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cosmotron at Brookhaven, which gets up into the 2 billion and 3 billion electron volt range.
Mr. DOLLIVER. Does it not take a man of very considerable experience and skill to actually operate one of them?
Dr. DUNHAM. It takes more than one man. It takes a whole team to operate one of these newer, more high-powered ones.
Mr. DOLLIVER. The technique of their operation is not widely known or widely dispersed; is that right? I mean, you have to have trained personnel?
Dr. DUNHAM. Yes.
Mr. DOLLIVER. Unless you have trained personnel their operation can be most dangerous?
Dr. DUNHAM. Right.
Mr. DOLLIVER. And quite lethal if they are not properly operated. Would it not follow from that that there should not be so many of these machines until we learn how to operate them a little better?
Dr. DUNHAM. I think our record is pretty good so far. Of course, as you probably know, we have a fellowship training program to train people in radiological physics who can sort of police these machines and see that the longer haired scientists do not hurt themselves.
Mr. DOLLIVER. Did I not see one of these out here at the Bureau of Standards several years ago? I think they had one set up out there. Dr. DUNHAM. They have a betatron and also one of the Van de Graaf machines.
Mr. DOLLIVER. Those two terms do not mean very much.
Dr. DUNHAM. The Van de Graaf is the one you may remember. It stood up very high with some big knobs up at the top.
Mr. DOLLIVER. Yes.
Dr. DUNHAM. The betatron, I guess, has been finished in the last year or two. That is where things go round and round and come out on the side.
Mr. CARLYLE. Mr. Chairman?
The CHAIRMAN. Mr. Carlyle.
Mr. CARLYLE. Doctor, I was just wondering how you arrived at the price of 20 percent when you sell isotopes.
Dr. DUNHAM. We were charging nothing. We found there was a little reluctance to separate out the use of isotopes on the orders. Therefore, we put this charge of 20 percent on so that there would be no confusion. It has reflected itself in the fact that, though the number of users has gone up under the cancer program, the actual numbers dispensed under cancer as opposed to those that were paid full price for has gone down. It really sort of clarified the atmosphere, as it were, from the standpoint of bookkeeping.
Mr. CARLYLE. Your statement a few minutes ago relating to cataracts was that an increase was found to exist after the bombs had been dropped in Japan?
what the scientists call Only two of these are developed some 4 to 5 clearly of a type that There has been some
Dr. DUNHAM. They found over 100 cases of cataracts among the survivors in Hiroshima. severe enough to require operation. They all years after exposure, but they seem to be very is seen almost entirely in radiation exposures. experience with that type of cataract in this country. Mr. CARLYLE. That is all.
Mr. ROBERTS. Mr. Chairman?
The CHAIRMAN. Mr. Roberts.
Mr. ROBERTS. Dr. Dunham, you mentioned the work of Dr. Van de Graaf, and I, of course, am very interested in that because he comes from my beloved State of Alabama. When did he begin his work in this connection; do you remember? What was about the time of his development?
Dr. WARREN. As I recall it, it was about 1933 or 1934 at the Massachusetts Institute of Technology.
Mr. ROBERTS. I knew that his work was done there. Thank you very much.
The CHAIRMAN. I do not wish to seem even a little bit critical in this. I am asking more from the standpoint of what might be a policy in the future. Having in mind that the assets of the Atomic Energy Commission amount to approximately $10 billion, having in mind that the Atomic Energy appropriation budget amounts to approximately $1 billion, and having further in mind the fact that the cancer budget of your Division is $3 million, I wonder if the charging for the isotopes is a significant thing and necessary or would it not be better to dispense them for research purposes without charge? Dr. DUNHAM. You mean for all research purposes?
The CHAIRMAN. I would say for all, but, of course, we are interested particularly in this hearing in cancer.
Dr. DUNHAM. Yes.
The CHAIRMAN. As our direct interest.
Dr. DUNHAM. Dr. Warren, I think, would like to speak on that point as a user of isotopes.
The CHAIRMAN. We would be pleased to hear from you, Doctor.
STATEMENT OF DR. SHIELDS WARREN, DIRECTOR, CANCER RESEARCH INSTITUTE, NEW ENGLAND DEACONESS HOSPITAL, BOSTON, MASS.
Dr. WARREN. If I might, Mr. Chairman.
