Nagalingam Suntharalingam, PhD, FASTRO
By Dwight Heron, MD, MBA and Eric Gressen, MD
The following interview of Nagalingam Suntharalingam, PhD, FASTRO, was conducted on May 3, 2017, by Dwight Heron, MD, MBA, Eric Gressen, MD and Saiful Huq, PhD.
Dwight Heron: I think of you in many ways from my time of training as one of the key leaders in radiation oncology. So it certainly is a distinct pleasure for me to have the opportunity to interview you for the ASTRO History Committee.
So why don’t we start at the top, the general basic concepts. Do you want to tell me a little bit about your background, where you grew up, your educational background, and then we can go from there.
Nagalingam Suntharalingam: I was born in Jaffna, Northern Province, Sri Lanka, formerly called Ceylon. My undergraduate education was at Royal College in Colombo, the capital city of Ceylon. Royal College was one of the top two high schools in the country, and I was fortunate to be accepted there. And I was glad my parents, even though they couldn’t afford my living in Colombo, made sure that I was cared for. I thank them for the effort they put in to give us a good education.
My PhD degree was at the University of Wisconsin in Madison under Dr. John Cameron who was then known as the father of TLD, thermoluminescence dosimetry. I had the privilege of working with him on thermoluminescence. We co-authored a monograph with another physicist, Gordon Kenney. To this date this is considered as the bible on TLD, and I see the book all over the world.
Dwight Heron: Yeah. So Suntha, before we move into the professional side of things, you mentioned that your family obviously sacrificed a fair amount to kind of get you through school. So tell me a little bit about your family. Were you the only child? Were you one of several?
Nagalingam Suntharalingam: I was one of five. I was the second, and the second son. My oldest brother went into the military, and went to Sandhurst Academy in England for training. My younger brother became a physician. I have two sisters who are married. They’re all married and doing well.
Dwight Heron: Tell me about your early educational experience. What made you say I want to be a medical physicist? Because I think that’s really interesting, how life sort of gets us. There are very few people from their formative educational year say I want to be a medical physicist or a doctor. How did you get into it?
Nagalingam Suntharalingam: It was my chance that I wanted. I was in Philadelphia. I went and saw John Hill at the University of Pennsylvania to see whether a young physicist can be taken on to staff. He said he didn’t have any openings, but go and see Robert Gorson at Jefferson who is building a team there. So I went to Robert Gorson and he promptly accepted me into his small group. I was the number three person. Number two was Benjamin Galkin who became the radiation safety officer. That is how I started in hospital medical physics.
Dwight Heron: I see. But what caused you to say –- so, again, the happenstance to kind of get there. What was it about medical physics at the time that made you say, wow, this is what I want to do and this is what I want to keep doing?
Nagalingam Suntharalingam: At that time I didn’t know much. But once I started getting a feeling for how physicists play a role in radiology and radiation oncology, I got interested and I wanted to pursue it further. At that time Jefferson had one big radiology department which included radiation therapy and nuclear medicine. Unfortunately at one point, within a year or two, I had a little problem with the then Chairman of Radiology, Dr. Jack Edeiken. He tried to impress on me that there was only one chairman; that I listen to him and not to Simon Kramer. So the very next day I said thank you very much, I am moving over to the Department of Radiation Oncology and be a physicist for Simon Kramer. That is what happened as far as my movement was concerned. Then I stayed there for a long time, until my retirement in December of ‘99.
Dwight Heron: Yeah, that was ‘99.
Nagalingam Suntharalingam: Yeah.
Dwight Heron: That was a year before I graduated. It was the year you graduated, Eric, right?
Eric Gressen: Yes. And I can tell you, at least from my interview with Suntha, that the on-job trainee, you started at Jefferson Medical College was 1962. You’re certified by 1964 and that you returned to JMC in 1967, which my guess is when you became part of Dr. Kramer’s team, and went from there.
Nagalingam Suntharalingam: Even with the certification I run into a problem because at that time you needed to be citizen of the United States to be certified by the American Board of Radiology. So I said, look, can you at least give me the exam? You don’t have to give me the diploma until I become a citizen. So I created a problem for them. Sure enough, they accepted me for the exam and I passed. They said I passed the exam, but they delayed giving me the certificate or diploma until I became a citizen. I think it was in 1976.
Dwight Heron: Okay. So Dr. Huq has joined us, Dr. Suntha.
Saiful Huq: Hi, Dr. Suntha.
Dwight Heron: So I just told Saiful that we are sort of reminiscing here a bit. You have three people on the phone here that you truly have been an amazing mentor and giant to, so that’s a testament to your impact on the field of radiation oncology.
Actually, I wanted to ask you a follow up question. So you were given shall we say the opportunity to choose, and you chose Dr. Kramer in radiation oncology. Walk us through a little bit why you made that decision. Obviously, that was probably attributable to some extent with some of the things that was going on in radiation oncology at the time this field as it was clearly maturing and emerging. Can you walk us through some of the more important things the time?
Nagalingam Suntharalingam: My interest started in general radiology but still in radiation therapy, so I requested that I be assigned as a physicist for radiation therapy. So I worked with Simon Kramer and developed a program. He gave me freedom to build on a talent that I could put together. And it was a little later on that the patterns of care study, which Simon Kramer was the leader, came into existence. Simon Kramer requested that I be the chief physicist for that study, and that helped me recruit other physicists to participate in the pattern study.
Dwight Heron: Of course, as we know, the patterns of care study even until today remains one of the landmark efforts that really helped in many ways mature and to some extent standardize a lot of what we do in radiation oncology today. It was certainly the forerunner. Now there had been iterations of those patterns of care study subsequently, but this truly had helped define and accelerated the maturation of the field. So if I could ask you a couple more questions down that line, just give us some context.
The patterns of care effort obviously arose because there was a deficit, right? We were doing things in a number of different ways and there was no clear set of standards for a variety of diseases. Can you walk us through historically the things, the conversations that were going on at the time, conversations perhaps that you had with Simon Kramer and other founding members of the patterns of care study and the philosophy of how that developed into a program that gave us what was better off for what we have today in terms of how we care for patients?
Nagalingam Suntharalingam: The original concept and idea of the patterns of care study was put out by a fellow called David Herring. He was a physicist, but he was essentially getting involved in various projects. He was a self-employed individual, so he approached Simon Kramer with the concept of doing a patterns of care study. Simon enlisted a few other famous physicians at that time. One person coming to mind is - I’m drawing a blank on the name - the current chairman at MD Anderson.
Saiful Huq: Steve Hahn?
Nagalingam Suntharalingam: No. He’s retired.
Dwight Heron: He retired. He was there before Steve. Now we’re blanking on the name. This is bad.
Nagalingam Suntharalingam: I know. I’m also drawing a complete blank. I can picture him in front of me, but I’m drawing a blank.
Dwight Heron: Yes. Oh my god, how can -- it will come to us. Okay. Go ahead. Keep going.
