Braquiterapia historia

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Braquiterapia historia

  1. 1. 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
  2. 2. 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.
  3. 3. ASTRO 2007 History of Radiation Oncology Origins of Brachytherapy J. Frank Wilson, M.D.
  4. 4. Natural Artificial Radioactivity Radioactivity 1898 1935 The Curie Era
  5. 5. Röntgen observed the fluorescence of platino - cyanide salts exposed to x-rays. Wilhelm Conrad Röntgen 1845-1923
  6. 6. In 1896, Becquerel reported the “phosphorescence” of uranium capable of fogging photographic plates through a thickness of aluminum. Antoine Henri Becquerel 1852-1908 Radiogram of a medal
  7. 7. Newlyweds, July, 1895. Mme. Curie’s post doctoral work was to study the “uranium rays”.
  8. 8. Polonium “discovered.” June, 1898 Radium “discovered.” December 26, 1898
  9. 9. Primitive ionization chamber built by Curies to detect radiation.
  10. 10. “ It seemed to me that the first thing to do was to measure the phenomenon with precision.” “Instead of the usual electroscope, I used a more perfect apparatus.” Marie Curie, 1923 Electrometer built by P. Curie
  11. 11. Pierre Curie c. 1899 Shown working with the quartz piezo-electroscope he invented, by which rays of radium could be measured.
  12. 12. Initial radium extraction process. One decigram isolated by June, 1903.
  13. 13. “ One of our joys was to go into our workroom at night; we perceived on all sides the feebly luminous silhouettes of the bottles or capsules containing our products. It was really a lovely sight and one always new to us. The glowing tubes looked like faint, fairy lights.” Marie Curie, 1923
  14. 14. “ In this miserable old shed we passed the best and happiest years of our life…” Marie Curie, 1923
  15. 15. • Nobel’s will was contested. • First prize awarded in 1901. • Roentgen was the first Nobel Laureate in Physics. • Becquerel and the Curies were Alfred Nobel Nobel Laureates in 1903. 1833 - 1896
  16. 16. “In criminal hands radium might prove very dangerous, and the question therefore arises whether it be to the advantage of humanity to know the secrets of nature, whether we be sufficiently mature to profit by them, or whether that knowledge may not prove harmful.” Pierre Curie Nobel Acceptance Speech, 1903
  17. 17. Pierre Curie’s self-inflicted severe skin reaction to radium. 1903 As early as 1905 both Pierre and Marie were showing negative health effects from their work.
  18. 18. Radium applicators for surface and intracavitary applications, used by Danlos and later by Wickham.
  19. 19. “…there is no reason why a tiny fragment of radium sealed up in a glass tube should not be inserted into the very heart of the cancer; thus acting directly upon the diseased material.” A.G. Bell Letter to Science, 1903
  20. 20. Pasteur Pavilion, Claudius Regaud, Radium Institute 1870 - 1940 c. 1913
  21. 21. Marie Curie, WW I (c. 1917) First radiographer and inventor of mobile radiology.
  22. 22. Carcinoma, left infraorbital region, treated by Columbia paste mounted radium.
  23. 23. Intraoral Moulds Radium “Packs”
  24. 24. Radiumtherapy pioneers 1920 - 1936 Jean Pierquin Georges Richard 1887 - 1958 1888 - 1962
  25. 25. Paul Langevin (1872- 1946)
  26. 26. Radium: The unprecedented panacea.
  27. 27. Radon Bath Radon Emanator Courtesy of Robison & Mould
  28. 28. Jaw Necrosis in a Radium Dial Painter
  29. 29. Irene Curie earned her Ph.D. studying the alpha rays of polonium. (c. 1925)
  30. 30. Paul Langevin, G. Boreau, Frederick Joliot, Irene Joliot-Curie Joliot receives his Academician’s sword. November 17, 1946
  31. 31. “With the neutron we were too late. With the positron we were too late. Now we are in time.” Joliot to a student, Jan. 1934 Nobel Prize, 1935
  32. 32. The Pantheon Latin Quarter, Paris April 20, 1995
  33. 33. Pantheon Crypt, 2007
  34. 34. THE HISTORY OF LDR BRACHYTHERAPY CANCER of the CERVIX Gustavo S. Montana M.D., F.A.C.R. Duke University Medical Center ASTRO 2007
  35. 35. Disclosures I have nothing to disclose.
  36. 36. RADIATION THERAPY HISTORY Important 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 interstitial therapy 1903 Margaret A. Cleaves describes the treatment of a gynecological patient with intracavitary radium in New York. 1903 H. Streble describes afterloading interstitial technique.
