External beam Radiotherapy

External beam radiotherapy or teletherapy is the most common form of

radiotherapy. The patient sits or lies on a couch and an external source of
radiation is pointed at a particular part of the body.

External beam radiation therapy uses a high –energy x-ray machine –

called a linear accelerator(linac)- to direct radiation to the tumor. The
procedure lasts afew minutes, and is typically repated several times a
week over several months.

Types of external beam radiation treatments include:-

1-Three-dimensional conformal radiation therapy
A technique where the tumor is mapped with imagining
equipment and then treated with multiple beams of radiation.
3D conformal radiation therapy.
2- Proton beam radiation therapy
A technique uses protons, instead of x-rays,to kill the tumor .
protons are parts of atoms that can pass through healthy
tissues with little damage, and destroy tumor cells at the end
of their path.
3- Intensity-modulated radiation therapy(IMRT)
Atratment method in which the intensity of the radiation can
be changed during treatment.
(IMRT) gives radiation therapists the ability to "sculpt" the
edges of atumor, minimizing the damage to adjacent healthy
tissue.
Treatment Planing for external beam radiation
The process of planing external beam radiation therapy has
many steps and may take several days to complete. The
treatment will give the strongest dose of radiation to the
cancer buy will spare normal tissue as much as possible
1-The first part of treatment planing is called "simulation", it
will be asked to lie still on a table while the health care team
works out the best treatment position and how to keep in that
position.
2-The doctor may use imaging tests to check the size of the
tumor , figure out where it is more likely to spread,outline
normal tissues in the treatment area,take measurment ,and
develop the treatment plan.
3- photons may also be taken and are used to make the daily
treatment set-up easier.
4- Through a complex process called dosimetry, computer
programs are used to find how much radiation the nearby
normal structures would be exposed to in order to deliver the
prescribed dose to the cancer
Internal radiation therapy(Brach therapy):-
Brachtherapy is one type of radiation therapy used to treat cancer.
Radiation therapy is the use of a type of energy called ionizing
radiation to kill cancer cells and shrink tumor.

Internal radiation therapy is also known as brachtherapy, which means

short-distance therapy. With this method ,radioactive containers are
placed into the tumor or into a body cavity close to the tumor . The
advantage of brachtherapy is the ability to deliver a high dose of
radiation to small area. It is useful for tumors that need a high dose of
radiation or a dose that would be more than the normal tissue could
stand if it had to come in from to outside.

Types of internal radiation :-

1-Interstitial radiation:- the radiation source is placed directly
into or next to the tumor using small pellets,seeds,wires,tubes,or
containers

2-Interacavitary radiation:- a container of radioactive material

is placed in a cavity of the body such as the chest ,rectum,uterus, or
vagina,Ultrasound ,X-rays or CT scans are used to help the doctor put
the radioactive source in the right place.

3-Permanent brachtherapy:- involves using small containers

called pellets or seeds which are about the size of a gain of rice. they
are put right into the tumors using thin, hollow needles.

4-Temporary brachtherapy:-can be high dose rate [HDR] or

low dose rate [LDR] either type briefly places hollow needles,tubes,
or fluid-flled balloons into the area to be treated radioactive material
can be put in these containers for a short time and then removed, This
may be done by hospetalstaff or the radioactive material can be put
into the device remotely by machine.
For HDR brachytherapy, the radiation source is put into place for
about 10 to 20 minutes at a time and then removed. This process may
be repeated twice a day over the courceof a few days.

For LDR brachytherapy, the radiation source stays in place for up to 7

days. To keep the implant from moving,will need to stayin bed and lie

Fainly still. For this reason will be kept in the hospital during LDR
therapy.

Treatment with internal radiation:-

1-Radioactive material(such as seeds or pellets) is pushed to the size
of the tumor through a delivery device, such as a needle. Catheter or
asplicator- both of which are thin , hollow tubes- or single balloon
catheter

2-The physician may manually insert and remove the radioactive

material immediately after placing the delivery device.

3- using a computer- control ed machine , X-rays, ultrasound or CT

scans may be used to help position the radioactive material to most
effectively treat the tumor.

4- In treatment planning , a computer is used to help calculate the

amount of time needed to deliver the correct dose of radiation to the
tumor.

Electron beam therapy:-

X-rays are generated by bombarding a high atomic number
material with electrons. If the target is removed(and the beam
current decreased) a high energy electron beam is obtained.
Electron beams are useful for treating superficial Lesions
because the maximum of dose deposition occurs near the
surface .The dose then decreases rapidly with depth, sparing
underlying tissue. Electron beams usually have nominal
energies in the range 4-20 MeV. Depending on the energy
this translates to a treatment range of approximately 1-5
cm(in water –equivalent tissue).
Energies above 18 MeV are used very rarely. Although the
X-ray target is removed in electron model, the beam must be
fanned out by sets of thin scattering foils in order to achieve
flat and symmetric dose profiles in the treated tissue.