Beruflich Dokumente
Kultur Dokumente
A.KUMAR
PG STUDENT
ORAL MEDICINE AND RADIOLOGY
CONTENTS
INTRODUCTION
RADIATION MEASUREMENTS
RADIATION INJURY
Terminologies
TYPES OF RADIATION EFFECTS
Stochastic effects
Deterministic (non-stochastic) effects
Short term effects (acute)
Long term effects (chronic)
Somatic effects (late)
Genetic effects
In-Utero Effects
Factors determine biological effects of radiation
BIOLOGICAL EFFECTS
EFFECT ON CELLS
1.DNA
2.CYTOPLASM
3.NUCLEUS
4.CHROMOSOMES
5.PROTEINS
6.CELL DIVISION
7.CELL DEATH
RADIATION EFFECT ON CRITICAL ORGANS
1.SKIN
2.BONE MARROW
3.THYROID
4.GONADAL
5.EYE
EFFECT ON ORAL TISSUES
1.ORAL MUCOSA-MUCOSITIS
2.TASTE BUDS
3.SALVARY GLANDS-XEROSTOMIA
4.TEETH- RADIATION CARIES
5.BONES-OSTEORADIO NECROSIS
EFFECT ON WHOLE BODY
1.ACUTE RADIATION SYNDROME
2.HEMATOPOITIC SYNDROME
3.GASTROINTESTINAL SYNDROME
4.CARDIOVASCULAR SYNDROME
5.CENTRAL NERVOUS SYNDROME
RADIATION BIOLOGY
INTRODUCTION
RADIATION MEASUREMENTS
RADIATION INJURY
Terminologies
TYPES OF RADIATION EFFECTS
Stochastic effects
Deterministic (non-stochastic) effects
Short term effects (acute)
Long term effects (chronic)
Somatic effects (late)
Genetic effects
In-Utero Effects
Factors determine biological effects of radiation
RADIATION MEASUREMENTS
INTRODUCTION
RADIATION MEASUREMENTS
RADIATION INJURY
Terminologies
TYPES OF RADIATION EFFECTS
Stochastic effects
Deterministic (non-stochastic) effects
Short term effects (acute)
Long term effects (chronic)
Somatic effects (late)
Genetic effects
In-Utero Effects
Factors determine biological effects of radiation
RADIATION INJURY
INTRODUCTION
RADIATION MEASUREMENTS
RADIATION INJURY
Terminologies
TYPES OF RADIATION EFFECTS
Stochastic effects
Deterministic (non-stochastic) effects
Short term effects (acute)
Long term effects (chronic)
Somatic effects (late)
Genetic effects
In-Utero Effects
Factors determine biological effects of radiation
Terminologies
36
RELATIVE BIOLOGIC
EFFECTIVENESS(RBE)
37
LATENT PERIOD
38
maximum permissible dose
INTRODUCTION
RADIATION MEASUREMENTS
RADIATION INJURY
Terminologies
TYPES OF RADIATION EFFECTS
Stochastic effects
Deterministic (non-stochastic) effects
Short term effects (acute)
Long term effects (chronic)
Somatic effects (late)
Genetic effects
In-Utero Effects
Factors determine biological effects of radiation
Stochastic effects
• Genetic effects are not seen in the irradiated person but are passed
on to future generations. Radiation injuries that produce changes in
genetic cells do not affect the health of the exposed individual.
• Instead, the radiation-induced mutations affect the health of the
offspring .
• Genetic damage cannot be repaired.
• Doubling dose: dose of radiation expected to double the number of
genetic mutations in a generation.(or) Amount of radiation that
doubles the incidence of stochastic effects.
• Human data from Hiroshima/Nagasaki suggest somewhat average
doubling dose is 1.6 Sv
Effects on the unborn child
• The presence of oxygen in a cell acts as a radiosensitizer, making the effects of the
radiation more damaging. Tumor cells typically have a lower oxygen content than
normal tissue.
• This medical condition is known as tumor hypoxia and therefore the oxygen effect acts
to decrease the sensitivity of tumor tissue. Generally it is believed that neutron
irradiation overcomes the effect of tumor hypoxia, although there are
counterarguments.
BIOLOGICAL EFFECTS
EFFECT ON CELLS
1.DNA
2.CYTOPLASM
3.NUCLEUS
4.CHROMOSOMES
5.PROTEINS
6.CELL DIVISION
7.CELL DEATH
RADIATION EFFECT ON CRITICAL ORGANS
1.SKIN
2.BONE MARROW
3.THYROID
4.GONADAL
5.EYE
EFFECT ON ORAL TISSUES
1.ORAL MUCOSA-MUCOSITIS
2.TASTE BUDS
3.SALVARY GLANDS-XEROSTOMIA
4.TEETH- RADIATION CARIES
5.BONES-OSTEORADIO NECROSIS
EFFECT ON WHOLE BODY
1.ACUTE RADIATION SYNDROME
2.HEMATOPOITIC SYNDROME3.