Nagalingam Suntharalingam: Anyway, so I worked with him closely. And being the chief physicist assigned to the patterns of care study, I had a lot of responsibility in making sure that different aspects of the program was well-cared for. I recruited several physicists to participate. That was a wonderful experience to every one of us, interacting with the physicians and having the physicist and physicians sit side by side and participate in a new program.
Dwight Heron: Jim Cox, right?
Nagalingam Suntharalingam: That’s right. Yeah.
Dwight Heron: Jim, yeah. Okay.
Nagalingam Suntharalingam: James Cox, yeah.
Dwight Heron: So did you have a sense at the time, with the patterns of care study, of its potential impact in the decades to come? Was there a sense by the group that this was likely to be something quite substantial, major, and of that magnitude? Or what was your sense as a member of the team?
Nagalingam Suntharalingam: Yeah. I mean it was decided that we will have a patterns of care study for different clinical sites. Decision trees were drawn so that one could follow through and decide on the appropriate treatment for the type of disease, state of disease, and it was a feeling that all participating in the subcommittees had to be unanimous in their outcome. It was a wonderful experience for me working with physicians side by side, and also that I could get other physicists involved and have physicists being recognized by our physician colleagues.
Dwight Heron: If you think back, and this is probably my last question around this unless Eric or Saiful has a question to jump in, were there areas of significant controversy? What were the challenges in putting those patterns of care studies together?
Nagalingam Suntharalingam: I don’t recall any controversies. I think it was a unified approach. Everyone felt that an effort like this would help the discipline, and it is the first effort in any branch of medicine that has been undertaken. I’m drawing a blank again on another physician who came from Milwaukee. He was with Jim Cox and later became president of ASTRO also.
Eric Gressen: Dr. Wilson?
Nagalingam Suntharalingam: Yeah, Wilson. Yeah, Wilson. He was also very active and participated in putting the teams together.
Eric Gressen: Suntha, I have a separate question just because in the history of Jefferson I know they had, I believe, the first simulator in the United States of America in 1966 when Dr. Kramer collaborated with the Picker Medical Corporation. Did you have any role in the creation of the first simulator at Jefferson?
Nagalingam Suntharalingam: It was only purely doing some acceptance testing, but the concept of a simulator came from Dr. Kramer. He worked closely with, as you correctly said, with Picker Corporation. That simulator was used for a long time, a very long time.
Dwight Heron: Yeah. So can you tell us a little bit more about your personal area of research over your career? As you sort of looked at some of perhaps -- and again, people’s interest change over time, but maybe if you can give us a little bit of context of what your initial interests were. I think you told us a little bit about that.
Nagalingam Suntharalingam: Yeah.
Dwight Heron: How they sort of morphed and changed as your career matured? That would be really interesting. Maybe if you have some anecdotes or highlights of inflection points, the things that you recollect, that you’d like for us to record.
Nagalingam Suntharalingam: Jefferson had one of the most massive and expensive Brown Boveri 45 MeV Betatron.
Eric Gressen: Oh, yes.
Nagalingam Suntharalingam: That Betatron was primarily for electron beams, but also at that energy you could get some photon beam intensity. But once you started putting flattening filters, you were lucky if you got 25 rad/s per minute at one meter. So we primarily used that machine for electron beams and that developed my interest in high energy photons and electrons. We had a 4 MeV linear accelerator which took care of the bread and butter treatments, replacing cobalt. What else? Okay, what’s your next question?
Dwight Heron: Oh, no. No. Go ahead. Saiful has one question.
Saiful Huq: You may have already asked this question; I stepped in later. You have been involved with Dr. Kramer from very early on in the clinical trials. It got established by I believe RTOG, by Dr. Kramer. Can you maybe walk us through the formative times, the discussions that happened in terms of the formation of the clinical trials and what led to it then?
Dwight Heron: And your role on that, yeah.
Nagalingam Suntharalingam: The Radiation Therapy Oncology Group was formulated or formed to perform the trials and that physicians could submit some of their studies. It gets evaluated and it gets implemented. I was again the physicist in charge of the RTOG program. We had two dosimetrists within RTOG who evaluated the submitted data so that they were in agreement with what the intent was. Each institution had to submit a lot of information including details of their machines, machine calibrations, and up to date QA program. That was evaluated. If there were deficiencies, they were pointed out. That had to be corrected before they could be accepted as an RTOG member. The physician who played a greater role with RTOG was Larry Davis, and he was the physician in charge of the RTOG program.
Dwight Heron: Since we’re talking a little bit about the RTOG, can you tell us a little bit about some of the other founding physicians. You mentioned Larry Davis. Obviously, folks that were involved, too, include Luther and Phil Rubin, some of those giants. Can you give us some anecdotes about whether it’s through the cooperative groups or through the specialty society like ASTRO and the AAPM for that matter? We’re going to go into AAPM in just a minute. But can you tell us a little bit about some of those interactions, maybe some anecdotes from the early years?
Nagalingam Suntharalingam: Rubin was a giant and he always wanted to be the leader. He would impress on others the need for a good quality assurance type review program. He introduced workbooks with some typical cases for planning, and the institutions had to submit their plans. They would give a cross-sectional contour and some details about the cancer and the tumor location, and the institution had to submit their plans. That would get evaluated and we would have a session at one of the ROTG meetings, a morning session devoted to that.
That reminds me about an incident. I’m embarrassed, but I will tell you this. At one of these meetings, Simon Kramer and I met in his room after a long meeting. He opened a bottle of Scotch and before we knew it we drank a fair amount. I sort of staggered myself to my bedroom. The next morning Simon Kramer and I were supposed to have an 8:00 session with the group. So I jumped out of bed about ten minutes to 8:00 and I rushed, and I see Simon Kramer already there holding his hand to his head and just sitting there. But we managed to have the one-and-a-half hour workshop. The next thing I knew, I went back to my room. I slept the whole day. I didn’t come out until the next day. That was a little embarrassing, but it was okay.
Dwight Heron: Yeah.
Saiful Huq: One other question, Dr. Suntha. In your career, you really shaped the lives of many physicians, many physicists. There are a lot of physicians who went to Jefferson and to their residency program. You helped them grow. Can you maybe tell us how you bridged the gap between the physicians and physicists that came to Jefferson?
Nagalingam Suntharalingam: Yeah. I mean the physicians obviously were the residents who were selected by the physician team, but I was also asked to interview the potential resident candidates. I don’t know if I interviewed any of you, but in the process I could tell you another interesting story without mentioning names. One resident had to load iridium wires, radioactive wires for a breast implant. Now, I told her that there are some that are high activity and some that are low activity, but the person chose the high activity.
At that time Dr. Joe Stella used to come and spend some time from Atlantic City Hospital with Dr. Kramer. He was a surgeon in his previous career, so he was doing these implants. So he implanted. When I went to look at the safe where the sources are kept, I found that the high activity sources were not there. So I rushed to the resident and I was told, “No. No. I picked up the sources, you said they are high.” I said they’re high for that particular occasion, but not a real high activity.
