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Cataloged from PDF version of article. The purpose of this study was to demonstrate the use of a transrectal system that enables precise magnetic resonance (MR) image guidance and monitoring of prostate interventions. The system used a closed-bore 1.5-T MR imaging unit and enables one to take advantage of the higher signal-to-noise ratio achieved with traditional magnet designs, which is crucial for accurate targeting and monitoring of prostate interventions. In the first of the four canine studies, reliable needle placement, with all needles placed within 2 mm of the desired target site, was achieved. In two other studies, MR imaging was used to monitor distribution of injected contrast agent solution (gadopentetate dimeglumine mixed with trypan blue dye) in and around the prostate, thereby confirming that solution had been delivered to the desired tissue and also detecting faulty injections. In the final study, accurate placement and MR imaging of brachytherapy seeds in the prostate were demonstrated. The described system provides a flexible platform for a variety of minimally invasive MR image-guided therapeutic and diagnostic prostate interventions.

Among the areas defined by the National Cancer Institute as "Extraordinary Opportunities for Research Investment" that are highly relevant to the technology-oriented disciplines within the broad field of radiology are cancer imaging, defining the signatures (ie, underlying molecular features) of cancer cells, and molecular targets of prevention and treatment. In molecular target credentialing, a specific molecular target is imaged, the molecular signature is defined, a treatment is given, and the effect of the intervention on the image findings and the signature is then evaluated. Such an approach is used to validate the proposed target as a legitimate one for cancer therapy or prevention and to provide the opportunity to ultimately individualize therapy on the basis of both the initial characteristics of the tumor and the tumor's response to an intervention. Therapeutic radiation is focused biology (ie, radiation produces molecular events in the irradiated tissue). Radiation can (a) kill cancer cells by itself, (b) be combined with cytotoxic or cytostatic drugs, and (c) serve to initiate radiation-inducible molecular targets that are amenable to treatment with drugs and/or biologic therapies. Focused biology can be anatomically confined with various types of external beams and with brachytherapy, and it can be used systemically with targeted radioisotopes. These new paradigms link diagnostic imaging, radiation therapy, and nuclear medicine in unique ways by way of basic biology. It is timely to develop new collaborative research, training, and education agendas by building on one another's expertise and adopting new fields of microtechnology, nanotechnology, and mathematical analysis and optimization.

Six departments of radiology and six departments of radiation oncology from areas with low, medium, or high managed care penetration were asked to complete a questionnaire designed to address the impact of managed care on research and scholarly activity. Information, when available, was taken from fiscal years 1993 and 1998. Questionnaires were followed by site visits to the 12 departments. The study showed that departments with medium to high managed care penetration reported more dissatisfaction in their ability to remain active in their education and research goals. Results indicated that for the period surveyed, the departments needed to increase clinical time to make up for decreasing patient care revenues. In turn, this has reduced the time and money devoted to scholarly activities. Information from this study will be used to develop a trends database for all U.S. radiology and radiation oncology departments. This, together with a more comprehensive study by the RSNA, will assist in measuring the current and potential long-term impact of managed care and other system changes on the practice of radiology and radiation oncology.

Medical physics has changed dramatically since 1895. There was a period of slow evolutionary change during the first 70 years after Roentgen’s discovery of x rays. With the advent of the computer, however, both diagnostic and therapeutic radiology have undergone rapid growth and changes. Technologic advances such as computed tomography and magnetic resonance imaging in diagnostic imaging and three-dimensional treatment planning systems, stereotactic radiosurgery, and intensity modulated radiation therapy in radiation oncology have resulted in substantial changes in medical physics. These advances have improved diagnostic imaging and radiation therapy while expanding the need for better educated and experienced medical physics staff.

Between 1960 and 1971, 137 children with inoperable or partially resectable brain tumors were treated in the Division of Therapeutic Radiology at Duke University. The treatment approach to each major type of tumor is discussed, including radiotherapy techniques and time-dose relationships. Results are presented with regard to survival time, complications of radiation, symptomatic relief and quality of survival. Particular emphasis is placed on the question of retreatment and tolerance of the brain to irradiation.

IT is not uncommon to see a brilliant local response to radium therapy of primary carcinomatous lesions of the female external genito-urinary organs. This observation prompted a review of the total number of these cases seen in the Section on Therapeutic Radiology of The Mayo Clinic. The study includes all patients with the conditions under consideration, who were treated from 1915 to 1929, inclusive, a total of 95. Radium therapy was first employed at The Mayo Clinic for carcinoma of the vulva in 1915. Rentschler, of the Clinic, reported a similar study recently. In his review he included only cases seen on the surgical service between 1907 and 1927. The present report includes 38 cases studied by Rentschler. This number was referred to the Section on Therapeutic Radiology from the surgical service. The incidence of carcinoma involving the external female genitalia has been recorded by various authors. Schwarz gave the incidence as 1.38; Virchow reported 1.35 or 1.40; Gurlt gave the incidence of 1.48; Ta...

