Standardizing Radiation Treatment for Brain Tumor Patients: a Canadian experience since 1947

• In Event: Shaping Standards

English Abstract

Tracing the development of new approaches of radiation treatment to cerebral tumors in Canada, I examine how local and international uncertainties of the dose, frequency, and mode of delivery of radiation found their resolution in the clinic and beyond. Since most malignant diseases defied therapy throughout this period, cancer clinical trials became sites of experimental and potentially dangerous research on patients, producing ethical dilemmas for physicians and researchers. In this context, I analyze the role of new institutions (Advisory Committees on Radiation Therapy) and funding bodies (National Cancer Institute of Canada), technological innovations (from Cobalt-60 machines to linear accelerators) and debates over professional authority among physicians, physicists, radiotherapists, and radiation oncologists.
A red thread in this Canadian story is the evolution of standardizing units of radiation exposure during treatment to correlate biological effects of a certain dose of radiation from different radiotherapy machines. Investigators transitioned from “r.e.b.a.” to “rem” and then to “rad”, and finally to Gray, the SI unit of the absorbed dose of ionizing radiation commonly used today. I argue that these transitions evolved from purely empirical bases into a remarkable era in which all the basic tenets of radiotherapy were established despite a lack of solid scientific basis. Analyzing a variety of historical sources including archival records, published literature, and oral interviews with investigators, I build on the work of Angela Creager and Gerald Kutcher to explore how patients’ evidence entered the equation of scientific-medical data and professional expertise in negotiating radiation exposure and tolerance.

Author

• Fedir Razumenko, University of Calgary