So we had to call Joe Stella from Atlantic City. He came. Within two hours we removed the sources and put in the required low activity sources. That was an embarrassment for the resident. The resident almost decided to give up residency. He came to my office crying. I said, well, we all make mistakes. We do overlook certain details. That’s all right. He will probably never make this mistake again. So then carry on with what you have to do. The person later became one of the leading radiation oncologists and, I can tell you, secretary of ASTRO. The person is now retired.
Dwight Heron: Sorry. Go ahead.
Eric Gressen: So Suntha, I did want to comment on one thing. I knew when I went to your residency, one thing that you pushed through your physics teaching with the rest of the physicists is your interaction with the residents and with the other radiation oncologists. That does not typically happen on residency programs. What I mean by that is often I’d be involved with a physicist when I’m interacting with the patient. I got the impression when talking to the other physicists that that was something very specific about your program of educating your fellow physicists. That you’re not just in the background checking charts and making sure we give the appropriate dose, but you’re actually very much involved in the patient care and their job. It became very routine for me to pull one physicist into a room when I’m seeing a patient. Do you have any thoughts on how you decided to do that?
Nagalingam Suntharalingam: I always wanted the physicists to be with the physician, if possible, even in the examining room at times when they’re trying to decide on the particular treatment. Two incidents come to mind. One, suddenly I got a call from the operating room that they had lost an yttrium bead - I don’t know if you remember - yttrium strontium little ceramic beads, radioactive beads, and they were implanted into the nostrils. Dr. Kramer was putting one of this and he dropped one. So now one is somewhere on the floor or on the sheets and they need a physicist to come and find it.
So I go in there and I said everyone would have to get out of room because, otherwise, I don’t know who is carrying that bead with them. So as each one walked over, I couldn’t detect any. But Simon Kramer was the last and everywhere he went I was able to measure something. He had stepped on it and it stuck to the bottom of his shoe.
Eric Gressen: Interesting.
Nagalingam Suntharalingam: I found it and that’s the end of that story. Once, when putting iridium wires, he was given a four centimeter wire with tweezers. It slipped off him and it fell and we didn’t know where. Again, my sharp eye searched around, and sure enough it was stuck to the sheet that was covering the patient. So we recovered that.
There was other incident that I’m trying to recall, Martha Southard was involved with that, where we lost a radium needle. The reason why we lost a radium needle was this particular needle, a 20 milligram radium equivalent, was painted white. But some of the inserts that we had also were white. They were all in the drawer. So when the chief therapist was removing the sources, threw this into the trash thinking it was one of the inserts because it was white. So he had a massive headache, and we searched all over.
We went to the incinerator to see whether it went in there. It didn’t. I think it got printed on the papers the next day because we were alerting people that there’s this little piece of like a white rod about four centimeters that’s radioactive and missing. We had to pay the penalty to the city for the concerns we created, but we never found that source. That went into, I think, the burial site.
Eric Gressen: It was buried forever.
Nagalingam Suntharalingam: At that time we learned that 60 percent of the radium in the country was unaccounted for.
Dwight Heron: Oh, wow.
Nagalingam Suntharalingam: That much radium was going around.
Dwight Heron: Unaccounted for. Wow. Yeah. Obviously, as you say early days, but in those formative years, from the beginning of your career to the end, how would you characterize say our understanding our protection of personnel from radiation? Again, obviously in the old days we used to handle radiation a lot without maybe a lot of protection. Some of those regulations and some of those processes changed over time. Can you talk to us a little bit about that and the impact that that has had?
Nagalingam Suntharalingam: Radiation safety was always a concern. We were lucky to have Physicist Benjamin Galkin as the radiation safety officer. He would often come and review some of our programs. Removing of the iridium wires from breast implants was also of concern and every ribbon had to be accounted for. On one particular occasion my assistant physicist called me from the radium room and said, “Dr. Suntha, we’re supposed to have removed five sources, five ribbons. I see only four.” I said, all right, I’ll come over there. With the most sensitive radiation detector, which is the scintillation detector, I had him walk with me all the way from our department to the bedroom where the patient was.
Now, when we got there the patient had been moved and also they had changed the sheets. But as we got closer to the room, the sensitive scintillation detector started beeping and giving a signal. So sure enough we were lucky to locate the source on the floor under the bed. Now, I had to find fault with the resident because he didn’t tell the truth. He put down that he removed five sources even though there were only four sources in the drawer. So that particular resident had to be sort of warned about his future program, but he did all right. He became a practicing radiation oncologist later on. So we survived that episode. But radiation safety was always a concern because people are aware that radiation can be damaging. So they’re very concerned about walking into an environment where there is radiation.
Saiful Huq: Dr. Suntha, one other question from me. I was trying to allude to, you know, as time evolved the relationship between ASTRO and AAPM. I’m sure you had a major role in those days bridging -- it’s not bridging the gap. It’s enhancing the relationship between the two professional societies in a way.
Nagalingam Suntharalingam: Yes.
Saiful Huq: I mean the professionals from both societies together. Do you want to comment on that?
Nagalingam Suntharalingam: Yeah. The American Board of Radiology is made up of six or seven organizations. At that time, AAPM was not one of the sponsoring organizations. I was president of the AAPM and I took it upon myself to face the challenge of getting accepted as a sponsoring organization. You had to first get approval from all existing organizations. So the first organization I went to was ASTRO because they were very friendly. They knew who I was and they immediately said we have no problem, we will support AAPM membership. Then I went to the American College of Radiology, and again they immediately accepted.
But the very next day Jack Edeiken, who happened to hear about it, found fault with his colleagues who are accepting physicists as a sponsoring organization. So they withdrew their support and I had to win back again the support of the radiologists. But finally, all seven organizations - it took some effort - did approve, and AAPM became a sponsoring organization of the Board of Radiology. Now you have I think three physicists on the examining panel of the Board of Radiology. If I’m correct, I think it is three.
Dwight Heron: Yeah, three. Right. So, Dr. Suntha, we’re moving along here. We have another 15 minutes or so and there is a little bit of ground here to cover. So if you were to just be reflective on your career, what would you say were the most transformative developments in radiation oncology? Radiation oncology over your career, what would you say is maybe one or two or if you have more highlights? What do you think are the transformative developments?
Nagalingam Suntharalingam: The introduction on use of high energy beams, photons and electrons. I have to get my thoughts. And the ability to work together and willingness to share your knowledge with others involved in the team.
Dwight Heron: So collaborative approach to care.
Eric Gressen: Yeah, which is team-based.
Dwight Heron: Okay. We hope that lots of folks would be looking at this. If you were to give advice to a burgeoning radiation oncologist not like Eric and myself, we’re further along now but of course we could obviously take your advice. What sage advice would you give somebody who’s just starting out in radiation oncology? Whether they’re physicists or a physician or somebody that’s interested in the field, what advice would you give?
