The evolution of radiotherapeutic techniques copy.ppt

THE EVOLUTION OFTHE EVOLUTION OF
RADIOTHERAPEUTICRADIOTHERAPEUTIC
TECHNIQUESTECHNIQUES
FROM STOPWATCH EXPOSURE TOFROM STOPWATCH EXPOSURE TO
IMAGE GUIDED AND ADAPTIVEIMAGE GUIDED AND ADAPTIVE
RADIATION THERAPYRADIATION THERAPY
Ismail Kazem, MD, FRCR, FACRIsmail Kazem, MD, FRCR, FACR
IK/@2007
Emeritus Professor of Radiation Oncology
College of Medicine, USF, Tampa, Fl., USA

Chronologic Milestones:Chronologic Milestones:
 1895 W.K.Roentgen discovered X-Rays.1895 W.K.Roentgen discovered X-Rays.
 1896 Becquerel reported natural radioactivity in1896 Becquerel reported natural radioactivity in
Uranium compounds.Uranium compounds.
 1898 Marie and Pierre Curie isolated radium1898 Marie and Pierre Curie isolated radium
from pitchblende.from pitchblende.
 1900 Villard reported that radium emitted alpha,1900 Villard reported that radium emitted alpha,
beta and gamma radiations.beta and gamma radiations.
 1934 Frederic and Irene Joliot (Curie’s daughter)1934 Frederic and Irene Joliot (Curie’s daughter)
discovered artificial radioactivity.discovered artificial radioactivity.
IK/2007

Chronologic Milestones:Chronologic Milestones:
 1898 Becquerel’s vest-pocket skin erythema and1898 Becquerel’s vest-pocket skin erythema and
reports of x-ray ‘burns’.reports of x-ray ‘burns’.
 1903 Bergonie and Tribondeau described1903 Bergonie and Tribondeau described
radiosenstivity of proliferating cells.radiosenstivity of proliferating cells.
 1930 Coutard proposed treatment fractionation.1930 Coutard proposed treatment fractionation.
 1950 Paterson’s definition of Therapeutic Ratio:1950 Paterson’s definition of Therapeutic Ratio:
Normal Tissue Tolerance/ Tumor Control Dose.Normal Tissue Tolerance/ Tumor Control Dose.
IK/2007

EARLY CHALLENGES:EARLY CHALLENGES:
 Detection of Ionizing Radiation.Detection of Ionizing Radiation.
 Defining the Quality of Radiation.Defining the Quality of Radiation.
 Defining the Quantity of Radiation.Defining the Quantity of Radiation.
 Understanding the Mechanism of Action ofUnderstanding the Mechanism of Action of
Radiation.Radiation.
 Optimizing Radiation DeliveryOptimizing Radiation Delivery
Equipments.Equipments.

TECHNIQUESTECHNIQUESMeasuring Radiation Dose:Measuring Radiation Dose:
 Skin Erythema Dose.Skin Erythema Dose.
 1902 Holzknecht in Vienna developed the Chromoradiometer.1902 Holzknecht in Vienna developed the Chromoradiometer.
 1904 Sabouraud and Noire in France modified Holzknecht’s method1904 Sabouraud and Noire in France modified Holzknecht’s method
to Pastille-dose technique using pastilles of barium platinocyanide.to Pastille-dose technique using pastilles of barium platinocyanide.
 1913 Ionization current measurement developed in Paris, and1913 Ionization current measurement developed in Paris, and
adopted in 1928 at the ICR as the standard unit “r”: x or gammaadopted in 1928 at the ICR as the standard unit “r”: x or gamma
radiation producing 1 e.s.u in 1 cc of air.radiation producing 1 e.s.u in 1 cc of air.
 1953 at the ICR the ‘rad’ was introduced as the unit of absorbed1953 at the ICR the ‘rad’ was introduced as the unit of absorbed
dose: equal to 100 ergs per gram.dose: equal to 100 ergs per gram.
 1970 the rad was redefined in a metric system: the Gray: joules1970 the rad was redefined in a metric system: the Gray: joules
absorbed per kg. 1 Gray = 100 rads.absorbed per kg. 1 Gray = 100 rads.
IK/2007

