Application Of Radium Research Articles

Dosage Calculations for Various Combinations of Parametrial Needles and Intracervical Tandems

Radium application by interstitial para-metrial needles in combination with intracervical tandems has been used and advocated in recent years by several authors (3, 4, 5). The published clinical results are quite promising and they seem justified on theoretical consideration of this method. There are many possible variations in the number, strength, and position of the needles and in the size and strength of the tandem. It is the purpose of this study to calculate the distribution of radiation in several such schemes of radium implantation and to compare the results with those published for other methods of treating cervix carcinoma. Theoretically this method is proposed to yield a wider distribution of radiation in the pelvis because of the introduction of the radium sources directly into the parametria. Furthermore, the use of many weak sources rather than a few strong ones will tend to produce a more uniform field of radiation and eliminate the danger of extensive necrosis around individual sources. This use of many weak sources has no relationship to the opinion sometimes voiced, that protracted low-intensity radiation may have a more pronounced physiological effect than shorter and more intense treatment. Actually the radiation may be delivered as rapidly (or even more rapidly) by means of many weak sources as by a few strong ones. A uniform field of radiation and the avoidance of strong individual sources are important in the treatment of carcinoma of the cervix. It is quite necessary to avoid extensive necrosis and local over-irradiation, because of the morbidity and mortality associated with them. Tod (14) has shown that there is a definite relationship between over-irradiation of the so-called paracervical triangle and three-year survival rates. She emphasizes that there is an upper limit to the dosage that may be delivered to the region in the base of the broad ligament lateral to the cervix. Overdosage there brings a high percentage of “overdosage effects” and deaths. “... these deaths are not . . . solely due to necrosis. They are due to recurrence which may either be local or a result of residual disease in the pelvic lymph nodes growing down into the pelvis. These facts have been verified by a number of post-mortem examinations .... This peculiar combination of necrosis and recurrence has been called in this Clinic [Christie Hospital and Holt Radium Institute] ‘supralethal ef-fect.’” Others have mentioned this effect but, so far as is known, no adequate explanation has been offered. On the other hand, it has been brought out by several investigators (1, 9) that there is a definite relationship between lymph node involvement and the percentage of five-year survivals. No method of treatment, therefore, will increase the overall salvage unless it controls, not only the primary tumor, but also the field of lymphatic drainage. There are four groups of nodes along the course of lymphatic spread: the hypogastric nodes at the bifurcation of the common iliacs, the ureteric node at the crossing of the uterine arteries and the ureters, the obturator node at the entrance of the obturator canals, and the “ganglion principal” along the lateral pelvic wall halfway between the hypogastrics and obturators. It is generally considered that only 50 per cent of patients with carcinoma of the cervix are “operable” when they first apply for treatment, and in this group it has been found on serial sections that there is carcinomatous extension to the nodes in about 50 per cent. Thus, only about 25 per cent of patients with cervix cancer are treated before this lymphatic spread has occurred (9). (One must presuppose that there is already lymphatic involvement in the inoperable cases.)

SCLEROMA

Within the past few years there have appeared in the literature over 100 case reports of scleroma. While most persons suffering from this chronic ailment have been foreign born, a considerable number have been native Americans. It is necessary, therefore, that this condition be kept in mind when granulation tissue appears any place in the respiratory passages. While the diagnosis is usually a routine procedure a universal method of treatment has not been adopted. Many types of therapy have been employed. The one which at present seems to offer the best prognosis is surgical removal of the granulation tissue followed by application of radium or roentgen rays. It is earnestly desired that physicians reporting patients so treated as "improved" or "cured" state how long such improvement has been noted. It is only by observing the time element that such treatment can be evaluated. I should like to report the following