Nagalingam Suntharalingam: Well, for physicians, I would say that they have to work closely with physicists and understand the physics of radiation oncology. As for physicists, I would say work closely with the radiation oncologists. I mean they may not be doing things right, but we need to alert them to what needs to be done. During the board exam during my time, there were oral exams, and one of the questions asked of me was, “You are in the treatment room with the radiation oncologist and you find that he is doing something wrong. How would you handle the situation?” The correct answer was obviously to request a meeting outside the room and point out that what was being done was wrong so that the patient is not aware of what the problem was. That was the answer they were expecting, and that’s the answer I gave because obviously they didn’t want the discussion to be in front of the patient.
Dwight Heron: Correct.
Nagalingam Suntharalingam: Once there was a physician who dragged a physicist in the treatment room and pointed to the serious skin reaction on the breast treatment and said see what you did to this patient, see what you did to this patient. I mean the physicist obviously was very upset, hurt, and here the physician telling him what he did was wrong. But the question turned around and asked where was the physician when this was happening? So it’s a team effort. One has to be aware that we are working as a team and not as individuals.
Dwight Heron: Indeed. So, a couple of other questions for you, what would you see as future radiation oncology? Where do you –- since retirement?
Nagalingam Suntharalingam: There’s no magic bullet yet, so radiation will always be required as a modality of treatment maybe with chemo or with surgery, but radiation also will play a major role. Physicians and physicists involved in radiation oncology have to be aware that the end is still not in sight. They have to keep working hard to see whether they can manipulate their treatment to have greater success.
Dwight Heron: Eric, questions?
Eric Gressen: No. I think you certainly discussed the future of oncology. Typically, believe it or not, we like to also discuss the family. So we can go on to that, if you like.
Dwight Heron: Yes. I just wanted to make sure before we went, we pivoted. So, Suntha, you’ve told me a little bit about your siblings, a little bit of your family. But here’s an opportunity to tell us about your own family. Obviously, you’ve had quite a bit of success there. So do you want to tell us about your wife, grandkids?
Nagalingam Suntharalingam: My wife also was a science teacher in high school before we got married.
Dwight Heron: How did you meet her?
Nagalingam Suntharalingam: At the university in Sri Lanka. We do get a chance sometimes even though the number of girls is much less than the number of boys. So I met her there. It’s not common to have, quote, love marriages. Most of the marriages there are arranged. So it took some effort to convince both sides, both parents that this is what we want to do.
We have three children, two daughters and a son. Our oldest daughter is a pediatrician in Atlanta with a private group. My son is Mohan, a radiation oncologist and now CEO of the University of Maryland Medical System. My youngest daughter went into banking. She’s the vice president of a bank in New Jersey.
Dwight Heron: How long have you been married?
Nagalingam Suntharalingam: We got married in 1961, so it’s 55 years or 56 years.
Dwight Heron: Wow.
Eric Gressen: What’s the secret, Dr. Suntha?
Nagalingam Suntharalingam: I don’t know. We have been thankful that we have a great family. The children are very close to us. And now we have a great-grandson also who was born a month ago.
Dwight Heron: Excellent. So how many grandchildren? You’ve got your first great-grand. How many grandchildren?
Nagalingam Suntharalingam: We have six grandkids, two from each.
Eric Gressen: Wow. Congratulations.
Nagalingam Suntharalingam: Thank you.
Dwight Heron: So, again, we’re in the closing session here. Tell us a little bit about being a very prominent and nationally known physicist at the time. It must have been challenging. How did you work that out, the work-life balance, with kids at home, at one point young kids, and in the formative years of radiation oncology with lots of things changing? You talked about patterns of care.
Nagalingam Suntharalingam: I have a supportive wife who didn’t complain at that time that I was spending far too much time in the department and worrying about what is going on there. I had also the satisfaction that I trained almost 20 physicists. My message to them was, this is postdoctoral training, work closely with your mentor and be willing to share your knowledge. I’m happy that every one of the physicists who went through our program has ended up as leaders in the field. They now have their own medical physics groups and they’re all doing very well, well-accepted, and that brings me a lot of pleasure.
Saiful Huq: That is definitely true, Dr. Suntha. If we look at the medical physics community, some of the top leaders, they’re all products that came from your training and grew up under your leadership.
Nagalingam Suntharalingam: Saiful, thank you.
Dwight Heron: Since your retirement, they say your second job, your second big job really occurs after retirement. So what are your hobbies? What have you been doing since you retired, I think you said it was 1999.
Nagalingam Suntharalingam: Interesting. My wife always finds faults with me. I’m quite happy doing nothing. I have not done anything. I can watch television sports. I read the papers every morning and listen to some of the news. Other than that, there are no hobbies. I mean recently my wife pressured me and the two of us are going and playing some chess in our development. But other than that, we have very little that keeps us going.
Dwight Heron: Well, again, you’ve achieved enough in one lifetime what would take lots of folks two or three lifetimes. So R&R is certainly well-deserved. It was a true pleasure on my part to have the opportunity to reminisce with you.
Nagalingam Suntharalingam: Before I leave you, I have to mention that I’m supporting a cancer treatment center in a northern province in Sri Lanka.
Dwight Heron: Yes. Please tell us about that.
Nagalingam Suntharalingam: It’s funded by me and my family. At the moment, it’s a cobalt treatment facility. It was started ten years ago. We make sure that there are adequate funds for some of the activities. They are now anxiously waiting for the delivery and installation of a linear accelerator. I trained a physicist there who had done very well. Then he went to Cape Town, South Africa and got a PhD. He has come back and he is the physicist who handles the cancer treatment program. I’m very happy that I was able to help them out.
Dwight Heron: That’s truly wonderful. Eric, comments?
Eric Gressen: The only comment I would make is, I always thought it was interesting when I spoke to fellow physicists at the time that when it came to board examination, you were one of the most scary people they’d ever interacted with; that your tough. They’re fearful of what you’re going to say to them. Then from a radiation oncology resident and a physician, you were a walking textbook quite literally that any topic that Dwight or I would ask for that week, you wouldn’t pick a book. You’d start right from whatever topic we wanted. You wrote on the chalkboard and went right to the topic and explained things at every level of whoever was in the room.
If there was a medical student, you explained physics for medical students. If there was a chairman in there, you’d say physics for chairman. You knew how to speak to everyone at every level, and really educate everyone in a way that I rarely see from anyone in my lifetime. So personally, I want to thank you because you really exhibited excellence throughout your entire career and made a major difference not only for people like Saiful in physics but for any radiation oncology doctor or resident that has interacted with you.
Nagalingam Suntharalingam: Thank you very much for your kind words.
Dwight Heron: I would agree with that. I think in many ways a lot of, in fact all of what I am today in terms of a radiation oncologist and the things that we do not only here in the United States but the opportunity that we’ve been afforded internationally has clearly been informed by a lot of my training and Saiful is here with me in Pittsburgh - and I think he would agree by our training in Jefferson. Obviously, you’re a key and instrumental to that entire academic and humanitarian environment. So we thank you so much for your service to us individually, for the folks on the phone, but really to the broader radiation oncology community. We can’t thank you enough for a lifetime of really making a difference in radiation.