Quality of Radiation:Quality of Radiation:
 1913 Coolidge in the USA engineered the first successful1913 Coolidge in the USA engineered the first successful
X-ray tube using hot-filament and Tungsten target.X-ray tube using hot-filament and Tungsten target.
 1920 higher voltages with more powerful transformers1920 higher voltages with more powerful transformers
and rectifiers: Contact therapy @ 50 KV, Superficial @and rectifiers: Contact therapy @ 50 KV, Superficial @
100-150 KV and Deep X-rays @ 200-400 KV. Effect of100-150 KV and Deep X-rays @ 200-400 KV. Effect of
added filtration.added filtration.
 Quality measured by HVL.Quality measured by HVL.
 1933-1950 the Megavolt era: Van de Graaff electrostatic,1933-1950 the Megavolt era: Van de Graaff electrostatic,
the Betatron, the Cobalt units and the Linear accelerator.the Betatron, the Cobalt units and the Linear accelerator.
IK/2007

Treatment Planning:Treatment Planning:
 Central Axis % Depth Dose.Central Axis % Depth Dose.
 Plotting Isodose Curves.Plotting Isodose Curves.
 Multiple Fields Cross-Fire.Multiple Fields Cross-Fire.
 Manual Patient Contouring and Manual IsodoseManual Patient Contouring and Manual Isodose
Curve Summation.Curve Summation.
 Computer Treatment Planning Central Axis andComputer Treatment Planning Central Axis and
Off-Axis.Off-Axis.
 Image Based 3-D Dose Distribution.Image Based 3-D Dose Distribution.
IK/2007

Understanding the biology of Cancer:Understanding the biology of Cancer:
 The natural history of different tumorsThe natural history of different tumors
based on cell types.based on cell types.
 The importance of cancer staging.The importance of cancer staging.
 Retrospective outcome studies andRetrospective outcome studies and
prospective Clinical Trials.prospective Clinical Trials.
 Identifying Dose Response expectations.Identifying Dose Response expectations.
IK/2007

Impact of Modern Technology:Impact of Modern Technology:
 Impact of Computer technology.Impact of Computer technology.
 New Imaging technology.New Imaging technology.
 Advances in Molecular biology.Advances in Molecular biology.
 The multidisciplinary approach to CancerThe multidisciplinary approach to Cancer
treatment.treatment.
IK/2007

MODERN RADIOTHERAPEUTICMODERN RADIOTHERAPEUTIC
 Image based treatment planning.Image based treatment planning.
 3-d conformal treatment planning.3-d conformal treatment planning.
 Intensity Modulated Radiation TreatmentIntensity Modulated Radiation Treatment
(IMRT).(IMRT).
 Image Guided Radiation Treatment andImage Guided Radiation Treatment and
Adaptive Radiation Treatment.Adaptive Radiation Treatment.
 Investigational: Proton and ParticleInvestigational: Proton and Particle
Therapy.Therapy. IK/2007

BRACHYTHERAPY TECHNIQUESBRACHYTHERAPY TECHNIQUES
 Use of Radium Tubes and Needles.Use of Radium Tubes and Needles.
 Empirical use of mg/hr for dose calculation.Empirical use of mg/hr for dose calculation.
 Parker and Paterson Tables for doseParker and Paterson Tables for dose
calculations.calculations.
 The Manchester System for source distribution.The Manchester System for source distribution.
 Edith Quimby simplified dose calculation.Edith Quimby simplified dose calculation.
 The development of after-loading techniques.The development of after-loading techniques.
 Automated remote after-loading LDR and HDR.Automated remote after-loading LDR and HDR.
IK/2007

THE EVOLUTION OF SYSTEMICTHE EVOLUTION OF SYSTEMIC
RADIATION THERAPYRADIATION THERAPY
 POST WW-II ATOM FOR PEACEPOST WW-II ATOM FOR PEACE
PROJECT.PROJECT.
 Radioactive Iodine-131 for HyperthyroidRadioactive Iodine-131 for Hyperthyroid
and Functioning Thyroid Cancer.and Functioning Thyroid Cancer.
 P32 Orthophosphate: for PolycythemiaP32 Orthophosphate: for Polycythemia
Vera.Vera.
 P32-Chromic-Phosphate Colloid forP32-Chromic-Phosphate Colloid for
Malignant effusions.Malignant effusions.
 Labeled Antibodies for Target Therapy.Labeled Antibodies for Target Therapy.IK/2007

SYSTEMIC RADIOTHERAPY : I-131 FOR
METASTATIC THYROID CARCINOMA
IK/2007

Bottom Line:Bottom Line:
 Maximum Tumor Control with MinimumMaximum Tumor Control with Minimum
Side Effects.Side Effects.
 SAFETY TO PATIENT.SAFETY TO PATIENT.
 SAFETY TO PERSONELL.SAFETY TO PERSONELL.
 SAFETY TO THE ENVIRONMENT.SAFETY TO THE ENVIRONMENT.
IK/2007

The evolution of radiotherapeutic techniques copy.ppt

The evolution of radiotherapeutic techniques copy.ppt

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