Pregnancy Following the Intra‐uterine Application of Radium

Pregnancy Following the Intra‐uterine Application of Radium

Gestation fourteen years after radium induced amenorrhea

T HE report of this case is of interest for it presents several problems worthy of consideration because of the widespread use of radiation for various gynecologic conditions, The possibility of conception occurring following intrauterine radium treatment of pelvic pathologic conditions has been accepted and is an established fact. However, in reviewing the literature on this subject,, one finds that gestation after fourteen years’ amenorrhea following the intrauterine application of radium is a rare occurrence. In the treatment of functional female disorders, especially where subsequent pregnancies are desired, the use of radiation has not yet been universally approved. There are many instances reported of the birth of abnormal children following irradiation4 It is also noted that there is a tendency toward abortion in the first pregnancies following irradiat,ion, while later pregnancies may terminate in normal offsprings1 There is therefore that danger in temporary radium sterilization, and some authorities advocate that. permanent rather bhan temporary sterilization be performed. Pregnancies have been reported after radium therapy for various pathologic conditions, such as cancer of the body of the uterus, of the cervix, fibroids, et cetera I. Kaplan2 reports a case in which carcinoma of the cervix complicating pregnancy was given x-ray therapy and was followed by the birth of a normal child. C. Kargl discusses the history of two women who conceived after restoration of menstruation following intrauterine radiot,herapy. Both patients aborted. I’. Burger3 reviews a series of cases collected by Flascamp. In 1.17 patients who had been irradiated with roentgen rays, there were 133 gestations, and among 46 women treated with radium, 54 pregnancies occurred. He states, that it is well known that infants born after irradiation which was given during pregnancy are frequently deformed, t,he nervous system being particularly involved and defective. In cases where the irradiation was carried out in the pregestational period, the children born after such treatment are nearly always normal. However some authors maintain that such babies map also be born wit,h malformations. D. I’. Murphy4 reviews over 283 pregnancies in women subjected t,o pelvic irradiation with the conclusion that ’ (there is yet no definite indication that ovarian irradiation prior to fertilization has any detrimental influence upon the health or development of any subsequent children: that, irradiation of pregnant women is a procedure extremely dangerous t,o t,he health of the offspring (61.3 per cent being defective) and should not be undertaken unless the existing pregnancies are t,o be terminated artificially prior to the period of viability of t,he child. ” Of 230 pregnancies occurring in women who received preconception pelvic irradiation, 50 aborted (21.7 per cent). Of the 180 children born at term 27

NASOPHARYNGEAL RADIUM APPLICATOR

The nasopharyngeal radium applicator is used in the treatment of conduction deafness resulting from the overgrowth of lymphoid tissue about the pharyngeal orifices of the eustachian tubes, in a manner similar to that described by Crowe and associates. The applicator consists of a standard 50 mg. radium capsule attached to a pliable copper wire (fig. 1). The brass capsule contains 5 standard 10 mg. radium needles. Each radium needle has a wall thickness of 0.03 mm. of platinum; the brass capsule has a wall thickness of 0.8 mm., with a platinum equivalent of 0.2 mm.; the combined wall thickness is 0.5 mm. platinum equivalent, adequate filtration to remove the caustic beta rays. The nasopharyngeal radium applicator is inserted through the middle meatus or along the floor of the nose. The insertion is somewhat comparable to the passing of a eustachian catheter. Local anesthesia is usually used; however, in a few

The Absorption of the Primary Beta Radiation from Radium in Lead and Platinum and the Specific Gamma-ray Dose Rate at a Filtration of 0·5 mm. of Platinum

The range of the primary β radiation from radium in platinum is 0·53 mm.; the ratio of β- to γ-ray ionisation at 0·50 mm. of platinum is of the order of 1 per cent. The mass absorption coefficient of the hard component of the β radiation in platinum is 7·7 cm.2 gm.1 The γ-ray dose rate in air at 1 cm. from 1 mg. of radium filtered by 0·5 mm. of platinum is 8·47 e.s.u./cc./hr. as measured by a graphite thimble chamber of 1 cc. volume with a flat radium applicator.

The Quantitative Determination of Radium by a Photographic Method

The action of radium γ rays on photographic emulsions has been the subject of several investigations. Rogers1 and Bell2 have shown that the Bunsen-Roscoe reciprocity law is valid over an intensity range of 100 to 1, and the absorption coefficients of various materials have been measured photographically by Rogers.1,3,4 Photographic methods have also been employed in medical practice for the dosimetry of radium applicators, but the methods used were not suitable for the quantitative determination of radium, because their accuracy was insufficient, they were tedious in operation, and special apparatus was required. In view of the difficulties experienced with the electroscope method in certain cases it was decided to investigate whether a simple and accurate photographic method could be developed suitable for the routine measurement of radium preparations without using elaborate apparatus. The main sources of error of photographic methods, i.e., variations of the emulsion of different films, even from the s...

