, th co
the quan sat thay nhng roi loan cua nhiem sac the
(chromosome aberration),
Roi loan NST: nhan oi (duplication), cat bo (deletion),
them vao mot oan gen (inversion), chuyen oan gen sang
nhiem sac the khac (translocation).
Nhng roi loan NST rat tieu bieu do tac dung cua bc xa la
s hnh thanh NST hai tam (dicentric) va NST vong.
S t nhanh cua ADN, neu khong sa cha c, sa cha
khong ay u hay sa cha sai co the dan en s roi loan
nhiem sac the, co the quan sat c bang knh hien vi trong
giai oan phan bao (mitosis)
78
S roi loan nhiem sac the
a) NST bnh thng. b) trai: t cuoi; phai: t mot khe. c) roi loan NST,
trai: mat mot khoang gia; phai mat cuoi. d) hai oan cua nhanh nay b
cat va noi sang nhanh khac. e) NST b noi thanh vong. f) hai nhanh b cat
noi thanh vong. g) mot cap NST bnh thng. h) Hai NST dnh lai thanh mot
NST hai tam + hai oan t hon hp. i) Trao oi cac oan cua hai NST
a) b) c) d) e)
f) g) h) i)
79
S roi loan nhiem sac the
80
S roi loan nhiem sac the
81
nh hng ln mng t bo
Tc dng ln nhn l c vai tr quan trng nht trong s sng
cn ca t bo.
Nu mng t bo b tn thng do bc x, chc nng thm
thu ca mng c th b thay i
nhy bc x ca cc tiu th gn vi mng c th b thay
i
82
nh hng ln mng t bo
Tc dng ca vic chiu x ln ton b v ln mt phn ca hng cu
ln ca Amphiuma. (Bushbaum & Zirkle, 1949)
Hemolysis: s tan mu
83
Tac dung cua bc xa cap te bao - S chet cua te
bao
S chet cua te bao
S chet cua te bao co the c chia lam hai loai: chet gia
phase (interphase death) va chet kha nang sinh san
(reproductive cell death).
Mot lieu rat cao (vai tram Gy) co the huy hoai moi hoat
ong cua te bao va lam te bao chet gia pha.
Mot lieu thap hn (vai Gy) se co tac dung chu yeu len cac te
bao co kha nang tang trng nhanh (cac te bao mam trong
mo ang tang trng hay trong khoi u ung th), v bc xa
lam chung b mat kha nang nay.
Ve hnh thai hoc, cac te bao nay dng nh nguyen ven, van
co the tong hp protein va ADN va co the phan bao vai lan,
nhng chung khong co kha nang phan chia mai mai c.
cap te bao, ba hieu ng chnh co the quan sat c t s chieu xa ADN
la s chet cua te bao (cell death), va s ot bien dan en benh ung th ac
tnh (malignant disease) hay ton thng di truyen (genetic damage).
84
Tac dung cua bc xa cap te bao - S ot bien
S ot bien
Nhng thay oi khong c phuc hoi cua ma thong tin di
truyen (gen) c goi la s ot bien (mutation).
S ot bien co the dan en pha huy hoat ong cua enzym, lam roi
loan s trao oi chat cua te bao, lam te bao sinh soi nhanh va khong
kiem soat c (ung th)
Neu s ot bien o ch xay ra te bao than (somatic cell),
th no khong di truyen cho the he con chau. Neu ot bien
xay ra te bao sinh duc (germ cell) th no co the di truyen
cho the he sau.
S ot bien co the xay ra t phat (khong b chieu xa).
Lng bc xa e lam so ot bien tang gap oi goi la lieu gap
oi.
oi vi c the ngi, lieu gap oi trung bnh la 0,6 Gy.
Ngha la khi nhan mot lieu 0,6 Gy, xac suat b benh ung
th tang len gap oi.
