Jenny Kouri

Biologically Effective Dose (BED) is an isodose formula used to compare varying dose
fractionations by measuring the true biological dose delivered to individual tissues. BED
observes the early and late responses of reacting tissues based off of fractionation
regimens. BED is equivalent to the total dose, nd, (number of fractions multiplied by
dose per fraction), which is characterized by a/B, a biological ratio of the target cells.
Alpha and beta values describe the curvature of a cell survival curve depicted by the
linear quadratic (LQ) model, which defines the sensitivity of dose per fraction. LQ allows
for comparison of various fractionation schemes in terms of BED. The total dose, nd, is
multiplied by the relative effectiveness (RE), which describes the changes of fraction size
associated to different types of tissue.

BED can be used to calculate external beam (EBRT) alone or the combination of EBRT
and brachytherapy (BT) schedules.

Typically, BED is not readily understood unless used frequently in clinical, despite its
simplicity and convenience during the calculation process. Limitations of BED include
the following:

1. Must know the a/B ratio

2. Linear quadratic (LQ) of cell kills fail at extremes of low dose rate and large
fractionations
3. BEDs of different tissues have to be kept separate from each other
4. Breaks during treatment
5. Usually designated by the a/B ratio as a postfix, generic values of 10 Gy for
tumors and 3 Gy for normal tissue
6. Extremes of age
7. Previous surgery or chemotherapy
8. Hot or cold spots of treatment
Since most tissue toxicities are presented by the conventional fractionation of 2 Gy per
fraction, the BED model can be further evaluated to include EQD2 model, which is
biologically equivalent to 2 Gy fractionation schemes. The EQD2 can be found for any
BED by dividing the RE for 2 Gy fractions, using the appropriate a/B ratio. The EQD2
model is found to be more practical, familiar, and easier to understand in clinical practice
than BED.

I found these two example problems that I found very helpful to distinguish the use for
BED and EQD2.