Nagalingam Suntharalingam: Again thank you very much.
The following interview of Nagalingam Suntharalingam, PhD, FASTRO, was conducted on May 3, 2017, by Dwight Heron, MD, MBA, Eric Gressen, MD and Saiful Huq, PhD.
Dwight Heron: I think of you in many ways from my time of training as one of the key leaders in radiation oncology. So it certainly is a distinct pleasure for me to have the opportunity to interview you for the ASTRO History Committee.
So why don’t we start at the top, the general basic concepts. Do you want to tell me a little bit about your background, where you grew up, your educational background, and then we can go from there.
Nagalingam Suntharalingam: I was born in Jaffna, Northern Province, Sri Lanka, formerly called Ceylon. My undergraduate education was at Royal College in Colombo, the capital city of Ceylon. Royal College was one of the top two high schools in the country, and I was fortunate to be accepted there. And I was glad my parents, even though they couldn’t afford my living in Colombo, made sure that I was cared for. I thank them for the effort they put in to give us a good education.
My PhD degree was at the University of Wisconsin in Madison under Dr. John Cameron who was then known as the father of TLD, thermoluminescence dosimetry. I had the privilege of working with him on thermoluminescence. We co-authored a monograph with another physicist, Gordon Kenney. To this date this is considered as the bible on TLD, and I see the book all over the world.
Dwight Heron: Yeah. So Suntha, before we move into the professional side of things, you mentioned that your family obviously sacrificed a fair amount to kind of get you through school. So tell me a little bit about your family. Were you the only child? Were you one of several?
Nagalingam Suntharalingam: I was one of five. I was the second, and the second son. My oldest brother went into the military, and went to Sandhurst Academy in England for training. My younger brother became a physician. I have two sisters who are married. They’re all married and doing well.
Dwight Heron: Tell me about your early educational experience. What made you say I want to be a medical physicist? Because I think that’s really interesting, how life sort of gets us. There are very few people from their formative educational year say I want to be a medical physicist or a doctor. How did you get into it?
Nagalingam Suntharalingam: It was my chance that I wanted. I was in Philadelphia. I went and saw John Hill at the University of Pennsylvania to see whether a young physicist can be taken on to staff. He said he didn’t have any openings, but go and see Robert Gorson at Jefferson who is building a team there. So I went to Robert Gorson and he promptly accepted me into his small group. I was the number three person. Number two was Benjamin Galkin who became the radiation safety officer. That is how I started in hospital medical physics.
Dwight Heron: I see. But what caused you to say –- so, again, the happenstance to kind of get there. What was it about medical physics at the time that made you say, wow, this is what I want to do and this is what I want to keep doing?
Nagalingam Suntharalingam: At that time I didn’t know much. But once I started getting a feeling for how physicists play a role in radiology and radiation oncology, I got interested and I wanted to pursue it further. At that time Jefferson had one big radiology department which included radiation therapy and nuclear medicine. Unfortunately at one point, within a year or two, I had a little problem with the then Chairman of Radiology, Dr. Jack Edeiken. He tried to impress on me that there was only one chairman; that I listen to him and not to Simon Kramer. So the very next day I said thank you very much, I am moving over to the Department of Radiation Oncology and be a physicist for Simon Kramer. That is what happened as far as my movement was concerned. Then I stayed there for a long time, until my retirement in December of ‘99.
Dwight Heron: Yeah, that was ‘99.
Nagalingam Suntharalingam: Yeah.
Dwight Heron: That was a year before I graduated. It was the year you graduated, Eric, right?
Eric Gressen: Yes. And I can tell you, at least from my interview with Suntha, that the on-job trainee, you started at Jefferson Medical College was 1962. You’re certified by 1964 and that you returned to JMC in 1967, which my guess is when you became part of Dr. Kramer’s team, and went from there.
Nagalingam Suntharalingam: Even with the certification I run into a problem because at that time you needed to be citizen of the United States to be certified by the American Board of Radiology. So I said, look, can you at least give me the exam? You don’t have to give me the diploma until I become a citizen. So I created a problem for them. Sure enough, they accepted me for the exam and I passed. They said I passed the exam, but they delayed giving me the certificate or diploma until I became a citizen. I think it was in 1976.
Dwight Heron: Okay. So Dr. Huq has joined us, Dr. Suntha.
Saiful Huq: Hi, Dr. Suntha.
Dwight Heron: So I just told Saiful that we are sort of reminiscing here a bit. You have three people on the phone here that you truly have been an amazing mentor and giant to, so that’s a testament to your impact on the field of radiation oncology.
Actually, I wanted to ask you a follow up question. So you were given shall we say the opportunity to choose, and you chose Dr. Kramer in radiation oncology. Walk us through a little bit why you made that decision. Obviously, that was probably attributable to some extent with some of the things that was going on in radiation oncology at the time this field as it was clearly maturing and emerging. Can you walk us through some of the more important things the time?
Nagalingam Suntharalingam: My interest started in general radiology but still in radiation therapy, so I requested that I be assigned as a physicist for radiation therapy. So I worked with Simon Kramer and developed a program. He gave me freedom to build on a talent that I could put together. And it was a little later on that the patterns of care study, which Simon Kramer was the leader, came into existence. Simon Kramer requested that I be the chief physicist for that study, and that helped me recruit other physicists to participate in the pattern study.
Dwight Heron: Of course, as we know, the patterns of care study even until today remains one of the landmark efforts that really helped in many ways mature and to some extent standardize a lot of what we do in radiation oncology today. It was certainly the forerunner. Now there had been iterations of those patterns of care study subsequently, but this truly had helped define and accelerated the maturation of the field. So if I could ask you a couple more questions down that line, just give us some context.
The patterns of care effort obviously arose because there was a deficit, right? We were doing things in a number of different ways and there was no clear set of standards for a variety of diseases. Can you walk us through historically the things, the conversations that were going on at the time, conversations perhaps that you had with Simon Kramer and other founding members of the patterns of care study and the philosophy of how that developed into a program that gave us what was better off for what we have today in terms of how we care for patients?
Nagalingam Suntharalingam: The original concept and idea of the patterns of care study was put out by a fellow called David Herring. He was a physicist, but he was essentially getting involved in various projects. He was a self-employed individual, so he approached Simon Kramer with the concept of doing a patterns of care study. Simon enlisted a few other famous physicians at that time. One person coming to mind is - I’m drawing a blank on the name - the current chairman at MD Anderson.
Saiful Huq: Steve Hahn?
Nagalingam Suntharalingam: No. He’s retired.
Dwight Heron: He retired. He was there before Steve. Now we’re blanking on the name. This is bad.
Nagalingam Suntharalingam: I know. I’m also drawing a complete blank. I can picture him in front of me, but I’m drawing a blank.
Dwight Heron: Yes. Oh my god, how can -- it will come to us. Okay. Go ahead. Keep going.
