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The History of RO: Brachytherapy
• Jesse N. Aronowitz, M.D.• Martin Colman, M.D.• Gustavo S. Montana, M.D.• Roger Robison, M.D.• Herman D. Suit, M.D., D. Phil.• J. Frank Wilson, MD
Objectives• Learn about the need for and the development of
the first oncology societies, which were based on gamma ray therapy.
• Understand how low-dose-rate brachytherapy developed as the gold standard.
• Explain the continuing development of radioactive seed implantation and of after-loading intracavity/interstitial brachytherapy.
J. Frank Wilson, M.D. J. Frank Wilson, M.D.
ASTRO 2007ASTRO 2007History of Radiation Oncology History of Radiation Oncology
Origins of BrachytherapyOrigins of Brachytherapy
Natural Natural RadioactivityRadioactivity
18981898
Artificial Artificial RadioactivityRadioactivity
19351935
The Curie EraThe Curie Era
RRööntgen observed the ntgen observed the fluorescence of platino fluorescence of platino --cyanide salts exposed to cyanide salts exposed to
xx--rays.rays.
Wilhelm Conrad RWilhelm Conrad Rööntgenntgen18451845--19231923
In 1896, Becquerel reported the In 1896, Becquerel reported the ““phosphorescencephosphorescence”” of uranium of uranium capable of fogging photographic capable of fogging photographic plates through a thickness of plates through a thickness of aluminum.aluminum.
Antoine Henri BecquerelAntoine Henri Becquerel18521852--19081908
Radiogram of a medal Radiogram of a medal
Newlyweds, July, 1895.Newlyweds, July, 1895.Mme. CurieMme. Curie’’s post doctoral work was to study the s post doctoral work was to study the ““uranium raysuranium rays””..
Radium Radium ““discovered.discovered.”” December 26, 1898December 26, 1898Polonium Polonium ““discovered.discovered.”” June, 1898June, 1898
Primitive ionization chamber built by Primitive ionization chamber built by Curies to detect radiation.Curies to detect radiation.
““ It seemed to me that the first It seemed to me that the first thing to do was to measure the thing to do was to measure the phenomenon with precision.phenomenon with precision.””
““Instead of the usual electroscope, Instead of the usual electroscope, I used a more perfect apparatus.I used a more perfect apparatus.””
Electrometer built by P. CurieElectrometer built by P. Curie
Marie Curie, 1923Marie Curie, 1923
Pierre CuriePierre Curiec. 1899c. 1899
Shown working Shown working with the quartz with the quartz piezopiezo--electroscope electroscope he invented, by he invented, by which rays of which rays of radium could be radium could be measured.measured.
Initial radium extraction process.Initial radium extraction process.One decigram isolated by June, 1903.One decigram isolated by June, 1903.
““ One of our joys was to go into our workroom at One of our joys was to go into our workroom at night; we perceived on all sides the feebly night; we perceived on all sides the feebly luminous silhouettes of the bottles or capsules luminous silhouettes of the bottles or capsules containing our products. It was really a lovely containing our products. It was really a lovely sight and one always new to us. The glowing sight and one always new to us. The glowing tubes looked like faint, fairy lights.tubes looked like faint, fairy lights.””
Marie Curie, 1923Marie Curie, 1923
““ In this miserable old shed we passed the best In this miserable old shed we passed the best and happiest years of our lifeand happiest years of our life…”…”
Marie Curie, 1923Marie Curie, 1923
Alfred NobelAlfred Nobel1833 1833 -- 18961896
•• NobelNobel’’s will was contested.s will was contested.
•• First prize awarded in 1901.First prize awarded in 1901.
•• Roentgen was the first Nobel Roentgen was the first Nobel
Laureate in Physics.Laureate in Physics.
•• Becquerel and the Curies were Becquerel and the Curies were
Nobel Laureates in 1903.Nobel Laureates in 1903.
