The cobalt-60 unit at the M. D. Anderson Hospital and Tumor Institute in Houston, Texas, employs a 3000-curie source. This unit has a mechanism that allows for rotation therapy about a stationary patient. Many different treatment positions are possible. This patient, shown in position for therapy, has above her chest an auxiliary diaphragm that consists of an expanded metal tray on which blocks of either tungsten or lead are placed to absorb gamma rays and thus shape the field of treatment. In this case they allow for irradiation of the portions of the neck and chest delineated by the lines visible on the patient.
Since a curie is the amount of radioactivity in a gram of radium that is in equilibrium with its decay products, a 1000-curie source is comparable to 2 pounds of pure radium. Neglecting for the moment the scarcity and enormous cost of that much radium (millions of dollars), we have to consider that it would be large in volume and consequently difficult to apply. Radiation from such a quantity cannot be focussed; consequently, either much of it will fall upon healthy tissue surrounding the cancer or much of it will be wasted if a narrow passage through the shield is aimed at the tumor. In contrast, a tiny cobalt source provides just as much radiation and more if it can be brought to bear upon the exact spot to be treated.
Most interesting of all is the principle by which internal cancers can be treated with a minimum of damage to the skin. Deep x-irradiation has always been the approved treatment for deep-lying cancers, but until recently this required very cumbersome units. With the modern rotational device shown in the diagram, a very narrow beam is aimed at the patient while the source is mounted upon a carrier that revolves completely around him. The patient is positioned carefully so that the lesion to be treated is exactly at the center of the circular path of the carrier. The result is that the beam strikes its internal target during the entire circular orbit, but the same amount of radiation is spread out over a belt of skin and tissue all the way around the patient. The damage to any one skin cell is minimized. The advantage of this device over an earlier device, in which the patient was revolved in a stationary beam, is that the mechanical equipment is much simpler.
CONCLUSIONS
In summary, then, we may say that radioisotopes play an important role in medicine. For the diagnostician, small harmless quantities of many isotopes serve as tools to aid him in gaining information about normal and abnormal life processes. The usefulness of this information depends upon his ingenuity in devising questions to be answered, apparatus to measure the results, and explanations for the results.
For therapeutic uses, on the other hand, the important thing to remember is that radiation damages many kinds of cells, especially while they are in the process of division (reproduction).[13] Cancer cells are self-reproducing cells, but do so in an uncontrolled manner. Hence cancer cells are particularly vulnerable to radiation. This treatment requires potent sources and correspondingly increases the hazards of use.
In all cases, the use of these potentially hazardous materials belongs under the supervision of the U. S. Atomic Energy Commission.[14] Licenses are issued by the Commission after investigation of the training, ability, and facilities possessed by prospective users of dangerous quantities. At regular intervals courses are given to train individuals in the techniques necessary for safe handling, and graduates of these courses are now located in laboratories all over the country.
The future of this field cannot be predicted with certainty. Research in hundreds of laboratories is continuing to add to our knowledge, through new apparatus, new techniques, and new experiments. Necessarily the number of totally new fields is becoming smaller, but most certainly the number of cases using procedures already established is bound to increase. We foresee steady improvement and growth in all uses of radioisotopes in medicine.