In 1939 Desjardins, McCullough, and one of us (Leddy) reported some results of the roentgen treatment of patients suffering from primary inoperable carcinoma of the breast. One of the most distressing features encountered in the group of cases on which that series was based was the high incidence of ulceration and its associated inconvenience and embarrassment to the patient. In the 1939 report there were 67 instances of ulceration among the 212 cases reported. In nineteen of them the ulcers had healed for a time after suitable roentgen therapy. The palliative results reported in the earlier paper prompted us to approach the problem of ulcerated carcinoma of the breast from a slightly different point of view. From 1925 to 1940, inclusive, 98 patients suffering from primary inoperable ulcerating carcinoma of the breast were treated in the Section on Therapeutic Radiology at the Mayo Clinic. Included in this group were both patients who had had no previous treatment at all and those whose treatment had not ...

Changes in the crystalline lens of the human eye incident to absorption of ionizing radiation have been the subject of increasing interest and concern. Although these have been described as “fairly characteristic in the early stages” (2), many etiological exceptions have been noted (1, 2). Sinskey (4) stated that the earliest changes of “posterior subcapsular plaques are a relatively nonspecific type of reaction by the lens to injury.” Such minimal changes, recognized only with slit-lamp biomicroscopy, may be followed by progressive development of a bivalve opacity, later appearance of flocculent cortical opacities (1), and eventual diffuse, dense opacification, indistinguishable from cataracts of any etiology. Although there have been exhaustive experimental studies in animals, there is limited knowledge of radiation-produced change in man's crystalline lens. Information pertinent to the human has been obtained from reconstructed situations, particularly that of total-body irradiation of the Japanese fro...

IN this paper, the term “inoperable carcinoma,” applying throughout to carcinoma of the breast, will include ulcerated carcinoma, carcinoma fixed to the thoracic wall, carcinoma with widespread cutaneous metastatis, carcinoma which could be extirpated surgically but accompanied by involvement of supraclavicular nodes, carcinoma with extensive involvement of axillary and supraclavicular nodes, carcinoma with osseous or visceral metastasis irrespective of nodal involvement, and carcinoma in the presence of such poor physical condition, due to complicating organic disease, that the risk of operation would be too great. The study concerns 41 patients treated in the Section on Therapeutic Radiology at the Mayo Clinic in the years 1925 to 1929, inclusive. Obviously, treatment in advanced stages of carcinoma of this type has little to offer in the way of cure. For this reason, radical surgical and radiologic treatments are not justified, even though they may give brilliant and unexpected results in a small perce...

Sweden has at present a population of 7.5 million. Just under 2 million live in the sparsely populated northern two-thirds of the country. The other 5.5 million occupy the industrialized third in the south. There are five medical faculties: in Stockholm, Uppsala, Lund, Gothenburg, and Umea. The Last Decade of the Nineteenth Century The question as to who should receive the honor of being the first to have achieved a cure in cancer has been contended, but there seems to be justification for saying that it should go to two Swedes, Tor Stenbeck and Tage SjO gren, both of them general practitioners in Stockholm. On July 4, 1899, Stenbeck began to use roentgen therapy in a woman of forty-nine with basal-cell cancer on the nose. After a total of ninety-nine treatments over a period of several months, the patient was permanently cured. She was presented before a meeting of the Swedish Society of Medicine on Dec. 19 of the same year and was also shown to the members at the Second International Congress of Radiolo...

UV and β radiations have been used separately and in combination on human and rabbit skin. The responses are complex and highly dose-dependent. UV reduces injury at certain levels of β dose while increasing injury at other levels. The observations are in accord with the hypothesis that mammalian cells have a “triggered” or “induced” repair system. The activation of the triggered system requires a threshold level of radiation dose. A radiation-induced repair system is undoubtedly significant for therapeutic radiology.

Proliferation kinetics of normal and tumor cells are reviewed and related to steady-state tissues and tumor growth, and the relationship between these factors and the radiotherapeutic response of tumors is considered. The radiotherapist should be familiar with the substantial changes in normal tissue response which result from relatively small changes in daily dose fractions.

The CORADS project is an answer to the need for more accurate and complete data concerning treatment of radiation therapy patients. Compendiums of information are needed for research, but obtaining them from traditional medical records is an increasing problem. The overall goal of the CORADS project is to collect data in an innovative fashion and to provide them in a reorganized and integrated format when requested.