85
3. Phan loai cac tac dung cua bc xa mc lam sang
Tac dung ca the (somatic) va tac dung di truyen
Tac dung sinh hoc cua bc xa: la t dung e ch chung cac
trieu chng lam sang xac nh, v du s noi o da, ung th,
s chet cua te bao, cac ton thng di truyen v.v..
Tac dung sinh hoc cua bc xa co the c phan loai theo
nhieu cach:
1. Tac dung ca the (somatic) va tac dung di truyen (genetic)
ay la cach phan loai theo ca the chu tac dung:
Tac dung ca the: la nhng tac dung ch xay ra trong mot ca
the.
Tac dung di truyen: nhng tac dung xay ra cac the he sau.
Tac dung ca the xay ra khi cac te bao ca the (somatic
cells) b ton thng.
Tac dung di truyen ch xay ra khi cac te bao sinh duc
(sex cells) b ton thng.
Cac te bao sinh duc rat nhay bc xa.
86
3. Phan loai cac tac dung cua bc xa mc lam sang
Tac dung ngau nhien (stochastic) va tat nhien (deterministic)
ay la cach phan loai theo quan he gia lieu hap thu va ap ng:
a. Tac dung ngau nhien
Ngau nhien: khi mot ca the b chieu xa th ca the o co the b
hoac khong b tac dung (v du ung th). Nhng khi xet mot so
ln ca the cung chu chieu xa nh nhau, th se co mot t le nhat
nh ca the chu tac dung.
T le nay c goi la xac suat xay ra tac dung.
Du lieu hap thu thap bao nhieu i na, tac dung van co the
xay ra (khong co ngng).
Xac suat xay ra tang theo lieu hap thu (t le ca the chu tac
dung tang).
Nhng: mc o tram trong tren moi ca the la khong phu thuoc
lieu, va khi no xay ra, cac hau qua la nh nhau.
V du: ung th
87
3. Phan loai cac tac dung cua bc xa mc lam
sang
Tac dung ngau nhien (stochastic) va tat nhien (deterministic)
b. Tac dung tat nhien (deterministic, con goi la non-
stochastic)
La cac tac dung chac chan se xay ra khi lieu vt
qua mot mc ngng nao o.
Ch xay ra khi lieu vt qua mc ngng.
Mc o tram trong cang tang khi lieu cang ln.
V du phan ng cua da.
Trong bieu dien RDRR, tac dung ngau nhien la loai
tuyen tnh khong co ngng, con tac dung tat nhien
la loai S-type.
Tat ca cac tac dung di truyen eu thuoc loai tac
dung ngau nhien.
88
3. Phan loai cac tac dung cua bc xa mc lam sang
Tac dung sm va tac dung muon
ay la cach phan loai cac tac dung ca the theo khoang thi
gian t luc b chieu en khi chung xuat hien.
a. Cac tac dung sm (early) hay cap tnh (acute): la nhng tac
dung xay ra hau nh ngay sau khi b chieu.
Tat ca cac tac dung sm eu thuoc loai tac dung tat nhien.
b. Cac tac dung muon (late), con c goi la tac dung man
tnh (chronic): la nhng tac dung ch co the quan sat sau
nhieu nam, chung co the thuoc loai ngau nhien hay tat
nhien.
Mot ngi khi b chieu xa co the b nhng tac dung
cap tnh hay khong (tuy theo lieu), nhng luon luon
co nguy c b cac tac dung muon ngau nhien.