Nagalingam Suntharalingam: Anyway, so I worked with him closely. And being the chief physicist assigned to the patterns of care study, I had a lot of responsibility in making sure that different aspects of the program was well-cared for. I recruited several physicists to participate. That was a wonderful experience to every one of us, interacting with the physicians and having the physicist and physicians sit side by side and participate in a new program.
Dwight Heron: Jim Cox, right?
Nagalingam Suntharalingam: That’s right. Yeah.
Dwight Heron: Jim, yeah. Okay.
Nagalingam Suntharalingam: James Cox, yeah.
Dwight Heron: So did you have a sense at the time, with the patterns of care study, of its potential impact in the decades to come? Was there a sense by the group that this was likely to be something quite substantial, major, and of that magnitude? Or what was your sense as a member of the team?
Nagalingam Suntharalingam: Yeah. I mean it was decided that we will have a patterns of care study for different clinical sites. Decision trees were drawn so that one could follow through and decide on the appropriate treatment for the type of disease, state of disease, and it was a feeling that all participating in the subcommittees had to be unanimous in their outcome. It was a wonderful experience for me working with physicians side by side, and also that I could get other physicists involved and have physicists being recognized by our physician colleagues.
Dwight Heron: If you think back, and this is probably my last question around this unless Eric or Saiful has a question to jump in, were there areas of significant controversy? What were the challenges in putting those patterns of care studies together?
Nagalingam Suntharalingam: I don’t recall any controversies. I think it was a unified approach. Everyone felt that an effort like this would help the discipline, and it is the first effort in any branch of medicine that has been undertaken. I’m drawing a blank again on another physician who came from Milwaukee. He was with Jim Cox and later became president of ASTRO also.
Eric Gressen: Dr. Wilson?
Nagalingam Suntharalingam: Yeah, Wilson. Yeah, Wilson. He was also very active and participated in putting the teams together.
Eric Gressen: Suntha, I have a separate question just because in the history of Jefferson I know they had, I believe, the first simulator in the United States of America in 1966 when Dr. Kramer collaborated with the Picker Medical Corporation. Did you have any role in the creation of the first simulator at Jefferson?
Nagalingam Suntharalingam: It was only purely doing some acceptance testing, but the concept of a simulator came from Dr. Kramer. He worked closely with, as you correctly said, with Picker Corporation. That simulator was used for a long time, a very long time.
Dwight Heron: Yeah. So can you tell us a little bit more about your personal area of research over your career? As you sort of looked at some of perhaps -- and again, people’s interest change over time, but maybe if you can give us a little bit of context of what your initial interests were. I think you told us a little bit about that.
Nagalingam Suntharalingam: Yeah.
Dwight Heron: How they sort of morphed and changed as your career matured? That would be really interesting. Maybe if you have some anecdotes or highlights of inflection points, the things that you recollect, that you’d like for us to record.
Nagalingam Suntharalingam: Jefferson had one of the most massive and expensive Brown Boveri 45 MeV Betatron.
Eric Gressen: Oh, yes.
Nagalingam Suntharalingam: That Betatron was primarily for electron beams, but also at that energy you could get some photon beam intensity. But once you started putting flattening filters, you were lucky if you got 25 rad/s per minute at one meter. So we primarily used that machine for electron beams and that developed my interest in high energy photons and electrons. We had a 4 MeV linear accelerator which took care of the bread and butter treatments, replacing cobalt. What else? Okay, what’s your next question?
Dwight Heron: Oh, no. No. Go ahead. Saiful has one question.
Saiful Huq: You may have already asked this question; I stepped in later. You have been involved with Dr. Kramer from very early on in the clinical trials. It got established by I believe RTOG, by Dr. Kramer. Can you maybe walk us through the formative times, the discussions that happened in terms of the formation of the clinical trials and what led to it then?
Dwight Heron: And your role on that, yeah.
Nagalingam Suntharalingam: The Radiation Therapy Oncology Group was formulated or formed to perform the trials and that physicians could submit some of their studies. It gets evaluated and it gets implemented. I was again the physicist in charge of the RTOG program. We had two dosimetrists within RTOG who evaluated the submitted data so that they were in agreement with what the intent was. Each institution had to submit a lot of information including details of their machines, machine calibrations, and up to date QA program. That was evaluated. If there were deficiencies, they were pointed out. That had to be corrected before they could be accepted as an RTOG member. The physician who played a greater role with RTOG was Larry Davis, and he was the physician in charge of the RTOG program.
Dwight Heron: Since we’re talking a little bit about the RTOG, can you tell us a little bit about some of the other founding physicians. You mentioned Larry Davis. Obviously, folks that were involved, too, include Luther and Phil Rubin, some of those giants. Can you give us some anecdotes about whether it’s through the cooperative groups or through the specialty society like ASTRO and the AAPM for that matter? We’re going to go into AAPM in just a minute. But can you tell us a little bit about some of those interactions, maybe some anecdotes from the early years?
Nagalingam Suntharalingam: Rubin was a giant and he always wanted to be the leader. He would impress on others the need for a good quality assurance type review program. He introduced workbooks with some typical cases for planning, and the institutions had to submit their plans. They would give a cross-sectional contour and some details about the cancer and the tumor location, and the institution had to submit their plans. That would get evaluated and we would have a session at one of the ROTG meetings, a morning session devoted to that.
That reminds me about an incident. I’m embarrassed, but I will tell you this. At one of these meetings, Simon Kramer and I met in his room after a long meeting. He opened a bottle of Scotch and before we knew it we drank a fair amount. I sort of staggered myself to my bedroom. The next morning Simon Kramer and I were supposed to have an 8:00 session with the group. So I jumped out of bed about ten minutes to 8:00 and I rushed, and I see Simon Kramer already there holding his hand to his head and just sitting there. But we managed to have the one-and-a-half hour workshop. The next thing I knew, I went back to my room. I slept the whole day. I didn’t come out until the next day. That was a little embarrassing, but it was okay.
Dwight Heron: Yeah.
Saiful Huq: One other question, Dr. Suntha. In your career, you really shaped the lives of many physicians, many physicists. There are a lot of physicians who went to Jefferson and to their residency program. You helped them grow. Can you maybe tell us how you bridged the gap between the physicians and physicists that came to Jefferson?
Nagalingam Suntharalingam: Yeah. I mean the physicians obviously were the residents who were selected by the physician team, but I was also asked to interview the potential resident candidates. I don’t know if I interviewed any of you, but in the process I could tell you another interesting story without mentioning names. One resident had to load iridium wires, radioactive wires for a breast implant. Now, I told her that there are some that are high activity and some that are low activity, but the person chose the high activity.
At that time Dr. Joe Stella used to come and spend some time from Atlantic City Hospital with Dr. Kramer. He was a surgeon in his previous career, so he was doing these implants. So he implanted. When I went to look at the safe where the sources are kept, I found that the high activity sources were not there. So I rushed to the resident and I was told, “No. No. I picked up the sources, you said they are high.” I said they’re high for that particular occasion, but not a real high activity.
