11Roentgen’s pamphletAnnouncing the discovery of the X-Ray was reprinted twice in the Spring of By the time of the second reprint the pamphlet was considered a collectors item!
12Henri BequerelDiscovered the phenomenon of radioactivity in February 1896 whilst working with double sulfate of uranium and potassium, and was awarded the Nobel prize for Physics in 1903
13Image of UraniumImage obtained after wrapping some photographic film in lightproof paper, placing some uranium compound on top,and instead of placing it in sunlight, [because it was cloudy], Bequerel put it in a drawer.He subsequently exposed the film and was surprised to find an image!
14Marie and Pierre Curie. 1867-1934 1859-1906 Awarded the Nobel Prize in Physics in 1903 for their work with radioactivity - a term coined by Marie in July 1898.
15Marie CurieAwarded Nobel Prize in chemistry in 1910 for the discoveries of polonium [July 1898] and radium [Dec 1898] , both radioactive elements. She became the first person to win 2 Nobel Prizes!
16“The miserable old shed.” It took over 3 years to isolate 1/10th gm of pure Radium Chloride from several tons of radioactive ore!
17December 1898 Gamma Rays discovered by P Villard.
18The Electromagnetic spectrum. The range of all possible electromagnetic radiation from the size of a fraction of an atom to thousands of kilometers.
19The world discovers the X-Ray! “NEW LIGHT SEES THROUGH FLESH TO BONES!”Screamed the headlines of US newspapers in mid January 1896!
20Worry over side-effects by 1896. March 3rd - First reports of X-Ray injury; damage to eyes.April 10th - Epilation noted from X-Ray exposure.April 18th - Skin effects first noted.July Reports of accidental injury [burns].
21First ad in English accompanied by a Radiograph April 1896 film of forearm achieved with “only” 30 minutes exposure!
22“Soon every house will have a cathode ray machine!” Apparatus soon widely available.Low cost.Studios opened for bone portraits.Poems appeared in popular journals!
23The necessary apparatus was easily acquired. An evacuated glass tube with anode and cathode and a generator, [coil or static machine], combined with photographic materials could set anyone up in business as a “skiagrapher.”
24X-Ray enters medical practice! The simplicity of the apparatus allowed a variety of people to “try their hand”, among them electricians and photographers!
25Test subjects!Wives and female assistants often were used as test subjects to ensure that the ‘tube’ was ready for the day’s work!
26X-Ray studioX-Ray Studios like this one in New York opened in cities large and small to take “bone portraits,”often on subjects who had no physical complaints!
27Foot in a high button shoe! Radiograph made in Boston by Francis Williams in March Typical of early images reproduced in the popular press
28Experimental radiograph Coins in purse.Many tests conducted on the penetrating strength of the rays.
37Early newspaper article. By the late 1890’s radiation was being used to good effect in the treatment of superficial malignancies.
38Early cures 1899 Stockholm.49 year old treated for basal cell cancer of the nose by Thor Stenbeck.Patient treated for squamous cell cancer by Tage Stenbeck.
39Early pioneers thought nothing of daily exposure to the RAYS! -Gauged the strength of the tubes-Positioned patients.-Steadied patients-Calculated “ERYTHEMA DOSE” on their hands!
40Magic rays could kill as well as cure! POOR UNDERSTANDING of TIME DISTANCE SHIELDINGOverexposure of early workers led to skin burns amputations and carcinogenesis!Mihran KassabianObituaries of early pioneers appeared with somber regularity!First such death reported in 1904.
411899 April – Radiographer licensure recommended to protect public. May –MALPRACTICE AWARD for “X-Ray burns.” Listing of protective devices [gloves, aprons, etc] in X-ray catalogue.
42American Roentgen Ray Society charter members Buffalo New York 1901 Formed to define and establish standards in diagnosis and therapy.Marginal practitioners soon purged and excluded.For $5 per yearannual dues the new “ radiologist” could participate in the national activities of the specialty and receive the American X-Ray Journal.
43Early Journals.[First X-Ray journal in English, the Archives of Clinical Skiagraphy became the British Journal of Radiology.]
44By 1905 200 companies making X-Ray machines in the US! The construction room of the Waite and Bartlett Manufacturing Company in New York [ca 1903][Most hospitals had X-Ray rooms by 1905]
45Early Radium treatment using Gamma Rays. With small amounts of Radium leant by the Curies this child’s birthmark was cured in 1907 by a group of Parisian physicians.
46Office based therapy by 1910 using kilovoltage X-Rays. Hermann Rieder’s Munich therapy office shows typical aspects of treatment in the period.Simultaneous patient treatments.Protective shielding.Sometimes sparks, loud cracklings and smoke!BUT TREATMENTS WERE EFFECTIVE!
47Kellog’s Rice Krispies tried to increase sales by luring “radiation- crazed” consumers with a free X-Ray viewer included in each box of cereal!
481930’s death of the wrist watch dial painters! These young girls repeatedly ingested tiny amounts of radium-based paint while ‘tipping’ their paint brushes with their tongues.They were so thoroughly imbued with radiation that their teeth could expose photographic film!