The accurate localization of intracranial neoplasms as well as a simple assessment of tumor response are essential to modern therapeutic radiology. Until recently the radiotherapist had no satisfactory diagnostic aid for exact portal placement in the treatment of single or multiple intracranial neoplasms, or for the re-treatment of recurrent or persistent brain tumors. Conventional as well as special roentgenographic studies are frequently inconclusive and do not permit exact tumor localization before treatment. The extent of a neoplasm may be equally difficult to ascertain at the time of craniotomy. The advent of brain scanning has aided considerably not only in the diagnosis but also, and perhaps more importantly, in the localization of intracranial neoplasia (1). The purpose of this communication is to report our experience with the brain scan in the planning and follow-up of cranial radiotherapy. Clinical Material Seventy patients given radiotherapy for proved intracranial neoplasms had scans performe...

A versatile and easily used whole body repositioning system is described. It may be quickly and inexpensively constructed. The system has been found to be particularly helpful in the extended field treatment of Hodgkin disease, head and neck treatments, and in tumors of the abdomen and pelvis.

During the last 10 years or so, many departments of therapeutic radiology have lost their medical and fiscal independence by administrative incorporation into “departments of oncology.” The author feels that the aims of oncology centers, viz., consolidation of cancer-related activities, promotion of the image of a functioning cancer center, and the multidiscipline care of cancer patients, do not justify the radiotherapist's loss of identity within such a complex.

The 1972 biannual survey of the author reveals a notable increase of residents-in-training in the field of exclusive therapeutic radiology. The present annual output of 50 radiotherapists barely fills the presently increasing demands.

The authors outline present and future uses of digital computers in therapeutic radiology. It is emphasized that ease of use is a primary requisite for the successful computerization of a procedure and its implementation. Some precautionary statements are presented on the use of computer programs in therapeutic radiology.

A lease contract for radiologic equipment may be structured to require a standard of installation and continued maintenance acceptable to the radiologist. To accomplish this goal the equipment company should provide total installation and maintenance. Other desirable provisions include relative uniformity of equipment brand and full-time service men. The responsibilities of the equipment company and the hospital must be clarified in detail.

At a workshop sponsored by the NIH Radiation Study Section it was agreed that the present rationale for the trial of high-LET radiations is that they may give a better differential effect between normal and malignant tissue than low-LET radiations because of the oxygen effect. In addition, some beams of high-LET radiations have unique and advantageous depth-dose distributions. Machines for delivering the radiations are now scarce and expensive, but it appears that specialized therapy facilities could be produced at acceptable cost. There are no contraindications to clinical trials.

An increased utilization of radiation therapy techniques resulting from their demonstrated effectiveness has been accompanied by a decrease in numbers of radiotherapists, radiation physicists, radiation therapy technologists, and radiation biologists. Encouragement should be given to centralization of radiation therapy facilities, to systems for education and training of allied health personnel, the separation of diagnostic and therapy training programs, the development of radiation therapy programs in medical schools with radiation oncologists responsible for the delivery of radiation therapy to every cancer patient. Continuing educational programs should be developed for the practicing physician, the general radiologist, and the radiation oncologist.

Of the several specialties comprising medicine, radiology is perhaps the most closely linked to the principles and methods of physics. Starting with Wilhelm Conrad Roentgen, who founded radiology little more than half a century ago (12), physicists have continued to contribute to the development of what has evolved into contemporary radiology and its subspecialties, diagnostic and therapeutic radiology, nuclear medicine, and radiobiology. Progress in radiology continues to depend on physics, probably even more today, in view of some of the profound advances characterizing modern physics. It is our contention that significant opportunities exist for enhancing the contributions and the productivity of medical physicists. These include improving pre-medical preparation in physics and mathematics, enriching the teaching program in physics for radiology residents, upgrading medical physics itself, and ameliorating the climate in which physicists function in our medical centers. a. Physics and Mathematics as P...

The author reports on the use of the Amster grid test to document and quantitate the results of radiation therapy. The test can be done by the patient at home and requires him to indicate on a piece of graph paper which lines appear distorted as he looks at the centered dot in the grid. It is rapid, inexpensive, and allows the therapist to compare various regimens and dosage schedules.

Delayed hypersensitivity to dinitrochlorobenzene (DNCB) was tested prior to radiation therapy in 206 patients with solid tumors. The patients were separated into a DNCB-positive group who showed a significant response to DNCB and a DNCB-negative group who did not. After one year, it was found that patients with a positive DNCB reaction had a statistically better chance of survival than those with a negative DNCB reaction. Although this is not proof that DNCB testing can indicate those patients who should be excluded from radical therapy, it can help identify those who may respond favorably to extended efforts at palliation or cure despite clinically advanced disease.