““In criminal hands radium might prove very In criminal hands radium might prove very dangerous, and the question therefore arises dangerous, and the question therefore arises whether it be to the advantage of humanity to whether it be to the advantage of humanity to know the secrets of nature, whether we be know the secrets of nature, whether we be sufficiently mature to profit by them, or whether sufficiently mature to profit by them, or whether that knowledge may not prove harmful.that knowledge may not prove harmful.””
Pierre Curie Pierre Curie Nobel Acceptance Speech, 1903Nobel Acceptance Speech, 1903
Pierre CuriePierre Curie’’s selfs self--inflicted severe skin inflicted severe skin reaction to radium.reaction to radium.
19031903
As early as 1905 both Pierre and Marie were As early as 1905 both Pierre and Marie were showing negative health effects from their work.showing negative health effects from their work.
Radium applicators for surface and intracavitary applications, Radium applicators for surface and intracavitary applications, used by Danlos and later by Wickham. used by Danlos and later by Wickham.
“…“…there is no reason why a tiny fragment of there is no reason why a tiny fragment of radium sealed up in a glass tube should not be radium sealed up in a glass tube should not be inserted into the very heart of the cancer; thus inserted into the very heart of the cancer; thus acting directly upon the diseased material.acting directly upon the diseased material.””
A.G. BellA.G. BellLetter to Letter to Science, 1903Science, 1903
c. 1913c. 1913
Claudius Regaud, Claudius Regaud, 1870 1870 -- 19401940
Pasteur Pavilion, Pasteur Pavilion, Radium InstituteRadium Institute
Marie Curie, WW I Marie Curie, WW I (c. 1917)(c. 1917)First radiographer and inventor of mobile radiology.First radiographer and inventor of mobile radiology.
Carcinoma, left infraorbital region, treated by Carcinoma, left infraorbital region, treated by Columbia paste mounted radium.Columbia paste mounted radium.
Intraoral MouldsIntraoral Moulds Radium Radium ““PacksPacks””
Jean PierquinJean Pierquin1887 1887 -- 19581958
Georges RichardGeorges Richard1888 1888 -- 19621962
Radiumtherapy pioneers 1920 Radiumtherapy pioneers 1920 -- 19361936
Paul Paul LangevinLangevin(1872(1872-- 1946)1946)
Radium: The unprecedented panacea.Radium: The unprecedented panacea.
Radon BathRadon Bath
Radon EmanatorRadon Emanator
Courtesy of Robison & MouldCourtesy of Robison & Mould
Jaw Necrosis in a Radium Dial PainterJaw Necrosis in a Radium Dial Painter
Irene Curie earned her Ph.D. studying the alpha rays of poloniumIrene Curie earned her Ph.D. studying the alpha rays of polonium..
(c. 1925)(c. 1925)
Paul Paul LangevinLangevin, G. , G. BoreauBoreau, Frederick Joliot, Irene Joliot, Frederick Joliot, Irene Joliot--CurieCurieJoliot receives his AcademicianJoliot receives his Academician’’s sword.s sword.
November 17, 1946November 17, 1946
““With the neutron we were too late. With the neutron we were too late. With the positron we were too late. With the positron we were too late. Now we are in time.Now we are in time.”” Joliot to a student, Jan. 1934Joliot to a student, Jan. 1934
Nobel Prize, 1935Nobel Prize, 1935
The PantheonThe PantheonLatin Quarter, ParisLatin Quarter, Paris
April 20, 1995April 20, 1995
Pantheon Crypt, Pantheon Crypt, 20072007
THE HISTORY OF LDR BRACHYTHERAPY
CANCER of the CERVIX
Gustavo S. Montana M.D., F.A.C.R.Duke University Medical Center
ASTRO 2007
DisclosuresI have nothing to disclose.
RADIATION THERAPY HISTORYImportant Dates
1901 Henri Becquerel and Pierre Curie described the biological biological effects of radium on the skin. Becquerel carried carried a radium tube in his waistcoat pocket and Pierre Curie intentionally exposed his arm.
