This document provides a history of radiation and radiotherapy from its discoveries in the late 19th century to modern applications. It describes how radiation was discovered in 1895 by Roentgen and how Becquerel discovered radioactive elements. It then outlines the early uses of radiation in medicine by Grubbe and how fractionation was developed. It discusses the advancements of technologies like cobalt-60 units, linear accelerators, 3D conformal radiotherapy, IMRT and IGRT that have allowed more precise targeting of radiation doses to tumors.

1. HISTORY OF RADIATION AND
RADIOTHERAPY.
Dr Deepika Malik
JR-1 , Radiotherapy
04/03/14

2. WHAT IS RADIATION
Radiation is the emission and propogation of energy
through space or a material medium.

3. WHAT IS RADIATION THERAPY
 Radiation therapy is a clinical modality dealing with
the use of ionising radiations in treatment of
patients with malignant neoplasias ( and
ocassionally benign diseases)
 The aim of radiation therapy is to deliver a precisely
measured dose of radiation to a defined tumour
volume with as minimal as possible damage to
surrounding healthy tissue.
 This results in eradication of tumour, a high quality
of life, and prolongation of survival.

4. WHAT IS RADIATION ONCOLOGY?
 Radiation oncology is that discipline of human
medicine which deals with the generation ,
conservation and dissemination of knowledge
related to causes , prevention and treatment of
cancer , involving special expertise in therapeutic
applications of ionising radiations.

5. William Roentgen discovered X-Rays
in 1895 while studying cathode rays in
a gas discharge tube.
He observed that another type of
radiation was produced that could be
detected outside the tube.
This radiation could penetrate opaque
substances,produce flourescence,
blacken a photographic plate and
ionize a gas.
He named this new radiation as X-
Rays.

6. He also noted that these X-rays
could be used to image bones.
Infact one of the first known x-ray
images ever produced was of his
wife Bertha’s left hand.
Roentgen characterized and
validated his findings in a
technical report within 6 weeks.
News of Roentgen’s remarkable
discovery travelled rapidly
around the world. In recognition
of his ground-breaking research,
he was awarded the first Nobel
Prize in Physics in 1901.

7. Henri Becquerel's discovery
of spontaneous radioactivity is a
famous example of serendipity, of how
chance favours the prepared mind.
Becquerel had long been interested
in phosphorescence, the emission of
light of one colour following a body's
exposure to light of another colour.
In early 1896, in the wave of
excitement following Rontgen's
discovery of X-rays , Becquerel
thought that phosphorescent
materials, such as
some uranium salts, might emit
penetrating X-ray-like radiation when
illuminated by bright sunlight.

8. By May 1896, after other experiments
involving non-phosphorescent uranium
salts, he arrived at the
explanation, namely that the
penetrating radiation came from the
uranium itself, without any need for
excitation by an external energy source.
Photographic plate made by Henri
Bequerel following exposure to
radiation from a uranium salt.

9. Bequerel’s doctoral students Marie
Curie with her husband Pierre Curie
showed that Bequerel rays could be
measured using ionising techniques ,
and radiation intensity is directly
proportional to the amount of uranium
in a substance.
They also isolated the first known
radioactive elements Polonium (after
Marie’s homeland of Poland) and
Radium in 1898.
They later collaborated with Bequerel
and shared the nobel prize in physics
with him in 1903.

10. Not more than two months after
discovery of X-Rays, a medical student
in Chicago named ‘Emil Grubbe’ noted
pealing of his hands on exposure to X-
Rays.
He convinced his professor and
assembled his x-ray machine in
Chicago in 1896 itself , and that same
year, used it to treat a woman named
‘Rose Lee’ with recurrent carcinoma of
the breast.
By 1960, Grubbe had instructed over
7000 other doctors in the medical use of
x-rays.
In the course of his lifetime, he
underwent more than 90 surgeries for
multiple cancers caused by his intense,
ongoing exposure to radiation

11. In the early days of radiation, it was
generally held that the biggest dose
(tolerated), given as fast as possible,
was the best treatment.
During the period, roughly 1920 to
1930, Claude Regaud argued the
differential effect of X-rays on cancer
and normal tissues could be best
obtained by giving the treatment slowly.
For example, healing was very much
better when skin cancer was treated
over a period of a week than over a day.

12. He exposed sheep testicles to large doses of ionising
radiations. The rams could be sterilised with 1 large dose
but this quantity of radiation also caused the skin adjacent
to ram’s scrotum to have a skin reaction. It was found that if
the original dose was fractionated or broken into smaller
doses spread out over a period of time, the animals would
still become sterile but with considerably less damage to
their skin.
This approach, known as FRACTIONATION , is one of the
most important underlying principles in Radiation Therapy.
To this day, fractionation lies at the heart of many treatment
programs currently used in Radiation Oncology.

13. Henri Coutard , an early French Radiation
Oncologist pioneered the use of
fractionated Radiotherapy in a wide
variety of tumors.
He reported impressive results using this
approach in patients with locally
advanced laryngeal cancers in 1934.