The implementation of an oncologic diagnostic radiology subspecialty would provide better communication between the radiologist and the clinician and a greater opportunity to teach the general principles of therapeutic radiology. Practical aspects of the development of a section in oncologic radiology are discussed.

There are old methods to be improved, new skills to be acquired, and new ideas which excite our curiosity and imagination. Provision of these has been the intent of the Program Committee arranging the Forty-Ninth Annual Meeting of The Radiological Society of North America. Sunday, Nov. 17, is a small radiological fair in itself. In the afternoon the panel, Refresher Course on Therapeutic Radiology, will be given; in the evening the popular session on film interpretation will again be presented. Also on Sunday a panel of the American College of Radiology will supply information and wisdom in the realm of economics. Monday afternoon sees the opening of the Scientific Sessions. Dr. Kurt Amplatz has been selected to present the Memorial Fund Lecture. Also at this general session Dr. Reynold F. Brown, one of our representatives on NCRP, will present his views of the developments in radiation control in 1963 and a projection of what 1964 may bring. One scarcely needs mention that this subject is important to us...

In their institution, the authors have established a specific diagnostic oncology subspecialty section in order to consolidate the roentgen aspects of teaching, research, and patient care in study of patients with neoplastic disease. This service is responsible for all arteriographic and venographic studies on patients with known or suspected neoplasms (excluding neuroradiology), lymphangiography, laryngography, percutaneous lung aspiration biopsy, chest tomography, bronchography, and mammography. It is also responsible for all x-ray examinations on patients with cancer being treated according to the various investigative clinical protocols. The diagnostic staff also participates in the weekly hospital Tumor Board and in radiotherapy work conferences concerned with patient care.

In considering the geographic location of the increasing numbers of radiotherapists who are expected to augment the present number, the author recommends centralization of radiotherapy in centers with perhaps a minimum of 1,000 new patients a year. In this way equipment and personnel may be used most efficiently. Advantages would accrue from the controlled studies that individual centers would be able to establish intramurally. With exposure to a large volume of patient material, the specialist would receive continuing experience or retraining. Finally, it is suggested that the present “shortage” in radiotherapy manpower may mean only a shortage in technologists.

In this issue of Radiology there appears an article by Kenneth R. McCormack, M.D., entitled, “Training in Nuclear Medicine for Radiology Residents.” The purpose of this editorial is to state personal views on some of the opinions which he expresses. The American Board of Radiology made Nuclear Medicine a mandatory part of its examination in 1962. At the same time, it made three months training or the equivalent thereof in the field a required part of the three-year training program in Radiology. This division of time in the training program was decided upon after much discussion and thought as a basic minimum. During the three-year program, the resident must have training in Diagnostic Roentgenology in its many aspects, including the various special procedures; in Therapeutic Radiology; in Radiation Physics; in Radiobiology; and in Nuclear Medicine. Training in Nuclear Medicine is usually given during the required twelve months of therapeutic radiology but may be allocated to either Diagnostic Radiology o...

Problems arising with the use of posterior fields can be solved by the unde0072-couch technique. Treatment couches with a large window covered with transparent Mylar polyester (D) film can support the patient and do not interfere with the supervoltage beam.

The Spring 1960 examination by the American Board of Radiology will be held at the Terrace Hilton Hotel, Cincinnati, Ohio, June 6-10. The deadline for filing applications was Jan. 1, 1960. The Fall 1960 examination will also be held in Cincinnati, Dec. 5-9. The deadline for filing applications is July 1, 1960. A Special Examination in Nuclear Medicine for those diplomates in Radiology or Therapeutic Radiology will be offered, provided there are sufficient applications.

Emphasis on change in undergraduate curriculum has resulted in a general awareness of the modifications. Within the specialty of radiology, less generally recognized nontraditional concepts are being developed. The requirements established by the American Board of Radiology in 1934 have in part determined the distribution of time for resident training. The requirement, since 1957, for certification in Diagnostic Radiology or Therapeutic Radiology has further directed residency programs. The introduction of a four-year program in general radiology or an optional three-year training program in either diagnosis or therapy enabled residents to determine the viability of any of these programs by selection. The residents are in a position therefore to affect future training programs of a given institution. In 1969 the American Association of Academic Chief Residents of Radiology was created. Its first annual symposium in Berkeley, Calif., permitted an interchange of opinions and experience among advanced reside...