the evolution of radiotherapeutic techniques copy.ppt

THE EVOLUTION OF THE EVOLUTION OF RADIOTHERAPEUTIC RADIOTHERAPEUTIC

TECHNIQUESTECHNIQUESFROM STOPWATCH EXPOSURE TO IMAGE FROM STOPWATCH EXPOSURE TO IMAGE

GUIDED AND ADAPTIVE RADIATION GUIDED AND ADAPTIVE RADIATION THERAPYTHERAPY

Ismail Kazem, MD, FRCR, FACRIsmail Kazem, MD, FRCR, FACR

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Emeritus Professor of Radiation OncologyCollege of Medicine, USF, Tampa, Fl., USA

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TECHNIQUESTECHNIQUESChronologic Milestones:Chronologic Milestones: 1895 W.K.Roentgen discovered X-Rays.1895 W.K.Roentgen discovered X-Rays. 1896 Becquerel reported natural 1896 Becquerel reported natural

radioactivity in Uranium compounds.radioactivity in Uranium compounds. 1898 Marie and Pierre Curie isolated radium 1898 Marie and Pierre Curie isolated radium

from pitchblende.from pitchblende. 1900 Villard reported that radium emitted 1900 Villard reported that radium emitted

alpha, beta and gamma radiations.alpha, beta and gamma radiations. 1934 Frederic and Irene Joliot (Curie’s 1934 Frederic and Irene Joliot (Curie’s

daughter) discovered artificial radioactivity.daughter) discovered artificial radioactivity.

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TECHNIQUESTECHNIQUESChronologic Milestones:Chronologic Milestones: 1898 Becquerel’s vest-pocket skin 1898 Becquerel’s vest-pocket skin

erythema and reports of x-ray ‘burns’.erythema and reports of x-ray ‘burns’. 1903 Bergonie and Tribondeau described 1903 Bergonie and Tribondeau described

radiosenstivity of proliferating cells.radiosenstivity of proliferating cells. 1930 Coutard proposed treatment 1930 Coutard proposed treatment

fractionation.fractionation. 1950 Paterson’s definition of Therapeutic 1950 Paterson’s definition of Therapeutic

Ratio: Normal Tissue Tolerance/ Tumor Ratio: Normal Tissue Tolerance/ Tumor Control Dose.Control Dose.

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TECHNIQUESTECHNIQUESEARLY 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 Understanding the Mechanism of

Action of Radiation.Action of Radiation. Optimizing Radiation Delivery Optimizing Radiation Delivery

Equipments.Equipments.

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TECHNIQUESTECHNIQUESMeasuring Radiation Dose:Measuring Radiation Dose:

Skin Erythema Dose.Skin Erythema Dose. 1902 Holzknecht in Vienna developed the 1902 Holzknecht in Vienna developed the

Chromoradiometer.Chromoradiometer. 1904 Sabouraud and Noire in France modified Holzknecht’s 1904 Sabouraud and Noire in France modified Holzknecht’s

method to Pastille-dose technique using pastilles of barium method to Pastille-dose technique using pastilles of barium platinocyanide.platinocyanide.

1913 Ionization current measurement developed in Paris, 1913 Ionization current measurement developed in Paris, and adopted in 1928 at the ICR as the standard unit “r”: x 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.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 1953 at the ICR the ‘rad’ was introduced as the unit of absorbed dose: equal to 100 ergs per gram.absorbed dose: equal to 100 ergs per gram.

1970 the rad was redefined in a metric system: the Gray: 1970 the rad was redefined in a metric system: the Gray: joules absorbed per kg. 1 Gray = 100 rads.joules absorbed per kg. 1 Gray = 100 rads.

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TECHNIQUESTECHNIQUESQuality of Radiation:Quality of Radiation:

1913 Coolidge in the USA engineered the first 1913 Coolidge in the USA engineered the first successful X-ray tube using hot-filament and successful X-ray tube using hot-filament and Tungsten target.Tungsten target.

