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Nowadays, the term medical physics usually refers to the work of physicists employed in hospitals, who are concerned Lancet 2011; 379: 1517–24
mainly with medical applications of radiation, diagnostic imaging, and clinical measurement. This involvement in Published Online
clinical work began barely 100 years ago, but the relation between physics and medicine has a much longer history. In April 18, 2012
DOI:10.1016/S0140-
this report, I have traced this history from the earliest recorded period, when physical agents such as heat and light
6736(11)60282-1
began to be used to diagnose and treat disease. Later, great polymaths such as Leonardo da Vinci and Alhazen used
See Comment pages 1463
physical principles to begin the quest to understand the function of the body. After the scientific revolution in the and 1464
17th century, early medical physicists developed a purely mechanistic approach to physiology, whereas others applied This is the first in a Series of
ideas derived from physics in an effort to comprehend the nature of life itself. These early investigations led directly five papers about physics
to the development of specialties such as electrophysiology, biomechanics, and ophthalmology. Physics-based medical and medicine
technology developed rapidly during the 19th century, but it was the revolutionary discoveries about radiation and Department of Medical
radioactivity at the end of the century that ushered in a new era of radiation-based medical diagnosis and treatment, Physics, Guy’s and St Thomas’
NHS Foundation Trust,
thereby giving rise to the modern medical physics profession. Subsequent developments in imaging in particular London, UK (S F Keevil PhD);
have revolutionised the practice of medicine. We now stand on the brink of a new revolution in post-genomic and Division of Imaging
personalised medicine, with physics-based techniques again at the forefront. As before, these techniques are often Sciences and Biomedical
the unpredictable fruits of earlier investment in basic physics research. Engineering, King’s College
London, London, UK (S F Keevil)
Correspondence to:
Introduction so arguably is the earliest example of diagnostic imaging. Dr Stephen F Keevil, Department
Medical physics, as we usually understand the term, By 200 AD, priests on the Greek island of Samothrace of Medical Physics, Rayne
emerged as a distinct scientific discipline early in the were selling magnetic rings to treat arthritis,3 another Institute, St Thomas’ Hospital,
20th century in response to the growing use of ionising approach that has parallels nowadays, despite the absence London SE1 7EH, UK
stephen.keevil@kcl.ac.uk
radiation in diagnosis and treatment. Establishment of of a convincing evidence base.4
the first posts for hospital-based physicists during this Some of the greatest thinkers of the medieval period
period laid the foundations for a new health-care pro- worked at the interface between medicine and physics.
fession, which continues to play an important part in the The Iraqi polymath Ibn al-Haytham (circa 965–1039),
development and safe and effective implementation of usually known by the Latinised name Alhazen,
physics-based technology. However, the relation between revolutionised the development of science and the
physics and medicine has a much longer and richer scientific method in Europe and the Islamic world.
history than this conventional picture suggests. In fact, Alhazen made particularly important contributions to
medical physics could be anywhere between 100 and optics, including a description of the physics of vision,
5000 years old, depending on how broadly it is defined. and the first experimental demonstration that sight is
In this report, the first in The Lancet Series, I have caused by rays of light entering the eye rather than by
taken a broad view of how this relation has evolved,
sometimes intentionally but perhaps more often by
chance, across several centuries. It ends with a glimpse Key messages
into the future, exploring how medical physics as a • The relation between physics and medicine dates back to the earliest recorded period
profession and a scientific discipline might develop as of medical history.
new areas of physics begin to be used by clinicians in • Across the centuries, application of physics laid the foundations for scientific
the post-genomic world. exploration of the functions of the body.
• Disciplines such as electrophysiology, biomechanics, and ophthalmology are the direct
Antiquity and the middle ages result of the application of physics to medical and physiological questions.
Physical techniques have been used in medicine from • Early in the 20th century, increasing use of radiation in medicine led to a demand for
the earliest times. The Edwin Smith Surgical Papyrus, physicists who could apply their expertise directly to the clinical care of patients, and
written in Egypt between 3000 and 2500 BC, is the oldest the modern medical physics profession began.
known medical document. It contains a remarkable • Many advances in medicine, such as MRI and modern radiotherapy, are unpredictable
description of the treatment of breast abscesses by spin-offs from fundamental physics research, and were only possible because of past
cauterisation with a fire drill.1 A little later, the iconic investment in basic science.