So we had to call Joe Stella from Atlantic City. He came. Within two hours we removed the sources and put in the required low activity sources. That was an embarrassment for the resident. The resident almost decided to give up residency. He came to my office crying. I said, well, we all make mistakes. We do overlook certain details. That’s all right. He will probably never make this mistake again. So then carry on with what you have to do. The person later became one of the leading radiation oncologists and, I can tell you, secretary of ASTRO. The person is now retired.
Dwight Heron: Sorry. Go ahead.
Eric Gressen: So Suntha, I did want to comment on one thing. I knew when I went to your residency, one thing that you pushed through your physics teaching with the rest of the physicists is your interaction with the residents and with the other radiation oncologists. That does not typically happen on residency programs. What I mean by that is often I’d be involved with a physicist when I’m interacting with the patient. I got the impression when talking to the other physicists that that was something very specific about your program of educating your fellow physicists. That you’re not just in the background checking charts and making sure we give the appropriate dose, but you’re actually very much involved in the patient care and their job. It became very routine for me to pull one physicist into a room when I’m seeing a patient. Do you have any thoughts on how you decided to do that?
Nagalingam Suntharalingam: I always wanted the physicists to be with the physician, if possible, even in the examining room at times when they’re trying to decide on the particular treatment. Two incidents come to mind. One, suddenly I got a call from the operating room that they had lost an yttrium bead - I don’t know if you remember - yttrium strontium little ceramic beads, radioactive beads, and they were implanted into the nostrils. Dr. Kramer was putting one of this and he dropped one. So now one is somewhere on the floor or on the sheets and they need a physicist to come and find it.
So I go in there and I said everyone would have to get out of room because, otherwise, I don’t know who is carrying that bead with them. So as each one walked over, I couldn’t detect any. But Simon Kramer was the last and everywhere he went I was able to measure something. He had stepped on it and it stuck to the bottom of his shoe.
Eric Gressen: Interesting.
Nagalingam Suntharalingam: I found it and that’s the end of that story. Once, when putting iridium wires, he was given a four centimeter wire with tweezers. It slipped off him and it fell and we didn’t know where. Again, my sharp eye searched around, and sure enough it was stuck to the sheet that was covering the patient. So we recovered that.
There was other incident that I’m trying to recall, Martha Southard was involved with that, where we lost a radium needle. The reason why we lost a radium needle was this particular needle, a 20 milligram radium equivalent, was painted white. But some of the inserts that we had also were white. They were all in the drawer. So when the chief therapist was removing the sources, threw this into the trash thinking it was one of the inserts because it was white. So he had a massive headache, and we searched all over.
We went to the incinerator to see whether it went in there. It didn’t. I think it got printed on the papers the next day because we were alerting people that there’s this little piece of like a white rod about four centimeters that’s radioactive and missing. We had to pay the penalty to the city for the concerns we created, but we never found that source. That went into, I think, the burial site.
Eric Gressen: It was buried forever.
Nagalingam Suntharalingam: At that time we learned that 60 percent of the radium in the country was unaccounted for.
Dwight Heron: Oh, wow.
Nagalingam Suntharalingam: That much radium was going around.
Dwight Heron: Unaccounted for. Wow. Yeah. Obviously, as you say early days, but in those formative years, from the beginning of your career to the end, how would you characterize say our understanding our protection of personnel from radiation? Again, obviously in the old days we used to handle radiation a lot without maybe a lot of protection. Some of those regulations and some of those processes changed over time. Can you talk to us a little bit about that and the impact that that has had?
Nagalingam Suntharalingam: Radiation safety was always a concern. We were lucky to have Physicist Benjamin Galkin as the radiation safety officer. He would often come and review some of our programs. Removing of the iridium wires from breast implants was also of concern and every ribbon had to be accounted for. On one particular occasion my assistant physicist called me from the radium room and said, “Dr. Suntha, we’re supposed to have removed five sources, five ribbons. I see only four.” I said, all right, I’ll come over there. With the most sensitive radiation detector, which is the scintillation detector, I had him walk with me all the way from our department to the bedroom where the patient was.
Now, when we got there the patient had been moved and also they had changed the sheets. But as we got closer to the room, the sensitive scintillation detector started beeping and giving a signal. So sure enough we were lucky to locate the source on the floor under the bed. Now, I had to find fault with the resident because he didn’t tell the truth. He put down that he removed five sources even though there were only four sources in the drawer. So that particular resident had to be sort of warned about his future program, but he did all right. He became a practicing radiation oncologist later on. So we survived that episode. But radiation safety was always a concern because people are aware that radiation can be damaging. So they’re very concerned about walking into an environment where there is radiation.
Saiful Huq: Dr. Suntha, one other question from me. I was trying to allude to, you know, as time evolved the relationship between ASTRO and AAPM. I’m sure you had a major role in those days bridging -- it’s not bridging the gap. It’s enhancing the relationship between the two professional societies in a way.
Nagalingam Suntharalingam: Yes.
Saiful Huq: I mean the professionals from both societies together. Do you want to comment on that?
Nagalingam Suntharalingam: Yeah. The American Board of Radiology is made up of six or seven organizations. At that time, AAPM was not one of the sponsoring organizations. I was president of the AAPM and I took it upon myself to face the challenge of getting accepted as a sponsoring organization. You had to first get approval from all existing organizations. So the first organization I went to was ASTRO because they were very friendly. They knew who I was and they immediately said we have no problem, we will support AAPM membership. Then I went to the American College of Radiology, and again they immediately accepted.
But the very next day Jack Edeiken, who happened to hear about it, found fault with his colleagues who are accepting physicists as a sponsoring organization. So they withdrew their support and I had to win back again the support of the radiologists. But finally, all seven organizations - it took some effort - did approve, and AAPM became a sponsoring organization of the Board of Radiology. Now you have I think three physicists on the examining panel of the Board of Radiology. If I’m correct, I think it is three.
Dwight Heron: Yeah, three. Right. So, Dr. Suntha, we’re moving along here. We have another 15 minutes or so and there is a little bit of ground here to cover. So if you were to just be reflective on your career, what would you say were the most transformative developments in radiation oncology? Radiation oncology over your career, what would you say is maybe one or two or if you have more highlights? What do you think are the transformative developments?
Nagalingam Suntharalingam: The introduction on use of high energy beams, photons and electrons. I have to get my thoughts. And the ability to work together and willingness to share your knowledge with others involved in the team.
Dwight Heron: So collaborative approach to care.
Eric Gressen: Yeah, which is team-based.
Dwight Heron: Okay. We hope that lots of folks would be looking at this. If you were to give advice to a burgeoning radiation oncologist not like Eric and myself, we’re further along now but of course we could obviously take your advice. What sage advice would you give somebody who’s just starting out in radiation oncology? Whether they’re physicists or a physician or somebody that’s interested in the field, what advice would you give?