TREATMENT OF CUTANEOUS DISEASES WITH RADON OINTMENT AND RADIUM PADS

Radon ointment (radium emanation ointment) was introduced into medical therapy by Strasburger 1 in 1921 and was applied first in dermatology by Uhlmann 2 in 1930 for the treatment of roentgen ray dermatitis and ulcers. Since that time it has been successfully used in many European countries. Happel 3 reported his experience in 1933 and 1934 with the application of radium emanation ointment in the treatment of various dermatoses, and Langer 4 made a report in 1934. In 1937 Brunauer 5 published his results with the use of radon ointment and radium pads in the treatment of cutaneous diseases. Radium pads were mentioned first in the literature by Heiner, 6 in 1928. Lomholt 7 in 1936 reported his results with radon-containing wax plates. During the year just passed both forms of radium application were used in the Skin and Cancer Unit of the New York Post-Graduate Medical School and Hospital.

The Construction of a Universal Dosemeter with Notes on its Use for Measurement of High Resistances

The essential features of the instrument described in the following article are: (a) Vacuum insulation of ionisation current leads as far as possible. (b) A variable condenser system, with a range from 4μμF to 60μμF, carried in a vacuum chamber, and fitted with a “Townsend balance” circuit. (c) “Air walled” ionisation chambers. These are detachable and can be replaced by others of different wall thickness and size. (d) A series of high resistance from 70,000 to 1,000,000 megohms are carried in a rack inside the evacuated chamber (vide section (b)). (e) The measuring instrument is a Lindemann electrometer mounted with a microscope. In designing such an instrument the object was to produce an apparatus capable of measuring ionisation currents of widely differing values such as are obtained in dosage measurement of the radiation from a contact therapy X-ray tube with an output of 10,000 r/min. and a radium applicator with an output of 50 r/hour. The instrument is constructed so as to be mobile, and photograp...

Responsibility in Radiotherapy

Sometime since, a letter appeared in the British Medical Journal from a well known consulting surgeon to the London Hospital concerning his own history. He had an epithe1ioma of the left tonsillar lingual fold and was treated with x-ray by a well known American radiologist, a total of 3,540 r units being given in fourteen exposures, or about 250 r per treatment. This was supplemented by the insertion of ten radium seeds in the tonsillar pillar and fifteen seeds in the left side of the neck. The radiation produced a first-degree erythema and the tumor disappeared temporarily. The patient's point in making the report was that he suffered severe pain for eight months and even after that time was very uncomfortable. This letter set in motion a long correspondence in the same journal, some of the writers discoursing on the intense suffering which follows the application of heavy therapeutic doses of radiation; others denying unpleasant results if the treatments are properly administered. Some of those writing were physicians who had been treated; some were radiologists who protested that the radiation was given too rapidly; one, the well known surgeon of the Cancer Hospital in London, Mr. Cecil Rowntree, took a conservative position, and pointed out that a certain amount of pain follows radiation as it follows surgery. Finally, Sir Leonard Hill, the head of an institute for physical therapy, suggested that it would be for the good of mankind if the radium which is in possession of the British Government and has been concealed underground to avoid destruction by bombing were left and never again brought to light. This letter was widely publicized by the press in this country. The whole discussion was closed by the death of the original correspondent from his carcinoma of the tonsillar fold. There is a good deal of practical interest in such correspondence. It reveals first the fact that there is a great divergence of opinion as to the technical methods of handling radiation. It also calls attention to the fact that the current method of x-ray therapy with a fairly rapid rate of administration, with or without supplementary radium applications, may give rise to prolonged neuralgic disturbances over a long period, and it raises the question of the proper selection of patients for surgery or radiation. In addition it shows the necessity for frank discussion with the patient who is to be treated by radiation, of the possibilities of prolonged discomfort. The chief significance of this discussion is in connection with tumors of the oropharyngeal region, in which severe discomfort is much more likely to occur than, for example, after treatment of carcinoma of the cervix.