Greek physician Hippocrates (circa 460–377 BC) described • As we stand on the brink of a revolution in post-genomic personalised medicine,
the first recorded method for measurement of body once again physicists have the opportunity to play leading parts in the safe and
temperature.2 Hippocrates’ technique was actually a form effective use of new physics-based techniques for diagnosis and treatment.
of thermal imaging akin to thermography (figure 1), and
clinical activities, for example Frank Hopwood (1884–1954) physics led to implementation of megavoltage x-ray therapy
at St Bartholomew’s Hopsital, London, and Gilbert Stead at the Massachusetts General Hospital in Boston (MA,
(1888–1979) at Guy’s Hospital, London.27 By 1932, between USA) and at St Bartholomew’s Hospital in London in the
ten and 12 medical physicists were based in hospitals in late 1930s (figure 6).23 In 1949, the Canadian physicist
the UK,16 growing to 35–40 by World War 2.29 Harold Johns (1915–98) pioneered the use of betatron
Nuclear medicine was the last piece in the jigsaw of accelerators, again developed in the context of nuclear and
medical radiation physics to fall into place. Setting aside particle physics, to deliver 20–22 MV x-ray therapy.23
early unsuccessful attempts to use radium and radon,20 Furthermore, artificial radioisotopes, which initiated
imaging with radioactive tracers is perhaps one of the nuclear medicine, also had beneficial spin-offs in
more benign consequences of the Manhattan Project. radiotherapy. In the late 1940s, work by the dual-qualified
Although artificial production of radioisotopes had been physicist and physician Joseph Mitchell (1909–87) in
achieved in 1934,30 wartime developments in nuclear Cambridge, UK, and by Mayneord, led to the adoption
physics technology were needed for isotopes to be of ⁶⁰Co produced in a nuclear reactor as an alternative
produced in sufficient quantities for practical use in source of high-energy γ rays for teletherapy, with a higher
medicine. The first radioisotope to be used clinically dose rate than could be achieved with radium.43 Telecobalt
was ¹³¹I,31 which was produced from the Berkeley therapy was first used clinically in Saskatoon, SK, Canada,
cyclotron (Berkeley CA, USA), in 1939 and was used for
thyroid investigations. These early studies used
autoradiography and crude external counting techniques
rather than imaging. The same isotope was soon used for
treatment of hyperthyroidism and thyroid cancer.32–34 A
wide range of other artificial isotopes became available
subsequently, and preparation in appropriate chemical
forms allowed studies of a range of organs. However,
after an imaging demonstration in 1964,35 ⁹⁹mTc rapidly
became the most widely used radioisotope because of its
convenient physical and chemical properties.
In 1950, the Dutch neuroradiologist Bernard
George Ziedses des Plantes (1902–93) described a means Figure 5: William Valentine Mayneord’s rectilinear scanner
of moving a Geiger-Müller tube over a patient’s thyroid, Reproduced from Maynerord and colleagues,37 by permission of Nature
Publishing Group.
thus mapping out the distribution of radioactivity.36
This report came a year before the generally acknow-
ledged description of the rectilinear scanner by
William Valentine Mayneord (1902–88; figure 5).37,38
With these developments, nuclear medicine became a
fully fledged functional imaging technique. Mayneord,
who spent most of his career at the Royal Marsden
Hospital in London, made numerous important
contributions to radiation dosimetry, radiobiology, and
nuclear medicine.27 He disliked the term medical physics,
believing that physics is “one entity, fundamental and
indivisible”,26 and hence preferred to refer to the discipline
as "physics applied to medicine."26 The rectilinear scanner
was superseded by Hal Anger’s (1920–2005) gamma
camera in the 1960s.39 Nuclear tomographic imaging, also
known as single photon emission CT, was developed in
the 1960s,40 only to be eclipsed by x-ray CT before
undergoing something of a renaissance from the 1980s
onwards. Imaging by detection of annihilation photons
after positron emission by a radionuclide was first reported
in 1951.41 This work led to the development of clinical PET
systems,42 capitalising on advances in the synthesis of
positron emitting radionuclides and on detector technology
originating in nuclear and particle physics.
A period of great innovation in radiotherapy occurred
Figure 6: One of the world’s first megavoltage radiotherapy units at
after, and to a large extent because of, World War 2. St Bartholomew’s Hospital, London, UK, in 1937
Developments in accelerator technology for basic nuclear Reproduced from Laughlin,45 by permission of the British Institute of Radiology.
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