26. Clark C. Radium Girls, 176.
27. Lazarus-Barlow W. S. “On the disappearance of insoluble radium salts from the bodies of mice.”
28. Engelmann W. “Radium emanation therapy.”
29. Zueblin E. “Radioactive therapy in medicine.”
30. Pierre Curie did something similar with the mouse, an animal model more relevant to humans. He found that just a few granules of radium placed near the backbone of a mouse produced paralysis in three hours (Mullner R. Deadly Glow, 13).
31. Mullner R. Deadly Glow, 15–17.
32. Clark C. Radium Girls, 174.
33. A total of 112 dial painters are thought to have died from radium poisoning, with the last radium-related death in 1988. (Mullner R. Deadly Glow, 5.) Several radium dial painters lived into their hundreds. The last known radium dial painter was Mabel Williams. She died at 104 years old in Olympia, WA, on July 23, 2015.
34. Buchholz M. A., and M. Cervera. Radium Historical Items Catalog, 1.
35. Clark C. Radium Girls, 202.
36. Clark C. Radium Girls, 201–202.
37. Upton A. C. “The first hundred years.”
38. Yoshinaga S., et al. “Cancer risks among radiologists.”
39. Upton A. C. “The first hundred years.”
40. The roentgen was originally defined as a unit of radiation exposure equal to the quantity of ionizing radiation that will produce one electrostatic unit of electricity in one cubic centimeter of dry air at 0°C and standard atmospheric pressure.
41. Technically, a roentgen is a unit of exposure, not dose. So to define a unit of dose in roentgens is not appropriate. Nevertheless, at the time, the terms “exposure” and “dose” were often used interchangeably.
42. The limit was soon reduced to 0.1 roentgen per day.
43. Quinn S. Marie Curie, 415.
44. Quinn S. Marie Curie, 416.
45. Quinn S. Marie Curie, 413–414.
46. Greenwood V. “My Great-Great-Aunt Discovered Francium.”
47. Quinn S. Marie Curie, 431–432.
48. Nature. “Curie laid to rest with France’s heroes.”
49. Nature. “X-rays, not radium, may have killed Curie.”
50. Clark C. Radium Girls, 163.
51. Brothers Cecil and Philip Drinker took an interest in studying the health effects of radium dust in cats. Philip, an engineer, invented a machine to control the inhalation rates of cats. In 1928, the apparatus was scaled up to human size and used to assist polio victims in breathing. The machine, known as the iron lung, saved the lives of many polio patients (Clark C. Radium Girls, 207).
52. Radioactivity carried within the body is known as the body burden and is expressed in either units of radioactivity or mass, typically microcuries or micrograms, respectively. The maximum permissible body burden for any radioisotope is one that will result in an MTD.
53. Clark C. Radium Girls, 193.
54. Taylor died of complications from Alzheimer’s disease in 2004, at the age of 102.
55. Oransky I. “Lauriston Taylor.”
56. Frame P. W. “Tales from the atomic age.”
57. This chapter highlights only some of the key events leading to the introduction of national and international radiation protection standards. Those seeking a complete and chronological history of radiation protection practices should refer to: Taylor L. S. Organization for Radiation Protection.
58. Isaacson W. Einstein, 471–478.
59. Zoellner T. Uranium.
60. Hacker B. C. The Dragon’s Tail, 29.
61. The Manhattan Project began two years before the United States formally entered World War II (December 7, 1941), but the war had been waging in Europe since Germany invaded Poland on September 1, 1939. The atomic bomb’s intended use was against Germany because the Germans were correctly suspected of having their own atomic bomb project, but the war in Europe ended before they had completed the task. After the Japanese surrendered, it was learned that they also had their own unsophisticated bomb project that was led by Yoshio Nishina (1890–1951), a former student of Ernest Rutherford. Some evidence suggests that Nishina may have sabotaged the project by assigning Japan’s most gifted physicists to menial tasks and the less intelligent physicists to the critical work (Rotter A. J. Hiroshima, 66).
62. Mullner R. Deadly Glow, 125.
63. A radiation protection standard used in 1939 illustrates the crudeness of dental film dosimetry (i.e., the measurement of dose based on the level of exposure of photographic dental film) at that time: “If after a week of exposure and standard development, none of the films is so dark that, when it is put up to a printed page in good light, the letters cannot be distinguished through it, then protection is adequate” (Hacker B. C. The Dragon’s Tail, 37).