RADIATION PROTECTION IN FORTY-FIVE HOSPITALS

The increasing use of radiation in medicine, industry and research demands increased knowledge of radiation effects and protection methods. The authors visited forty-five hospitals of all types, ranging in size from forty-four to over three thousand beds (thirty-two have more than two hundred beds) and studied storage and handling of radium, calibration and shielding of roentgen therapy equipment and technics of use and shielding of roentgenographic and fluoroscopic units. Ionization chambers ranging in sensitivity from 0.25 roentgen to 100 roentgens full scale were used in making measurements. Estimates of average exposures were calculated from ionization measurements made during typical operations such as preparation of radium applicators and roentgenoscopic and roentgenographic procedures, multiplied by the average daily time spent performing such activities. Adequacy of equipment and practices were judged in most instances on the basis of recommendations for protection which have been published by various writers¹and those in the

Low-Voltage Contact Roentgen Therapy (Chaoul Therapy)

In 1931, proceeding on the assumption that it has never been demonstrated that the biological effect of radiation is dependent upon its wave length and that there is, on the contrary, a considerable weight of evidence against such a thesis, Chaoul and Adam began to investigate the possibility of using low-voltage radiation applied under conditions approximating those obtaining in the surface application of radium. Their motivation was, of course, the scarcity and high price of radium in Germany. Briefly stated, their thesis was this: It may be regarded as axiomatic that the effect of radiant energy depends, not on wave length, but on the total energy absorbed per cubic centimeter of tissue, and the time spacing or fractionation of that total energy. Holthusen has compared the results of irradiation of the skin with rays of a quality represented by a half value layer of 0.37 mm. Al, with the results of irradiation of the skin with gamma rays. With equal amounts of energy he found no qualitative or quantitative difference in erythema or epilation, and in another series of experiments he noted no difference in the effects on Ascaris eggs. Englemann has shown that with like amounts of radiation, the morphological changes observed in tumor cells were identical whether low-voltage x-rays or gamma rays were employed. The conditions which obtain in radium therapy (except teleradium therapy), and which it was sought to approximate, are; (1) a short distance between the surface and the source of radiation, (2) a consequent absorption of a large amount of the energy in the first few centimeters of tissue. To fulfill these conditions it was necessary to devise a special apparatus which was shock-proof, which had a very low inherent filter value, and which was so constructed that the anode-surface distance was very short. Furthermore, the radiation produced should be relatively soft, and the fields irradiated should be small. All of these conditions are met in the apparatus which we have employed, namely, the Philips Metalix Contact Therapy Unit (Fig. 1), operating at 50 kv. constant potential, with 2 ma. of current passing through the tube. The tube used is constructed with a metal sheath, is ray-proof, shock-proof, and has a high-tension connection only to the anode, the cathode side being grounded. It is cooled by an air blower. It is cylindrical in shape and measures 23.7 inches in length, with a diameter at its distal end of 1.18 inches. It is, therefore, easily introduced into body cavities and into surgical incisions. The radiation emerges axially, passing through a glass window and a protective cap of a plastic material having a total inherent filter value of 0.2 mm. Al. The anode-surface distance is 18 mm. The tube is usually used with a rubber covering, which adds 2 mm. to the distance, and if filters are employed the total anode-surface distance becomes 22 mm.

Inverse Square Law Errors in Gamma-ray Dose Measurements

A Characteristic feature of the radiation field of a radium applicator or implant is the high gradient of dosage perpendicular to the radium bearing surface. Parallel to that surface the dosage level is uniform within certain limits depending upon the arrangement of the radium sources. Any physical measurement of the γ-ray output of such a radium distribution therefore necessitates the use of a very small ionisation chamber, if the recorded ionisation is to give a measure of the dosage rate at the geometrical centre of the chamber. If the dimensions of the ionisation chamber are of the same order as the radium source distances, inverse square law errors may be expected to arise owing to the non-uniformity of the radiation intensity across the chamber. Condenser ionisation chambers commonly used for γ-ray measurements have dimensions of about one centimetre, or somewhat less, and in many dose measurements on moulds and implants radium source distances of this magnitude are involved. Some investigation has ...

