Historical Development of Radiation Therapy

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Historical Development of Radiation Therapy

• Lalith Kumaraswamy, M.Sc
• Roswell Park Cancer Ins.

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Discovery of X-raysWilhelm Conrad Röntgen

• 8 November 1895, external effects from the
  various vacuum tubes.
• Fluorescent effect on barium coated screen.
• He saw the shadows of the bones of his hand.
• "I have seen my death!
• Earned the first Nobel Prize for discovering the
  X-rays.

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First American X-Ray

• Dartmouth NH, February 1896.

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Western NY first X-ray machine
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Discovery of RadioactivityAntoine Henri
Becquerel

• In 1896, he discovered the phenomenon natural
  Radioactivity.
• Connection between X-rays and phosphorescence.
• Rays emitted by uranium caused gases to ionize.
• Unlike X-rays, these rays can be deflected by
  electric or magnetic field.
• He won the Nobel Prize in 1903 for discovering
  spontaneous radioactivity.

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Discovery of Radium Polonium

• Creation of a theory of Radioactivity.
• Using the electrometer her husband built, she
  discovered uranium salts caused sample to conduct
  electricity.
• Activity only depends on the amount of uranium
  present.
• She discovered that pitchblend is about 4 times
  as active as uranium.
• Discovery of Polonium Radium.

Marie Curie
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First Therapy

• First patient was treated with radiation in 1896,
  two months after discovery of X-rays.
• Rose Lee a 65 year old woman with locally
  recurrent breast cancer
• Treating physician was a Chicago medical student
  named Emil Grubbe

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The 1st Radiation Oncologist
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Fractionation

• At first, Radiotherapy was delivered primarily in
  a limited number of treatments (Breast
  superficial lesions)
• Claude Regaud Introduced Fractionation (1920s).

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Fractionation

• The early French Radiation Oncologist Henri
  Coutard pioneered the use of fractionated
  Radiotherapy in a wide variety of tumors.

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Limitations

• X-ray machines inability to produce high
  energy, deep penetrating beams.
• Thus difficult to treat deep-seated tumors
  without excessive skin reactions.

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Brachytherapy

• Placed radioactive sources close proximity or
  within the tumor.
• Cervical and uterine cancers, brachytherapy
  became the mainstay of treatment.

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Patterson-Parker

• Following World War II, England became the
  primary focus for Radiotherapy research.
• Ralston Patterson Herbert Parker developed
  Patterson-Parker rules for Brachytherapy.

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Patterson-Parker rules

• Rules were developed uniform dose (/- 10) to a
  plane or volume.
• Provided rules of source distribution.

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Co-60 Unit

• Scientists tried building sources of ionizing
  radiation called "radium bombs" for teletherapy.
• But radium radiation was too weak for the job.
• In 1949, Dr.  Harold Johns of the University of
  Saskatchewan approched Wilfrid Bennett Lewis, the
  director of the Atomic Energy Division of the
  National Research Council (NRC), requesting that
  cobalt-60 produced by the NRX reactor be used in
  the construction of a prototype cobalt therapy
  unit.

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Co-60 Unit

• Physics team headed by Dr. Harold Johns ---
  Saskatoon, Saskatchewan.
• Physician Engineering team headed by Eldorado
  Mining and Refining Ltd --- University of Western
  Ontario.
• First treatment occurred on October 1951, just 4
  days after installation.

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Linear Accelerator

• Henry Kaplan, MD Ed Ginzton developed the first
  medical linear accelerator in North America.

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Linear Accelerator

• 1.65 m long accelerator guide.
• Max Field size of 15x15.
• Dose rate of 100 cGy/min at 1m.

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Linear Accelerator

• First patient was a two year old boy with
  retinoblastoma in 1957.
• The patient is still living with normal vision.

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Modern Linac

• Multiple electron photon energies.
• Increased X-ray energy.
• Beam shaping devices.

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Area of technical advances

• Seeing better
• Planning better
• Treating better

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Seeing better
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3D information
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MRI aids in target delineation
Y Cao, University of Michigan
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PET/CT

• Multislice CT scanner mated to a PET scanner
• Possibly three scans acquired during procedure
• Attenuation correction CT
• PET
• Treatment planning CT, with contrast if
  necessary

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• 50 yr old women with non-small cell lung cancer.
• PET shows multiple hyper metabolic activity in
  the anterior cervical region.

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Planning Better
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IMRT

• Allows radiation to be directed more precisely to
  the tumor.
• Dose escalation.

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IMRT
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Treating betterMulti leaf collimator

• Tungsten.
• 20 120 leafs arranged in pairs.
• Efficiency.
• IMRT.

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Improving Precision and Accuracy
IGRT IMRT
Accurate Not Precise
Precise Not Accurate
Accurate And Precise
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Future ??
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HIV Virus
HIV Virus 10,000 nucleotides
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HIV Virus
HIV Virus 10,000 nucleotides
Human DNA 3 billion base pairs
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• Thank You