1903 Alexander Graham Bell proposes the use of interstitialtherapy
1903 Margaret A. Cleaves describes the treatment of a gynecological patient with intracavitary radium in New York.
1903 H. Streble describes afterloading interstitial technique.
RADIATION THERAPY HISTORYImportant Dates
1904 W. Pusey and E. Caldwell treat uterine cancer with a radium capsule inserted in the uterus.
1905 L. Wickman and P. Degrais designed applicator for intracavitary therapy for treatment of carcinoma of the cervix.
1910 L. Wickman and P. Degrais published brachytherapy textbook and described gynecological applicators.
1912 Dr. Koning uses large quantity of radium externally, for for treatment of pelvic cancers. “The Radium Canon”
RADIATION THERAPY HISTORYImportant Dates
1934 Irene and Frederic Joliot-Curie discover artificial radioactivity.
1937 First clinical use of the Van de Graaf accelerator.
1948 First clinical use of the Betatron.
1951 First patient treated with a kilocurie cobalt unit.
1956 First Linear Accelerator installed in the U.S.
RADIATION THERAPY HISTORYImportant Dates
1963 Afterloading Intracavitary
1974 High Dose Rate Brachytherapy
1977 Afterloading Transperineal
1977 3D Treatment Planning
1996 (IMRT) Intensity Modulated Radiation Therapy
BRACHYTHERAPYRequirements
• Accessible Tumors• Radiosensitive Tumors• Tolerance of Normal Tissues• Orderly Pattern of Spread
BRACHYTHERAPYADVANTAGES
• Inverse Square Law• High Dose to Limited Volume • Differential Effect of High Dose Rate
on Tumor & Normal Tissues
BRACHYTHERAPY DOSE RATES
• Low Dose Rate ~ 40-200 cGy/hr
• High Dose Rate ≥ 200 cGy/hr
CARCINOMA of the CERVIX Intracavitary Systems
* Paris* Stockholm * Manchester* MD Anderson* Mallinckrodt Institute of
Radiology* CT/MR 3D System
The Paris System Curie Institute, Paris, France.Claudius Regaud 1910-1920
• Tandem: Rubber.• Colpostats: Cork, coated with paraffin.• Uterine dilatation for 24 hours prior to procedure.• Five consecutive days application (120 hours).• Applicator removed every day for douching.• Loading:
Tandem: 6.66 – 13.33 – 13.33 = 33.32 mgs RdColpostats: 13.33 – (6.66) – 13.33 = 26.66 to 33.32 mgs Rd
• Dose: 7200 mgm/hrs.
The Paris System
The Stockholm SystemRadiumhemment Institute
Stockholm, SwedenDominici & Forsell 1913 - 1914
• Tandem: metal tube• Colpostats: metal box wrapped in lead?• Three applications of 20 to 30 hours,
over a period of 3 weeks Loading:• Tandem 33.7 to 40.1 mgs Rd• Vaginal plaque: 70 mgs Rd• Dose: 6844 to 7266 mgm/hrs
The Stockholm System
The Manchester SystemHolt Radium Institute Manchester, England
M. Tod & Meredith 1938
• Tandem: Rubber• Ovoids: Rubber (large, medium and small)
• Loading: Units of radium (1 unit = 5 mgs Rd)Tandem: long = 2-2-1; medium = 2-1; short = 2 Ovoids: large 5; medium 4; small 3
• Dose: 7200 r prescribed to Point A. Calculation of of dose to Points A & B based on Sievert’s formula. formula.