89
Tom tat cac hieu ng cua bc xa tren c the ngi
Tac dung sm Tac dung muon
+ Hoi chng cap tnh:
huyet hoc
da day va ruot
than kinh trung ng
+ Ton thng mo cuc bo:
da
tuyen sinh duc
t chi
+ Suy giam huyet hoc
+ Ton thng te bao di
truyen
+ Benh bach cau
+ Cac benh ac tnh khac: ung th xng, ung
th phoi, ung th tuyen giap, ung th ngc
+ Ton thng mo cuc bo: da, tuyen sinh duc,
mat
+ Giam tuoi tho
+ Ton thng di truyen
Ton thng te bao di truyen
Giam lieu gap oi
+ Hieu ng oi vi bao thai:
Chet trc khi sinh
Chet trong khi sinh
B benh bam sinh
B u ac tnh luc con tre
Cham ln, cham phat trien
90
4. Cac yeu to sinh hoc anh hng en tac dung sinh
hoc cua bc xa len te bao
Nhiu yeu to co the co anh hng en tac dung sinh hoc cua
bc xa: Cac yeu to vat ly va cac yeu to sinh hoc.
Cac yeu to vat ly la liu hp th, LET, lng Oxy, nhiet o
( ni trn), suat lieu v s phan lieu (s hc di).
Mc o tac dung sinh hoc cua bc xa c quyet nh
chu yeu bi lieu hap thu.
Cac yeu to sinh hoc l:
loi t bo
mc trng thnh cua te bao
mc hoat ong cua te bao cc nh lut Bergonie
giai on ca t bo trong chu k t bo
91
o nhay bc xa cua cac te bao khac nhau
Cac nh luat Bergonie & Tribondeau (1906)
Cac te bao mam (stem cell) rat nhay oi vi bc xa. Te bao
cang trng thanh cang t nhay bc xa.
Tuy xng rat nhay bc xa va can c bao ve.
Cac te bao than kinh t nhay bc xa.
Cac mo va c quan cang tre th cang nhay bc xa.
Tre s sinh rat nhay bc xa.
Mc o trao oi chat cang cao th o nhay cang cao.
Toc o tang trng (proliferation rate) cua cac te bao va toc
o phat trien (growth rate) cua cac mo cang cao th cang
nhay bc xa.
Te bao ung th nhay bc xa hn te bao lanh.
92
S phu thuoc cua o nhay bc xa vao chu ky te bao
Chu ky tien hoa cua mot te bao (co kha
nang phan) chia bao gom 4 giai oan:
+ M (phan chia te bao: mitosis)
+ G1 (chuan b tong hp: 1st growth)
+ S (tong hp: synthetic)
+ G2 (tang trng: 2nd growth)
Cac giai oan G1, S, G2 c goi la gia
pha (interphase).
Mot so te bao, v du cac nron than kinh, la khong phan chia va
khong tang trng.
Nhng te bao thuoc cung mot loai co o nhay bc xa khac nhau,
tuy thuoc vao chung ang giai oan nao.
o nhay cua te bao trong cac giai oan:
G2 > S > G1 > M
93
5. Quan he lieu-ap ng
(radiation dose-response relationship, RDRR)
Mc o xay ra mot tac dung sinh hoc cu the la mot ham cua
lieu hap thu. Trong bieu dien toan hoc, quan he nay c goi
la quan he lieu-ap ng
Muc ch cua hau het cac nghien cu sinh hoc bc xa la thiet
lap cac quan he nay. o la mot ham toan hoc mo ta quan he
gia lieu bc xa vi cac mc o cua cac tac dung quan sat
c.
ng dung cua RDRR :
e cung cap c s cho viec lap qui trnh ieu tr trong xa tr,
e cung cap c s cho viec phong chong bc xa.
Tuy theo muc ch nghien cu, ngi ta thiet lap nhng quan
he cho tng loai tac dung cu the.
ay chung ta ch xem xet dang ieu chung cua quan he
lieu-tac dung nay.
94
Quan he lieu-ap ng cua tac dung tat nhien
N la so n v cua tac dung xay ra, v du so te bao b ton thng.
Khi lieu di mot mc ngng S, khong co tac dung nao xay ra.
gia vung S va iem uon, ap ng tang nhanh, sau o tang cham va
at bao hoa: dang ch S (nen c goi la S-type).
V tr cua S, o doc va dang cua ng cong phu thuoc vao loai te bao
hay loai mo, pha cua te bao trong chu ky luc b chieu, lng oxy trong
mo, LET, v.v..
