braquiterapia historia

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.