The Manchester System
MD ANDERSON SYSTEMMD Anderson Hospital
Houston, Tx, USAG. Fletcher 1952
• Dimensions: Similar to those of the Manchester System
• Loading: Similar to the Manchester System 1.2 to 1 ratio uterine to vaginal cavity activity
• Prescription: According to stage of disease “Milligram/hours + EBRT” dose to the whole pelvis pelvis
• Vaginal Mucosa Dose Tolerance• Bladder and Rectal Dose Tolerance
Mallinkcrodt Institute of Radiology System (MIR)
St. Louis MO, USAW. Powers & C. Perez 1979
• Closely related to the MD Anderson System• Loading of the uterine tandem and the ovoids somewhat
different than MDA System. Higher ovoid loading• Intracavitary performed during EBRT, if possible• EBRT to parametria between intracavitary insertions• Dose Prescription: Mgr/hours + EBRT & Dose to
Manchester Points • Vaginal Mucosa Dose Tolerance• Bladder and Rectal Dose Tolerance
MANCHESTER SYSTEM “CAVEATS”
• Variable Definition and Measurement• No Constant Applicator/Anatomical Relationship• Different Isodose Dose Contour ⇒
Same Dose to Point A• Described as Tolerance Dose• Difference in Biological Effects of Brachytherapy
Brachytherapy and EBRT not taken into account
MGHRS SYSTEM“CAVEATS”
• Different loadings can result in different different isodose = mghrs dose
• No Constant Applicator/AnatomicalRelationship
• Difference in Biological Effects ofBrachytherapy and EBRT not taken into into account
CT Compatible ApplicatorDuke University Medical Center
Rectal & Bladder D Max PointsPoints
CT Compatible Applicator
CT Compatible Applicator
Radium InstituteParis, France
C. L. Regaud (1925)
1919 9.1%1920 19.3%1921 29.5%1922 34.4%1923 43.9%
Treatment
Year
Symptom-FreeSurvival
(1-6 years)
RadiumhemmetStockholm, Sweden
Heyman (1924)
Yearof Rx
5-yearSymptom-Free
Survival# of
Patients
1914 26 26.9%1915 40 32.5%1916 47 8.5%1917 63 14.3%1918 41 26.8%
RadiumhemmetStockholm, SwedenHeyman (1934)
Total number of patients treated 1455Symptom-free after 5 years 327Relative Cure Rate 22.5%
5 - Year Results (1914 - 1925)
Holt Radium Institute Manchester, EnglandW. J. Meredith (1948)
1934 - 1935 332 26%1936 - 1937 298 28%1938 - 1939 307 32%1940 - 1940 612 35%1942 - 1943 577 38%
Yearof Rx
5-yearSurvival# Patients
M.D. AndersonKatz (2004)
Early Stage 78%
Advanced Stage 61%
5 - Year DFS
THE END!
Afterloading Brachytherapy Review of the Early Development
Herman SuitMassachusetts General Hospital
Harvard Medical School
Collaboration with T Mauceri, Peter Biggs, G Chen, A Russell and K Doppke
Start of Radiation Therapy • Immediately After Röntgen’s
• Discovery: Nearly Worldwide
• Rush into Radiology
Physics Discoveries 1896-1898• 1896 Radioactivity
• 1897 The Electron• 1897 Alpha and Beta Rays• 1898 Gamma Rays
Radiation Biology 1896• T Grover Lyons Papers in Lancet
• Feb 1 Proposed Effect on Bacteria
• Feb 17 No effect on TB and Diphtheria
Start of Radiation Therapy • EBRT Success Against Skin SCC
• Lupus Vulgaris and Misc Lesions
Radiation Injury In Man 1896• E Grubb January 27, 1896 to Hospital
• For “painful, swollen and inflamed hands”
• Dr J Gilman ¿Therapeutic Effect on Diseased Tissues?
Early Radiation Martyrs • 1904 Clarence Dally Asst to T Edison
• 1916 Walter Dodd MGH Radiologist
• Numerous Others
Alexander Graham Bell• 1903:
• Insert 226Ra [Glass Tube] into Tumor.
