Radium brachytherapy a predecessor to modern brachytherapy: A historical review from an Indian perspective

The discovery of X-rays and radium formed the basis of radiation therapy. Radium was the first radioisotope used in medicine in the form of surface mold, intracavitary, and interstitial implants, which is a highly conformal form of radiation therapy. India was one of the early users of radium, and Colonel Vaughan J.C. used 10 mg of radium at Ranchi. Major V Arthur Ponnaiah, was appointed as a radium safety officer, Barnard Institute of Radiology, Chennai, the first in India. The methods, Sievert integral, Manchester system, and Patterson-Parker rules, along with milligram-hour and millicurie-destroyed per square cm, were used in dosimetry. K Munjunath Rai (Chennai), P. K. Haldar (Agra), J. P. Sinha (Patna), and M.L. Aggarwal (Amritsar) were the pioneers of earlier radium applications in India. Y. Siddique had an exclusive radiation therapy training and was awarded by the Faculty of Radiologists (Present FRCR), London. Tata Memorial Hospital (TMH) established the first Radon plant in India under the physicist Ramaiah Naidu. Due to its long half-life, loss of sources, chances of leakage of radioactive material, and bent needles, radium was withdrawn from hospitals and replaced by a Manual Cs-137 kit, supplied by the Bhabha Atomic Research Centre (BARC). Later, Iridium-192 wires were used for manual interstitial implants, followed by remote after-loading systems. Establishment of the specialty of radiology and taking over radium from the purview of surgeons were a challenge in many hospitals. The journey of radium application was an early milestone of cancer therapy management, which was built over the sacrifices of many Indian surgeons, radiologists, and physicists. This paper reviewed the use of radium, from information collected from the individuals and hospitals who had the opportunity to work with them.