A hard rubber plaque for anchoring and facilitating the removal of radium applications to the body of the uterus

A hard rubber plaque for anchoring and facilitating the removal of radium applications to the body of the uterus

The Treatment of Carcinoma of the Corpus Uteri

CARCINOMA of the corpus uteri is a serious disease, the prognosis of which is much more grave than one has been led to believe. Statistical evidence is gradually being accumulated to indicate that intra-uterine radium followed by hysterectomy and supplemented with x-ray therapy Yields better results than either method alone. However, the frequent finding of local vaginal and parametrial recurrences, the occasional finding of distant metastasis in moderately advanced cases, and the fact that the five-year cure rate is probably less than 50 per cent, indicate that there is still room for perfection of our treatment technic. Recognition of the necessity for improving the radium technic by developing a flexible and adaptable radium applicator which will more homogeneously irradiate uterine cavities of various sizes and shapes constitutes the radiation problem. It is the purpose of this presentation to describe a new radium applicator, called “hysterostat,” which attempts to meet the geometric requirements of ...

Radiation Therapy of Carcinoma of the Skin

THE purpose of this paper is to analyze all cases of epithelioma of the skin treated in this Hospital during the past two years, and to review the recent literature on the subject with the objective of determining the optimum technic for curing the largest number of skin carcinomas by the first series of treatments. It is readily seen that the proper treatment of carcinoma of the skin is an important consideration when one realizes there are about four thousand deaths annually in the United States attributed to carcinoma of the skin. It is an established fact that treatment by irradiation produces less scarring than any other method. Since most carcinomas of the skin are on the face, irradiation is the treatment of choice from the standpoint of cosmetic effect. Many people with carcinoma of the skin are reluctant to submit to surgical removal, but will submit to irradiation. The curability of these lesions by irradiation, taken as a whole, is estimated to be from 85 to 95 per cent. At least 85 per cent of all skin carcinomas, and at least 95 per cent of all curable skin carcinomas, can be cured by properly administered irradiation alone. It has long been known (first expressed by Bérgonie and Tribondeau in 1904) that immature cells and cells in the active stage of division are more sensitive to irradiation than are cells which have already acquired their adult or complete morphologic and physiologic characteristics. It is also known that the nucleus is the most sensitive part of the cell, and that the chromatin is the most vulnerable part of the nucleus. Basal cells, having a large amount of chromatin, are, therefore, relatively sensitive to irradiation. Since tumor cells grow more rapidly than normal cells, they are more sensitive to irradiation than are normal cells, and are, therefore, destroyed by smaller doses. The more rapidly growing a tumor is, the more radiosensitive it usually is. There are several exceptions to this rule. Certain malignant melanomas are highly undifferentiated and rapid in growth, but, nevertheless, highly radioresistant. Increased radiosensitivity does not necessarily mean greater radiocurability since the latter involves many other factors, such as metastasis and involvement of bone or cartilage. The more undifferentiated a tumor is, the more likely it is to metastasize early or to infiltrate deeply. Surface radium application, having a continued effect over a long period of time, is superior to x-ray because it is more likely to act on the cells during their active stage of division. It has, however, the disadvantage of rapid decrease in its depth dose, with the danger of not destroying the cells at the base of deep-seated or infiltrating lesions. The time required for radium treatments and the amount of radium available make its wide use impracticable in our Clinic, and these disadvantages probably hold for many other clinics in this country.