• 1st Radium User : Margaret Cleaves
First Reports of After Loading
1903 Stroebel
19041910 Abbe
After Loading Brachytherapy • Afterloading Techniques Vary
• Widely but All Provide Reduced
• Dose to Personnel
After Loading Brachytherapy
• Virtually All Brachytherapy
• Is Now After Loading
Early Clinical Use of AL
• Many Publications 1956-70
• Long After Strobel of 1903
• and the Many Martyrs
Early Clinical Use of AL
• Mowatt 1956• Fishman 1956• Henschke 1960• Wolever 1960• Morphis 1960• Suit 1961
Rationale for After Loading• Zero Dose to OR Staff• Radiation Oncologists• Physicists• Nurses Anesthesiologists
Rationale for After Loading• Transportation Personnel• Nurse and Staff on the Ward • Medical Staff for Patient Exam
Rationale for After Loading• 2. No Time Pressure for the Implant
• 3. No risk in Imaging of the Implant
• 4. Decision to Re-position Un- Affected by Risk of Radiation
Rationale for After Loading• 5. Quality of Implant Improved
Remote After Loading• No Dose to Any Person
• Dose Contouring after
• Catheters/Applicators in Place
Afterloading Early History
• Why the Long Delay Between
• Abbe and the Post War II
• Period? I Do Not Know
Afterloading Early History
• To Start by Giving a Tribute to
• Ullrich Henschke
Ullrich Henschke• A L for Ovoid and Tandem Early
• 1950s
• Adopted in Many Centers
Early French Experience IGR
• B Pierquin D Chassagne
• 1956-1970 1600 Patients
• 198Au Wires to 1960• 192Ir Wires 1960-70
Early Italian Experience
• 1959-70 Roma, Torino, Pavia and
• Padova 1000 Patients
• Techniques of Pierquin IGR
A Sudarsanam and K Charyulu• In the 1960s, Several AL Applicators.
• Also, Phase III Trials, Pre-operative
• Radiation, 3 D Planning
Harry Horwitz• Array of Applicators in 1960s
HS Work in AL
• Illustrative Cases
• Data on Radiation Exposure
• Important Recent Advances
At NCI 1957-59• Physicist R Swain
• Excellent Machine Shop
Retrobulbar Small Cell Sarcoma
• ~ 17 y/o Male
• Local Failure at 18/12 after 40 Gy
• Stage Mo
Plan• 30 Gy Rt Lateral/Ant 2 MeV
• Wedge.
• Needle Implant: Truncated Cone
Plan• 5 Orbital + 1 Lateral Ethmoid
• Needles: 23 Gage
• Variable Length
Plan• Isotope: 192Ir Wires
• 0.4 MeV
• T1/2 74 Days
Plan• Require 2 Crossing Needles
• For Posterior Globe Surface
• “Fish Hook” Shaped Needles
Plan• Study Anatomy and Practice
• Anatomic Specimen: 6 Orbits
• Small Protractor for OR Use
Total Tongue • Standard Volume Implant
• 30 Needles
• No Exposure During Procedure
Ca Cervix MDAH 1959• ~ 500 Radium Insertions/Year
• ie 5-6 at two Sessions/Week
Ca Cervix MDAH 1959• P Chau and I had the Friday Cases
∴Powerful Stimulus to Develop
∴AL System Immediately
Collaborators• Bailey Moore Machine Shop
• R Worsnop Physicist
• G Fletcher Rad Oncologist
Plan• Modify Fletcher Applicators for
• AL: Same External Dimensions
• Standard Radium Tubes
Progress• Mark I, II and III
• Radiology 1963
• Luis Delclos Further Development 1970→
Radiation Exposure mr/mgPersonnel Preloaded Afterloaded
Staff MD 0.12 0.02
Resident 0.12 0.02
Anesthetist 0.08 0.00
Recovery Rm 0.11 0.00
Rad Tech 0.08 0.00
Ward Nurses 0.08 0.01
μgm Radium Sources• Measure Dose to Bladder Base and
Anterior Rectal Wall
• μgm Instead of mgm Ra Sources
• Scintillation Probe For Dose Rate
Extension To Pelvic Wall• III B Cervical Stump, Parametrial and
• Paravaginal Tumor Fixed to Pelvic Wall
Extension To Pelvic Wall• 60 Gy by 4 Field Betatron
• Radium to Stump and Vagina.