V du: lieu e co 50% trng hp t vong sau 30 ngay b chieu toan
than bi bc xa co LET thap la D
50
4,5 Gy.
N
0,5
S D
50
lieu hap thu
95
Quan he lieu-ap ng cua tac dung ngau nhien
Khi lieu hap thu la thap, cac tac dung tat nhien khong xay ra. Nhng khi
o van co the xay ra nhng tac dung ngau nhien.
Viec quan sat cac tac dung ngau nhien gay bi lieu thap la rat kho. Do
o ngi ta thng xac nh cac tac dung nay ng vi lieu cao, roi ngoai
suy cho trng hp lieu nho.
Phng phap ngoai suy thong dung nhat la ngoai suy tuyen tnh: ngi ta
gia thiet rang lieu thap, xac suat xay ra tac dung ngau nhien la t le vi
lieu hap thu, va khong co ngng.
N
lieu hap thu
96
Quan he gia lieu hap thu va so lng te bao song sot
1. ng cong lieu - song sot
ng cong dien ta so lng te bao co kha nang song sot theo lieu hap
thu c goi la ng cong lieu-song sot (dose-survival curve).
Khi lieu hap thu tang len, so lng te bao co kha nang song sot b giam
i. Nhng qui luat nay khac nhau oi vi cac loai te bao va loai mo khac
nhau.
e ng dung viec chieu xa mot cach hieu qua, ngi ta can biet ro qui
luat nay vi tng loai te bao.
a. ng cong lieu-song sot cua vi khuan
Nhng hieu biet au tien ve ng cong lieu-song sot oi vi bc xa ion
hoa co c t viec nghien cu vi khuan.
Kha nang song sot cua vi khuan giam theo ham e
-x
khi lieu tang.
ng cong lieu-song sot trong bieu dien tren gian o ban logarit (truc
hoanh tuyen tnh, truc tung chia theo logarit) la mot ng thang vi o
doc am.
97
ng cong lieu - song sot cua vi khuan
N/N
o
D
o
2D
o
3D
o
lieu hap thu
100%
37%
13,5%
4,9%
ng cong lie u - song sot cua vi khuan theo lieu hap thu
N/N
o
: t so gia so vi khuan con song va so vi khuan ban au
D
o
: lieu hap thu e lam so vi khuan song sot con bang 1/e = 37%.
98
ng cong lieu - song sot cua vi khuan
Qui luat giam theo ham mu: Khi tang lieu hap thu them mot lng xac
nh, th mot t le khong oi vi khuan se b chet.
Lieu hap thu D
o
can thiet e lam giam so vi khuan song sot xuong con
37% ( = 1/e, vi e la hang so mu Euler) la mot tham so ac trng cho
ng cong lieu-song sot.
D
o
cang be th ng thang tren hnh cang doc va te bao cang nhay vi
bc xa.
Neu ban au ta co N
o
vi khuan lanh, sau khi b chieu mot lieu D
o
th so
lng vi khuan se giam xuong con N = N
o
/e, hay N/N
o
= 37%. Neu nhan
c mot lieu 2 D
o
, th so vi khuan song sot se con (0,37)
2
= 13,5% cua
N
o
,.
Noi chung, vi mot lieu n D
o
, th t le vi khuan song sot se la (N/ N
o
) =
1/e
n
.
Tnh chat giam theo ham mu (tng t hien tng phan ra phong xa) cho
thay s giet chet vi khuan mang tnh chat ngau nhien: khi ban mot chum
hat vao mot tap the cac vi khuan, ta khong the tien oan vi khuan nao se
b giet chet, nhng co the tien oan so lng trung bnh cac vi khuan b
giet chet.
99
ng cong song sot cua te bao ong vat co vu
Noi chung ng cong song sot cua ong vat co vu co mot
vung vai (shoulder region) trc khi giam theo ham mu.
