Cyprian B. Reid

The Survival of Patients with Inoperable Lung Cancer: A Large-Scale Randomized Study of Radiation Therapy Versus Placebo

The death toll from lung cancer, particularly for the American male in the prime of life, is beginning to approach the dimensions of a national calamity. This year we may expect 55,000 new cases and 50,000 deaths, of which 42,000 will be in males and 8,000 in females (1). Lung cancer is already responsible for 1 out of 4 deaths from cancer in men. It is imperative, therefore, that a dependable assessment be made of the patients outlook for survival according to the stage of the disease and the therapeutic modality employed. Guide lines for such an assessment may be drawn from retrospective long-range survival studies in a single institution or center. More dependable answers can be derived from planned, prospective large-scale studies involving many patients, strict randomization with concurrent controls, and strong biostatistical support. In the hospital system of the Veterans Administration (VA), which supports 170,000 beds, nearly all the patients are males, and a large percentage are cigarette smoker...

RADIATION EXPOSURE TO PERSONNEL DURING CARDIAC CATHETERIZATION. A PRELIMINARY STUDY.

The authors studied the radiation exposure to personnel in the examining room during a complete cardiac catheterization procedure. Commercial film badges and thermoluminescent LiF wafers were worn at several anatomical sites. Data on the examining physician alone indicate an exposure of 50 mrems to the trunk area during a complete cardiac procedure. Exposure levels for 2 attending physicians, a nurse, and a technician are also given.

IN VIVO RADIATION DOSIMETRY. REVIEW OF A 12-YEAR EXPERIENCE.

Abstract The authors describe the design and development of systems for direct in vivo measurement of dose within the living subject. They have used the method since 1957 for therapy, diagnosis, nuclear medicine, and radio-biology. The systems include home-grown and commercial luminescent solid state dosimeters of various types and geometries, read-out instrumentation, and a methodology for implantation and removal of dosimeters in virtually every body organ and tissue in living patients and animals.

The Use of Radiothermoluminescent Dosimeters in the Field of Diagnostic Radiology

Our investigation deals only with the applicability of synthetic CaF2:Mn, lithium fluoride, calcium sulfate, and preliminary work with lithium borate to medical and radiobiological dosimetry. In order to protect radiothermoluminescent phosphors from ambient atmospheric gases which may cause spurious thermoluminescence and to reduce the possibility of tribothermoluminescence, a protective carrier was developed. In an earlier report (1), radiothermoluminescent dosimeters were employed which were permanently encapsulated, following an out-gassing and flushing procedure with inert gas as specified by Schulman (2, 3). Accordingly, calcium fluoride, lithium fluoride, lithium borate, and calcium sulfate phosphors were encapsulated and outgassed. Some of these dosimeters were stimulated by conduction heating; that is, they were placed upon a platinum heating strip through which direct current was passed for thirty seconds. Due to the varying spectral response of each of the phosphors investigated, several separat...

A Critical Survey of Radiation Dosimeters for In-Vivo Dosimetry During Clinical and Experimental Radiotherapy

The principal interest of our investigative group is in the development of effective in-vivo dosimetry systems for use in the living organism during clinical and experimental radiation therapy. Such tools are essential to a better understanding of the impact of therapeutic ionizing radiation upon the structure and function of living human tissues, malignant and benign. Measurements in vivo will be far more meaningful in the management of the individual cancer patient than mass dosage data derived from calculations and from phantoms. Further, treatment planning, time-dose formulae, tissue tolerance guides, bolus technics, inhomogeneity correction values, etc., may be materially improved by in-vivo measurements, enhancing the patients chance for cure and diminishing the risk of serious complications. With this objective, we undertook initially an orderly, systematic, and critical survey of existing dosimeters (Table I). We have prepared a panel of “ideal” criteria or specifications which we consider essent...

