Radiation therapy in Hungary

Author: Dr. Csilla Pesznyák

 

Medical physics as a science is concerned with the application and development of the principles and techniques of physics to the diagnosis, treatment and prevention of human diseases. In 1896, Dr. József Jutassy made the first skin cancer treatment with X-rays. The first publication in Hungary about the biological effect of x-rays was written by Endre Hőgyes, and it was published in Orvosi Hetilap (Weekly Medical Journal).
The very first Hungarian application of isotope 226Ra was performed in a hospital of the National Health Insurance Institute – now Uzsoki Hospital. The Radium Clinic was opened in 1932. Andor Semsey spent the majority of his property for charity. His property was inherited by his brother Count László Semsey, who purchased in 1924 a large amount of radium for the treatment of malignant diseases. Pál Kisfaludy MD (1890-1956) was chief medical officer of National Health Insurance Institute from 1929. Foundation of the Loránd Eötvös Radium and X-Ray Institute was in 1935, with two famous Hungarian physicists: Johanna Toperczer and László Bozóky. In 1952, the Ministry of Health expanded it into the National Institute of Oncology. The radiation protection and radiation therapy were redefined by Professor Bozóky. He established the first medical physics laboratory. It was equipped with modern instrumentation; some of them were developed by himself. Seven years after the installation of the first cobalt unit in the world, in 1958 Hungary also started the teletherapy treatment with a Hungarian-made Cobalt unit “Gravicert” (the name reflects that the force of gravity moved the source) at the Institute of National Oncology. This cobalt unit was constructed on the base of Professor Bozóky’s plan and manufactured by company Medicor Művek. In 1961, an improved version with movable collimator was installed in Uzsoki Hospital, by which the field size could be changed continuously. The first Hungarian rotating cobalt unit with name ROTACERT was put into operation in 1965.

Figure 1: Gravicert cobalt unit

 
For a long time the treatment planning was made in two dimensions. The definition of target and critical organs in 2D are not so perfect because the tumor and its environment are three-dimensional. A transversal image of 2D treatment plan from the seventies is shown in the figure. This time the dose calculation was made on the base of percent depth dose curves depending on field size. The patient’s CT image was magnified and contoured on tracing paper. The dose distribution was calculated from the summation of single field isodose curves.

Figure 2: Treatment plan in 2D

 
In 1978 the work of the Computerized National Treatment Planning Network was started. The Network was organized by IAEA, Ministry of Health of Hungary and NIO. For dose calculation the J. van de Gejn’s algorithm was used, which was one of the best systems of the time. Twenty years after the first international appearance, in 1985 the first linear accelerator was installed in Hungary. The Siemens Neptun 10p accelerator delivered 9 MV photon energy and 6, 9 and 10 MeV electrons. From this year, the treatment planning was based on CT, using the CT of the Postgraduate Medical University.
Today Hungary has 12 radiation therapy centers, each equipped with 2 to 5 linear accelerators, treatment simulators, treatment planning system(s) (TPS), HDR afterloading, etc.

Literature

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2. Köteles Gy. (2005) Fizika az orvoslásban, Fizikai Szemle, 1: 17.
3. Mayer Á, Zaránd P. (2007) 75 éves az önálló sugárterápia az Uzsoki utcai Kórházban, Orvosi Hetilap, 37: 1731-4.
4. Varjas G, Pazonyi B, Forgács Gy. (2005) Számítógépes besugárzástervezés: visszatekintés és korszerű módszerek, Magyar Onkológia, 49(3): 245-9.
5. Sugárterápia. Szerk.: Németh Gy, Springer Hungarica, Budapest. 2001