100
ng cong song sot cua te bao ong vat co vu
ng cong song sot nay co the c ac trng bi 3 tham
so, o la lieu ngng D
q
, lieu D
o
va so ngoai suy n.
Lieu ngng D
q
: ac trng cho o rong cua vung vai.
Vung vai the hien kha nang t sa cha nhng ton thng
di mc t vong do bc xa lieu thap gay nen, s t sa cha
lam cho t le song sot giam cham theo lieu hap thu.
Nhng khi tiep tuc tang lieu hap thu, t le song sot giam
nhanh va sau o tuan theo qui luat ham mu e
-x
nh trong
trng hp vi khuan.
Nhng ton thng di mc t vong co the se bien thanh ton
thng t vong khi tang lieu hap thu, ngha la co s tch luy
cac ton thng nhe thanh ton thng nang.
D
q
cang ln th kha nang hoi phuc cua te bao khi b chieu bi
lieu thap cang cao.
101
ng cong song sot cua te bao ong vat co vu
Trong phan giam theo ham mu (phan ng thang trong o th),
khi lieu hap thu tang them mot lng khong oi th t le te bao
song sot se giam i mot lng khong oi.
o doc cua vung nay cung c ac trng bi D
o
, giong nh cua
cac vi khuan.
So ngoai suy n: la giao iem cua ng keo dai cua phan giam
theo ham mu va truc tung.
Y ngha cua n co the c giai thch theo ly thuyet bia: Theo o so
n c hieu nh la so bia (ngha la cac phan t co vai tro trong
s song con cua te bao) can phai b lam mat tac dung e co the
lam chet te bao, hay so ton thng ma mot bia duy nhat phai chu
ng e co the lam chet te bao. oi vi te bao cua ngi, n nam
trong khoang t 2 en 10.
Dang chung cua ng cong song sot la giong nhau cho moi te
bao. Tuy nhien, cac cac te bao lanh cua tuy xng, da va ruot,
cung nh cac te bao cua nhieu mo ung th khac nhau co o
doc (D
o
), o rong cua vung vai (D
q
) hay so ngoai suy n khac
nhau.
102
Cac mo hnh giai thch ng cong song sot
e giai thch cac ng cong song sot tren,
nhieu ly thuyet khac nhau a c e xuat.
Co the phan loai hai nhom ly thuyet: ly thuyet
bia (target theory) va mo hnh nhieu thanh
phan (mo hnh tuyen tnh-bac hai)
103
Cac mo hnh giai thch ng cong song sot
Ly thuyet bia
e giai thch cac ng cong song sot tren, nhieu ly thuyet khac nhau a
c e xuat.
Co the phan loai hai nhom ly thuyet: ly thuyet bia (target theory) va mo
hnh nhieu thanh phan (mo hnh tuyen tnh-bac hai).
Ly thuyet bia
Te bao cha nhieu phan t co chc nang khac nhau trong viec duy tr s
ton tai bnh thng cua no. Hau het cac chc nang c thc hien bi
nhieu phan t cung loai ong thi.
Cac ton thng do bc xa gay tren cac phan t nay se khong gay nen ton
thng ang ke cua te bao, do nhng phan t cung loai khong b ton
thng co the tiep tuc duy tr hoat ong cua te bao.
Mot vai phan t khac co vai tro ac biet quan trong trong viec duy tr
hoat ong bnh thng cua te bao. Cac phan t nay ton tai trong te bao
vi so lng khong nhieu, va thc te co the ch co mot phan t, nh
trng hp ADN.
S ton thng bc xa gay nen tren cac phan t nay co the anh hng
nghiem trong en te bao, v khong co phan t khac cung loai co the thay
the vai tro cua no e duy tr hoat ong bnh thng cua te bao.
Phan t nay c goi la phan t bia (target molecule).
104
Ly thuyet bia
e te bao co the chet do bc xa, phan t bia phai b lam te
liet hoat ong.