In-Vivo Dosimetry with Miniature Glass Rods

A glass rod microdosimeter (1 × 6 mm.), utilizing the concept of radiophotoluminescence (1), is being used for human in vivo measurements in all modes of radiation therapy. Due to its miniature size and integrating ability, it is an ideal dosimeter for medical use (2). The undesirable feature of energy dependence in the range of 200 kev to 1.3 Mev is being corrected by a suitable gold shield designed by the authors (3). A fluorimeter electronic reader, with modifications designed by the U. S. Naval Research Laboratory, assures reproducible and stable results. In human subjects with cancer, the miniature dosimeters were placed with ease in the pharynx, the esophagus, the bladder, and other deep organs. Technics were devised to introduce these units directly into tumors and normal body tissues. In all the clinical experiments, there was a remarkable degree of correlation between the dosimeter reading and the calculated dose when beam irradiation (260 kv, 1000 kv, cobalt 60), radium implants, or isotope ther...

An “Ideal” in Vivo Dosimetry System for Clinical and Experimental Radiation Therapy

This is a progress report on the development of an “ideal” in vivo dosimetry system for both experimental and routine clinical use in radiation therapy of cancer. During rigorous clinical studies this system has thus far proved to be unusually dependable, practical, versatile, and economical to operate. It has been applied in nearly every anatomical structure in living subjects. Further, it is promptly available for general application in clinical practice. The basic dosimeter consists of a tiny photoluminescent glass rod (1 × 6 mm.) encased in a miniature gold cartridge which we designed (1.6 × 10 mm.), with a removable screw-cap. Placed within or upon the body and exposed during radiation therapy, the glass rod may be removed at any time and “read” in a chamber which may be easily constructed or purchased from the commercial source which now supplies the glass rods. Unlike other dosimeters, “reading” does not discharge the unit and it may be replaced in the body for cumulative dose recording as high as ...

A Cranial Immobilization Device for Use in Roentgen Therapy

In roentgen therapy of radiocurable cancer, there can be no excuse for a “geometric miss” caused by ineffective immobilization of the involved body part during the treatment period. The risk is greatest in mobile structures such as the head and neck, where malignant lesions are relatively small and often lie perilously close to such important normal structures as the eyes, brain stem, spinal cord, and mandible. In supervoltage and rotational therapy, with longer target-skin distance and more radical tumor dosage, the hazard of a “geometric miss” is aggravated. The success of rotational therapy, in particular, depends critically upon the absolute fixation of the tumor site within the axis of rotation throughout the period of irradiation. There appears to be no commercially available apparatus which provides effective cranial immobilization under all treatment conditions, and especially for rotational technics. A device fulfilling these requirements was designed and fabricated in our Mold Room at moderate e...

A preliminary study of thermoluminescent dosimetry.

A miniature solid state dosimeter based on the phenomenon of thermoluminescence (1) is presently being investigated in our laboratory for introduction into an in vivo dosimetry system, previously described by the authors (1, 3, 4). The radiation-sensitive element is a manganese-activated calcium fluoride phosphor. Development of this phosphor was carried on at the U. S. Naval Research Laboratory by Schulman et al. (2). The dosimeter we are using is in the form of a needle, 10 mm. long and less than 1 mm. in outside diameter. It is sealed within a glass tube and read by heating at a constant rate. Heating liberates electrons which were trapped during irradiation, and these electrons attempt to return to their ground state by emitting energy in the form of blue-green light. A graph of fluorescent intensity vs. time, generated at a constant heating rate, is called a “glow curve.” Either the area under the glow curve, or its peak, may be used to read the dosimeters; we prefer to use the former. This area may ...

The use of photocells for determination of patient movement during roentgen therapy.

In roentgen therapy, it is imperative that the anatomical part harboring the lesion be completely immobilized during exposure to the beam. Particularly is this so in radical therapy of radiocurable cancer. A method for maintaining a graphic record of the patients movements, if any, and for continuous surveillance during x-ray therapy would be most desirable. The reliability of immobilization technics, the accuracy of beam direction, and the patients co-operation may thus be permanently recorded and carefully evaluated. We have designed and adopted a simple, effective, and relatively inexpensive system for this purpose, utilizing a miniature photocell, a light pipe, and a graphic recorder (Fig. 1). Miniature photocells are mounted on a plaster bandage treatment shell on the patients body at any two selected points at 90° to each other (Fig. 2). A light source is placed in close proximity to each photocell. Dual strip chart recorders are employed to plot the slightest displacement of the two selected ref...