Use of radiobiology in medical jurisprudence, with particular reference to delays in diagnosis and therapeutic onset

Journal article

OBJECTIVE: This paper considers aspects of radiobiology and cell and tissue kinetics applicable to legal disputations concerned with diagnostic and treatment onset delays.

METHODS: Various models for tumour volume changes with time are reviewed for estimating volume ranges at earlier times, using ranges of kinetic parameters. Statistical cure probability methods, using Poisson statistics with allowances for parameter heterogeneity, are also described to estimate the significance of treatment delays, as well as biological effective dose (BED) estimations of radiation effectiveness.

RESULTS: The use of growth curves, based on parameters in the literature but with extended ranges, can identify a window of earlier times when such tumour volumes would be amenable to a cure based on the literature for curability with stage (and dimensions). Also, where tumour dimensions are not available in a post-operative setting, higher cure probabilities can be achieved if treatment had been given at earlier times.

CONCLUSION: The use of radiobiological modelling can provide useful insights, with quantitative assessments of probable prior conditions and future outcomes, and thus be of assistance to a Court in deciding the most correct judgement.

ADVANCES IN KNOWLEDGE: This study collates prior knowledge about aspects of radiobiology that can be useful in the accumulation of sufficient proof within medicolegal claims involving diagnostic and treatment days.

Authors: Jones, B

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Institute of Radiology
• Journal: British Journal of Radiology
• Volume: 92
• Issue: 1104
• Article number: 20190672
• Publication date: 2019-11-07
• Acceptance date: 2019-10-08
• DOI: 10.1259/bjr.20190672
• EISSN: 1748-880X
• ISSN: 0007-1285
• Pmid: 31603350
• Language: English
• Keywords: radiation oncology; time factors; poisson distribution; cell cycle; neoplasms; relative biological effectiveness; biomarkers, tumor; algorithms; prognosis; delayed diagnosis; FFR; cell proliferation; neoplasm staging; tumor burden; radiobiology; time-to-treatment; problem solving