S tng tac gia bc xa va cac thanh phan cua te bao la
ngau nhien, do o s tng tac gia bc xa va bia la ngau
nhien. Bc xa khong i tm bia. Cac phan t bia s d nhay
bc xa la do vai tro song con cua no trong te bao.
Khi mot bia b lam te liet hoat ong (inactivated) do s
tng tac (trc tiep hay gian tiep) vi bc xa, ngi ta noi
rang a xay ra mot hit (trung ch).
Ly thuyet bia c m rong e giai thch cac dang ng
cong song sot khac nhau.
Co ba loai mo hnh cua ly thuyet, bao gom: mot bia-mot lan
trung ch (single-target, single-hit model), nhieu bia-mot lan
trung ch (multi-target, sigle-hit model) va nhieu bia-nhieu
lan trung ch (multi-target, multi-hit model).
105
Mo hnh tuyen tnh-bac hai
Mo hnh nhieu thanh phan la mot s ket hp cua cac mo hnh tren
ong thi.
ang chu y nhat la mo hnh tuyen tnh-bac hai (linear-quadratic),
c s dung rong rai trong nhng nam gan ay.
Mo hnh nay da tren quan sat thc nghiem: cac ton thng t
nhanh oi khong hoi phuc c co the gay nen s chet cua te bao.
Cac ton thng t nhanh oi co the xay ra khi co mot vet bc xa
LET cao i bang qua (mot bia-mot lan trung ch), hay hai vet bc
xa co LET thap i qua gan nhau (mot bia-hai lan trung ch). Khi
o t le song sot se la tch cua hai trng hp nay
Do xac suat xay ra mot hit t le vi D, xac suat xay ra hai hit t le
vi D
2,
nen
( )
2 2
D . D . D . D .
o
e e . e
N
) D ( N
+
= =
106
Mo hnh tuyen tnh-bac hai
Do s phu bac mot (tuyen tnh) va bac hai vao D cua so mu,
mo hnh nay c goi la mo hnh tuyen tnh-bac hai.
Vay ng cong song sot noi tren co the c mo ta bi hai
tham so va .
ai lng can xac nh ve mat thc nghiem la t so /. No
xac nh phan ong gop cua moi c che gay nen t nhanh
oi ng vi mot lieu hap thu xac nh.
Khi (/) ln, ngha la khi phan ong gop cua la nho, th
ng cong song sot co mot phan vai hep, tiep theo la mot
ham mu giam.
Vi (/) nho, ngha la khi phan ong gop cua la ln, th
ng cong song sot co mot phan vai rong va sau o la mot
ham mu giam.
107
Mo hnh tuyen tnh-bac hai
0 5
10
15 20
0,01
0,1
1
T

l
e

s
o
n
g

s
o
t
Lieu hap thu (Gy)
/ ln
/ be
108
Mo hnh tuyen tnh-bac hai
Ve mat sinh hoc bc xa, t so / cho biet kha nang sa cha
cua te bao oi vi nhng ton thng be. T so nay be ngha
la te bao kha nang sa cha tot hn.
Vi bc xa co LET thap, s phu thuoc bac hai vao D chiem
u the, va vi bc xa co LET cao, s phu thuoc bac mot vao
D chiem u the.
Ngha la s sa cha cua te bao ch co hieu qua vi bc xa
co kha nang ion hoa be.
109
Cac mo ap ng sm va muon
Ve mat thi gian, ap ng cua cac mo oi vi bc xa co the
chia lam hai loai: sm (ngay, tuan) va muon (thang, nam).
Cac mo ung th co toc o ap ng sm oi vi bc xa.
Mot so loai mo lanh co ap ng sm va mot so co ap ng
muon. oi vi cac mo lanh, khoang thi gian t luc b chieu
en khi co nhng bieu hien lam sang ngan (sm) hay dai
(muon) la phu thuoc vao toc o thay oi cua cac te bao
trng thanh trong mo.
