According to the article “21 years of Biologically Effective Dose” by Fowler (2010), a report suggesting the new term "biologically effective dose" or BED was initially presented in 1989 in the British Journal of Radiology. The creation of the term was connected with the radiobiological quadratic cell endurance. It was designed for the quantitative indication of the impact of any radio therapeutic procedure, considering the adjustments in the dose rate, overall dose and total time. Appropriate medical results have been commonly documented employing the BED estimates. It appears to be in growing use, despite the fact that occasionally it is incorrectly documented as ‘‘biologically equivalent dose’’. The difference lies in the large factors, as the article points out. The typically twisting character of the linear quadratic curve is put to doubt in the article, but it is acknowledged that BED has performed effectively for evaluating therapies using numerous techniques, with some utilizing large fractions. A couple of essential developments took place in the formula of BED. First of all, in 1999, the formula began to incorporate high linear energy transfer radiation (LET radiation). Then, in 2003, when new researches suggested time variables for intense mucosal tolerance, it was proposed that the best possible total times could be subsequently ‘‘triangulated’’ to streamline tumour BED as well as cell kill. It appears that this takes place exclusively when both earlier as well as later BEDs reach their maximum limitations at the same time. Innovative techniques for dose delivery, such as stereotactic body and intensity modulated radiation treatments, rapid arc, protons, cyber-knife and tomography, utilize a number of large fractions and evidently go against the well-recognized fractionation periods. Thorough biological modelling becomes necessary to harmonize the varying tendencies of the fraction size as well as the gradient of local dose. BED is currently employed for dose escalation research, brachytherapy, radio chemotherapy, radionuclide-focused treatment, high-LET particle beams and for quantification of any procedures working with ionic radiation.
The article discusses the considerable gains between the 2F/day and 1F/day periods. These kinds of factors are appropriate when SBRT, protons and radiosurgery are taken into account and they have a tendency for brief periods characterized by quite significant doses per fraction. In the best case scenario they are grounded on faster dose gradients from tumour to adjoining common tissue or, in the worst case, on cost factors. Thus, the modelling indicates fairly solidly that two fractions per day is the most effective and reasonable decision for exterior beam radiation, with pulsed dose rates as an intriguing rival in the wings, even when it is utilized beyond ‘‘office hours.’’ The contemporary systems make it possible for the technique to be solely attainable as brachytherapy possessing a number of its intrinsic decent physical dose gradients. Despite the fact that the two sections of the BED formula, proposed by Fowler, are quite apparent simplifications of something that might be a lengthier sequence of terminology, it seems to function quite effectively. As a result, this representation of the BED formula appears to be helpful, both for severe mucosa and for tumours. Likewise, it can be applied for subsequent systemic difficulties. However, it goes without saying that it not the limit of what could be accomplished by means of this kind of modelling.
The article is structured in a well-organized manner. It starts with the background of the BED formula and the earlier achievements accomplished by researchers before 1989. Then, it provides a chronological account of the three primary milestones reached in the BED research with final idea being that these stages were instrumental in letting scientists identify how radiotherapy with multiple fractions worked in improving tumor cell kill.
It was very insightful to devote a section of the article to the advantages and disadvantages of the BED term use, since this part of the work allowed a reader to see the both sides of the coin – the possible positive outcomes and the unfortunate circumstance of the ambiguity of the term. The way the term is expressed, that is “Biologically Effective Dose”, is very confusing if we likewise use “Biologically Equivalent Dose”. If abbreviated, they are absolutely the same – BED. However, this problem may be solved by means of renaming of the terms to avoid ambiguity.
Further, the article continued to discuss the adjustments made to the BED research in terms of the size of the fractions and the most effective schedule of treatment. The exposition of the material was quite consistent, chronological and orderly which allowed gaining a comprehensive picture of the BED formula development and its application.
The data presented in the work are illustrated and proved by tables and graphs, among which I would point out the schedule tables and the modelling estimate graphs. The references range in the date of publication from 1989 to 2010, which was inescapable since the author’s objective was not only to provide the current use of the BED, but also to comprehensively outline the progress previously made.
My opinion of the article is that it was quite instrumental in providing a systematic point-by-point discussion of the origination and application of biologically effective doses in the realm of radiobiology. It goes without saying that the peculiar feature of this article is that is totally focused on the subject it is named with, and I would highly recommend it to students who are in need of a more detailed and structured explanation of the way how radio therapeutic procedures work.
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