At our Cancer Research Institute at the New England Deaconess Hospital we use considerable quantities of isotopes. One of the peculiarities of isotopes is that they remain radioactive only certain lengths of time. Each radioactive element has its own time during which it remains radioactive. These are expressed in terms of half life, or the length of time that it takes for the activity to be reduced by one-half.
The materials used chiefly in research and in cancer treatment have relatively short half lives, and it is rather necessary to order only what one needs, rather than stocking up on a large amount of material and letting it spoil on the shelf, so to speak.
One of the problems is that if there is no charge made for things there tends to be less value placed on them, and sometimes they are crdered more freely than they are actually needed. And as a user I have found it rather helpful to have this nominal charge, which represents only a few dollars on each shipment, in order to remind me that these are valuable materials, that they are needed by other investigators than myself.
I think I am speaking for the majority of users in feeling that this nominal charge has been a worthwhile thing and has prevented overordering and wastage of these relatively short-lived materials. The CHAIRMAN. You speak of a nominal charge?
Dr. WARREN. Yes, sir.
The CHAIRMAN. What do you have in mind?
Dr. WARREN. As I recall it in the treatment of a patient with radioactive phosphorus, which is one of the short-lived materials which we use, it amounts to approximately $1.25 or thereabouts.
The CHAIRMAN. Does that cover the shipping charges?
Dr. WARREN. No. That does not cover the shipping charges. The user bears the cost of the shipping charges.
The CHAIRMAN. I assume that is more expensive than the charge made for the isotopes.
Dr. WARREN. That is quite true, sir.
The CHAIRMAN. How much does that usually run?
Dr. WARREN. That varies with the weight of the shipment. The amount of shielding required for each isotope varies, so sometimes our container will weigh only thirty-odd pounds. Sometimes it may go well over 100 or more pounds. Also, it varies with the destination. We obtain some materials-most of our materials-from Oak Ridge, and some come from Brookhaven. The charge, as I recall it, runs about $20 per shipment for us on the average in the New England
The CHAIRMAN. Any further questions, gentlemen? It seems to me that as we progress the hearing continues to increase in interest, so we will proceed in whatever way Dr. Bugher suggests. Whom would you like to have as your next witness?
Dr. BUGHER. I would like to continue with a discussion of the special program at the Brookhaven National Laboratory located on Long Island at the site of the old Camp Upton, operated for us by Associated Universities, Inc., which in turn is the operating agency for nine northeastern universities.
The Brookhaven Laboratory has a very vigorous and imaginative medical program, and the laboratory has been the pioneer in the utilization of neutron radiation from the reactor in the treatment of brain tumors. I would like to present Dr. Godwin to present the discussion of the Brookhaven program.
The CHAIRMAN. Dr. Godwin, we would be pleased to hear from you.
STATEMENT OF DR. JOHN T. GODWIN, PATHOLOGIST, MEDICAL DEPARTMENT, BROOKHAVEN NATIONAL LABORATORY, UPTON, LONG ISLAND, N. Y.
Dr. GODWIN. Mr. Chairman and members of the committee, I am happy that Mr. Roberts has identified himself and the recorder as being from Alabama, since at least I think they will be able to understand my Georgia accent.
At the Brookhaven National Laboratory we have a 35-bed hospital associated with a nuclear reactor, or atomic pile. All patients admitted are subjects for investigation of various diseases. The staff numbers around 15 scientists, composed principally of physicians, with a few doctors of philosophy of various training.
This combination of facilities enables us to utilize short half life isotopes and the nuclear reactors in investigative therapeutics.
The aim of the cancer research program at Brookhaven is to investigate the therapeutic application of nuclear energy in the treatment of human neoplasms with particular emphasis on the short half life isotopes.
Dr. Warren, I think, has adequately explained what we mean by the half life isotopes, and to reiterate, we are using half life isotopes with a half life of some 30 minutes, or 2 hours, or 8 days.
Now, radiations which disintegrate over a short period of time produce their effects by destruction. Our aim is to place the proper ionizing radiations in the proper place and to obviate as completely as possible the destructive effects on normal tissues. With some short half life isotopes we can accomplish a part of this in that a large amount of ionizing radiations can be localized to an area for a relatively short period of time with minimum damage to the organism as a whole.