64. Dose versus exposure: The term “dose” refers to what actually gets into your body due to a certain exposure. A good analogy is secondary cigarette smoke. If a group of people is in a room where someone is smoking, the nonsmokers are all exposed to the same smoke-contaminated air, but their doses will differ. If someone is holding her breath, she may receive no dose from the smoke exposure, while someone else with a fast respiration rate with deep breaths will receive a high dose. It’s the dose that drives health effects, not the exposure. Although the two are highly correlated and are often confused, dose and exposure are not the same thing.
65. One mSv is equal to 100 mrem.
66. The older dose equivalent unit—the mrem—is still used by the US Nuclear Regulatory Commission (as of 2015) despite the fact that it has been replaced by the mSv in every other country in the world. In the author’s opinion, the NRC’s policy of sticking with mrem is a bad practice that unnecessarily confuses the public. This was particularly true during the nuclear power plant disaster in Japan in 2011, when the Japanese authorities were reporting to the media in mSv and the American authorities were using mrem. In this book, dose equivalents will be reported in mSv throughout.
67. Microorganisms can survive radiation doses hundreds of times higher than humans can.
68. Since nonionizing types of radiation, by definition, don’t produce any ions, the mSv is not an appropriate unit for measuring their doses. Nonionizing radiation measurement requires metrics that quantify energy deposition based on other physical principles.
69. Hacker B. C. The Dragon’s Tail, 43.
70. We will deal further with the exact meaning of dose equivalent, how it is measured, and its utility for predicting cancer risk in chapter 9.
71. This concept survives today as ALARA, an acronym for as low as reasonably achievable. Its use in the radiation work environment is now legally mandated by the regulations of the US Nuclear Regulatory Commission.
72. Neutrons release visible blue light as they move at extremely high speeds through matter. This blue light is called Cherenkov radiation, after its discoverer, but it is actually just light from the blue part of the visible wavelength spectrum. It has no health consequences of its own, but it does indicate the presence of high-speed particulate radiation, typically neutrons.
73. Conant J. 109 East Palace, 339.
74. Conant J. 109 East Palace, 340.
75. In fact, this is the exact safety approach that is used in nuclear power plants today. Control rods are mechanically raised, under electrical power, to initiate the nuclear fission reaction, so that accidental loss of electricity in the plant will cause the rods to drop down under the force of gravity and, thereby, terminate the fission reaction.
76. Beryllium is a dull brittle metal that is prone to undergoing nuclear reactions that emit neutrons. It can absorb both alpha particles and gamma rays and emit neutrons in exchange. It was the alpha particle reaction of beryllium that Irène Curie and Frédéric Joliet first witnessed (see chapter 4). Slotin’s team was using the beryllium to absorb gamma rays emitted from the plutonium core and convert them to neutrons, thus boosting the neutron yield of the core and pushing it closer to criticality. Because of its neutr
on producing characteristics, beryllium was widely used at the time by nuclear physicists who studied neutrons. Unfortunately, its brittleness causes it to produce a dust that is highly toxic to the respiratory system. Enrico Fermi was one victim of this dust. He died from beryllium poisoning, at the age of 53 (Kean S. The Disappearing Spoon, 192–193).
77. This is reminiscent of the alpha particle bounce-back experiments that allowed Rutherford to detect the atomic nucleus and measure its size (see chapter 4), but radar works on a much grander scale than alpha particles (i.e., bouncing off planes and ships versus nuclei).
78. Brown D. E. Inventing Modern America, 80–83.
CHAPTER 6: THE HIPPOCRATIC PARADOX
1. Hodges P. The Life and Times of Emil H. Grubbe, 7.
2. Hodges P. The Life and Times of Emil H. Grubbe, 21.
3. Radiation oncology is the medical specialty that uses radiation therapy to treat cancer. (Although radiation therapy is often called “radiotherapy,” the author believes that this word is misleading because it implies that radio waves are used. Ironically, radio waves are the one type of radiation that is not used to treat cancer because its energies are too weak to kill cancer cells, or any other cells.)
