The 1890’s highlighted an important era in the development of medical practice; several significant discoveries were made which were to change the course of medicine forever:

Early Therapeutic X-Ray Application

The first reported ‘cure’ of cancer was documented in literature in 1899 when a basal cell epithelioma (now referred to as a basal cell carcinoma or BCC) was treated by the application of radiation via a radium source to the skin. This instigated the evolution of radiation therapy as a treatment modality for cancer.

In the early days treatment was delivered with little understanding or knowledge of the physical nature and biological effects of radiation; there were no methods of calculating the dosage and equipment was cumbersome and unwieldy. Additionally, as the equipment could only deliver low energy therapeutic X-Rays only tumours arising in superficial tissue layers could be treated, usually in one single session and over a large area of the body, in the hope that the tumour would be destroyed. As a consequence there were many reported complications arising from the treatment; literature from this period documents numerous examples of effects resulting in destruction of normal tissue such as necrosis, infection and even death. Unsurprisingly, the rate of recurrence following these early treatments was high.

By the late 1920’s this treatment modality had somewhat evolved, enabling a better understanding of the nature of radiation and its biological effects which, in turn, led to the introduction of fractionated treatment schedules and the concept of the use of dosage units, although even during this stage radiation dose was often monitored according to the patients skin reaction. As the correlation between dose and biological effects were realised treatment schedules were developed and refined, however treatment was still only used to treat malignant and benign skin lesions and only with palliative intent.

Developments in the type and nature of the equipment provided significant technological advances. The introduction of the vacuum X-Ray tube allowed the production of X-Ray energies up to 200 kV which highlighted a major breakthrough in the application of radiation for therapeutic purposes. For the first time in its history radiation therapy had the capacity to cure superficial skin tumours, without the associated complications previously observed.

The development of teletherapy equipment and the subsequent Linear Accelerator, in the 1940’s, enabled the production of much higher energy therapeutic X-Rays which allowed deep seated tumours to be treated and with the reduction of severe skin reactions, as the maximum dose now occurred below the skin surface.

However, the use of low energy therapeutic X-Rays remained the treatment of choice when treating lesions at shallow depths, due to the physics of low energy X-Rays and the relatively low cost, simplicity and low maintenance requirements of the equipment.
Following a period of development throughout the 1990’s, superficial and orthovoltage machines have undergone several advances which include the addition of integrated dosimetry, a record and verify system and the ability to network the machines with other departmental patient information systems. Such advances have ensured that, today, Kilovoltage X-Ray equipment maintains an integral role in the modern radiotherapy department for the treatment of both malignant and benign conditions.

Radiotherapy Nurse Positioning Xstrahl 200 on a Patient (Source: Xstrahl.com)
Radiotherapy Nurse Positioning Xstrahl 200 on a Patient (Source: Xstrahl.com)

Background

In 1895 Röntgen first discovered X-Rays whilst working in his laboratory, experimenting with a Crookes tube; a glass bulb with positive and negative electrodes, evacuated of air, which displayed a fluorescent glow when a high voltage current was passed though it. On shielding the tube with heavy black cardboard, he found that a greenish fluorescent light could be seen from a platinobaium screen nine feet away. He concluded that a new type of ray emitted from the tube which passed through most substances, including the soft tissues of the body, but left the bones and most metals visible.

In 1896 Becquerel first noted the concept of radioactivity while investigating phosphorescence in uranium salts.

In 1898 the radioactive properties of radium were noted by Marie and Pierre Curie.

These significant discoveries led to the understanding not only of the diagnostic properties of X-Rays but also their therapeutic applications.

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