3.GASTROINTESTINAL SYNDROME
4.CARDIOVASCULAR SYNDROME
5.CENTRAL NERVOUS
Single strand break can repair
Double strand break is responsible for
.mutation
.cell death
.carcinogenisis
Point mutations: Effect of radiation on
individual genes is referred to as point
mutation.
CYTOPLASM
• cell cycle:
Chromosome Aberrations
94
ORAL MUCOUS MEMBRANE
102
TASTE BUDS
108
SALIVARY GLANDS
115
Teeth
126
• OSTEORADIO NECROSIS
OSTEORADIO NECROSIS
DEFINITION;
An exposure of irradiated bone which fails to heal with out
intervention (Marx 1983)
It is a chronic nonhealing wound caused by hypoxia,
hypocellularity, and hypovascularity (3H)of irradiated
tissue. Marx and Johnson (1987)
Clinical definition by Van Merkesteyn (1995)
Bone and soft tissue necrosis of 6 months duration
excluding radiation induced periodontal breakdown
INCIDENCE
• Triad RADIATION
TRAUMA INFECTION
Pathophysiology
OSTEONECROSIS
Types of osteoradionecrosis
• SPONTANEOUS ORN (39%) – degradative function exceeds new
bone production.
• Little-evident
• sequestra or involucra occur late
• radiolucent modeling -nonsclerotic
Histologically
Emergency Indications
•Acute Traumatic Ischemia
Crush Injuries and
Compartment Syndrome
•Carbon Monoxide Poisoning
Clinical •Gas Gangrene
Hyperbaric •Surgical Infections
•Failed Flaps and Grafts
Oxygen •Diving Injuries
Therapy Scheduled Indications
•Non-Healing Diabetic and problem
Wounds
•Radiation soft tissue necrosis, cystitis,
and proctitis.
•Osteoradionecrosis
•Osteomyelitis
Primary Mechanisms
• Hyper---oxygenation
• Vasoconstriction—reduce inflammation
• Microbiological effects
• Activate fibroblast and collagen synthesis
Secondary Mechanisms
• Angiogenesis
• Osteogenesis
• WBC Oxidative Killing
• Cell wall permeation
Side Effects of HBO
• Claustrophobia/ Confinement anxiety
• Barotrauma
• Reversible myopia
Contraindications
Absolute:
• Untreated pneumothorax
• Cis-Platin; Doxorubicin; Disulfiram
• Emphysema w/air trapping
Relative:
• Emphysema with CO2 retension
• Pulmonary lesion in CXR
• Uncontrolled high fever
• Claustrophobia
• Seizure disorder
• Malignant disease
BIOLOGICAL EFFECTS
EFFECT ON CELLS
1.DNA
2.CYTOPLASM
3.NUCLEUS
4.CHROMOSOMES
5.PROTEINS
6.CELL DIVISION
7.CELL DEATH
RADIATION EFFECT ON CRITICAL ORGANS
1.SKIN
2.BONE MARROW
3.THYROID
4.GONADAL
5.EYE
EFFECT ON ORAL TISSUES
1.ORAL MUCOSA-MUCOSITIS
2.TASTE BUDS
3.SALVARY GLANDS-XEROSTOMIA
4.TEETH- RADIATION CARIES
5.BONES-OSTEORADIO NECROSIS
EFFECT ON WHOLE BODY
1.ACUTE RADIATION SYNDROME
2.HEMATOPOITIC SYNDROME
3.GASTROINTESTINAL SYNDROME
4.CARDIOVASCULAR SYNDROME
5.CENTRAL NERVOUS SYNDROME
EFFECTS IN WHOLE BODY
158
ACUTE RADIATION SYNDROME
• Prodromal stage (N-V-D stage): The classic symptoms for this stage
are nausea, vomiting, as well as anorexia and possibly diarrhea
(depending on dose), which occur from minutes to days following
exposure. The symptoms may last (episodically) for minutes up to
several days.
• Latent stage: In this stage, the patient looks and feels generally
healthy for a few hours or even up to a few weeks.
• Manifest illness stage: In this stage the symptoms depend on the
specific syndrome and last from hours up to several months.
• Recovery or death: Most patients who do not recover will die within
several months of exposure. The recovery process lasts from several
weeks up to two years
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Bone marrow (hemopoietic)
syndrome: