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Brachytherapy;
A Life-time Experience ! |
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| Preface
by Felix W. Mick |
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Arriving in New York City in 1961
was an eye-opening experience! The
sight of tall buildings, numerous
luxury cars and masses of people made
a deep impression, and the years that
followed proved to be a truly magnificent
journey for me. Luck had it that when
a relative of mine took me to Memorial
Hospital in Manhattan on a Sunday
morning where I was introduced to
Dr. John Laughlin, then head of the
Department of Medical Physics. Several
months later, a job had opened in
Memorial Departments’s instrument
shop which presented me with the opportunity
to prove myself as a “Swiss trained”
precision instrument maker. Once again,
luck had that I was hired as such. |
Not long thereafter, I was introduced
to Ulrich K. Henschke, M.D., Ph.D.,
who opened doors to my further education.
He also gave me unparalleled insight
into Radiation Therapy and Brachytherapy,
which had particularly caught my
fancy, and laid the foundation for
a professional career that inspires
me more today than ever before.
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Professor
Ulrich K. Henschke
M.D., Ph.D.
1914 - 1980
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Recognized internationally, Ulrich
Henschke taught and extended radiation
therapy and brachytherapy technology
in the United States as well as in
other(including underdeveloped) countries.
He was especially known for the development
of the JANUS double headed Co-60 machine.
Between 1964 and 1972, units where
built and shipped from our small factory
in the Bronx, New York and installed
in the United States, Mexico, Haiti,
Greece, Korea, India and Africa. The
Janus machine housed a Co-60 source
of about 2000 Ci. Two specially designed
rooms were built adjacent to each
other; a patient was treated in one
room while, simultaneously, another
patient was readied for treatment
in the other. Upon completion of treatment,
the Co-60 source was hand-cranked
from one room into the other. Nearly
twice as many patients could be treated
as with conventional Cobalt machines,
and cost of upkeep, other than source
replacements, was insignificant. What
was significant, however, was the
experience gained while working under
often difficult circumstances, with
limited utilities such as water, communication
and electricity, or sometimes lacking
the availability of a simple bolt.
Nevertheless, these units served countries
and highly populated areas where cancer
treatments were previously unavailable.
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| Tragically,
Dr. Henschke perished when his plane
crashed en route to where a new cancer
center was under construction in Tanzania.
The loss of this legendary man left
a deep void in me as well as the entire
radiation therapy community. |
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JANUS
Co-60
Double Headed Unit
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During and after the “JANUS”
era, work proceeded to address the
prevalence and treatment of cervical
cancer, both in the USA and in underdeveloped
countries, with the development of
a manual remote afterloading system
known then as “The Kiss Afterloader”
(for “Keep it Simple, Stupid“).
Co-60 sources were purchased from
the Atomic Energy of Canada, Ltd.,
and encapsulation took place at Union
Carbide, in Tuxedo, New York. Once
again my skills were used (or abused)
when I was asked to attach the tiny
source capsule to a thin stainless
steel cable. As a precautionary note,
I was told “to do it very fast”!
In summary, the cable system allowed
for remote control of the source and
henceforth the creation of the first
HDR remote afterloading system in
the USA.
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The dedicated “afterloading room”
finally resolved the vexing problem
of radiation exposure to staff and
other personnel. From the control
area located outside the treatment
room, the single source was manually
pushed from the safe in the wall through
connecting tubes into the applicator’s
tandem or colpostats. Further developments
included motorization of source transfer
and multiple Co-60 sources. Oscillation
and added cam designs allowed for
the creation and delivery of specific
shaped (or “tailored”) isodose
distributions within the tandems,
while lateral sources were kept stationary.
Such a unit was kept operational at
MSKCC for nearly 10 years until I
discovered a German made remote afterloading
system in the fall of 1979. |
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Early in 1980, Mick Radio-Nuclear
imported and installed the
first Ir-192 HDR GammaMed
remote afterlaoder at Memorial
Hospital under the leadership
of Basil S. Hilaris, M.D.
and Lowell L. Anderson, Ph.D.
Thus, the era of HDR remote
afterloading was born! The
new features allowed for sources
to step incrementally, while
simultaneously source dwell
times could be altered to
produce “tailor shaped
isodose distributions”.
Reluctantly and slowly, other
institutions, such as Georgetown
University Hopsital, DC.,
University of SanDiego, CA.,
University of Birmingham,
AL., VA Hines, IL., and a
number of smaller and free-standing
centers followed suit with
the installations of HDR units.
Treating cancer of the cervix
other than the traditional
way was unthinkable then and
still is questionable today.
However, with the possibilities
of treating cancer of the
bronchus, the reluctance disappeared
and HDR found its way into
many facilities throughout
the country.
Technology evolved further
when Mick Nuclear obtained
a patent with the development
of a “12 channel indexer”,
increasing the number of
access channels from 1 to
12 (GammaMed II-i) and to
24 (GammaMed 12i). Following
the indexer development,
we encouraged Sauerwein
in Germany to manufacture
the Ir-192 sources in the
USA and, with little opposition
from abroad, RTS Technolgies,
in North Andover, MA., under
the leadership of John Munro
III, started the production
of HDR sources. The beginning
of the HDR era was associated
with great difficulties
and resistance both by faculty
and by virtue. Contrary
to many disbelievers, I
was convinced that HDR was
here to stay!
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prevelant was interstitial brachytherapy
and the use of Ir-192 seeds
in ribbons, Cs-137, Au-198 and
a variety of other brachytherapy
sources, all utilized in great
quantities across the USA. Radiation
exposure, although addressed
with the introduction of remote
afterloading, |
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reached an all-time high. The
“ALARA prinicipal”
was preached, however to no
avail. In early 1970, I was
asked to develop a low energy
source known as Iodine-125.
Iodide pellets were encapsulated
in Titanium tubing and irradiated
at the Union Carbide reactor
in Tuxedo, New York. Later,
Lawrence Softray, Inc. took
over and produced the first
commercially available seeds.
Benefits of low energy sources
not only provided radiation
protection to staff and personnel
but simultaneously added significant
clinical advantages. Following
these developments, better control
over loose seeds and added radiation
protection was sought after
resulting in the development
of the first generation of Mick
applicators in
1973; seeds were contained in
shielded cartridges while the
applicator was designed according
to the “afterloading principle”
developed by Dr. Henschke |
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New efforts are underway to
utilize HDR brachytherapy intraoperatively.
Ir-192 HDR-IORT prostate brachytherapy
offers new possibilities adding
accuracy, and most importantly,
optimization capabilities not
readily achievable with permanent
seed implants; and it expands
treatments of advanced or recurrent
colorectal and advanced tumors
of the pelvis or retroperitoneum,
chest wall sarcomas and superficial
tumors. Summarizing the events,
there is clear evidence that
further developments in brachytherapy,
whether LDR or HDR, will be
forthcoming to enhance patient
care and long time survival. |
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Looking back, there was a time
I thought I would run out of
work, but I do realize today
that my work has just begun.
As for myself, I humbly
acknowledge the many opportunities
over the years working with
esteemed leaders in Radiation
Therapy and Brachytherapy
together with medical physicists
from near and far.
Respectfully, Felix W. Mick
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