  37. 37. RADIATION THERAPY HISTORY Important 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”
  38. 38. RADIATION THERAPY HISTORY Important 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.
  39. 39. RADIATION THERAPY HISTORY Important Dates 1963 Afterloading Intracavitary 1974 High Dose Rate Brachytherapy 1977 Afterloading Transperineal 1977 3D Treatment Planning 1996 (IMRT) Intensity Modulated Radiation Therapy
  40. 40. BRACHYTHERAPY Requirements • Accessible Tumors • Radiosensitive Tumors • Tolerance of Normal Tissues • Orderly Pattern of Spread
  41. 41. BRACHYTHERAPY ADVANTAGES • Inverse Square Law • High Dose to Limited Volume • Differential Effect of High Dose Rate on Tumor & Normal Tissues
  42. 42. BRACHYTHERAPY DOSE RATES • Low Dose Rate ~ 40-200 cGy/hr • High Dose Rate ≥ 200 cGy/hr
  43. 43. CARCINOMA of the CERVIX Intracavitary Systems * Paris * Stockholm * Manchester * MD Anderson * Mallinckrodt Institute of Radiology * CT/MR 3D System
  44. 44. 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 Rd Colpostats: 13.33 – (6.66) – 13.33 = 26.66 to 33.32 mgs Rd • Dose: 7200 mgm/hrs.
  45. 45. The Paris System
  46. 46. The Stockholm System Radiumhemment Institute Stockholm, Sweden Dominici & 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
  47. 47. The Stockholm System
  48. 48. The Manchester System Holt 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.
  49. 49. The Manchester System
  50. 50. MD ANDERSON SYSTEM MD Anderson Hospital Houston, Tx, USA G. 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
  51. 51. Mallinkcrodt Institute of Radiology System (MIR) St. Louis MO, USA W. 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
  52. 52. 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
  53. 53. MGHRS SYSTEM “CAVEATS” • Different loadings can result in different different isodose = mghrs dose • No Constant Applicator/Anatomical Relationship • Difference in Biological Effects of Brachytherapy and EBRT not taken into into account
  54. 54. CT Compatible Applicator Duke University Medical Center
  55. 55. Rectal & Bladder D Max Points Points
  56. 56. CT Compatible Applicator
  57. 57. CT Compatible Applicator
  58. 58. Radium Institute Paris, France C. L. Regaud (1925) Treatment Symptom-Free Survival Year (1-6 years) 1919 9.1% 1920 19.3% 1921 29.5% 1922 34.4% 1923 43.9%
  59. 59. Radiumhemmet Stockholm, Sweden Heyman (1924) 5-year Year # of Symptom-Free of Rx Patients Survival 1914 26 26.9% 1915 40 32.5% 1916 47 8.5% 1917 63 14.3% 1918 41 26.8%
  60. 60. Radiumhemmet Stockholm, Sweden Heyman (1934) 5 - Year Results (1914 - 1925) Total number of patients treated 1455 Symptom-free after 5 years 327 Relative Cure Rate 22.5%
  61. 61. Holt Radium Institute Manchester, England W. J. Meredith (1948) Year 5-year # Patients of Rx Survival 1934 - 1935 332 26% 1936 - 1937 298 28% 1938 - 1939 307 32% 1940 - 1940 612 35% 1942 - 1943 577 38%
  62. 62. M.D. Anderson Katz (2004) 5 - Year DFS Early Stage 78% Advanced Stage 61%
  63. 63. THE END!
  64. 64. Afterloading Brachytherapy Review of the Early Development Herman Suit Massachusetts General Hospital Harvard Medical School Collaboration with T Mauceri, Peter Biggs, G Chen, A Russell and K Doppke
  65. 65. Start of Radiation Therapy • Immediately After Röntgen’s • Discovery: Nearly Worldwide • Rush into Radiology
  66. 66. Physics Discoveries 1896-1898 • 1896 Radioactivity • 1897 The Electron • 1897 Alpha and Beta Rays • 1898 Gamma Rays
  67. 67. Radiation Biology 1896 • T Grover Lyons Papers in Lancet • Feb 1 Proposed Effect on Bacteria • Feb 17 No effect on TB and Diphtheria
  68. 68. Start of Radiation Therapy • EBRT Success Against Skin SCC • Lupus Vulgaris and Misc Lesions
  69. 69. 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?