Radiation of Cancer of the Cervix

RADIUM element became a part of the therapeutic resources of the roentgen department of the Boston City Hospital in 1923. From that time until 1935, inclusive, a 13-year period, 289 patients with cancer of the cervix were seen in consultation with the gynecological service. Twenty-seven were judged unsuitable for any form of radiation therapy. Two hundred and sixty-two cases remain with history as to prodromal symptoms, physical findings, biopsy, radiation data, and follow-up believed adequate enough from which to deduce certain statistics and conclusions of value, at least intramurally. The average age was 50 years and nine months. The youngest patient was 21 and the oldest 82 years of age. Hemorrhage was the usual presenting symptom that brought the patient to the hospital, pain rarely. The average duration of the bleeding for the group was eight months. This would appear extraordinary if one did not reflect that women, especially of middle life, are apt to minimize the significance of this danger signal. The duration of the bleeding was not indicative of the stage of the disease. As often as not, recent hemorrhage, especially if massive, was found associated with advanced disease. In classifying the cases as to clinical stage of disease, the League of Nations (1) system was adopted and is as follows: Stage I. The growth is strictly limited to the cervix uteri. Uterus mobile. Stage II. Lesion spreading into one or more fornices with or without infiltration of the parametrium adjacent to the uterus, the uterus retaining some degree of mobility. Stage III. a. Nodular infiltration of the parametria on one or both sides extending to the wall of the pelvis, with limited mobility of the uterus or massive infiltration on one parametrium with fixation of the uterus. b. More or less superficial infiltration of a large part of the vagina, with a mobile uterus. c. Isolated metastases in the pelvic glands, with a relatively small primary growth. d. Isolated metastases in the lower part of the vagina. Generally speaking, all cases not falling into Stages II or IV will be placed under Stage III. Stage IV. a. Cases with massive infiltration of both parametria extending to the walls of the pelvis. b. Carcinoma involving the bladder or rectum. c. The whole vagina infiltrated (rigid vaginal passage), or one vaginal wall infiltrated along its whole length with fixation of the primary growth. d. Remote metastases. At a casual glance, this division of the stages of cancer of the cervix appears involved. Actually, in practice, it is simple and resolves itself into the clinical grouping of early, borderline, advanced, and palliative cases. Table I indicates the grouping of this series. Such a preponderance of hopeless material presenting itself may be ascribed partly, at least, to the social status of the entrants to a large municipal hospital. One hundred and eight received a single radium application prior to transfer to home or a cancer retreat.

The combustion gas turbine

Between August 1968 and May 1976 at the Tufts-New England Medical Center, Boston, Massachusetts, 264 patients with carcinoma of the cervix on intact uteri were treated with external irradiation followed by one radium application. Of these patients, 78 presented with Stage 1,126 with Stage II, 51 with Stage III, and 9 with Stage IV disease. In a majority of patients, external irradiation was given with 60Co when AP diameter was less than 17 cm, and with a 46 MeV Brown-Boveri Betatron when AP diameter was greater than 17 cm. A whole pelvic dose of 4000 rad was given for tumors smaller than 5 cm in size and 4500 rad for those larger than 5 cm. A dose was then given to the pelvic wall using 4 cm or 5 cm midline blocks. In Stage I disease, tumors of less than 2 cm received no pelvic wall irradiation and tumors greater than 2 cm and Stage HA patients received 1000 rad to both pelvic walls. In Stage IIB and IIIA disease, a dose of 1000 rad was given to the uninvolved pelvic wall and 1500 rad to the involved site. In Stage IIIB disease, after giving 1500 rad to the involved parametria, an additional 500 rad was given with a reduced field to the area of gross tumor in the parametrium. All patients had one radium application for 72 hr 7–14 days after completion of all external irradiation. There were no pelvic failures in Stage I patients, 856 in Stage IIA, 10/70 in Stage IIB, and 1752 in Stage III. The 5 year no evidence of disease (NED) actuarial survival was 100% in early Stage III (less than 1 cm), 90% in Stage III (greater than 1 cm), 79% in Stage IIA, 58% in Stage IIB, 42% in Stage III and 23% in Stage IV. There was no difference in survival or complications between patients who had tandem and colpostats and those who had protruding tandem.

A New Technique and Dosage System for Gamma Ray Therapy in Surface Application of Radium

A New Technique and Dosage System for Gamma Ray Therapy in Surface Application of Radium

A New Technique and Dosage System for Gamma Ray Therapy in Surface Application of Radium

A New Technique and Dosage System for Gamma Ray Therapy in Surface Application of Radium