Extension To Pelvic Wall• Dr Chau: 9 Needles via Perineum
• To Parametrial Mass
• 9 cm 192Ir Wires + Steel Wire Fillers
• Total Dose ~ 103 Gy
L Lateral Floor of Mouth• Deeply Infiltrating SCC
• Plan: Two Plane
• One Needle Repositioned
Chest Wall Recurrence• Low Dose Rate Radiation Preferred
Recent AL Implants at MGH
50Gy IMRT
1 cm
50Gy IMRT after Resection
tumor and vertebra resected
38Gy 40Gy48Gy
50Gy
30Gy
Dura surface
30Gy38Gy 40Gy
30Gy
(63-76)Gy
50Gy IMRT + 10Gy Y(90) Intra-operative (equivalent to 23-36 Gy fractionated )
Y(90) applicator
(43-45)Gy
Cord surface
Remote Control AL• First Reported by Henschke 1964
• Concept: Radium Withdrawn When
• Persons Go into Room
Remote Control AL• The Concept is Simple and
• Straight Forward:
• Eliminate Exposure of Personnel
Remote Control AL• Improve Dose Distribution by
• Determining Preferred Source
• Positions and Dwell Times
Remote Control AL• Correct for Slight Errors in
• Catheter Alignment
Remote Control AL• Achieve “Optimized” Dose
• Distribution
• Merit of High vs Low Dose Rate
Remote Control AL: Gains• High Dose Rate ∴ Several Large
• Dose Fractions ¿Late Effects?
• Superior Dose Distributions
Remote Control AL: Gains• Present Assessment:
• TCP and NTCP Comparable to Low
• Dose Rate BRT
Burying RadiumBurying RadiumThe Introduction of The Introduction of
Interstitial BrachytherapyInterstitial Brachytherapy
Jesse N AronowitzJesse N AronowitzUniversity of MassachusettsUniversity of Massachusetts
Disclosures• I have nothing to disclose.
Objectives• Learn about the need for and the development of the first oncology
societies, which were based on gamma ray therapy.• Understand how low-dose-rate brachytherapy developed as the gold
standard.• Explain the continuing development of radioactive seed implantation and
of after-loading intracavity/interstitial brachytherapy
Surface ApplicatorsSurface Applicators
Intracavitary Intracavitary RadiumRadium
...the rays emitted by radium ...the rays emitted by radium have been found to have a have been found to have a marked curative effect upon marked curative effect upon external cancers...external cancers......there is no reason why a ...there is no reason why a tiny fragment of tiny fragment of radium...should not be radium...should not be inserted into the very heart of inserted into the very heart of the cancer...the cancer... Alexander Graham BellAlexander Graham Bell
American MedicineAmerican Medicinep. 261, August 15, 1903p. 261, August 15, 1903
Robert AbbeRobert Abbe18511851--19281928
““I then determined to I then determined to plunge it directly in the plunge it directly in the tumortumor……. I ventured. I ventured…… to to pierce the tumor by a fine pierce the tumor by a fine knifeknife…… the radium tube the radium tube was pushed into the knife was pushed into the knife channel. The tube waschannel. The tube was……all all buriedburied in the tumor. I in the tumor. I left the radium left the radium in situin situ three three hours. The treatment was hours. The treatment was repeated three times repeated three times weekly for 15 times.weekly for 15 times.””
The Subtle Power of RadiumThe Subtle Power of Radium
Obstacles to Obstacles to Interstitial Interstitial
RadiumtherapyRadiumtherapy
•• Cost Cost ($120,000/gram)($120,000/gram) ••
BulkBulk
Specific ActivitySpecific Activity
Amount of radioactivity Amount of radioactivity per unit of substanceper unit of substance
SolutionsSolutions
American*American*
European*European*
The American The American Solution:Solution:
Radium EmanationRadium Emanation
““Radium treatment has caused with Radium treatment has caused with surprising regularity the reduction or surprising regularity the reduction or
disappearance of carcinomatous disappearance of carcinomatous nodules of the prostate.nodules of the prostate.