1920 higher voltages with more powerful 1920 higher voltages with more powerful transformers and rectifiers: Contact therapy @ 50 transformers and rectifiers: Contact therapy @ 50 KV, Superficial @ 100-150 KV and Deep X-rays @ KV, Superficial @ 100-150 KV and Deep X-rays @ 200-400 KV. Effect of added filtration. 200-400 KV. Effect of added filtration.

Quality measured by HVL.Quality measured by HVL. 1933-1950 the Megavolt era: Van de Graaff 1933-1950 the Megavolt era: Van de Graaff

electrostatic, the Betatron, the Cobalt units and the electrostatic, the Betatron, the Cobalt units and the Linear accelerator.Linear accelerator.

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TECHNIQUESTECHNIQUESTreatment 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 Manual Patient Contouring and Manual

Isodose Curve Summation.Isodose Curve Summation. Computer Treatment Planning Central Axis Computer Treatment Planning Central Axis

and Off-Axis.and Off-Axis. Image Based 3-D Dose Distribution. Image Based 3-D Dose Distribution.

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TECHNIQUESTECHNIQUESUnderstanding the biology of Cancer:Understanding the biology of Cancer: The natural history of different The natural history of different

tumors based on cell types.tumors based on cell types. The importance of cancer staging.The importance of cancer staging. Retrospective outcome studies and Retrospective outcome studies and

prospective Clinical Trials.prospective Clinical Trials. Identifying Dose Response Identifying Dose Response

expectations.expectations.IK/2007

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TECHNIQUESTECHNIQUESImpact 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 The multidisciplinary approach to

Cancer treatment.Cancer treatment.

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MODERN RADIOTHERAPEUTIC MODERN RADIOTHERAPEUTIC TECHNIQUESTECHNIQUES

Image based treatment planning.Image based treatment planning. 3-d conformal treatment planning.3-d conformal treatment planning. Intensity Modulated Radiation Intensity Modulated Radiation

Treatment (IMRT).Treatment (IMRT). Image Guided Radiation Treatment Image Guided Radiation Treatment

and Adaptive Radiation Treatment.and Adaptive Radiation Treatment. Investigational: Proton and Particle Investigational: Proton and Particle

Therapy.Therapy. IK/2007

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THE EVOLUTION OF THE EVOLUTION OF 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 dose Parker 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.

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THE EVOLUTION OF SYSTEMIC THE EVOLUTION OF SYSTEMIC RADIATION THERAPYRADIATION THERAPY

POST WW-II ATOM FOR PEACE PROJECT.POST WW-II ATOM FOR PEACE PROJECT. Radioactive Iodine-131 for Hyperthyroid Radioactive Iodine-131 for Hyperthyroid

and Functioning Thyroid Cancer.and Functioning Thyroid Cancer. P32 Orthophosphate: for Polycythemia P32 Orthophosphate: for Polycythemia

Vera.Vera. P32-Chromic-Phosphate Colloid for P32-Chromic-Phosphate Colloid for

Malignant effusions.Malignant effusions. Labeled Antibodies for Target Therapy.Labeled Antibodies for Target Therapy.

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SYSTEMIC RADIOTHERAPY : I-131 FOR METASTATIC THYROID CARCINOMA

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TECHNIQUESTECHNIQUESBottom Line:Bottom Line: Maximum Tumor Control with Maximum Tumor Control with

Minimum Side Effects.Minimum Side Effects. SAFETY TO PATIENT.SAFETY TO PATIENT. SAFETY TO PERSONELL.SAFETY TO PERSONELL. SAFETY TO THE ENVIRONMENT.SAFETY TO THE ENVIRONMENT.

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the evolution of radiotherapeutic techniques copy.ppt

Health & Medicine

quantity of radiation

depth dose

skin erythema dose

unit of absorbed dose

pastilledose technique

roentgen discovered

artificial radioactivity

treatment fractionation