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Library of Congress Cataloging-in-Publication Data
Names: Hall, Eric J., author. | Giaccia, Amato J., author.
Title: Radiobiology for the radiologist / Eric J. Hall, Amato
J. Giaccia.
Description: Eighth edition. | Philadelphia : Wolters Kluwer,
[2019] | Includes bibliographical references and index.
Identifiers: LCCN 2017057791 | ISBN 9781496335418
Subjects: | MESH: Radiation Effects | Radiobiology | Radiotherapy
Classification: LCC R895 | NLM WN 600 | DDC 616.07/57—dc23 LC record
available at https://lccn.loc.gov/2017057791
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Preface to the First Edition
This book, like so many before it, grew out of a set of lecture notes. The lectures
were given during the autumn months of 1969, 1970, and 1971 at the Columbia-
Presbyterian Medical Center, New York City. The audience consisted primarily
of radiology residents from Columbia, affiliated schools and hospitals, and
various other institutions in and around the city.
To plan a course in radiobiology involves a choice between, on the one hand,
dealing at length and in depth with those few areas of the subject in which one
has personal expertise as an experimenter or, on the other hand, surveying the
whole field of interest to the radiologist, necessarily in less depth. The former
course is very much simpler for the lecturer and in many ways more satisfying; it
is, however, of very little use to the aspiring radiologist who, if this course is
followed, learns too much about too little and fails to get an overall picture of
radiobiology. Consequently, I opted in the original lectures, and now in this
book, to cover the whole field of radiobiology as it pertains to radiology. I have
endeavored to avoid becoming evangelical over those areas of the subject which
interest me, those to which I have devoted a great deal of my life. At the same
time I have attempted to cover, with as much enthusiasm as I could muster and
from as much knowledge as I could glean, those areas in which I had no
particular expertise or personal experience.
This book, then, was conceived and written for the radiologist—specifically,
the radiologist who, motivated ideally by an inquiring mind or more realistically
by the need to pass an examination, elects to study the biological foundations of
radiology. It may incidentally serve also as a text for graduate students in the life
sciences or even as a review of radiobiology for active researchers whose
viewpoint has been restricted to their own area of interest. If the book serves
these functions, too, the author is doubly happy, but first and foremost, it is
intended as a didactic text for the student of radiology.
Radiology is not a homogenous discipline. The diagnostician and therapist
have divergent interests; indeed, it sometimes seems that they come together
only when history and convenience dictate that they share a common course in
physics or radiobiology. The bulk of this book will be of concern, and hopefully
of interest, to all radiologists. The diagnostic radiologist is commended
particularly to Chapters 11, 12, and 13 concerning radiation accidents, late
effects, and the irradiation of the embryo and fetus. A few chapters, particularly
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Chapters 8, 9, 15, and 16, are so specifically oriented towards radiotherapy that
the diagnostician may omit them without loss of continuity.
A word concerning reference material is in order. The ideas contained in this
book represent, in the author’s estimate, the consensus of opinion as expressed in
the scientific literature. For ease of reading, the text has not been broken up with
a large number of direct references. Instead, a selection of general references has
been included at the end of each chapter for the reader who wishes to pursue the
subject further.
I wish to record the lasting debt that I owe my former colleagues at Oxford
and my present colleagues at Columbia, for it is in the daily cut and thrust of
debate and discussion that ideas are formulated and views tested.
Finally, I would like to thank the young men and women who have regularly
attended my classes. Their inquiring minds have forced me to study hard and
reflect carefully before facing them in a lecture room. As each group of students
has grown in maturity and understanding, I have experienced a teacher’s
satisfaction and joy in the belief that their growth was due in some small
measure to my efforts.
E. J. H.
New York
July 1972
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Preface
The eighth edition is a significant revision of this textbook and includes new
chapters that were not included in the seventh edition. We have retained the
same format as the seventh edition, which divided the book into two parts.
Section I contains 16 chapters and represents both a general introduction to
radiation biology and a complete self-contained course in the subject, suitable for
residents in diagnostic radiology and nuclear medicine. It follows the format of
the syllabus in radiation biology prepared by the Radiological Society of North
America (RSNA). Section II consists of 12 chapters of more in-depth material
designed primarily for residents in radiation oncology.
