William H. Meyer

Heat as a Sensitizing Agent in Radiation Therapy of Neoplastic Diseases1

Part I—Introduction THE relatively greater sensitivity of certain types of neoplasms, as compared with the neighboring normal tissue, is undoubtedly an all-important factor in the successful treatment of certain malignant diseases. The regression obtained by means of radiation therapy in practically all of the various types of lymphomas is, of course, ascribable to the relatively greater radiosensitivity of these lesions, and, therefore, the dosage can be kept well below that which might result in serious damage to normal tissue. The difficulty arises when a given pathologic process is resistant to radiation therapy with a sensitivity approaching that of neighboring normal tissue. Unfortunately, the latter is all too often true in most of the adult types of carcinoma. Of the different methods suggested to increase the sensitivity of the more radioresistant types of neoplasm, the thought has occurred to the writers that heat might be employed as a simple and practical sensitizing agent. In reviewing the li...

Quality Determination of the Roentgen Rays

THE need of establishing some universally satisfactory and comprehensible method of quality designation of roentgen rays still exists. Though extreme accuracy may not be attainable, nevertheless some method should be adopted which is easily comprehensible and sufficiently simple of execution to be practically applicable by the average medical roentgenologist. The method should not only avoid complexities of procedure, but should be sufficiently simple of quotation as to be readily communicable. My effort, therefore, will in the main be an attempt to determine, by exclusion, the most satisfactory of the present-day methods. In selecting a standard for quality measurement, it should be remembered that the problem is not limited to high voltage therapy only, but that a vast number of machines are being operated at medium low voltages, with little or no filtration, especially in superficial therapy, and that qualitative standardization is also required in radiography. Any qualitative method of determination t...

Erythema Doses in Absolute Units1

OF all the various methods of determining the quantity and quality of the roentgen rays, the consensus of opinion to date would suggest that ionization in air. The first to propose such a unit, the so-called electrostatic unit, was the French physician Villard (1), as early as 1908. He defined as a quantimetric unit, that quantity of radiation that produces one electrostatic unit per cubic centimeter of air under normal conditions of pressure and temperature. From a scientific point of view the best definition of this unit was given by Behnken (2), in 1924, basing it on the valuable work of Friedrich (3), Duane (4) and Holthusen (5), as well as on his own investigations. Friedrich had already improved upon Villards definition in 1918, Duane publishing along similar lines at about the same time. Behnken defines the unit as follows: The absolute unit of the roentgen-ray dose is obtained from that roentgen-ray energy, which, by fully utilizing the secondary electrons and by avoiding secondary radiation from...

The Relation of Air Ionization to Radiation Absorbed and the Effect on Body Tissues

AS Dr. Taylor has announced, this is a volunteer contribution to replace some of the absentees on the program. The detail of my subject matter is not at hand but in New York. The presentation is, therefore, extemporaneous, with a further apology for the hastily prepared slide of the chart. This difficulty will be remedied in the final publication. Physicists have done much to give us standards of quantitative and qualitative measurements. There remains considerable doubt and controversy, with uncertainty in the linking of the physical dose measurement with observed skin reaction and biologic effect. Until some definite relation between physical quantitative and qualitative radiation measurements and skin and biological reaction is established present-day standardization remains but an arbitrary estimate of radiant energy or tube output. For more than twenty years we have continued our study of these problems, and in an article published as early as 1920 (1) I recorded my impressions on the relation of ski...

The Importance of Roentgen Gastric Functional Study in the Differential Diagnosis of Pyloric Lesions1

Preliminary BEFORE proceeding with a discussion of the material at hand I should like to present ten illustrations selected from the 101 cases in which operation and biopsy follow-up were obtained, and ask you to tax your imaginations and personal diagnostic abilities before noting the pathologic conclusions. Figure 1 The odd case in Figure 1, labeled No. 101 (not one of the pyloric series), which is obviously a neoplastic invasion of the pars cardia, was that of a young girl, aged 16 years. The pathologic interpretation is that of a congenital mesenchymatous tumor. Case 2 (Fig. 1), which shows extensive neoplastic invasion of the pars pylorica, is pathologically reported as a Krukenberg tumor and metastatic carcinoma of the ovary. Case 3 (Fig. 1), which in its radiologic aspect is somewhat similar to Case 2, is pathologically labeled lymphoblastoma (probable Hodgkins disease). Case 4 (Fig. 1) shows extensive gastric wall infiltration with several niches. The pathologic report is that of primary sarcoma ...

Depth Dose Calculation

A former publication (1) has aroused sufficient interest to bring forth inquiries as to how the qualitative data there illustrated may be applied in the calculation of depth dosage, the author having advanced this method of depth dose calculation in preference to the various intensities indicated on isodose charts or the still less useful percentage depth dose at the 10th centimeter. There is perhaps no gainsaying the fact that through any single portal the maximum absorption is always in the more superficial layers. Furthermore, the lower the voltage and weaker the filtration, the greater is the absorption, with the most intense biological effect in the superficial layers. When, therefore, in the treatment of superficial lesions a maximum radiation effect is desired, with the least damage to deeper lying tissues and a minimum exit dose, lower voltage and weaker filtration are the choice.2 To follow the same line of thought with regard to subcutaneous and more deeply seated lesions, the most logical metho...

Further Studies on the Influence of Radiation Quality on the Erythema Dose Measured in Physical Units1

IN a paper entitled “Erythema Doses in Absolute Units” (1), presented at the last Annual Meeting of this Society in Cleveland, we called attention to the fact that the roentgen-ray doses, measured in ionization units, which produce similar reactions on the human skin, are to a marked degree dependent upon the radiation quality employed. At that time we also described our method of skin dose estimation as well as the method of physical dose determination; these shall, therefore, not be dealt with again in this paper, since they have remained the same as formerly described. It should be recalled that our erythema reaction is always accompanied by epilation, which fact was not especially stressed in our former communication on the subject though the erythema dose as here calculated is practically 20 per cent over the epilation dose used in tinea capitis. Most of our doses have repeatedly been transferred to other therapy installations (40 within the last year, in addition to the 70 reported at the Cleveland ...