4. Grubbe didn’t graduate from medical school until March 1898, but maintained an active radiology practice at 2614 Cottage Grove Avenue in Chicago, starting in February 1896. Grubbe was criticized by some physicians in the neighborhood for being a quack because they were suspicious of x-rays and he was practicing medicine without a medical degree. Nevertheless, Grubbe carried on. At one point he made the claim that he and his staff were treating 70 patients per day for various ailments (not all of them cancer).
5. Hodges P. The Life and Times of Emil H. Grubbe, 25.
6. It was first known to Europeans as Jesuit’s bark because it was introduced by Jesuit missionary Agostino Salumbrino (1561–1642), who brought it back from Lima, Peru, after observing the native Quechua using it to treat fever. The active ingredient was later found to be quinine. Quinine and its synthetic derivatives are still used to treat malaria today.
7. Upton A. C. “The first hundred years.”
8. Regaud C., and Ferroux R. “Disordance des effets de rayons.”
9. Radiation castration does not achieve the same effects as surgical removal of the testicles in one respect—hormone elimination. Radiation does not typically kill the testosterone-producing cells (Leydig cells) in the testicles since they, unlike spermatogonia, are not dividing. Secondary sex characteristics, libido, and male aggressiveness are not typically affected by radiation doses that cause complete sterility. Since one of the purposes of livestock castration is to reduce testosterone-related male aggressiveness, radiation would not usually be a practical substitute for surgical castration (Mossman K. L., and W. A. Mills. The Biological Basis of Radiation Protection, 174–177).
10. Hodges P. The Life and Times of Emil H. Grubbe, 69.
11. A highly autobiographical book about the history of radiation therapy, written by Grubbe, is thought to be unreliable (Grubbe, E. X-Ray Treatment). Information regarding Grubbe’s contributions to radiation therapy reported here was obtained largely from a biography of Grubbe written by Paul C. Hodges, The Life and Times of Emil H. Grubbe. In writing his book, Hodges actually verified Grubbe’s essential claims of priority in radiation therapy with independent documents on deposit in the Smithsonian Institution in Washington, DC.
12. Mullner R. Deadly Glow, 31–33.
13. Implantation of radioactive “seeds” (usually palladium-103) in the prostate to treat prostate cancer is an example of modern brachytherapy. In the United States, more than 50,000 men receive prostate brachytherapy each year.
14. At the time, Austria owned the Ore Mountains, home of the Schneeberg and St. Joachimsthal radium mines, which were the only known source of pitchblende (radium ore).
15. Mullner R. Deadly Glow, 18 (quoted in the New York Times, July 17, 1904).
16. A stay bolt is a threaded metal rod that is used to connect opposing metal plates and hold them in a fixed position relative to each other.
17. Carnotite is a yellowish green mineral commonly found in the form of crusts or flakes in sandstone.
18. The site of the extraction plant in Canonsburg is contaminated with radium to this day. The federal government owns the site and the US Department of Energy (DOE) manages it. The contaminated area, estimated to contain 100 curies of radium, is confined within a containment cell designed to be impervious for 1,000 years. Its integrity is monitored continually by DOE to ensure that radioactivity does not leak into the water table and contaminate nearby Chartiers Creek. DOE’s license to operate the site has no expiration date, as it is expected they will manage the site in perpetuity.
19. Mullner R. Deadly Glow, 25.
20. Mullner R. Deadly Glow, 27.
21. Purification of radium was complicated because carnotite ore from Paradox Valley also contains barium (a nonradioactive metal). Barium and radium are both alkaline earth metals (like calcium; see chapter 5) and thus share similar chemistries; these make them resistant to separation from each other by chemical means.
22. It is estimated the Standard Chemical Company purified a total of 180 grams of radium (about the same mass as a large bar of soap), and most all of it passed through the Flannery Building at 3530 Forbes Avenue, in Pittsburgh. The building went through a series of subsequent owners who mostly used it as office space; ultimately it housed a bank. When the bank tried to sell the building in the 1980s, the sale failed due to the discovery of radium contamination. Litigation ensued, and the property remained in limbo. Finally, the Pennsylvania Department of Environmental Protection oversaw the building’s decontamination, which was completed in September 2003, and the building reopened for unrestricted use. Today the building houses commercial office space.