For specific application of short half life isotopes I will briefly discuss the use of chlorine 38 with a half life of 38 minutes, which we have employed in several patients with ovarian carcinoma which has spread over the abdomen. This is a cancer that originates in the ovaries of the female and as it progresses spreads over the surface of the abdominal cavity. Ordinary ammonium chloride is irradiated in the nuclear reactor and is thereby made radioactive. Ordinary ammonium chloride looks very much like common table salt. This is then placed in the abdomen of the patient. This form of therapy caused a decrease in the fluid accumulations and size of tumor in these cases.
We have also used a gas designated as krypton 87, which has a half life of 78 minutes. We have done that in similar fashion.
I have a photograph which I would like to show that will show the effects of this radioactive chlorine in a case of metastatic cancer to the lining of the thoracic cavity, and if you are interested, I will be happy to pass this out.
I might point out that this [indicating] is the lung and this [indicating] is the area in which the radiation was applied.
Now another project is the use of radioactive iodine in the treatment of thyroid carcinoma. A large number of patients have been treated and at present the study is directed toward ways of concentrating the radioactive iodine in the tumor, optimal doses, and following the chemical course of those patients until death in some cases, with thorough autopsy observations.
Radioactive phosphorus, which has a half life of 14 days is being employed in the treatment of patients with polycythemia and leukemia.
I am sure that you are all thoroughly familiar with the term "leukemia" after yesterday's discussions, and I might point out for Congressman Dolliver that polycythemia is an increase in the number of red blood cells as opposed to anemia, as you mentioned yesterday.
It may be significant that in the treatment of these patients many physicians are being trained in the handling and application of radioactive materials. This gives us a reservoir of physicians trained in handling radioactive materials for the future national needs, such as in warfare.
Although ionizing radiations have a therapeutic application, they may also initiate a cancerous process, as was mentioned yesterday and this morning; therefore, it is necessary that we know whether the isotopes in the doses employed might incite cancer in patients. This has necessitated long-term experiments with animals given very small doses of isotopes in order to ascertain whether or not they may develop tumors.
We have projects of this nature which have been under way for about 16 months.
A more recent interest has been the development of a germanium titanium phosphate material which can be made up into glass needles. The phosphorus is made radioactive and the glass needle may then be inserted into a tumor giving a good local irradiation with later absorption of the needle.
This material is about ready for investigative trials in humans.
One of the most interesting and recent advances in the radiation therapy of cancer has been the application of thermal, or slow neutron capture by boron in certain brain cancers.
We have been talking about these ionizing particles. We are now dealing with one which has not been mentioned which is the slow neutron. It is a fast neutron which has been slowed down.
In conventional radiation therapy the intervening and surrounding normal tissues are irradiated as well as the tumor. This is detrimental to the patient and one of our primary aims is to reduce the irradiation damage to the normal tissues.
Theoretically, the use of thermal neutron capture largely obviates the damaging effect on the surrounding tissues.
To briefly describe the procedure for the therapeutic application of this type of radiation, a patient with a known malignant brain tumor is placed atop the nuclear reactor. I also have a photograph which will show a patient in position atop the nuclear reactor, and you should hold the photograph in this position [illustrating], since this is a mirror which reflects the patient in the compartment. The head is centered over an opening leading into the reactor.
Now, as a side point, certain changes have been necessary in the reactor in order to adapt it for this type of investigation, since it was not originally designed for this type of medical application.
While in this position a solution of boron is injected into an arm vein. This material immediately begins to concentrate in the brain tumor due to the abnormal changes in the blood vessels in the tumor. After a few minutes the concentration of boron reaches a maximum and about this time the nuclear reactor has reached its full power and the patient's head is subjected to the bombardment of millions of slow neutrons. These reach the tumor and where there is boron the atoms of boron grab the slow neutrons very avidly. When this happens the boron is converted into another form of boron, which in a millisecond is converted to lithium and a very highly energetic ionizing radiation term "an alpha particle" which Dr. Dunham has mentioned. This particle though highly energetic travels only a short distance, 8 to 9 microns, a micron being a thousandth of a millimeter, and actually this distance is about the diameter of a red blood cell.
This means that the radiations are principally limited to the area of boron concentration, that is, in the tumor, with little effect on the surrounding normal tissues.