Striking resultsStriking results have been obtained have been obtained ......””
Benjamin BarringerBenjamin Barringer
JAMAJAMA, 68:1227, 68:1227--30, 191730, 1917
TechniqueTechniqueLow activity, heavily screened needlesLow activity, heavily screened needles
•• 2 mg/3 cm or 3mg/4.8 cm2 mg/3 cm or 3mg/4.8 cm•• 0.6mm platinum filtration0.6mm platinum filtration•• Typically 100mg (35 needles)Typically 100mg (35 needles)•• in situin situ 7 days (1200 7 days (1200 --1800 mghr)1800 mghr)
EpilogueEpilogue
Whatever became Whatever became ofof……
‘…‘… it is easy to concentrate attention too it is easy to concentrate attention too much upon the main mass of growth, and to much upon the main mass of growth, and to forget that secondary dissemination occurs forget that secondary dissemination occurs withinwithin the mammary gland. the mammary gland. Properly, the Properly, the whole breastwhole breast…… should be treatedshould be treated..’’ 19321932‘…‘… residual nodules were removedresidual nodules were removed……In 50% there was evidence of active cancer.In 50% there was evidence of active cancer.…… led to a reconsideration of the procedure.led to a reconsideration of the procedure.I therefore decided to I therefore decided to removeremove…… the tumourthe tumour……before irradiationbefore irradiation..’’ 19371937
‘‘The rapid improvement of xThe rapid improvement of x--ray techniqueray technique…… suggests suggests that that xx--rays may be used as rays may be used as an alternativean alternative..’’ 19371937
BarringerBarringer’’ss other other prostate cancerprostate cancer
innovationsinnovations•• Screening Screening
•• Transperineal biopsyTransperineal biopsy
•• Combined implant & beam therapyCombined implant & beam therapy
•• Combined implant & castrationCombined implant & castration
AMERICAN RADIUM EMPIRE: 1913-24
R.F. ROBISON, M.D.
• I have nothing to disclose
DENVER RADIUM CAPITAL• Ore sent from Paradox Valley by mule, • then truck, then narrow gauge D&RG/W.• Then standard gauge to Denver. • Refineries in downtown Denver (N.R.I.).• Or shipped by RR to PA (Standard).
Educational SessionHistory of Radiation Oncology II:
BrachytherapyFounding of the American Radium Society
Martin Colman, MDDepartment of Radiation Oncology
University of Texas Medical Branch, Galveston
ASTRO Annual ConferenceLos Angeles, CA
October 27 to November 1, 2007
Disclosures
• I have nothing to disclose.