Dickens’s famous beginning to a Tale of Two Cities, “It was the best of
times, it was the worst of times, it was the age of wisdom, it was the age of
foolishness, it was the epoch of belief, it was the epoch of incredulity . . . ,” very
much applies to the current world order. Although medical science and
technology have made great advances in alleviating disease and suffering,
irrational and unpredictable events occur quite frequently, instilling fear and
apprehension about potential nuclear terrorism. The eighth edition contains a
new chapter (Chapter 9) on “Medical Countermeasures to Radiation Exposure”
that summarizes the current therapies available to prevent or mitigate radiation
damage to normal tissues. This chapter nicely complements Chapter 14 on
“Radiologic Terrorism.”
Due to the strong request for including more information on molecular
techniques, we have included a new Chapter 17 on “Molecular Techniques in
Radiology.” The techniques described in this chapter should be useful to both the
novice as well as the skilled practitioner in molecular biology.
In this edition, we have eliminated the chapter on “Molecular Imaging.” The
basis for this decision was that the subject matter covered in this chapter does not
involve any radiobiologic principles, and in any case, there are several textbooks
devoted solely to the subject of molecular imaging. For these reasons, we have
decided to remove this chapter from the eighth edition. Overall, we believe that
this new edition represents a well-balanced compilation of both traditional and
molecular radiation biology principles.
The ideas contained in this book represent, we believe, the consensus of
opinion as expressed in the scientific literature. We have followed the precedent
of previous editions, in that, the pages of text are unencumbered with flyspeck-
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like numerals referring to footnotes or original publications, which are often too
detailed to be of much interest to the general reader. On the other hand, there is
an extensive and comprehensive bibliography at the end of each chapter for
those readers who wish to pursue the subject further.
We commend this new edition to residents in radiology, nuclear medicine,
and radiation oncology, for whom it was conceived and written. If it serves also
as a text for graduate students in the life sciences or even as a review of basic
science for active researchers or senior radiation oncologists, the authors will be
doubly happy.
Eric J. Hall
Columbia University, New York
Amato J. Giaccia
Stanford University, California
October 2017
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Acknowledgments
We would like to thank the many friends and colleagues who generously and
willingly gave permission for diagrams and illustrations from their published
work to be reproduced in this book.
Although the ultimate responsibility for the content of this book must be
ours, we acknowledge with gratitude the help of several friends who read
chapters relating to their own areas of expertise and made invaluable suggestions
and additions. With each successive edition, this list grows longer and now
includes Drs. Ged Adams, Philip Alderson, Sally Amundson, Joel Bedford,
Roger Berry, Max Boone, Victor Bond, David Brenner, J. Martin Brown, Ed
Bump, Denise Chan, Julie Choi, James Cox, Nicholas Denko, Bill Dewey, Mark
Dewhirst, Frank Ellis, Peter Esser, Stan Field, Greg Freyer, Charles Geard,
Eugene Gerner, Julian Gibbs, George Hahn, Simon Hall, Ester Hammond, Tom
Hei, Robert Kallman, Richard Kolesnick, Norman Kleiman, Gerhard Kraft,
Adam Krieg, Edward LaGory, Dennis Leeper, Howard Lieberman, Philip Lorio,
Edmund Malaise, Gillies McKenna, Mortimer Mendelsohn, George Merriam,
Noelle Metting, Jim Mitchell, Thomas L. Morgan, Anthony Nias, Ray Oliver,
Stanley Order, Tej Pandita, Marianne Powell, Simon Powell, Julian Preston,
Elaine Ron, Harald Rossi, Robert Rugh, Chang Song, Fiona Stewart, Herman
Suit, Robert Sutherland, Roy Tishler, Len Tolmach, Liz Travis, Lou Wagner,
John Ward, Barry Winston, Rod Withers, and Basil Worgul. The principal credit
for this book must go to the successive classes of residents in radiology,
radiation oncology, and nuclear medicine that we have taught over the years at
Columbia and Stanford, as well as at American Society for Radiation Oncology
(ASTRO) and RSNA refresher courses. Their perceptive minds and searching
questions have kept us on our toes. Their impatience to learn what was needed of
radiobiology and to get on with being doctors has continually prompted us to
summarize and get to the point.
We are deeply indebted to the U.S. Department of Energy, the National
Cancer Institute, and the National Aeronautical and Space Administration, which
have generously supported our work and, indeed, much of the research
performed by numerous investigators that is described in this book.
We owe an enormous debt of gratitude to Ms. Sharon Clarke, who not only
typed and formatted the chapter revisions but also played a major role in editing
and proofreading. Our publisher, Lauren Pecarich, guided our efforts at every
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stage.
Finally, we thank our wives, Bernice Hall and Jeanne Giaccia, who have
been most patient and have given us every encouragement with this work.
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