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It has been known for many years that excessive irradiation of the chest with either radium or x-rays can produce permanent fibrotic changes in the lungs. This fact was of relatively little practical importance until the development in recent years of the method of administering extremely large doses of radiation in the attempt to cure cancer of the lung, mediastinum or breast. While Holfelder has suggested the use of an oblique beam in the treatment of carcinoma of the breast and many workers in the field supplement moderate roentgen treatments with large doses of buried but highly filtered radium the action of which is chiefly local, nevertheless it has become more and more obvious that this fibrosis of the lung is one of the limiting factors in the treatment of malignant conditions in the chest. Most of the previous work on the subject has been done in a purely qualitative
Über die Wirkungen der Röntgenstrahlen auf die Lungen. JAMA. 1934;103(24):1880–1881. doi:10.1001/jama.1934.02750500062031