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Several methods to calculate dose equivalence have been published and revised.

Terms
such as BED and EQD2 have surfaced and can be difficult to interpret. Review the link
that contains a bit of this HISTORY . There are also some examples found in this
LECTURE. You may also benefit from specific RESEARCH. FInally there are CLINICAL
APPLICATIONS to help see the relevance of this work in progress.
Give a specific example of how any one of these equations may be used in your role as a
clinical medical dosimetrist. List any limitations of your example. Post your work for
others to review by Sunday, October 30. Review the work of each person in your group and
comment no later than Sunday, November 6th.

The biologic effective dose formula (BED) is used to calculate and compare dose effects from
differing fractionation schedules or techniques.1 The equation for BED is found below:
= 1 +

D = total dose
d = dose per fraction
/ = 10 (derived from the linear and quadratic components for the cell survival curve)

This equation is useful in to us in dosimetry because it allows us to somewhat predict and compare
the dose effects on patients to help choose the best treatment option. In a case where we want to
compare two different SBRT fractionation schemes, we would simply plug in the values into the
formula and the result will give us the dose at which we would start to see biologic changes in the
area of treatment.
An example would be to compare the following fractionation schedules for treatment:1
1. 5 fractions of 12 Gy, total dose of 60 Gy
2. 3 fractions of 20 Gy, total dose of 60 Gy
The equation would be set up as follows:
1. = 60 1 +

./
.0

BED = 132 Gy10


2. = 60 1 +

/0
.0

BED = 180 Gy10


In addition to this equation for SBRT fractionation, it is also customary to find the normalized total
dose (NTD), which is determined by calculating the physical dose under 2 Gy that would give the

same BED.1 This allows us to compare the biologic differences between normal fractionation and
SBRT fractionation. The calculation for this is:
= 1 +

2
10

For the first fractionation scheme:


1. 132 .0 = 1 +

/
.0

NTD = 110 Gy
For the second fractionation scheme:
2. 180 .0 = 1 +

/
.0

= 150
What this tells us is that, for each fractionation scheme that was calculated, the biologic effects
that will occur much sooner using normal fractionation than with SBRT treatment. In addition, it
also allows the physician and physics team decide on the best treatment plan for the patient based
on the information given. One thing to keep in mind however, is that the use of the linear quadratic
model values is only an approximation of dose and its application to SBRT treatments is still being
studied.1

Reference:
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins, a Wolters Kluwer business; 2014.

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