Preface

This book offers a comprehensive review of challenges and opportunities in the modern application of radiation therapy. As therapy has evolved into calculating radiation dose as a volume and applying modern tools for treatment execution, this book addresses several issues that affect modern management. Dose modeling processes are evolving into three- and four-dimensional processes and this book examines how linear quadratic models can be repurposed for treatment execution and computation. This will be especially important as additional layers of care including brachytherapy and radiopharmaceutical care become commonplace and part of daily composite radiation therapy treatment planning integrating the role of radiation therapy dose rate and radiobiological effectiveness with different therapy treatment modalities. Multiple image sets will be required for fusion into radiation therapy planning imaging in order to generate target volumes for treatment. The role of radiogenomics and dose painting will expand to include dose augmentation to volumetric subsets of tumor areas representing features consistent with both resistance and response to therapy. Modern aspects of care for patients with cervical cancer, prostate cancer, and hepatic therapy are discussed at length and represent many of the challenges of modern care. Finally, the last chapter helps define the ultimate goal of our practice by defining the late effects of treatment and what we should consider to mitigate these issues for patients moving forward. We wish to thank all the contributing authors and we hope you enjoy the book.

> **Thomas J. FitzGerald MD** Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, MA, USA

**Chapter 1**

*Jozef Sabol*

**Abstract**

international standards

thus forming a negative ion.

**1. Introduction**

**1**

Technologies

Basic Radiation Protection for the

Safe Use of Radiation and Nuclear

Any use of both ionizing radiation and nuclear technologies requires ensuring appropriate safety and security of persons as well as the adequate protection of the environment. This is why the applications and handling of sources of ionizing radia-

tion should be in line with the relevant national and international standards containing appropriate safety and security requirements and recommendations. In order to understand and follow these standards, it is necessary to assess the related radiation risks, which should be quantified by using specific dosimetry and radiation protection quantities and units. The chapter introduces and discusses these quantities and units aimed at the evaluation of the biological harms attributed to both stochastic and deterministic effects. The correct use and interpretation of radiation quantities are important to follow relevant regulations and to communicate radiation risks to workers and the public. The chapter takes into account the latest situation in the field,

relying on the recent position of relevant international expert bodies.

**Keywords:** radiation, protection, use of radiation, radiation technologies,

Radiation can be divided into two groups, namely *ionizing radiation* and *nonionizing radiation*. While ionizing radiation of sufficient energy is able to ionize the atoms of the matter with which it interacts, nonionizing radiation has not this ability. In general, **ionizing radiation**—particles or electromagnetic waves—carries enough energy to knock electrons from atoms or molecules, thereby ionizing them. The result is a positive ion and a free electron, which may be later attached to a neutral atom,

with increasing values to the right) is shown in **Figure 1** (based on [1]).

An illustration of nonionizing and ionizing radiation wavelengths (from the left

In principle, ionizing radiation can be directly ionizing radiation (charged particles) and indirectly ionizing radiation represented by photons (gamma, X-ray, annihilation photons) and neutrons. The interaction of this radiation can also result in