  70. 70. Early Radiation Martyrs • 1904 Clarence Dally Asst to T Edison • 1916 Walter Dodd MGH Radiologist • Numerous Others
  71. 71. Alexander Graham Bell • 1903: • Insert 226Ra [Glass Tube] into Tumor. • 1st Radium User : Margaret Cleaves
  72. 72. First Reports of After Loading 1903 Stroebel 19041910 Abbe
  73. 73. After Loading Brachytherapy • Afterloading Techniques Vary • Widely but All Provide Reduced • Dose to Personnel
  74. 74. After Loading Brachytherapy • Virtually All Brachytherapy • Is Now After Loading
  75. 75. Early Clinical Use of AL • Many Publications 1956-70 • Long After Strobel of 1903 • and the Many Martyrs
  76. 76. Early Clinical Use of AL • Mowatt 1956 • Fishman 1956 • Henschke 1960 • Wolever 1960 • Morphis 1960 • Suit 1961
  77. 77. Rationale for After Loading • Zero Dose to OR Staff • Radiation Oncologists • Physicists • Nurses Anesthesiologists
  78. 78. Rationale for After Loading • Transportation Personnel • Nurse and Staff on the Ward • Medical Staff for Patient Exam
  79. 79. 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
  80. 80. Rationale for After Loading • 5. Quality of Implant Improved
  81. 81. Remote After Loading • No Dose to Any Person • Dose Contouring after • Catheters/Applicators in Place
  82. 82. Afterloading Early History • Why the Long Delay Between • Abbe and the Post War II • Period? I Do Not Know
  83. 83. Afterloading Early History • To Start by Giving a Tribute to • Ullrich Henschke
  84. 84. Ullrich Henschke • A L for Ovoid and Tandem Early • 1950s • Adopted in Many Centers
  85. 85. Early French Experience IGR • B Pierquin D Chassagne • 1956-1970 1600 Patients • 198Au Wires to 1960 • 192Ir Wires 1960-70
  86. 86. Early Italian Experience • 1959-70 Roma, Torino, Pavia and • Padova 1000 Patients • Techniques of Pierquin IGR
  87. 87. A Sudarsanam and K Charyulu • In the 1960s, Several AL Applicators. • Also, Phase III Trials, Pre-operative • Radiation, 3 D Planning
  88. 88. Harry Horwitz • Array of Applicators in 1960s
  89. 89. HS Work in AL • Illustrative Cases • Data on Radiation Exposure • Important Recent Advances
  90. 90. At NCI 1957-59 • Physicist R Swain • Excellent Machine Shop
  91. 91. Retrobulbar Small Cell Sarcoma • ~ 17 y/o Male • Local Failure at 18/12 after 40 Gy • Stage Mo
  92. 92. Plan • 30 Gy Rt Lateral/Ant 2 MeV • Wedge. • Needle Implant: Truncated Cone
  93. 93. Plan • 5 Orbital + 1 Lateral Ethmoid • Needles: 23 Gage • Variable Length
  94. 94. Plan • Isotope: 192Ir Wires • 0.4 MeV • T1/2 74 Days
  95. 95. Plan • Require 2 Crossing Needles • For Posterior Globe Surface • “Fish Hook” Shaped Needles
  96. 96. Plan • Study Anatomy and Practice • Anatomic Specimen: 6 Orbits • Small Protractor for OR Use
  97. 97. Total Tongue • Standard Volume Implant • 30 Needles • No Exposure During Procedure
  98. 98. Ca Cervix MDAH 1959 • ~ 500 Radium Insertions/Year • ie 5-6 at two Sessions/Week
  99. 99. Ca Cervix MDAH 1959 • P Chau and I had the Friday Cases ∴Powerful Stimulus to Develop ∴AL System Immediately
  100. 100. Collaborators • Bailey Moore Machine Shop • R Worsnop Physicist • G Fletcher Rad Oncologist
  101. 101. Plan • Modify Fletcher Applicators for • AL: Same External Dimensions • Standard Radium Tubes
  102. 102. Progress • Mark I, II and III • Radiology 1963 • Luis Delclos Further Development 1970→
  103. 103. Radiation Exposure mr/mg Personnel 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
  104. 104. μgm Radium Sources • Measure Dose to Bladder Base and Anterior Rectal Wall • μgm Instead of mgm Ra Sources • Scintillation Probe For Dose Rate
  105. 105. Extension To Pelvic Wall • III B Cervical Stump, Parametrial and • Paravaginal Tumor Fixed to Pelvic Wall
  106. 106. Extension To Pelvic Wall • 60 Gy by 4 Field Betatron • Radium to Stump and Vagina.