14. Despite their promise, an
important limitation of the
early x-ray machines was
their inability to produce
high energy, deeply
penetrating beams. It
was thus difficult to treat
deep-seated tumors
without excessive skin
reactions.

15. Many early advocates of Radiation Therapy thus
relied instead on the placement of radioactive
sources in close proximity or even within the
tumor, a technique known as BRACHYTHERAPY.
This modality dates back to when Pierre
Curie suggested to Danlos that a radioactive
source could be inserted into a tumour.
It was found that the radiation caused the tumour
to shrink.
In the early twentieth century, techniques for the
application of brachytherapy were pioneered at
the Curie institute in Paris by Danlos.

16. Ralston Patterson who was a
radiologist and who had keen interest
in newer advances related to the field
was appointed as Director of the Holt
Radium Institute in 1931, who went
on to build a world recognised centre
for the treatment of cancer by
radiation.
Among the team was his wife Edith
Paterson, who started research work
at the Christie Hospital in 1938, and
who became a world-renowned
pioneer in biological dosimetry,
childhood cancers and anti-cancer
drug treatment methods.

17. Herbert Parker who was a medical
physicist at the Holt Radium institute
who developed the MANCHESTER
SYSTEM for radium therapy along with
Patterson in 1932
Their techniques enabled physicians
to arrange radium needles or tubes in
configurations that would maximize the
radiation dose to a tumor while
minimizing that to healthy tissue.
The Manchester System for therapy
was the most comprehensive and
widely used system in the field of
radiotherapy.

18. Following initial interest in
brachytherapy in Europe and the US,
its use declined in the middle of the
twentieth century due to the problem
of radiation exposure to operators
from the manual application of the
radioactive sources.
However, the development of remote
afterloading systems, which allow the
radiation to be delivered from a
shielded safe, in the 1950s and
1960s, reduced the risk of
unnecessary radiation exposure to the
operator and patients.

19.  This, together with more recent advancements in
three-dimensional imaging modalities,
computerised treatment planning systems and
delivery equipment has made brachytherapy a safe
and effective treatment for many types of cancer
today.

20. In 1949, Dr. Harold E. Johns , a
Canadian medical physicist sent a
request to the National Research
Council(NRC) asking them to produce
Cobalt-60 isotopes for use in a cobalt
therapy unit prototype.
On October 27, 1951, the world’s first
cancer treatment with COBALT 60
radiation took place at Victoria
Hospital for a 43 year old cervical
cancer patient.
This marked an important milestone
for the fight against cancer.

21. Despite advances made in radiation therapy technology, the
Cobalt-60 unit remains the world’s main radiotherapy
machine. Due to its cost effectiveness, reliability and ease of
use, it is prevalent in developing countries.
Cobalt-60 technology is currently used to treat roughly 70 per
cent of the world’s cancer cases treated by radiation.

22. An exciting development was the
introduction of high energy
(megavoltage) treatment
machines, known as LINEAR
ACCELERATORS OR LINACS .
Such machines were capable of
producing high energy, deeply
penetrating beams, allowing for
the very first time treatment of
tumors deep inside the body
without excessive damage to the
overlying skin and other normal
tissues.

23. Dr. Henry Kaplan and physicist
Edward Ginzton developed the
first
medical linear accelerator at
Stanford University, San
Francisco in 1956.

24. The first patient to be treated
using this machine was a 2
year old child named ‘Gordon
Isaacs’ with retinoblastoma.
Treatment was highly
successful . For more than 40
years later, this patient
remained free of disease with
good vision.

25. In subsequent years, the field of Radiation
Oncology experienced multiple technologic
revolutions.
With the advent of computers, of newer
technological advances , the radiotherapy
planning systems underwent a drastic
makeover.

26. It was in 1990’s that 3-D Conformal
Radiotherapy, a form of radiation
therapy where the fields used are
designed such that the radiation dose
is mostly delivered to the tumor, while
the surrounding tissues receive little
to no radiation dose.
This attempts to deliver a tumoricidal
dose to the tumor while minimizing
the damage to the surrounding
healthy tissues.
3-dimensional information about the
patient's body is supplied by the CT-
simulations process.

27. Intensity-modulated radiation
therapy (IMRT) is an advanced form
of three-dimensional conformal
radiotherapy(3DCRT).
It uses sophisticated software and
hardware to vary the shape and
intensity of radiation delivered to
different parts of the treatment area.

28. Today, Radiation Therapy
is in the midst of yet
another important
technologic revolution,
namely Image-Guided
RadiationTherapy
(IGRT).
While not truly new,
IGRT is rapidly growing in
popularity primarily due
to the widespread
adoption of new linear
accelerators which
function both as
treatment and imaging
machines.

29. Thus we have seen that over a period of just
120 years , the modality of radiotherapy has
evolved rapidly from some anonymous rays to
the present scenario where radiotherapy is
almost indispensible when it comes to the cure of
cancer.
Growth means change and change involves risk,
stepping from the known to the unknown.

30. Thank you……