49TELECURIETHERAPY using Gamma Rays. These machines, popular in the 1930’s were the forerunners of the Cobalt 60 unit.They offered higher dose rates, longer source to patient distances and improved shielding and collimation.Cancers were treated curatively and palliativly at this time as were selected benign diseases.
50Cobalt 60 Teletherapy using Gamma Rays. First unitbrought on linein 1951.
51How are X-Rays made?X-Rays are produced when electrons strike a metal target.The electrons are liberated from the heated filament and accelerated by a high voltage towards the metal target. The X-Rays are produced when the electrons collide with the atoms and nuclei of the metal target.
52Mullard Phillips 4 MeV Linac. First installed atNewcastleHospital in 1953.
536 Mev Linac installed at Stanford 1955. The first patient, a boy with retinoblastoma, was treated in 1956 and remained cancer free 40 years later.
54Still having “fun” with X-Rays??? I remember loving to see my bones and would go to the shoe shop in town whenever possible in the late 1950’s! No wonder I have such trouble with my feet!
55Siemens MevatronVIII.A pioneering device for dual energy photon beams which underwent further upgrades after it’s initial appearance in 1966.
56Table 1: Improved Percent of Survival of Several Types of Cancer When Treated with Megavoltage RadiotherapyImproved percent of survival of several types of cancer when treated with megavoltage Radiotherapy.Type of CancerWith Kv X-rays (1950’s)With MeV X-rays (1970’s)Hodgkin’s DiseaseCancer of the CervixCancer of the Prostate5 - 15Cancer of the NasopharynxCancer of the Bladder0 - 5Cancer of the OvaryRetinoblastomaSeminoma of the TestesEmbryonal Cancer of the TestesCancer of the Tonsil40 – 50
57Varian Clinac treatment unit, 1990’s. Dual energy linear accelerator enables radiation team to choose the most effective energy beam to treat deep seated or more superficial lesions.Controls are computerized for easier operation.
58RADIATION THERAPYRadiation therapy is a very common treatment method prescribed for almost half of all cancer patients.It can be given alone or in combination with chemo or biotherapy.It is given for cure or for palliative purposes.It can be delivered externally or internally and sometimes a combination of the two methods is used.Side effects depend on the part of the body that is treated.Side effects are minimized by careful treatment planning and appropriate symptomatic treatment.Cure rates are improving all the time due to earlier detection and more effective treatment strategies!
59SOME RADIATION MYTHS Radiation therapy is painful. Radiation therapy will cause me to be radioactive.Radiation therapy will cause me to lose my hair.Radiation therapy will cause nausea and vomiting.Radiation therapy causes cancer.Radiation therapy will make me sterile.
60DID YOU KNOW THAT“Cancer cell growth is unwieldy and uncontrolled- these cells just don’t have their act together like normal cells do. When normal cells are damaged by radiation, they are like a big city with a fire and police department and trained emergency squads to come and put out the fire.Damaged cancer cells are more like a disorganized mob with a bucket.”-Marisa Weiss MD.
62Immobilizing your body. In order to ensure accurate positioning on a daily basis immobilizers are used such as this Vac-Lock bag which is like a bean bag with the air removed.It holds its shape and cradles the patient in the optimal position enabling precise and reproducible treatment sessions.
63Immobilizing your head. A thermoplastic mask is used for immobilizing the head.It is often used to treat patients with head and neck or brain cancer and it ensure accurate daily positioning and reproduction of treatments.
64CT simulation and treatment planning. Done before treatment in most patients to image the treatment area in cross section. Each CT slice is scrutinized, the areas of interest are outlined, the images reconstructed, and blocks drawn to include the tumor and areas at risk for spread with an appropriate margin of surrounding normal tissue. After computer planning the patient is ready to begin treatment.
65Treatment planningOnce the radiation oncologist has prescribed a course of treatment the dosimetry and physics team develops a plan that works best for you.This may involve a single beam of radiation or it could include multiple beams. Depending on the complexity of the plan you may need to wait several days after simulation before you can begin treatment.
66Before starting treatment Reference marks.Check films are taken of the treatment fields and are compared with the treatment planning reconstructed radiographs. They should be identical! Once this is confirmed a minimum of tattoos are used to replace the temporary skin marks and to ensure accurate daily set-up.
67TREATMENTS BEGIN In summary Radiation is a local, targeted therapy designed to kill cancer cells.The actual delivery of the radiation treatment is painless.External radiation treatment, the most common kind of radiation treatment does not make you radioactive.You will receive treatment 5 days a week up to 7 weeks.Since the daily appointments are about a half hour, you will most likely be able to keep to your normal routine.You will not lose your hair during treatment unless your head is being treated or if you are taking chemo.Over the course of your treatment you may notice some fatigue.The side effects of radiation are usually temporary.In summary
68Potential for improvement Maximize the therapeutic index.Minimize treatment failure.Increase delivery system precision with innovations such as IMRT.