  107. 107. Extension To Pelvic Wall • Dr Chau: 9 Needles via Perineum • To Parametrial Mass • 9 cm 192Ir Wires + Steel Wire Fillers • Total Dose ~ 103 Gy
  108. 108. L Lateral Floor of Mouth • Deeply Infiltrating SCC • Plan: Two Plane • One Needle Repositioned
  109. 109. Chest Wall Recurrence • Low Dose Rate Radiation Preferred
  110. 110. Recent AL Implants at MGH
  111. 111. 50Gy IMRT 50Gy IMRT after Resection tumor and vertebra resected 50Gy 1 cm 48Gy 38Gy 40Gy 38Gy 40Gy 30Gy 30Gy Dura surface Cord surface 50Gy IMRT + 10Gy Y(90) Intra-operative (equivalent to 23-36 Gy fractionated ) Y(90) applicator (63-76)Gy (43-45)Gy 30Gy
  112. 112. Remote Control AL • First Reported by Henschke 1964 • Concept: Radium Withdrawn When • Persons Go into Room
  113. 113. Remote Control AL • The Concept is Simple and • Straight Forward: • Eliminate Exposure of Personnel
  114. 114. Remote Control AL • Improve Dose Distribution by • Determining Preferred Source • Positions and Dwell Times
  115. 115. Remote Control AL • Correct for Slight Errors in • Catheter Alignment
  116. 116. Remote Control AL • Achieve “Optimized” Dose • Distribution • Merit of High vs Low Dose Rate
  117. 117. Remote Control AL: Gains • High Dose Rate ∴ Several Large • Dose Fractions ¿Late Effects? • Superior Dose Distributions
  118. 118. Remote Control AL: Gains • Present Assessment: • TCP and NTCP Comparable to Low • Dose Rate BRT
  119. 119. Burying Radium The Introduction of Interstitial Brachytherapy Jesse N Aronowitz University of Massachusetts
  120. 120. Disclosures • I have nothing to disclose.
  121. 121. 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
  122. 122. Surface Applicators
  123. 123. Intracavitary Radium
  124. 124. ...the rays emitted by radium have been found to have a marked curative effect upon external cancers... ...there is no reason why a tiny fragment of radium...should not be inserted into the very heart of the cancer... Alexander Graham Bell American Medicine p. 261, August 15, 1903
  125. 125. “I then determined to plunge it directly in the tumor…. I ventured… to pierce the tumor by a fine knife… the radium tube was pushed into the knife channel. The tube was… all buried in the tumor. I left the radium in situ three hours. The treatment was repeated three times weekly for 15 times.” Robert Abbe The Subtle Power of Radium 1851-1928
  126. 126. Obstacles to Interstitial Radiumtherapy • Cost ($120,000/gram) • Bulk
  127. 127. Specific Activity Amount of radioactivity per unit of substance
  128. 128. Solutions American* European*
  129. 129. The American Solution: Radium Emanation
  130. 130. “Radium treatment has caused with surprising regularity the reduction or disappearance of carcinomatous nodules of the prostate. Striking results have been obtained ...” Benjamin Barringer JAMA, 68:1227-30, 1917
  131. 131. Technique Low activity, heavily screened needles • 2 mg/3 cm or 3mg/4.8 cm • 0.6mm platinum filtration • Typically 100mg (35 needles) • in situ 7 days (1200 -1800 mghr)
  132. 132. Epilogue Whatever became of…
  133. 133. ‘… it is easy to concentrate attention too much upon the main mass of growth, and to forget that secondary dissemination occurs within the mammary gland. Properly, the whole breast… should be treated.’ 1932 ‘… residual nodules were removed… In 50% there was evidence of active cancer. … led to a reconsideration of the procedure. I therefore decided to remove… the tumour… before irradiation.’ 1937
  134. 134. ‘The rapid improvement of x- ray technique… suggests that x-rays may be used as an alternative.’ 1937
  135. 135. Barringer’s other prostate cancer innovations • Screening • Transperineal biopsy • Combined implant & beam therapy • Combined implant & castration
  136. 136. AMERICAN RADIUM EMPIRE: 1913-24 R.F. ROBISON, M.D.
  137. 137. • I have nothing to disclose
  138. 138. 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).
  139. 139. ASTRO Annual Conference Los Angeles, CA October 27 to November 1, 2007 Educational Session History of Radiation Oncology II: Brachytherapy Founding of the American Radium Society Martin Colman, MD Department of Radiation Oncology University of Texas Medical Branch, Galveston
  140. 140. Disclosures • I have nothing to disclose.
