X-ray Therapy

X-ray therapy or conventional therapy is a radiation therapy method that belongs to teletherapy (percutaneous radiation therapy) and uses X-rays. X-rays (Bremsstrahlung) are ionizing photon radiation produced by the deceleration of electrons in the Coulomb field of the atomic shell.

Indications (areas of application)

The indications for radiotherapy are limited because of their unsatisfactory dose homogeneity (uniform dose in the irradiation area) in larger target volumes. Possible areas of application are those diseases that require only a small total radiation dose, so that dose peaks can be accepted. Also suitable are superficially located structures to be irradiated, which lie in the maximum of the absorbed energy in the skin. Examples of radiotherapy indications:

  • Anti-inflammatory irradiation for acute inflammation.
    • Panaritium (inflammation of the fingers/toes).
    • Paronychia (inflammation of the nail bed)
    • Sweat gland abscesses (boils, infected acne).
    • Thrombophlebitis (phlebitis)
    • Skin eczema, psoriasis (psoriasis)
    • Non-healing fistulas, phlegmons (purulent, diffusely spreading infectious disease of the soft tissues) and ulcers (ulcers).
    • Herpes zoster (shingles)
  • Anti-inflammatory irradiation or pain irradiation in chronic inflammation or degenerative diseases of the joints and soft tissues.
    • Non-outlet impingement in the glenohumeral joint (narrowing of the subacromial space due to tendon calcifications, bursitis (bursitis), rotator cuff instability, or loosening of the acromioclavicular joint).
    • Arthrosis deformans (deforming osteoarthritis) of the large joints.
    • Degenerative spinal diseases
    • Epicondylitis radialis humeri (epicondylitis humeri lateralis; also tennis elbow; tennis elbow; inflammation of the tendon insertions on the humerus) or epicondylitis ulnaris humeri (golfer’s elbow, golfer’s arm).
    • Achillodynia (pain syndrome of the Achilles tendon).
  • Antiproliferative irradiation of hyperproliferative processes (excess cell formation).
    • Excess formation of collagen fibers: Cicatricial keloid (exuberant scar), Dupuytren’s contracture (scar contracture of the palmar aponeurosis of the hand), desmoid (aggressive fibromatosis, neoplasia of connective tissue).
    • Excessive activity of mesenchymal cells: heterotopic ossification (formation of bone tissue) after joint surgery.
    • Overproliferation of myofibroblasts of the vessel wall: intimal fibrosis (thickening of the inner skin of blood vessels by increasing collagenous, often also elast. Fibers) of the arteries, restenosis (renewed vascular occlusion) after vascular dilatation (vasodilatation).
    • Excessive vascular sprouting: exudative macular degeneration, increased vascularization (vascularization) after keratoplasty (replacement of a diseased cornea), etc.
  • Radiotherapy of small superficial skin tumors.
  • Palliative (medical treatment not based on a cure for an existing underlying disease) radiotherapy of superficially located metastases/daughter tumors (on ribs or skin)

The procedure

X-ray therapy is performed using X-ray irradiation equipment. An X-ray facility consists of a generator, X-ray tube, tube protective housing, stand, switchgear and possibly a patient treatment table. Different generator voltages are required for different applications. The corresponding tube voltages vary between 7 kV (marginal rays) and 300 kV and require an adapted design of the generator or the X-ray tube. A distinction is made between:

  • Soft beam therapy
    • Soft beam therapy is a therapy of very superficially located lesions, in which a high skin exposure with a simultaneous sharp drop in dose is to be achieved after only a few millimeters of tissue depth.
    • Technique: tube voltage between 10 and 50 kV (soft radiation), short focus-skin distance, thin beryllium sheet against self-filtering of the X-ray tube.
  • Hard radiotherapy
    • Hard radiotherapy is used for the treatment of degenerative joint and spinal diseases.
    • Technology: tube voltage of 100-400 kV, filters for hardening, complex structural radiation protection.

Possible complications

Not only tumor cells, but also healthy body cells are damaged by radiotherapy. Therefore, it is always necessary to pay careful attention to radiogenic (radiation-related) side effects and to prevent them, if necessary, detect them in time and treat them. This requires a good knowledge of radiation biology, radiation technique, dose and dose distribution as well as permanent clinical observation of the patient. The possible complications of radiotherapy are essentially dependent on the localization and size of the target volume. Prophylactic measures must be taken especially if there is a high probability of side effects occurring. Common complications of radiation therapy:

  • Radiogenic dermatitis (skin inflammation).
  • Mucositides (mucosal damage) of the respiratory and digestive tracts.
  • Tooth and gum damage
  • Intestinal diseases: Enteritides (intestinal inflammation with nausea, vomiting, etc.), strictures, stenoses, perforations, fistulas.
  • Cystitis (urinary bladder infections), dysuria (difficult bladder emptying), pollakiuria (frequent urination).
  • Lymphedema
  • Radiogenic pneumonitis (collective term for any form of pneumonia (pneumonia), which does not affect the alveoli (alveoli), but the interstitium or intercellular space) or fibrosis.
  • Radiogenic nephritis (inflammation of the kidneys) or fibrosis.
  • Limitations of the hematopoietic system (blood-forming system), especially leukopenias (decreased number of white blood cells (leukocytes) in the blood compared with the norm) and thrombocytopenias (decreased number of platelets (thrombocytes) in the blood compared with the norm)
  • Secondary tumors (second tumors).