Nagalingam Suntharalingam: Well, for physicians, I would say that they have to work closely with physicists and understand the physics of radiation oncology. As for physicists, I would say work closely with the radiation oncologists. I mean they may not be doing things right, but we need to alert them to what needs to be done. During the board exam during my time, there were oral exams, and one of the questions asked of me was, “You are in the treatment room with the radiation oncologist and you find that he is doing something wrong. How would you handle the situation?” The correct answer was obviously to request a meeting outside the room and point out that what was being done was wrong so that the patient is not aware of what the problem was. That was the answer they were expecting, and that’s the answer I gave because obviously they didn’t want the discussion to be in front of the patient.
Dwight Heron: Correct.
Nagalingam Suntharalingam: Once there was a physician who dragged a physicist in the treatment room and pointed to the serious skin reaction on the breast treatment and said see what you did to this patient, see what you did to this patient. I mean the physicist obviously was very upset, hurt, and here the physician telling him what he did was wrong. But the question turned around and asked where was the physician when this was happening? So it’s a team effort. One has to be aware that we are working as a team and not as individuals.
Dwight Heron: Indeed. So, a couple of other questions for you, what would you see as future radiation oncology? Where do you –- since retirement?
Nagalingam Suntharalingam: There’s no magic bullet yet, so radiation will always be required as a modality of treatment maybe with chemo or with surgery, but radiation also will play a major role. Physicians and physicists involved in radiation oncology have to be aware that the end is still not in sight. They have to keep working hard to see whether they can manipulate their treatment to have greater success.
Dwight Heron: Eric, questions?
Eric Gressen: No. I think you certainly discussed the future of oncology. Typically, believe it or not, we like to also discuss the family. So we can go on to that, if you like.
Dwight Heron: Yes. I just wanted to make sure before we went, we pivoted. So, Suntha, you’ve told me a little bit about your siblings, a little bit of your family. But here’s an opportunity to tell us about your own family. Obviously, you’ve had quite a bit of success there. So do you want to tell us about your wife, grandkids?
Nagalingam Suntharalingam: My wife also was a science teacher in high school before we got married.
Dwight Heron: How did you meet her?
Nagalingam Suntharalingam: At the university in Sri Lanka. We do get a chance sometimes even though the number of girls is much less than the number of boys. So I met her there. It’s not common to have, quote, love marriages. Most of the marriages there are arranged. So it took some effort to convince both sides, both parents that this is what we want to do.
We have three children, two daughters and a son. Our oldest daughter is a pediatrician in Atlanta with a private group. My son is Mohan, a radiation oncologist and now CEO of the University of Maryland Medical System. My youngest daughter went into banking. She’s the vice president of a bank in New Jersey.
Dwight Heron: How long have you been married?
Nagalingam Suntharalingam: We got married in 1961, so it’s 55 years or 56 years.
Dwight Heron: Wow.
Eric Gressen: What’s the secret, Dr. Suntha?
Nagalingam Suntharalingam: I don’t know. We have been thankful that we have a great family. The children are very close to us. And now we have a great-grandson also who was born a month ago.
Dwight Heron: Excellent. So how many grandchildren? You’ve got your first great-grand. How many grandchildren?
Nagalingam Suntharalingam: We have six grandkids, two from each.
Eric Gressen: Wow. Congratulations.
Nagalingam Suntharalingam: Thank you.
Dwight Heron: So, again, we’re in the closing session here. Tell us a little bit about being a very prominent and nationally known physicist at the time. It must have been challenging. How did you work that out, the work-life balance, with kids at home, at one point young kids, and in the formative years of radiation oncology with lots of things changing? You talked about patterns of care.
Nagalingam Suntharalingam: I have a supportive wife who didn’t complain at that time that I was spending far too much time in the department and worrying about what is going on there. I had also the satisfaction that I trained almost 20 physicists. My message to them was, this is postdoctoral training, work closely with your mentor and be willing to share your knowledge. I’m happy that every one of the physicists who went through our program has ended up as leaders in the field. They now have their own medical physics groups and they’re all doing very well, well-accepted, and that brings me a lot of pleasure.
Saiful Huq: That is definitely true, Dr. Suntha. If we look at the medical physics community, some of the top leaders, they’re all products that came from your training and grew up under your leadership.
Nagalingam Suntharalingam: Saiful, thank you.
Dwight Heron: Since your retirement, they say your second job, your second big job really occurs after retirement. So what are your hobbies? What have you been doing since you retired, I think you said it was 1999.
Nagalingam Suntharalingam: Interesting. My wife always finds faults with me. I’m quite happy doing nothing. I have not done anything. I can watch television sports. I read the papers every morning and listen to some of the news. Other than that, there are no hobbies. I mean recently my wife pressured me and the two of us are going and playing some chess in our development. But other than that, we have very little that keeps us going.
Dwight Heron: Well, again, you’ve achieved enough in one lifetime what would take lots of folks two or three lifetimes. So R&R is certainly well-deserved. It was a true pleasure on my part to have the opportunity to reminisce with you.
Nagalingam Suntharalingam: Before I leave you, I have to mention that I’m supporting a cancer treatment center in a northern province in Sri Lanka.
Dwight Heron: Yes. Please tell us about that.
Nagalingam Suntharalingam: It’s funded by me and my family. At the moment, it’s a cobalt treatment facility. It was started ten years ago. We make sure that there are adequate funds for some of the activities. They are now anxiously waiting for the delivery and installation of a linear accelerator. I trained a physicist there who had done very well. Then he went to Cape Town, South Africa and got a PhD. He has come back and he is the physicist who handles the cancer treatment program. I’m very happy that I was able to help them out.
Dwight Heron: That’s truly wonderful. Eric, comments?
Eric Gressen: The only comment I would make is, I always thought it was interesting when I spoke to fellow physicists at the time that when it came to board examination, you were one of the most scary people they’d ever interacted with; that your tough. They’re fearful of what you’re going to say to them. Then from a radiation oncology resident and a physician, you were a walking textbook quite literally that any topic that Dwight or I would ask for that week, you wouldn’t pick a book. You’d start right from whatever topic we wanted. You wrote on the chalkboard and went right to the topic and explained things at every level of whoever was in the room.
If there was a medical student, you explained physics for medical students. If there was a chairman in there, you’d say physics for chairman. You knew how to speak to everyone at every level, and really educate everyone in a way that I rarely see from anyone in my lifetime. So personally, I want to thank you because you really exhibited excellence throughout your entire career and made a major difference not only for people like Saiful in physics but for any radiation oncology doctor or resident that has interacted with you.
Nagalingam Suntharalingam: Thank you very much for your kind words.
Dwight Heron: I would agree with that. I think in many ways a lot of, in fact all of what I am today in terms of a radiation oncologist and the things that we do not only here in the United States but the opportunity that we’ve been afforded internationally has clearly been informed by a lot of my training and Saiful is here with me in Pittsburgh - and I think he would agree by our training in Jefferson. Obviously, you’re a key and instrumental to that entire academic and humanitarian environment. So we thank you so much for your service to us individually, for the folks on the phone, but really to the broader radiation oncology community. We can’t thank you enough for a lifetime of really making a difference in radiation.
Nagalingam Suntharalingam: Again thank you very much.