23. Standard Chemical ultimately entered the radium watch business, and created a division in Chicago known as the Radium Dial Company. This was a competitor to the fluorescent dial business of United States Radium Corporation in New Jersey (chapter 5).
24. In the years to come, the mines of the Belgian Congo would become of extreme military importance because they represented the only known source of high-grade uranium ore outside of Nazi control. Uranium ore was required in large quantities for the Manhattan Project (Zoellner T. Uranium, 45–46).
25. Robison R. F. “Howard Atwood Kelly.”
26. After the Kelly Hospital closed in 1952, the building was found to be highly contaminated with radium. The switchboard from the first floor reception area was so covered with radioactivity that it was decided to encase it in concrete and dump it into the ocean. The building was eventually decontaminated and cleared for safe occupation by the US Atomic Energy Commission. (Mangrum, H. “1418 Eutaw Place.”) Later, the building was abandoned and became occupied by homeless people when the neighborhood deteriorated. It was ultimately demolished and the property reduced to a vacant lot. The site is currently a Baltimore City park.
27. Most of the information in this chapter about Kelly’s particular clinical procedures was obtained from: Aronowitz J. N., and R. F. Robison, “Howard Kelly establishes gynecologic brachytherapy.”
28. Kelly H. A., and C. F. Burnam. “Three hundred and forty-seven cases of cancer of the uterus and vagina.”
29. Rutherford had actually used a similar apparatus to discover radon. Working with Marie Curie’s observation that pitchblende emitted a radioactive gas, he built an apparatus to collect bubbles of the gas into an inverted glass flask. Rutherford soon identified the captured gas as radon-220, a previously unknown element (Kean S. The Disappearing Spoon, 302). (The more naturally abundant isotope of radon, radon-222, was later identified by Friedrich Ernst Dorn.)
30. It was not the radon-222 itself that provided the penetrating gamma rays needed for therapy. Radon-222 primarily emits alpha particles that are poorly penetrating, only rarely emitting a gamma ray (510 KeV gamma; 0.076% abundance). Rath
er, it was the gamma rays emitted by radon-222’s short-lived downstream progeny in the uranium-238 decay chain that were producing the tumor-penetrating gamma rays.
31. By 1914, Kelly was exclusively using radon encased in glass ampules, rather than radium itself, for his radiation therapy. These were the glass ampules of spent radon that Feather took back to the Cavendish in 1930 (see chapter 4).
32. New York Times. “$100,000 Radium Treatment Test to Save Bremner’s Life.”
33. Trenton Evening Times. “New Jersey Representative Succumbs in Baltimore Sanatorium.”
34. Quoted in Aronowitz J. N., and R. F. Robison. “Howard Kelly establishes gynecologic brachytherapy.”
35. The term linac for linear accelerator did not come into widespread use until 1950.
36. Tuddenham W. J., and A. Soiland. “Pioneer radiologist.”
37. Jacobs C. D. Henry Kaplan, 111–112.
38. Cobalt-60 is an artificial radioisotope that is produced by bombarding the stable isotope cobalt-59 with neutrons. Uptake of an additional neutron into the cobalt-59 nucleus produces cobalt-60, which has an unstable nucleus due to an excess of neutrons (33) relative to protons (27). (See “Radioactive Decay” in chapter 3 for an explanation of how neutron excess results in radioactivity.) The nuclear instability of cobalt-60 is relieved through radioactive decay; this occurs when the parent cobalt-60 transmutes into the progeny nickel-60, with the concurrent emission of two high-energy gamma rays. Nickel-60 is a stable isotope.
39. Lymph nodes are small olive-shaped organs. Hundreds are distributed widely throughout the body, serving as traps and filters for circulating foreign bodies. They have a major role in immunity and harbor specific types of white blood cells (lymphocytes and macrophages). The nodes typically swell when fighting an infection, but shrink back to normal again when the infection abates. Persistent swelling of lymph nodes in the absence of infection can be sign of lymph-node cancer (lymphoma).
40. As opposed to Hodgkin’s disease (Hodgkin’s lymphoma), with its well-defined progression pattern, non-Hodgkin’s lymphoma is actually a heterogeneous group of over 30 types of lymphoid cancers that differ in their microscopic appearance, biological behavior, and prognosis.
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