THE EVOLUTION OF RADIOTHERAPEUTIC TECHNI

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This power point presentation reviews the historical mile stones of the application of ionizing radiation in the treatment of cancer from the days of empirical uses to present day precision technology.

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THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES FROM STOPWATCH EXPOSURE TO IMAGE GUIDED AND ADAPTIVE RADIATION THERAPY Ismail Kazem, MD, FRCR, FACR IK/@2007 Emeritus Professor of Radiation Oncology College of Medicine, USF, Tampa, Fl., USA

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THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

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

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

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

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES EARLY CHALLENGES: Detection of Ionizing Radiation. Defining the Quality of Radiation. Defining the Quantity of Radiation. Understanding the Mechanism of Action of Radiation. Optimizing Radiation Delivery Equipments. IK/2007

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

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

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

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THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

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

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THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

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

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THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES Impact of Modern Technology: Impact of Computer technology. New Imaging technology. Advances in Molecular biology. The multidisciplinary approach to Cancer treatment. IK/2007

MODERN RADIOTHERAPEUTIC TECHNIQUES : 

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

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THE EVOLUTION OF BRACHYTHERAPY TECHNIQUES : 

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

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THE EVOLUTION OF SYSTEMIC RADIATION THERAPY : 

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

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

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES : 

THE EVOLUTION OF RADIOTHERAPEUTIC TECHNIQUES Bottom Line: Maximum Tumor Control with Minimum Side Effects. SAFETY TO PATIENT. SAFETY TO PERSONELL. SAFETY TO THE ENVIRONMENT. IK/2007

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