Cac mo ap ng sm co t so / ln (nam trong khoang
t 7 en 20 Gy) va cac mo ap ng muon co t so / be
(trong khoang t 1 en 5 Gy).
ieu nay c giai thch la oi vi cac mo ap ng cham,
cac te bao co thi gian e sa cha cac ton thng di mc
t vong tot hn.
110
Anh hng cua mot so yeu to en ng cong song sot
a. Anh hng cua LET
So sanh ng cong song
sot cua cac bc xa co LET
cao va thap.
e t le te bao song sot la
10%, khi chieu bang
neutron, ch can 2 Gy; con
khi chieu bang tia X, can 6
Gy.
2 4 6 8 Gy
LET cao
neutron
LET thap
tia X
Dung cac ng cong song sot te bao e xem xet mot vai v du
ve anh hng cua mot so yeu to en tac dung cua bc xa.
a. Anh hng cua LET en ng cong song sot
111
Anh hng cua mot so yeu to en ng cong song sot
b. Anh hng cua Oxy
Lng Oxy trong te bao cung anh
hng en xac suat giet te bao.
Anh hng nay cang manh khi
LET cua bc xa cang be.
Khi chieu cac te bao bang tia X,
e t le te bao song sot la 10%, khi
cac te bao trong ieu kien giau
Oxy, ch can 2 Gy; con khi cac te
bao trong ieu kien giau Oxy,
can mot lieu hap thu 6 Gy e at
c muc ch.
T so tang cng Oxy (Oxygen
Enhancement Ratio, OER) khi o
la bang 3.
Tia X
giau oxy
Tia X
ngheo oxy
OER = 3,0
2 4 6 8 Gy
(b)
112
Anh hng cua mot so yeu to en ng cong song sot
c. Anh hng cua suat lieu va s phan lieu
Cac ng cong song sot noi tren ng vi trng hp cac te
bao c chieu mot lan duy nhat, vi cac lieu hap thu khac
nhau.
Vi cung mot lieu hap thu, tac dung sinh hoc cua bc xa con
phu thuoc vao phng thc chieu.
Co 3 phng thc chieu c ap dung trong xa tr:
+ chieu mot lan duy nhat trong mot thi gian ngan (suat lieu cao);
+ chieu mot lan duy nhat trong mot thi gian dai (suat lieu thap) va
+ chieu nhieu lan vi cac phan lieu nho.
Cac phng thc chieu nay cho cac ng cong song sot
khac nhau.
Ly do: kha nang sa cha cua te bao oi vi cac ton thng
nhe.
113
Anh hng cua mot so yeu to en ng cong song sot
c. Anh hng cua suat lieu va s phan lieu
ng cong song sot
trong trng hp cac te
bao c chieu vi cac
suat lieu khac nhau:
+ 1: suat lieu cao,
+ 2: suat lieu trung bnh,
+ 3: suat lieu thap.
Vi cung mot lieu tong,
neu suat lieu cang thap
th so te bao song sot
cang cao.
(a) Lieu hap thu (Gy)
3
2
1
114
Anh hng cua mot so yeu to en ng cong song sot
c. Anh hng cua suat lieu va s phan lieu
1
2
3
(b) Lieu hap thu (Gy)
4
ng cong song sot khi cac te bao
c chieu bang mot lan duy nhat
(1+2) va bang ba phan lieu (1+3+4)
cach nhau mot khoang thi gian.
ng cong (3) la mot s lap lai cua
ng cong (1).
Vi cung mot lieu tong, trng hp
chieu bang nhieu phan lieu cho t so
te bao song sot ln hn.
oi vi cac mo ap ng cham, viec
phan lieu lam giam tac dung cua bc
xa.
oi vi cac mo ap ng nhanh, viec
phan lieu t lam giam tac dung cua bc
xa.
Trong xa tr, viec phan lieu giup
giam tac dung len te bao lanh, trong
khi gi nguyen tac dung len te bao
ung th.