Biologically Effective Dose (BED) is a measure of the true biological dose delivered by a given

combination of dose per fraction and total dose to a given tissue, which is characterized by a
particular / ratio. BED is utilized for calculating isoeffective dose. It compares the effects of
fractionation schedules. BED is calculated via the following formula:

n represents the number of fractions

d represents the dose per fraction
Total BED can be calculated for combined schedules of external beam radiation therapy (EBRT)
and brachytherapy (BT) using the following formula:

However, it should be noted that this equation does not take into consideration that the
proliferation during the treatment could decrease anywhere up to 1Gy/day. Therefore, the
following equation is used to account for this possible decrease in proliferation.

Ttreat represents the overall treatment time

Tk represents the time for the onset of proliferation
Tp represents the effective doubling time during proliferation
represents the linear parameter of the LQ model
In other words, Tp depicts the proliferation of the tumor after treatment created damage to the
tumor. Then, Ttreat Tk is the actual time available for accelerated repopulation; therefore, it is
not necessary to correct for proliferation when the total treatment time is less than Tk.
Separated out BED can be calculated for EBRT alone and BT alone in the following equations:

D represents the radiation dose

T represents the duration of the BT session
= ln(2)/T1/2 and characterizes the repair of sublethal damage in the irradiated tissues
T1/2 represents the half-life of sublethal damage repair
BED is different than biologically equivalent dose. Biologically equivalent doses are calculated
in 2-Gy equivalents using the EQD2 equation. BED can be recorded as equivalent dose in 2 Gy
per fraction, EQD2. Thus, since
BED = (total dose) * (RE), it can be said that
Total dose = BED / RE, where RE represents the relative effectiveness and
RE = (1 + d /[/]).
Thus, an equivalent total dose in 2-Gy fractions or EDQ2 can be calculated for any BED simply
by dividing the BED by the RE for 2-Gy fractions, utilizing the proper / ratio.
Here are 2 examples to demonstrate these concepts. Example 1 is a BED example. Example 2 is
an example using EQD2.
Example 1:
A treatment consists of a prescription of 50 Gy delivered in 25 fractions followed by 15 Gy
delivered in 3 fractions over the course of 5 days. Assuming that the / ratio is 2 Gy,

Determine the total BED.

Total BED = 50(1 + 2/2) + 15(1 + 5/2) = 152.5 Gy2
Example 2:
A Treatment consists of a prescription 50 Gy delivered in 25 fractions followed by 15 Gy
delivered in 3 fractions over the course 5 days. Assuming that the / ratio is 2 Gy,

EQD2 = 152.5/(1 + 2/2) = 76.3 Gy

This is an equivalent dose of approximately 76 Gy delivered in 38 X 2 Gy fractions.

In general, BED is difficult to interpret and there are some limitations to the use of BED.
Possible limitations of BED include:
-

The / ratio of the given tissues must be known

For very low or very high doses per fraction the validity of the linear quadratic (LQ)
model may be questionable, in other words, LQ fails
There are concerns regarding the / ratio for tumors for which / = 10
Generic values of 10 Gy for tumors and 3 Gy for normal
Hot spots of treatment
Previous cytotoxic chemotherapy
Previous surgery
Extremes of age
Vascular pathology
Breaks in treatment, compensation for accelerated proliferation

1. Oakland University William Beaumont School of Medicine. The Management of

Gynecological Cancers: Radiobiology.
https://uwlax.courses.wisconsin.edu/content/enforced/3331487UWLAC_2174_DYN_DOS_543_SEC501_3879/2013BrachytherapySpringRefresher.pdf?_&d2l
SessionVal=TKGuKLMMsS3uPBLPYfnDg9xqi. Accessed October 26, 2016.