The Four Doctors, by John Singer Sargent
Photograph by Aaron LevineCourtesy of The Alan Mason Chesney Archives, The Johns Hopkins Medical Institutions
Howard Kelly 1858-1943Radium Pioneer
One of original four faculty at Johns Hopkins, “The Four Doctors”
American Radium Society (ARS)
• Founded in 1916 • Oldest Multidisciplinary Oncology Society• Surgical Oncologists & Radiation Therapists• Radiation Oncology as a Medical Specialty• Foundation of Brachytherapy• Main Organization for Radiation Oncology• For 40 years before ASTR/ASTRO
Joseph Flannery (1867-1920)President, SCC of Pittsburgh
James Douglas (1837-1918)1914 - commenced radium
production with Howard A. Kellyand Charles L. Parsons
Henry H. Janeway
James Ewing 1866-1943 Commenced use of radium at
Memorial Hospital, 1913
William Duane 1872-1935
Adapted Marie Curie’s radonproduction system and glass seeds in Boston in 1913Facilitated similar systems at Memorial-NY and Baltimore
Gioachino Failla, 1891-1961
1918 Elected to ARS
Joseph Flannery (1867-1920)President, SCC of Pittsburgh
The Radium Research LaboratoryStandard Chemical Company of
Pittsburgh and The Radium Chemical Company
• 1913 – 1st radium production in the USA
• 71 grams through 1921• >50% of world supply• “sponsor” of ARS
Employees of SCC of Pittsburgh
Charles H. Viol, PhD 1886-1928 >
Director of Research
< William H. Cameron, MD (1879-1944)
Clinic Director
Radium Therapy Pioneer
“RADIUM” - 1913 to 1919Published by SCC
Henry K. Pancoast 1875-1939Founder Member of ARSPresident of ARS, 1920
First Professor of RadiologyUniversity of Pennsylvania
Henry B. Aikins 1859-1924First President of ARS
1916 & 1917
Henry Schmitz 1871-1939Founder Member of ARS President of ARS, 1921
6th Janeway Lecturer, 1938Prepared statutes for first meetingthat were adopted unanimouslyEstablished the name, ARS
Principal Founders of ARS
Charles H. Viol, PhD 1886-1928 >
Founder (Assoc) Member of ARS
< William H. Cameron, MD (1879-1944)
Founder Member of ARS
Radium Therapy Pioneer
President of ARS, 1935
Marie Curie 1867-1934Discoverer of Radium
Nobel Laureate, 1903 & 1907
1921 Elected Honorary Member of ARS
Howard Kelly 1858-1943Radium Pioneer
Elected honorary memberof ARS in 1921
James Ewing 1866-1943 1st Janeway Lecturer, 1933
AJR 31:153-163, 1934• Time Cover• Cancer Man Ewing• January 12, 1931• Included article
written at time of retirement from Cornell
William Duane 1872-1935
1922 Elected HonoraryMember of ARS
Edith H. Quimby 1891-19828th Janeway Lecturer, 1940
ARS President, 1954
ARS Historian #3AJR 75:443-456, 1956
Henry Harrington Janeway 1873-1921
Pioneer in Clinical Applications of Radium
1917 Elected to ARS
Burton J. Lee 1874-1933President of ARS, 1933
Established the JanewayMemorial Lecture, 1933
First Janeway – James Ewing
Edward H. Skinner 1881-19539th Janeway Lecturer, 1941
President of ARS, 1938
The Janeway MedalOdin exchanges his eye for knowledge
Reverse - Odin’s ravens
Albert Soiland, 1873-1946
1917 Elected to ARS
THE END
Significant Historical Resources
James T. Case, 1882 – 1960Founding Member of ARSPresident of ARS, 1924
24th Janeway Lecturer, 1959
ARS Historian #1AJR 70:487-490, 1953AJR 82:574-585, 1959
James Ewing 1866-1943
AJR 31:153-163, 1934
First Janeway Lecturer1933
Edith H. Quimby 1891-19828th Janeway Lecturer, 1940
ARS President, 1954
ARS HistorianAJR 75:443-456, 1956
Juan del RegatoARS President, 1969
38th Janeway Lecturer, 1973Historian Par Excellence
ARS Historian #4AJR 108:429-430, 1969
AJCO 14(2):93-100, 1991
E.R.N Grigg
• Radiologist, Chicago• Radiology Historian• Author -
“The Trail of Invisible Light”From X-Strahlen to Radio(bio)logy
• Chas Thomas, 1965
Other Significant Texts
• Claudia Clarke – Radium Girls, 1997• Ruth and Edward Brecher – The Rays: A
History of Radiology in the USA, 1969• Juan del Regato – Radiological
Oncologists: The Unfolding of a Medical Specialty, 1993.
• Raymond Gagliardi and Frank Wilson – A History of the Radiological Sciences –Radiation Oncology, 1996
Albert Soiland, Marie Curie, and Rene Ledoux-Lebard, Paris,
1931
Soiland Radiology Clinic L.A.
Recommended