  141. 141. The Four Doctors, by John Singer Sargent Photograph by Aaron Levine Courtesy of The Alan Mason Chesney Archives, The Johns Hopkins Medical Institutions
  142. 142. Howard Kelly 1858-1943 Radium Pioneer One of original four faculty at Johns Hopkins, “The Four Doctors”
  143. 143. 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
  144. 144. Joseph Flannery (1867-1920) President, SCC of Pittsburgh
  145. 145. James Douglas (1837-1918) 1914 - commenced radium production with Howard A. Kelly and Charles L. Parsons
  146. 146. Henry H. Janeway
  147. 147. James Ewing 1866-1943 Commenced use of radium at Memorial Hospital, 1913
  148. 148. William Duane 1872-1935 Adapted Marie Curie’s radon production system and glass seeds in Boston in 1913 Facilitated similar systems at Memorial-NY and Baltimore
  149. 149. Gioachino Failla, 1891-1961 1918 Elected to ARS
  150. 150. Joseph Flannery (1867-1920) President, SCC of Pittsburgh
  151. 151. The Radium Research Laboratory Standard 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
  152. 152. Employees of SCC of Pittsburgh < William H. Cameron, MD (1879-1944) Clinic Director Radium Therapy Pioneer Charles H. Viol, PhD 1886-1928 > Director of Research
  153. 153. “RADIUM” - 1913 to 1919 Published by SCC
  154. 154. Henry K. Pancoast 1875-1939 Founder Member of ARS President of ARS, 1920 First Professor of Radiology University of Pennsylvania
  155. 155. Henry B. Aikins 1859-1924 First President of ARS 1916 & 1917
  156. 156. Henry Schmitz 1871-1939 Founder Member of ARS President of ARS, 1921 6th Janeway Lecturer, 1938 Prepared statutes for first meeting that were adopted unanimously Established the name, ARS
  157. 157. Principal Founders of ARS < William H. Cameron, MD (1879-1944) Founder Member of ARS Radium Therapy Pioneer President of ARS, 1935 Charles H. Viol, PhD 1886-1928 > Founder (Assoc) Member of ARS
  158. 158. Marie Curie 1867-1934 Discoverer of Radium Nobel Laureate, 1903 & 1907 1921 Elected Honorary Member of ARS
  159. 159. Howard Kelly 1858-1943 Radium Pioneer Elected honorary member of ARS in 1921
  160. 160. 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
  161. 161. William Duane 1872-1935 1922 Elected Honorary Member of ARS
  162. 162. Edith H. Quimby 1891-1982 8th Janeway Lecturer, 1940 ARS President, 1954 ARS Historian #3 AJR 75:443-456, 1956
  163. 163. Henry Harrington Janeway 1873- 1921 Pioneer in Clinical Applications of Radium 1917 Elected to ARS
  164. 164. Burton J. Lee 1874-1933 President of ARS, 1933 Established the Janeway Memorial Lecture, 1933 First Janeway – James Ewing
  165. 165. Edward H. Skinner 1881-1953 9th Janeway Lecturer, 1941 President of ARS, 1938
  166. 166. The Janeway Medal Odin exchanges his eye for knowledge Reverse - Odin’s ravens
  167. 167. Albert Soiland, 1873-1946 1917 Elected to ARS
  168. 168. THE END
  169. 169. Significant Historical Resources
  170. 170. James T. Case, 1882 – 1960 Founding Member of ARS President of ARS, 1924 24th Janeway Lecturer, 1959 ARS Historian #1 AJR 70:487-490, 1953 AJR 82:574-585, 1959
  171. 171. James Ewing 1866-1943 First Janeway Lecturer 1933 AJR 31:153-163, 1934
  172. 172. Edith H. Quimby 1891-1982 8th Janeway Lecturer, 1940 ARS President, 1954 ARS Historian AJR 75:443-456, 1956
  173. 173. Juan del Regato ARS President, 1969 38th Janeway Lecturer, 1973 Historian Par Excellence ARS Historian #4 AJR 108:429-430, 1969 AJCO 14(2):93-100, 1991
  174. 174. E.R.N Grigg • Radiologist, Chicago • Radiology Historian • Author - “The Trail of Invisible Light” From X-Strahlen to Radio(bio)logy • Chas Thomas, 1965
  175. 175. 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
  176. 176. Albert Soiland, Marie Curie, and Rene Ledoux-Lebard, Paris, 1931
  177. 177. Soiland Radiology Clinic L.A.

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