History and development of radiation oncology in Japan

Abstract

The Japan Radiological Society (JRS) was founded in 1923 by physicians and scientists active in the field of radiology. This society now covers three fields: diagnostic radiology, therapeutic radiology, and nuclear medicine, with a membership of approximately 6,400 as of August 1995. The Japanese Society of Nuclear Medicine was organized in 1964, followed by the Japanese Society for Medical Imaging in 1986. These organizations are separate from the JRS, but most of their members are also members of the JRS. The Japanese Society for Therapeutic Radiology and Oncology (JASTRO) was created with a constitution and bylaws in 1988 to form an association to promote research on all aspects of radiation oncology in Japan. The membership was initially 614 but reached 1293 in 1995, with 978 physicians, 37 physicists, 39 radiobiologists, 54 medical engineers, and 184 technicians. Of the physicians, 567 are full-time radiation oncologists and the others are engaged in both the fields of diagnostic and therapeutic radiology. Again, most of the JASTRO members are also members of the JRS. The International Congress of Radiation Oncology was held in Kyoto in 1993 under the leadership of JASTRO. It was the first independent and successful world scientific assembly in radiation oncology. In Japan, there are 629 institutions in which a total of 685 megavoltage machines, including telecobalt, linacs, and betatrons, are installed. However, there are only 567 full-time radiation oncologists, which demonstrates an urgent need to increase the number of radiation oncologists. Such a shortage of not only radiation oncologists but also diagnostic radiologists resulted mainly from the tragedy of the atomic bombing of Hiroshima and Nagasaki. There is a strong aversion to radiation in Japan, which makes people afraid of receiving radiation therapy. This is clearly demonstrated by the fact that radiation therapy is used only on about 20% of all cancer patients (4). The Japanese Board of Radiology was authorized by the JRS to certify radiologists and has offered certification in general radiology since 1966. The certification examination is composed of oral and written examinations on diagnostic radiology, therapeutic radiology, and nuclear medicine. Candidates, desiring certification must have 5 years of training at board-certified training centers for radiologists. Those who succeed in the examination in all three fields are certified as board-certified radiologists. Because of the rapid strides in both therapeutic radiology and diagnostic radiology, more specialized radiologists were required. Therefore, separate certification in therapeutic radiology and diagnostic radiology, which includes nuclear medicine, was started in 1989. Currently, 2934 radiologists hold certificates from the Japanese Board of Radiology. The Society for Radiation Physics in Medicine was founded in 1961 and the board examination for Radiation Physics in Medicine was started in 1987. Several areas of remarkable development are described below in tracing the rise of radiation oncology in Japan.